The “Patients” of Jobe

Controversy and Washington DC go together like airborne roofs in a category five hurricane. The 600,000 citizens who walk the streets of the District of Columbia and the additional five million who reside within the Washington DC metropolitan region have long since built up an immunity to controversial news emanating from the Nations Capital. However, as a lifelong resident of the Washington, I can not recall a reaction quite like the one we saw last fall when the Washington Nationals in the midst of a World Series run, voluntarily sat their ace pitcher, Stephen Strasburg. It appears that we can handle; financial crises, sex scandals, irrational wars, corruption and daily child like behavior from our Congressional leaders and White House. But denying a city, who is desperate for a ticker tape parade chugging down Pennsylvania Avenue , one which does not include politicians, a championship, hit a nerve. One that is still exposed and raw six months later. In a time of economic stress, in the middle of one of the most vitriolic and nasty Presidential campaigns in history, Washingtonians sought solace in their newly beloved baseball team. Quite simply the city fell in love with the Nationals, overnight. Band wagoning? Any port in a storm? Maybe. But sitting in the stands watching the young exciting Nats win the National League East Pennant, it just did not matter. The moment was magical for a city who had not been to a playoff game since the old Washington Senators won the American League Pennant in 1933, seventy nine years ago. Since 1933, the Washington Senators had only five winning seasons until they moved to Texas in 1971. The dismal performance gave rise to the saying, “First in War, First in Peace, Last in the American League”

The Senators did manage to win the World Series in 1924, the only baseball championship in Washington’s bleak baseball history dating back over one hundred years to 1901. Led by pitching triple crown winner Walter Johnson, the Senators beat the New York Giants in seven games. Johnson recorded 23 wins against only seven losses with an ERA of 2.72 during the 1924 season and was named the World Series MVP. Future Hall of Fame inductee, Goose Goslin led the team in hitting with a .344 average. Trailing three games to two, the Series returned to Washington’s Griffith Stadium, named after longtime Senators owner Clark Griffith. The Senators took game six to square the Series at three. Manager Bucky Harris, who also played second base, opened the scoring with a solo homer run in the fourth inning of the deciding game seven. The Giants answered with three in the sixth. In the bottom of the eighth, Harris, whose $9,000 salary made him the highest paid player on the team, hit a grounder to third base which, and as legend has it, hit a pebble sending the ball over third baseman Freddie Lindstrom’s head. Scoring two, the game was tied at three and headed into extra innings. In a shocking coincidence, Earl McNeely’s ground ball to third base, in the bottom of the twelfth, took another bad hop over Lindstrom scoring Muddy Ruel sending the 31,667 fans into a frenzy. One not seen on a Washington baseball field for 88 long years.

The world of sports was far different back in the roaring 1920′s that it is today. Boston Red Sox Bill Buckner booted Mookie Wilson’s slow roller to first base in game six of the 1986 World Series. Allowing the grounder to roll through his legs, leading to an improbable comeback by the New York Mets, caused a sudden fall from grace for Buckner. He received death threats from his own fans and was forced to leave town. In a more congenial environment Freddie Lindstrom did not suffer the same fate. Late in the 1924 season he was called up by the Giants to replace injured third baseman, Heine Groh. In doing so at the young age of 18, Lindstrom became the youngest World Series player in history. He batted .333 in the 1924 Series and would go on to be inducted into the Baseball Hall of Fame. “So they won it,” Lindstrom later recalled. “(Giants pitcher) Jack Bentley, who was something of a philosopher, summed it up after the game. “Walter Johnson is such loveable character that the good Lord didn’t want to see him get beat again.” Babe Ruth, as the captain of the National League All Star team, picked Lindstrom as his third baseman for ten straight years. Modern day statistics maven Bill James has Lindstrom ranked the 43 best third baseman of all time.

