For pitchers, injuries aren't a matter of ‘if'. They're a matter of ‘when'.
It's the nature of the game for them to hurt. The act of pitching a Major League fastball, in itself, causes 'injuries' - the sudden, violent motion involved invariably produces multiple micro-tears in the muscles of the arm and shoulder, and its repetition through hundreds, then thousands, of pitches only compounds the damage through strains, sprains, stiffness, and soreness. No pitcher is immune from ‘pitchers' pain', and none are nearly 100% healthy throughout the season. The only question is in the extent of their injuries.
Dr. Frank Jobe may know those painful facts of baseball life as well as anyone. As the partner of Dr. Robert Kerlan in the early 1960's, he undertook some of the first serious studies of the cause and effect of pitching injuries, then pioneered the game's first rehabilitative surgeries. Dr. Jobe's greatest fame may have come in 1974, when his near-miraculous reconstruction of a Dodger's pitching elbow made headlines throughout baseball.
In the years ‘Tommy John' ligament replacement surgeries became commonplace, Dr. Jobe's only cemented his unparalleled legacy in sports medicine. He perfected the procedure and trained an array of protégés, none more renowned than Dr. James Andrews of the Alabama Sports Medicine and Orthopaedic Center and Dr. Tom House of the National Pitching Association. The Kerlan-Jobe Clinic also developed a breakthrough set of rehabilitation exercises for his patients, then set down ‘pre-habilitation' routines that prevent many injuries in the first place. To this day, at age 81, the good doctor still assists in surgeries and athlete counseling.
Over the years Dr. Frank Jobe's work has saved the careers of dozens of Major League pitchers, including superstars like Roger Clemens, John Smoltz and Mariano Rivera. Recently, he discussed his own career.
What did baseball mean to you when you were growing up?
I grew up in North Carolina, and there were no Major League teams around, but my father and I followed Major League teams from the newspaper. I played a lot but I was never good enough to be a star. In high school, even, I wasn't quite good enough to make it in the starting lineup. I did love the game, though.
When did you start thinking about becoming a physician?
In the service. I went into the Army in '43 and assigned to the 101st Airborne Division, 326th Medical Company. I was only 18, and my job was to take care of the medical supplies for the Divisions. I enjoyed the work, and the doctors in the service thought I was OK, so they asked what I would do when I got out. I hadn't given it much thought, but they encouraged me to go to medical school.
It was no ordinary Army organization. The 101st Airborne was the most highly decorated group in World War II, and they're probably best known today through the ‘Band of Brothers' miniseries.
The miniseries, I believe, was about the 506th parachute regiment, and we supplied them from the 326th, but we weren't on the front lines at all times, like they were. I was involved in Normandy [the D-Day invasion of France], went into Holland by glider, and helped out in operations like Bastogne [the Battle of the Bulge].
I was just a kid, but I looked up to the doctors and really got my teeth into the medicine. After the war, I did go to Loma Linda [medical school] and did my residency at USC.
How did you first work with the late Dr. Robert Kerlan?
He was one of my teachers during my residency, and about my second year, again, he asked me what I wanted to do in the future. I wasn't quite sure, so he said ‘Let's talk' and, shortly afterwards, we shook hands and said, ‘OK, let's be partners'. I've been very proud of the fact that we operated on nothing but a handshake for close to 20 years.
When you two started your practice, Dr. Kerlan was already well known in Los Angeles and was just getting involved with the newly-arrived Dodgers. Can you talk about your introduction to sports medicine?
During my residency, from 1960 to '64, Dr. Kerlan was at a ball game just about every night because he was taking care of both the Dodgers and the new L.A. Angels. I started by helping him out.
‘Sports medicine' was very novel term at the time. I remember when I first went in with Bob, another orthopedist went up to me and said, ‘Sports medicine, huh? Tell me - how is a broken leg for a lawyer different from a broken leg for a ball player?' (chuckles) I think I know the answer now, but at the time, I wasn't quite sure.
