A Review Paper The Process of Progress in Medicine, in Sports Medicine, and in Baseball Medicine Frank W. Jobe, MD, and Marilyn M. Pink, PhD, PT ome years ago, a mentor once said “I’m not inter- Ancient Greece ested in what you know as much as I’m interested The time of the Ancient Greeks was around 500 BC. in how you think.” That was a very curious state- Herodicus is one of the first progressive medical practitio- ment for an orthopedic surgeon. Doesn’t a surgeon ners of whom we know. Herodicus was a “gymnast”—a Shave to know the facts of the human body? Wasn’t that physician who interested himself in all phases of an ath- “what” I knew? lete’s training. Literally, gymnase in Greek means naked. Now, when at the opposite end of the career spectrum, And, it was Herodicus himself who recommended that the the wisdom behind those words is apparent. “How we athletes exercise and compete in the nude in order to keep think” determines the progress we’ll make. “What we as cool as possible and to perspire freely in the humidity. think” is that which we memorized to get through medical school and is good only for today. With that in mind, the story of baseball medicine is not “...the story of baseball just a story of baseball statistics—rather, it is a story of medicine...is a story of how how we arrived at today and where we are going tomor- row. If we are wise, we can learn from the story: we won’t we arrived at today and need to repeat history, but rather we can look at the com- where we are going tomorrow.” monalities in the progressive steps and invent our future. Now, let’s start at the beginning, with the Ancient Greeks. Herodicus was a firm believer in diet and exercise, and he Dr. Jobe is the Medical Director, Biomechanics Laboratory, used these tools for physical rehabilitation as well as for Centinela Freeman Regional Medical Center, Inglewood, the treatment of patients suffering from the “fevers.” His California, and the co-founder of the Kerlan-Jobe patients did well and he began to have followers. One of Orthopaedic Clinic, and Clinical Professor, Department of them was Hippocrates. Orthopaedics, University of Southern California School of In addition to practicing medicine, Hippocrates was a Medicine, Los Angeles, California. scientist. And he wrote prolifically. Actually, it is thanks Dr. Pink is Consultant, Biomechanics Laboratory, Centinela to Hippocrates that Herodicus’s works survived. It was Freeman Regional Medical Center, Inglewood, California. Hippocrates who documented these, in addition to many of his own subsequent works. Based on Dr. Jobe's Presidential Address at the 22nd Annual Hippocrates lived in a time when people believed that Closed Meeting of American Shoulder and Elbow Surgeons 1 (ASES), with the agreement of the ASES. disease was due to divine origin. Not only did they believe that there was no way to prevent or to treat disease, Request for reprints: Centinela Freeman Regional Medical Center, but they even considered it sacrilegious to attempt this. Biomechanics Laboratory, 555 East Hardy Street, Inglewood, Yet, Hippocrates realized that if he carefully observed CA 90301-4011. telephone 310/680-8070, FAX 310/671-5923, enough cases, he could predict the course of a disease [email protected] course: a basic concept of modern medicine. Am J Orthop. 2007;36(6):298-302. Copyright Quadrant HealthCom In his “Treatise on Surgery,” Hippocrates wrote Inc 2007. “Whoever wants to practice surgery, needs to go to war.”1 298 The American Journal of Orthopedics® F. W. Jobe and M. M. Pink Medicine obviously was needed on the battlefield, and was the accepted treatment for wound care.) Other physi- surgeons honed their practice out of necessity, given the cians said there was nothing to be done and walked away. abundance of cases. Even today, this proliferation of cases Paré was determined to find a way to treat these soldiers, so around a battlefield continues to create the opportunity to he began débriding and dressing the wound. He observed learn from them and spur medical advances. the results very carefully—and, lo and behold, his patients did better than those who had the hot oil treatment. Thanks Roman Times to Paré’s logical innovations and observations, this treat- The most influential sports medicine doctor of this time ment still stands today. would be Claudius Galen, and the time was 200 AD. He Paré was also a supporter of exercise, and in his prolific was probably the first team physician—for the Gladiators. writings, we see that he endorses exercising a fractured One of his frequent treatments for the Gladiators was to limb after treatment. He stated that exercise was indispens- pour wine onto the wounds. able to recovery. While most of his research in anatomy and physiology Paré was a biomechanist and an anatomist. In the was confined to animal dissection, Galen tells the story autumn of 1542, Paré journeyed to the siege of Perpignan, of finding the bones of a robber that were picked clean where he removed a lead ball (arquebus ball) from the by wild animals. And, he does urge the student to be shoulder of the Grand Master of the Artillery. Locating and on the lookout for an occasional human bone exposed in extracting the ball had baffled the other surgeons. Paré, the graveyard. 