Winning the World Series is extremely difficult, especially for a team like the Washington Nationals. After a grueling 162 game season, only ten of the thirty teams advance to the playoffs. The NFL, NHL and NBA all have significantly shorter seasons and a higher percentage of playoff teams. Hockey and basketball send over half of their thirty teams to the post season. Football sends twelve. Without salary caps in baseball, the strong get stronger. The New York Yankees payroll is $200 million, or four times the San Diego Padres spend of $50 million. Yankee stars, CC Sabathia and Alex Rodriguez respective salaries exceed the entire Padres team payroll as well as the “moneyball” Oakland Athletics. Empirical evidence supporting this thesis jumps off the list of World Series Champions. The Yankees, Giants, Cardinals, Athletics, Red Sox and Dodgers have won the World Series 67 of the 107 times the event has been contested. If there ever looked like a year in which the Nationals would win their first championship in almost a century, it was 2012. Not only did the Nationals win the National League East, they won 98 games ranking the team the best in all of Major League Baseball. Paired against the wild card St Louis Cardinals in the opening best of five series, the Nationals split the first two games in St Louis. The series returned to Washington for the final three games. After trading victories in games three and four the series pivoted to the winner take all game five. With 21 game winner Leo Gonzalez on the mound, the Nationals were heavy favorites. The start was auspicious. In the bottom of the first, Werth doubled, Harper tripled and Zimmerman homered. Three — zero Nationals. Bottom of the third, Harper hit a solo shot, while Morse followed up with a two run dinger. Six — zero Nationals. Gio is looking invincible, giving up only two hits through three innings. In a collapse painful even to cynical tortured Washington sports fans, the Cardinals would come back to win nine — seven. Early in the game, I could feel the deamons of decades of futility being exorcised from Nationals Park on a crisp clear fall evening. Zimmerman’s pop out to second with two outs in the ninth, sent 45,966 fans (110% of capacity) into slumber. Missing our boat ride back to Georgetown, and forced to hop in a rickshaw, I will never forget the look of disbelief emblazoned on so many despondent Nationals faithful. Dazed and confused fans apparently forgot how to drive, causing a traffic jam which strangled National Park like a bad debt you can not pay. A city that has witnessed the realization of so many dreams, so many hopes, so many triumphs, outside of the sports world, suddenly hit bottom, again. Cruel would be too kind of a word to describe the turn of events. Losing a six run lead after three innings at home in game five with the best pitcher in baseball on the mound, is well, impossible, unless you live in Washington. Just when you thought you had seen everything.

Shock and horror, turned to anger as Nationals fans calculated, “what could have been” had Stephen Strasburg suited up for the series. General manager Rizzo announced at the start of the 2012 season that in order to protect their superstar from further injury to his elbow, Strasburg would only pitch a limited number of innings during the season. Not known at the time, but disclosed eventually the number was 160. Strasburg pitched 159. With Gonzalez and Strasburg starting four games in a five game series, the Nationals win easily. Do not let anyone convince you otherwise. During the 2010 season, Strasburg tore his ulnar collateral ligament located on the inside of the elbow connecting the bone of the upper arm (humerus) to a bone in the forearm (ulna). Prior to 1974, this was a career ending surgery. Dr Frank Jobe changed this. From the Kerlan-Jobe website;

“Frank W. Jobe, M.D., Co-Founder of the Kerlan-Jobe Orthopaedic Clinic, is a legend in sports medicine. Dr. Jobe’s pioneering work in the field of sports medicine and sports surgery has led to countless awards and honors. After earning his medical doctorate at Loma Linda University, Dr. Jobe went on to his orthopedic residency at Los Angeles County Hospital. He was a Clinical Professor in the Department of Orthopedics, University of Southern California School of Medicine, and was the founder and Medical Director of the Biomechanics Laboratory at Centinela Hospital Medical Center, Los Angeles, California, where he co-developed groundbreaking research and education programs. Throughout his distinguished career, Dr. Jobe has been a major contributor in the medical professional community, having contributed to more than 140 medical publications, and authored 7 books and 24 book chapters. His has served in leadership roles for a number of professional organizations, including the American Orthopedic Society for Sports Medicine (former chairman), American Shoulder and Elbow Surgeons Association (former vice president), Major League Baseball Physicians Association (former president and secretary) and Western Orthopedic Association (former program chairman). Dr. Jobe was a consultant to the President’s Council on Physical Fitness and Sports. He was a Diplomate, American Board of Orthopedic Surgeons, and was a founding member of three professional associations, including the International Society of the Knee. Dr. Jobe was the long-time team physician and medical director for the Los Angeles Dodgers. He was the long-time medical director for the PGA Tour & Senior PGA Tour and continues as a consultant to the Tours. Also during his distinguished career, he was an orthopaedic consultant to the Los Angeles Lakers, Los Angeles Kings and Los Angeles Angels.”

