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Jeff Passan's "The Arm" strives to answer why pitchers are breaking, and how to fix them

Every time the trainer comes out to the mound, you wince and wonder if this is the big arm injury for a pitcher. But maybe it doesn't have to be this way. Jeff Passan's forthcoming The Arm takes a human look at the recent rash of Tommy John surgeries.

With each passing year, professional baseball pitchers are throwing harder and harder, and with each passing year, seemingly more of those arms are breaking down. Why is this happening? And more importantly, can anything be done to fix or prevent the problem?

These are the big questions tackled in Jeff Passan's The Arm: Inside the Billion-Dollar Mystery of the Most Valuable Commodity in Sports, set for an April 5 release from Harper Collins with a $26.99 price tag. I received a free copy from the publisher in advance in exchange for this review.

Passan, the lead baseball columnist at Yahoo Sports, set out to write this book because, in his own words, "the culture of baseball seemed backwards" - and Tommy John, a great unknown for most fans, needed "demystifying." He believes, and argues persuasively, that an entire generation of current pitchers is effectively broken, has been placed at heightened risk for elbow problems.

Though there are many culprits, he also believes it doesn't have to be this way, not for the next generation, including his own still-young son. So he traveled the world for three years in writing this book, from doctor's offices to podunk minor league towns, from a warehouse in Washington to the Florida swamp, across youth baseball fields from America to Japan and back.

Every Tommy John is its own story

If you are like me and you spend a lot of your time watching baseball games and reading articles about baseball, you may be tempted to think there is nothing you could learn that you don't already know. I harbored this feeling for all of one sentence of The Arm, the first sentence of the first chapter:

He didn't want a piece of the dead guy holding his elbow together. That's all he asked.

Did you ever know they used parts of dead people in some Tommy John surgeries? I sure didn't - and this was only the beginning of the education that The Arm brought to me. You will know more about Tommy John surgery when you are done than you ever did before

That includes the history of how that surgery came to be, with interviews from both Dr. Frank Jobe, who performed that first surgery before it had a name, only a man, Tommy John, who was willing to try anything to keep his baseball career going. It takes a special sort of doctor and a special sort of player to be the trailblazers.

Though the history is important, this is not some dry recitation of science and medical terminology. In Passan's travels he encountered all kinds of colorful characters, the sort you could seemingly only find playing baseball. That includes journeyman reliever Todd Coffey, the guy who doesn't want the dead man's tendon.

Unfortunately for Coffey, it's his second Tommy John surgery and his choices are few. Passan paints the picture of the room as Coffey's elbow is being operated upon with as much tension as you'd find in any prime time hospital drama. The surgeon, Dr. Neal ElAttrache, the same doctor who operated on both of Manny Machado's knees, is an artist at work, but it is still a long and stressful process for him.

Coffey, along with Diamondbacks pitcher Daniel Hudson, is one of two players who allowed Passan into their lives during the surgery and the rehab period. You can tell that Passan likes these guys and their families. His empathy for them, and for every baseball family young and old who has endured the same or may have to in the future, is what drives the book.

It's called The Arm, but every one of those arms belongs to a person with a career and a family, with hopes and dreams. They all have a story - and not a one of them have chosen to have Tommy John be a part of theirs. It is a stressful time for everyone.

As Sara Hudson, Daniel's wife, describes it colorfully, "We go from not seeing one another at all to me washing his balls. This is the shit that you save for eighty years old." That's only the very beginning of what players and their wives must navigate on the road back to the majors.

These are not the thing that the average baseball fan thinks about when a player on their favorite team goes under the knife. One day there's the diagnosis, soon after that the surgery, and then you stop thinking about them for a while.

Coffey is the kind of character who could seemingly only exist within the confines of baseball. The brash country boy from North Carolina was a 41st round pick who wasn't even supposed to sign. When the Reds drafted him, the scout presented him with the standard minor league contract - a paltry $1,000 bonus, and told him not to sign it, he should go to college and get more money later.

But Coffey didn't want to go to college in 1998, he wanted to play baseball, so he took the $1,000 - earning the scout a reaming from his boss because then-Reds owner Marge Schott, would ream THAT boss for the extra $1,000 expense over the budget.