2 however, placed the patient in the exact position that he Like Hippocrates, Galen was a prolific writer: he was in when he’d been hit and quickly found the damaging has over 2.5 million words in print that span the are- lead ball. This incident lead to his first book.6 nas of science, medicine, law, philosophy, mathematics, Paré demonstrated great interest in anatomy. He relates and grammar.3, 4 that he obtained the body of a criminal and dissected one Galen, again like Herodicus and Hippocrates, frequently side of the body and left the other side untouched. He prescribed exercise for diseased patients. He was the first claimed that he kept the body with all of its organs in good to realize that muscle had one function: to contract. He condition for over 27 years. Paré and his friend Thierry de realized muscles work in one direction, they frequently Héry (another barber-surgeon) published a small treatise on work in groups, and there is commonly an antagonistic anatomy in 1549.6 motion. Commonalities Among These Pioneers The Dark Ages The common characteristics of these great men are what Then came the fall of the Roman Empire and the rise of we will take forward into our look at the world of baseball the Medieval Church. Progress in this part of the world medicine. Those characteristics include intense study of was halted. Fortunately, Galen’s work survived thanks to anatomy and mechanics, hands-on clinical care with a a man who is called the Father of Muslim Medicine: Hakim volume of patients, believing there are always alternatives, ibn-e-Sina, or as he was known in the West, Avicenna.2 integrating good diet and exercise into patient care, prolific Avicenna found a copy of Galen’s work and translated it writing, and astute observation along with documentation into Arabic. He found the works so believable that he too of patients’ responses to controlled treatment. began to utilize Galen’s ideas on medical gymnastics. In his “Poem on Medicine,” Avicenna wrote, “Do not BASEBALL MEDICINE give up hard exercise; do not seek rest too long; preserve a It is appropriate to first ask, “What is baseball medicine?” happy medium. Exercise your limbs to help them repel the For our purposes, baseball medicine is defined as an bad humors by walking and struggling until you succeed intervention focused on the prevention and rehabilitation in panting.”5 of injury (and, in the rare case, on surgery), based upon Then came the Crusades, and the Arabic version of anatomy and baseball mechanics. Philosophically, this Galen’s work was reintroduced to the Western world, and a aligns with the approach of some of the great medical rebirth, or Renaissance period, began. practitioners mentioned earlier. Given this definition, we’d like to paraphrase Hippocrates’ quote from his “Treatise The Renaissance on Surgery’ and say “Whoever wants to practice baseball By the time of the Renaissance, exercise was thought of medicine need to go to the diamond.” as both preventive and therapeutic. Therapeutic exercise To historically look at mechanics and interventions, was taught in medical schools by the 15th century. Even in while also incorporating anatomy, we now turn to base- grammar schools, exercises were taught through physical ball’s rules, its statistics, and the injuries of the athletes. education classes. It was 1884 when the overhand pitch was first allowed. Ambroise Paré demonstrates many of the commonalities At that time there were approximately 112 games per of the process of progress in medicine. In 1537 Paré, a season. Within the ensuing 8 years, there were 69 pitch- 20-year-old barber-surgeon, found himself at the seige of ers who threw in excess of 389 innings. To put this in Turin without a drop of cauterizing oil. (Cauterizing oil perspective, today’s professional pitchers throw for 140 to June 2007 299 The Process of Progress: Medicine, Sports Medicine, and Baseball Medicine Cy Young's Story: Insight Into the Requirements for Longevity in Baseball Cy was a farmer and a rail splitter until age 23, when he by many longevity pitchers. It appears that the young men entered professional baseball (1890).