How is a broken leg for a lawyer different from a broken leg for a ball player?
There are many differences, but one principal difference is - a lawyer can go back to work as soon as you shore up the initial problem, but a ball player can't go back to work, on the playing field at least, until he's 100% rehabilitated. Anything less, and you're just asking for an even worse problem down the road.
Another major difference is in the nature of the problems. In football, as in ordinary life, there's a risk of catastrophic injuries, where someone or something can break you in half. The danger in baseball, for the most part, is in chronic injuries, those that develop over a long period of time. I call overuse, itself, an injury - it causes joint swelling, cartilage fraying, arthritic spurs. It takes specialized knowledge to appreciate and address that.
How would you describe the state of sports medicine when you started off with Dr. Kerlan and the Dodgers?
Very little surgery was being done and there was very little awareness of something like, say, calcification in the ulnar collateral ligament, and the damage that can do in something like the Tommy John situation. Obviously, we didn't have relatively elementary technology and techniques like MRI's and anthroscopy.
In their place, you had a lot of superstitions and myths. People believed a lot of things that were sort of voodoo medicine. One example was Karl Spooner, who struck out something like 15 batters in his debut game for the Dodgers [in 1954]. Soon afterwards, he hurt his shoulder and, when it didn't get better, he started getting advice on what was wrong. One doctor - I still don't know his name - said that the shoulder was bad because it was being infected from elsewhere in the body.
‘Infected from elsewhere in the body'?
‘Infected from elsewhere in the body'. Don't ask me how a physician came across that kind of notion.
Anyway, the doctor somehow convinced Spooner that the most likely source of infection was abscessed teeth, so he ended up pulling out all of Spooner's teeth. All that produced was a sore-armed ball player with no teeth. I mean, it's almost funny to hear about that kind of thing nowadays, but that's the kind of thinking that ruined guys' careers back in the 1950's or before.
You'd hear stories like that, but the biggest obstacle was a lack of understanding regarding the physiological limits of human beings. For example, today we know that 12- and 15- and 18-year olds all have different physical limits, based on the development of their bones and cartilage. That was unknown. Pitch counts and the rest were unknown, from Little Leagues to the Major Leagues.
From what I understand, in those early days, anything but the least serious injuries were career-killers.
That's true. If you tore the ulnar collateral ligament in the elbow, certainly, you were told to go back to wherever it was you came from. About any serious arm injury - that was it, as far as baseball was concerned.
When did that perception begin to change?
One important incident was when [Dodgers pitcher] Johnny Podres was hit on the elbow by a hit ball in, I want to say, '64. It produced a chipped bone in his left medial upper collateral. In my first surgery with Dr. Kerlan, we removed the bone chip. It was a relatively minor operation, but the thought was ‘Oh, Johnny's got a scar on his elbow, he's done'. When he pitched for a long time afterwards, that got people to thinking that there might be new possibilities.
How did you learn about new possibilities and solutions during those early years?
So much of it was in simple observation. It might sound like common sense now, but we noted that a guy who threw 130 pitches in a game would have a rough time of it the next time out, for instance. We also started to notice that bone spurs and chips in the back of the elbow can be a precursor to the stress that could do major damage to the ulnar collateral. Again, it seems obvious now, but in the early days we were still trying to learn.
How did the Sandy Koufax situation in 1966 affect your thinking?
Sandy's problem was looseness in the ulnar collateral ligament in the elbow, with bone chips and arthritis. It was getting worse and worse, and more painful, every time he pitched, and we simply didn't yet know how to fix it. Sandy wasn't the kind to hang on as a relief pitcher, so they made a joint decision for his retirement. He was just 31 years old [when he retired in 1966].
It was very, very unfortunate. I think we would have had a good chance to save his career if he came along maybe, ten years later, after the Tommy John situation. We may have given him another ten good years. Sandy's still a good friend, and he said that to me himself.
