Around the same time Bird was struggling to stay on the court, ElAttrache was at the University of Pittsburgh teaching himself how to perform arthroscopic elbow surgery, because in the late 1980s, “scoping an elbow was considered nearly impossible,” he says. “It’s a very small, very constrained joint with no room, and you’re a few millimeters away from nerves and blood vessels.” A slip-up could damage feeling and movement in the hands. Dr. Frank Jobe performed the first successful U.C.L. reconstruction — a.k.a. Tommy John surgery, named after its original recipient — on a big-league pitcher in 1974, which sounds like a long time ago. But before that, pitchers simply pitched through (undiagnosed, undocumented) injuries. “They played until they couldn’t play,” Fleisig says, “and then they were done.”
This is how a culture of injury omertà began in sports. You couldn’t do anything about it, so why complain? That information could be used against you — by an opponent exploiting a weakness, a teammate who wanted your job or maybe a general manager who wanted to replace you with someone younger and cheaper.
A few decades of soaring player salaries and surgical advancements gradually flipped the mental equation, though. In just 10 years, baseball’s highest average annual compensation — the number every pro is chasing — has more than doubled, from Zack Greinke’s $34 million in 2016 to Shohei Ohtani’s $70 million in 2026. The W.N.B.A.’s new collective bargaining agreement this March more than tripled the league’s minimum salary overnight. Now there’s simply far too much money at stake to play in a compromised condition and risk turning a minor injury into a major one, when you can just shut it down for a few weeks, or months, or even a year, and come back as good as new. “When a baseball player blows out his elbow right now,” Fleisig says, “everyone from the owners of the team to the players are like, ‘Well, OK, this is not great, but we know the road map here.’” And the journey keeps getting less daunting. A full “T.J.” procedure remains necessary for full tears, but a new approach using a device called a U.C.L. internal brace has become a popular alternative with incomplete tears because it cuts that recovery window from 12 to 14 months to as little as seven months.
The new methods are changing how players push their bodies. In the early days of Tommy John, when recovery took closer to two years and was far from assured, pitchers threw their absolute hardest for only a few pitches per night, and they saved those bullets for critical moments. Now it’s “max velo” on every single pitch. The Milwaukee Brewers All-Star Jacob Misiorowski doesn’t just throw an astonishing 104 m.p.h.; he tops 100 m.p.h. dozens of times in each start. His average fastball is 100.5 m.p.h. In basketball, a boom in 3-point shooting has stretched the geometry of defense. Every corner of the floor must be protected. Every “step-back 3” pushes a shooter’s ankles and Achilles’ tendons into red alert, a phenomenon that correlates with skyrocketing calf tears. The pace of the action, meanwhile, keeps accelerating, and it doesn’t matter if it’s the doldrums of the second quarter — you’d better not take off a play or you’ll get roasted on social media. Major injury is all but inevitable: the price of playing pro sports. And the reality is that a surgically repaired body part still isn’t as durable as mint condition.