Dr Jobe developed a surgical technique to repair an UCL tear named the Tommy John surgery after the Los Angeles star picture who blew out his arm in the 1974 season. By taking a tendon from another part of the body which is inserted through drilled openings in each arm bone, Dr Jobe became the most valuable sports doctor in the world, overnight. A twelve season veteran, Tommy John tore his UCL in the 1974 season. After taking the 1975 season off, John returned to the mound in 1976 and played fourteen more seasons amassing an additional 164 wins. His “gift horse” second career included a stellar 1979 season during which John posted a 21 — 9 record with an ERA of 2.96. Since Jobe invented the medical procedure, it is estimated that over 500 major league pictures have undergone Tommy John surgery. Of course, multiples more in other positions and sports have been saved by Dr Jobe’s invention. Notable MLB pitchers include; John Smoltz, AJ Burnett, David Wells, Chris Carpenter and of course Stephen Strasburg.

The results are mixed as one might expect. Medicine is a science, most of the time. However, when you start replacing ligaments with tendons and drilling holes in bones of high performance athletes, who place maximum stress on their bodies, anything can and does happen. What is perfectly clear is that there is no formula to how and when to bring a pitcher back from an UCL. Is 159 safe, while 160 innings dangerous? Of course not, but National’s general manager Mike Rizzo drew an unwavering “line in the sand.” Analyzing the data on the approximate 500 MLB pitchers who have undergone Tommy John surgery shows conclusively that there exists no correlation between innings pitched in the years immediately following the repair and success on the field. Some players never pitched again. Others rested, limited their innings pitched and went on to long careers. Others who followed the same protocol did not. Obviously percolating through Mike Rizzo’s mind was the thought that more rest surely must be better than less, especially when it comes to your star player who has the potential to dominate the sport for many years to come. Imagine the backlash if Strasburg pitched in the post season and suffered a career ending reinjury? This risk outweighed the reward of winning the World Series to the management and ownership of the Washington Nationals.

Logically Scott Boras, one of the most powerful sports agents in baseball, was also echoing in Rizzo’s ears on the Strasburg situation. Besides being close friends, Boras represents Bryce Harper and Danny Espinosa, three of the top Nationals minor league recruits and at least nine other players on the Nationals payroll. Oh and he also represents Stephen Strasburg. Subordinating a player’s health to a possible World Championship would damage the Rizzo and Boras partnership, which appears to be working magically as the duo team up to build a MLB powerhouse. Enough said here.

Critics, mostly in the non medical flavor, surfaced like cicadas blasting Mike Rizzo’s decision. Interestingly, one was none other than Tommy John himself who said this back in 2012,

“I would hope the general manager has a degree in orthopedic surgery, or at least kinesiology or physiology, and I dont think Mike Rizzo has any of that. Here is the thing, go back, Wikipedia Tommy John and see how many innings I pitched in 1976, my comeback year. I think it was like 206 or 207 innings.” We checked it was 207, a number 48 greater than Strasburg’s 159. Looked at another way, a likely seven game total; two in the divisional series, two in the NCLS and three in the World Series.

John emotionally exclaimed, if he were a Washington Nationals fan he “wouldn’t buy tickets” next year if they benched Strasburg. We shall see on April 1st, when recently announced starting picture, as if there was any doubt, Stephen Strasburg takes the mound in the Nationals home opener against the Florida Marlins.

It was widely reported that two MLB managers made the following statements;

“If we don’t win the World Series, I don’t care who does, as long as it’s not those guys. They don’t deserve to win it. Not after what they did.”

“I hope they go down in flames. I hope it takes another 79 years before they get back to the playoffs. That’s how strongly I feel about it.”

Someone weighed in, who in fact is a doctor, arguably one of the most successful and famous sports orthopedic surgeons in the business today, Dr James Andrews,

“If you look at the injury rates on re-dos for Tommy Johns, the highest injury rates they have is during the second year, when they’re coming back and really back up at top form and throwing and getting fatigued,” he continued. “So I think that’s a bold step, but it’s probably protective for him and for his long-term career, which is always more important than anything else, particularly in a high-level pitcher like that, and a young pitcher. Every pitcher’s a little different,” Andrews said. “But everything we do when you have them return — all the way from the beginning of the throwing program at four months after surgery — is a step-by-step progression. So their workload has to be individualized, certainly through their first year back and generally through their second year back. When asked about resting Strasburg during the 2012 season, Dr Andrews had this to say, “The problem with that is starting him back up. You all know that the major injuries occur any time when you start somebody back up early in the season when they’ve been off. So it’s a little bit unknown to be able to do that and do that safely. I don’t know how that would actually benefit him. It could benefit him, it could benefit the team, but also it may be dangerous to start him back up with appropriate rest. So I’m sorry to say, but it’s a damned if you do and damned if you don’t deal.”