As you well know, top-flight athletes are extremely competitive, and aren't accustomed to asking out of the lineup. How did you get around their reluctance to talk about their pain and physical damage?
That was more of a concern in the 1960's and early 1970's, when there were no guaranteed contracts. Hurt players would be thinking, ‘I better stay in there, no matter what, or I'll lose my job'. Now, with multi-year contracts, players are more likely to think about the long term.
I'm not sure we did a good job [in finding injuries], to tell the truth, especially in the early years. Too often, the thinking was, if a player's in the lineup, he's good to go. In many instances, Dodger players would talk to a terrific trainer named Bill Bueller and do therapy, then the doctors would step in only when they were too injured to play at all. Certainly, we didn't go around looking for preliminary situations.
I believe that's changed in recent years. Doctors and teams have gotten better at being proactive about strength and pitcher usage. There's been much more of an effort to prevent injuries before they occur.
Have you ever found yourself in a situation where your medical opinion was overruled by a manager or a coach?
Well, in the 1960's, we did have a coach who was urging a player to play despite my opinion that he should be shut down. [The dispute] got to [Dodgers owner] Walter O'Malley, and he said, ‘We hired you as the doctor, and your decision is what counts'. From then on, I never had a problem again.
The name ‘Dr. Frank Jobe' will always be linked to ‘Tommy John' in the game's history. Can you talk about how it all started?
As it happened, I was at the game where he was injured, against Montreal. It was the top of the fourth, with two men on base. On the pitch where he was hurt, the ball went into the stands. He tried again, and that pitch went into the stands again. Then Tommy just walked off the field and I met him immediately.
The chimpanzee could have made the diagnosis on what happened, because when he moved the arm laterally, it moved completely, at 45 degrees. It was a complete tear in the ligament. It was such a severe case that there was no way he'd come back to a Major League level without a long-shot surgery to reattach the ligament, and that was the origin of the ‘Tommy John surgery'.
How much in John's recovery was in the physical reconstruction and rehabilitation, and how much of it was in his attitude about coming back despite the pain and the odds?
I can tell you this - Tommy never showed any real doubts about coming back. When I proposed this new surgery to reconstruct the elbow, he said, immediately, ‘Let's do it'. He showed a lot of courage.
To answer your question, though, rehabilitation is both a physical and a mental process. It has to be both. On the physical side, there's a lot of pain and trauma involved, and on the mental side, there can be a hesitation to trust your own joint or their own body. Sometimes, the memory of a joint tearing open won't allow a player to trust it too easily.
The biggest challenge, I've found, is in trying to prevent athletes from coming back too soon. Many times, they feel better than they are in the first few months after surgery, and if they follow up by pushing themselves too hard, they can go back to square one or worse. After all these years, however, I think athletes have been more willing to trust our advice on how to come back.
If anything, modern athletes seem to have supreme trust in the Kerlan-Jobe Clinic's work. Pitchers don't seem to fear Tommy John surgery nearly as much, and it's even gained a reputation for strengthening arms in the long run.
(chuckles) I've heard that one, and I'd like to address that.
Our doctors don't do surgery in isolation. It's always part of a complete body rehabilitation, where we make the elbow stronger, the legs stronger, the torso stronger. The idea is to maximize the all-around benefits to be gained in the necessary down-time, which can last a year. Very often, yes, athletes are better off than they were before they started on the healing process, but they aren't nearly as well off as they would have been if they'd just done the exercises to begin with.
How do you deal with the situations when a Wayne Garland, for instance, can't come back to Cy Young Award form?
It's pretty disappointing. From what we understand in our surveys, about 93% of our patients have returned to their previous strength performance, but that isn't 100%. I wish it was. I always say, ‘Medicine is an art as well as a science'.
Do you work closely with coaches and managers during the rehab process?
