Baseball, Injuries in

In the 1960s, Nolan Ryan, a professional baseball pitcher, began lifting weights as part of his physical conditioning regimen. At that time, most people subscribed to the belief that strength training with weights was deleterious to the baseball player's body. Especially with regard to pitchers, it was believed that weight-lifting programs would produce muscle growth that would impede the player's movements and biomechanics. But within a decade, advancements in sports medicine disproved what everyone had thought to be true. By the end of the century, this transformation had a lasting effect, the likes of which almost no one perceived even a few years earlier.

Baseball is a team sport that requires the individual athlete to run, hit, and throw. Under normal conditions, these activities do not generally tax the human body. But under the conditions of a baseball game, the requirements to throw a ball, swing a bat, and run around the field of play put unusual distress on players’ joints and muscles. As a result, there has long been a focus on training methods that help prevent injury. Yet baseball, from the youth to the professional levels, has over time also become increasingly focused on performance.

The shift to performance enhancement poses enormous challenges for ballplayers and the sports medicine practitioners who attempt to keep them in playing condition. Despite the mounting existence and availability of performance-enhancing substances, the care and conditioning of ballplayers was essentially the same in the 1960s as it was at any time prior. But as people in the ranks of medical science and technology began to use their skills to perform more highly specialized work, the product of their work was increasingly applied to baseball and vice versa.

There may have been no greater a period of significant advancements in baseball-specific sports medicine than that which occurred during the two or so decades beginning around 1960. For instance, in 1966, the future Hall-of-Fame pitcher Sandy Koufax abruptly retired due to injury sustained from overuse of his throwing arm. The fastballs and curve balls he threw en route to recording 382 strikeouts in 1965 forced him to retire at age 30, on the heels of the last of his three Cy Young Awards. Throughout his 12-year career, which included winning 25 games three times, the bone spurs, scar tissue, adhesions to the cartilage covering the elbow, circulatory problems in his left (throwing) hand, and arthritis that he developed were treated with ice baths, massage therapy, and ointments. For Koufax and other ballplayers through that era, preventive treatments superseded curative treatments; the player tended to retire when the latter proved no longer effective.

But around the same time, physicians began to pay attention to injuries and ailments in ballplayers of all ages and skill levels. A body of research on baseball-related injuries and ailmentsmostly associated with pitchingbegan to emerge from clinical practices, one of which was the orthopedic practice run by Dr. Robert Kerlan. Kerlan, who as the first team physician in the history of the Los Angeles Dodgers recommended to Koufax that continuing his career past the 1966 season could result in permanent arm damage, later formed a partnership with Dr. Frank Jobe. Together, they devised innovative treatments and procedures that were a significant contribution to the game of baseball. By the mid-1970s, Jobe had invented a surgical procedure that could reconstruct a damaged elbow. The procedure to repair a torn ulnar collateral ligament by harvesting a nonessential tendon from a ballplayer's nonthrowing side wrist, followed by 18 months of recovery, allowed the then Dodgers’ pitcher Tommy John to resume a playing career in which he would eventually win a total of 288 games164 of which came after the operation that today informally bears his name.

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