Tuesday, June 28, 2016

Book Review: The Arm

Another fascinating sports book has reached The New York Times Bestseller List: The Arm by Jeff Passan.  The book evaluates the highly valued pitchers in baseball, the ones that collect more than 1.5 billion dollars each year, far more than competitors in other professional sports. As any parent with a child playing  baseball knows, there is one overarching concern, one huge unsolved problem for any pitcher: the elbow's ulnar collateral ligament (UCL), also know as the medial collateral ligament (MCL).

In this book, Jeff Passan comprehensively evaluates the risk, the science (or lack thereof), and the treatment related to the UCL.  We believe that the basic risk to this ligament is the torque applied to the elbow in the throwing motion, likely made worse with certain pitches like curveballs.  Injuries do not occur in softball pitchers and occur far less commonly in other throwers (outfielders, quarterbacks, etc).  And even more interesting, most of us do not even need this ligament.  That is to say, unless you are a thrower (typically we include baseball players- especially pitchers, quarterbacks, and javelin throwers) or perhaps a participant in another sports such as wrestling, you can participate in all of life's activities without this ligament.  The muscle surrounding the elbow and the bony architecture provide enough stability for most of us.

The book examines the culture behind the epidemic of MCL injuries.  He travels to Japan to better understand their very different pitching culture which often translates into far more innings and pitches than we Americans allow our kids.  He specifically discusses the industry which exists around youth baseball (and all parents should know that these money making entities exist around every youth sports at every level).  Showcases and tournaments are emphasized as a way for any child to gain exposure to potentially allow play at the next level (college or professionally).

I am a parent with highly sports- focused kids, and I have seen first hand this industry in action. Parents like me may feel trapped by a perceived need to participate in these events and tournaments lest their child miss a chance to make their mark and gain attention.  I was also fascinated to read how highly successful pitchers are constantly queried about the status of their arm, during and after each pitching outing (especially games that might not be as successful as expected).

Mr Passan also presents great information on sports medicine and the surgical field surrounding treatment of the MCL. He delves into the science of injury prevention and the real lack of knowledge that exists related to the risk factors and prevention strategies for MCL injuries.   He shares the story of the now famous surgery to treat MCL injury, often considered a rite of passage for pitchers, the 'Tommy John' surgery. We learn about Dr Frank Jobe who 'invented' MCL reconstruction on the willing patient and baseball pitcher, Tommy John.  We learn about many other pitchers who have been treated (both successfully and unsuccessfully) with reconstruction of this ligament.  We follow the surgery and recovery of two pitchers with MCL reconstruction and gain an understanding of their plight- absolutely fascinating.

In short, Mr Passan presents a comprehensive look the MCL and the world surrounding these catastrophic  injuries.  There are no concrete answers to this epidemic which now affects young teens (or even younger) but it is clear that there must be a shift in many aspects of baseball development and pitcher management.

I recommend this book to any physician who cares for athletes, any parent to a youth baseball player, and anyone who loves the game.  As a physician who treats many athletes, I found the book and its stories fascinating and humbling and know now, more than ever, that physicians and medical researchers need to produce better research as a way to understand, hopefully prevent, and treat these injuries.

Charles A. Goldfarb, MD
My Bio at Washington University

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