This is completely ridiculous, and it's not even in the top five most ridiculous Coffey anecdotes in the book. That's not even getting into Coffey's beloved concoction "Hot Cheese," nor the story behind why Coffey got divorced from his first wife.

The roots of the problem

You can kind of get the sense of Passan's opinion of baseball culture in Japan by the chapter title, "The Land of the Rising Arm Injury." In Japan, where baseball is called yakyu, there are twice-yearly national tournaments simply known as Koshien (after Koshien Stadium, its home,) that, in Passan's words, combine "the interest of the NFL, the urgency of the NCAA basketball tournament, and the parochialism of the World Cup."

The story from 2013 of 16-year-old Tomohiro Anraku, who threw 772 pitches over five games across nine days to lead his team to the Koshien finals, is not uncommon. Anraku was proclaimed kaibutsu - the monster - a sobriquet awarded to "only the most fearsome pitchers at Koshien." It is the highest compliment the Japanese can pay to a baseball player.

But to become kaibutsu, one must pull off a feat like Anraku. It is practically abuse. Years before Anraku, Daisuke Matsuzaka, too, was kaibutsu, in part thanks to a famous 17-inning, 250 pitch game. Masahiro Tanaka, good as he is, was not He was outdueled in the Koshien final by Yuri Saito, who tossed 948 pitches over the course of the tournament, the 948th of which struck out Tanaka to end it all. Saito was the kaibutsu of that Koshien.

To the Western world, this sounds crazy, and it is crazy. But, are things much better here? Orioles fans are well familiar with the injuries that have plagued Dylan Bundy, and in retrospect it now seems like a heavy high school workload, including one day when he pitched 181 pitches across two different games, was surely a contributing factor.

Of that 181 pitch day, Denver Bundy, Dylan's father, whose hardcore workout regimen is infamous, told Passan, "That's what we trained for." This, too, is crazy. It is an extreme American expression of the macho machine that unleashes kaibutsu in Japan, and at the same time destroys them.

This macho nonsense pervades the professional ranks as well. Though Passan doesn't directly condemn the Diamondbacks manager/GM tandem of the time, it seems a stretch to believe it's entirely a coincidence when Hudson was only the first of five Arizona players to need Tommy John surgery over a period of a couple of years.

Then-GM Kevin Towers lamented the state of his pitching staff without Hudson, whom he viewed as a bulldog. Arizona even offered Hudson a $15 million contract extension, which he declined, before his injury. Of those left behind after the rash of Tommy John surgeries, Towers said simply, "I hate guys that make excuses. I don't need pussies." That is not a guy who seems to have prioritized taking care of his pitching staff.

Hope for the future

It's a grim present state for Major League Baseball because the current generation of pitchers all grew up through an out-of-control youth baseball culture, driven onward to year-round baseball by the apparatus of Perfect Game, a showcase organization that's now, according to Passan, reviled throughout MLB but essentially too big to fail.

To break out of that cycle will take resolve of parents and coaches - for whom The Arm really ought to be mandatory reading - but one player who has done so should provide an example for others. Kansas high schooler Riley Pint is the #4 draft prospect in the class of 2016 according to Baseball America, and he and his family opted out of the Perfect Game circuit despite a full-court press of cajoling from its management.

Pint's draft stock is still high and he has stayed healthy even while sticking with basketball in winter time. Professional baseball will be better off if more young players make the choice that Pint has made, but will they be able to resist the macho pressure and do so?

Well, maybe. Passan's journeying brought him past a lot of parents of younger kids who seem to be aware in general of the risks to their sons' arms. The question after each bad outing: "Is your arm OK?" Sadder are the parents of teenagers with injured arms wondering whether they could have done more. Maybe they could have, if only they knew sooner. You can't help but feel for them.

As in the way it follows Coffey's and Hudson's respective surgeries and rehab, Passan brings us close up to the human side of all of this, up close and personal with another group of people the average MLB fan will never think about.

The future of MLB is wrapped up in the health of its arms, and if The Arm has its way, they will be healthier arms than we see now. MLB Hall of Famer John Smoltz pays it the finest compliment, praising it as "the most important baseball book in years." He is not wrong. Anyone who holds their breath in anticipation any time the trainer comes out to the mound owes it to themselves to read Passan's book.