At least one happy constituency is the Major League Baseball Hall of Fame who announced they will honor Dr. Jobe (87) for his significant contributions at this year’s induction ceremony.

“The ground-breaking work of Dr. Frank Jobe to conceptualize, develop, refine and make mainstream Tommy John Surgery, a complex elbow procedure that has furthered the careers of hundreds of ballplayers, is a testament to the positive role of medicine in our game’s growth,” said Jeff Idelson, President of the National Baseball Hall of Fame and Museum. “Dr. Jobe will be honored for the development of the historic elbow procedure known as “Tommy John Surgery” that has helped hundreds of Major League players past, present and future extend their baseball careers.”

Upon hearing the news, my initial reaction was mixed. However, I have come to understand, appreciate and fully support the Washington National’s decision to bench Strasburg. Please do not get me wrong, as I would have desperately loved to see a sorely needed championship come to this city in 2012. The Redskins won three Super Bowls during the Joe Gibbs reign, the last coming in 1992 over twenty years ago. Prior to the Super Bowl era, the Redskins won the NFL Championship in 1937 and 1942. The Bullets, behind Wes Unseld and Elvin Hayes, won the NBA Championship in 1978. Thats it. Seven championships in the big four sports in over one hundred years. My friend Mark Ein’s Washington Kastles have captured three straight World Team Tennis titles during a 32 unbeaten streak, one short of an all sport record is still going. DC United has captured four MLS Cups.

Regardless of how you feel about the decision, irrefutably the move to bench Strasburg stands in stark contrast to the way the management of the Washington Redskins handled an injury to their rookie superstar Robert Griffin III. RG3 suffered an injury to his knee in a regular season game against the Baltimore Ravens. After a game time medical review by sideline doctor James Andrews, (the doctor publicly denied that he saw the quarterback) Redskin head coach Mike Shanahan sent RG3 back in the game, only to have him sustain further injury. In the first round playoff game against the Seattle Seahawks, RG3 played a strong first half, however, his injury was simply too severe to continue in the second half. A fact obvious to everyone except the management of the Washington Redskins, who recklessly left him in the game. Watching the rookie superstar suffering on the field was a sickening sight which horrified the sports world. RG3 underwent ACL surgery in the off season. The surgeon was Dr James Andrews. The thought of a long awaited playoff victory was too intoxicating to the “powers that be” of the Washington Redskins.

Starting with a $250 loan from his wife in 1952, Ted Lerner went on to amass a real estate fortune. He ranks #329 on the Forbes world’s most wealthiest with an estimated net worth of $4 billion. Lerner’s business and investment philosophy has always focused on a long term approach. The majority owner of the Washington Nationals looks like he is continuing his successful management approach in his foray into the world of sports. As such, the decision to take a cautious forward looking approach in dealing with their superstar pitcher’s injury was not very unexpected. When general manager Mike Rizzo laid out the options; play Strasburg in the postseason risking permanent injury while possibly capturing the World Series, or follow a conservative long term course of action, I doubt Mr. Lerner took very much time to make a decision. Warren Buffett, one of the world’s most successful long term investors, believes a critical component of business success comes from, “Avoiding big mistakes.” No doubt this invaluable truism went through Lerner’s mind when he made the Strasburg decision.

The Book of Job, one of the most celebrated pieces of Biblical literature holding a spot near the top of the greatest books in history, teaches the virtues of patience. As his possessions are taken from him, Job’s faith is tested. The work details Job’s discussions with his friends about the origin and nature of human suffering. Two lines from the book catching our attention in relation to Washington sports history;

“How you have helped one / who has no power! / How you have assisted the arm / that has no strength!” Job sarcastically responding to a his friend Bilad in a freakish foreshadowing of his “descendant” Dr Jobe.

“For everything that was written in the past was written to teach us, so that through endurance and the encouragement of the Scriptures we might have hope.” (Romans 15:4)

As long standing suffering Washington sports fans, all we have is hope. If the Nationals can break through and finally win a World Championship, it will be because of an owner with an enduring patience and a man named Jobe. Put If You Please down as a believer. On April Fools Day, when Stephen Strasburg throws the first pitch of the Washington Nationals 2013 season, the joke will be on the doubters.