Not until relatively late in the process. Most arm problems come about with some combination of bad mechanics and overuse, but it's mostly overuse in one way or another. Once they're almost fully healed - ready to start pushing themselves at or near their full strength - that's when the coaches come in, to make sure they have good mechanics and a good transition to the on-field competition.
I think most modern coaches know their job really well and, in any case, they usually aren't too happy to hear a doctor tell them what to do. I usually just discuss a rehabbing pitcher's progress and leave it up to them to make the right game decisions. They usually come out with the right answers.
Unfortunately, we're seeing more arm injuries than ever among young players. Why do you suppose that's the case?
So many youth coaches seem to feel, ‘If a little exercise is good, a lot is better'. They have youngsters throwing far too much, maybe with an eye toward making a million-dollar player out of them. Very often, great high school pitchers might be pitching all-out for two, three days in a row.
I hope there's a greater realization that sort of thing does a terrible disservice to the young men in their development. The Little League recently instituted a rule for maximum pitch counts, in addition to innings counts, and I thought that was terrific. I wrote a letter congratulating them.
As a doctor, how do you view the steroids issue in baseball today?
There are so many facets of the steroids question, from a medical point of view, and so many unknowns.
I think it's relatively well-settled that steroids do indeed make you stronger. It won't make you hit or pitch effectively, but an already effective hitter can gain maybe another ten yards on his outfield drives and a pitcher might gain another two or three miles per hour on his fastball.
There's still a lot of speculation about what kind of damage they might cause in terms of tumors, cancers, and the rest. Regardless, I believe they should be banned. They do too much to mess up the game's history and set too bad of an example for kids.
One of the things that's unique about Major League doctors is the fact that they collaborate so often, regardless of their team affiliations. I know, for example, that other teams' physicians have helped out in your work with the Dodgers, and you've assisted them with their players. Can you talk about those efforts?
I can remember way back, there was some question whether we should meet with other teams' doctors, but that's almost completely cleared away by now. If you don't do that and keep learning, you embarrass yourself.
The Baseball Doctors' Association meets once a year to talk about our challenges. We don't use [patient] names, but we do our best to brainstorm on situations as they develop. It would be, ‘I've got a patient with such-and-such symptoms, and I haven't had any success with this certain treatment. Does anyone have any suggestions?' We talk also on the phone, along the same lines.
There are egos and affiliations involved but, in the doctors' group, I think it takes a back seat to our patients' best interests. That is, and should be, the number one concern.
With so many former patients out there, do you feel that they're ‘your' players in some sense?
Sort of. When I watch a ball game, I do try to spot our clinic's former patients. They used their own talent and hard work to become successful after the surgeries.
Tom Candiotti originally came to me as, I think, a Single-A player, and I didn't really know if I should go through with the procedure, just because it was relatively early in its development. I looked at him and said, ‘Are you a real Major League prospect?' (chuckles) He said to me, ‘Yeah, I think I am!' We went ahead and did it, and he was successful for a number of years. Thankfully. Tom still sends me Christmas cards signed, ‘Your Major League prospect'.
I'm proud of the surgical recoveries, as you might expect, but I suppose I feel even better about the exercise program we developed for the rotator cuff and the shoulder. That originally came out of the surgery rehabilitation programs, but came to include all sorts of preventative measures. It may be one reason why you don't hear about rotator cuff [injuries] quite as much any more. Injury prevention is just as important as injury treatment, even if it can't be evaluated in strict numbers.
Tommy John and Orel Hershiser, among others, believe that you should be in the Baseball Hall of Fame for your work in saving dozens of All Star careers. How do you feel about your own prospects?
I'm not sure if they have a place for doctors. Oh, I'd be tremendously honored.
After more then 40 years in and around baseball, are you more of a fan, less of a fan, or about the same?
More of a fan. It's been an honor to know so many players, especially those who have gone on to become coaches and managers and general managers. At the Clinic, we've always tried to maintain a family atmosphere, and I consider the baseball world sort of like a family.