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Wednesday, April 25, 2001

Trapped by Our Own Anatomy: Dr. Klawans’ Cautionary Tales of Sports Neurology

Don’s back problem ends up helping him learn something.

I spent a good portion of this last weekend watching
  my back. No, it had nothing to do with any of the events over at my weblog,
  though hope will always spring eternal for certain of you who seemingly live
  to spit my words back at me. Sometime late Friday evening, as we were returning
  from a pleasant day spent mostly on the coastal side of the San Francisco peninsula,
  the muscles in my back reared up with an anger only dimly approximated by the
  most indignant of my readers.


The silver lining of this incapacitation was that for the better
part of three days, I couldn’t assume a normal sitting position,
and was thus banished from my computer. Forced to crawl on my
belly like the side-show reptile that the truant at heart already
know me to be, I was reduced to three basic activities: lying
on my stomach (as opposed to doing so while standing upright),
taking painkillers, and reading.


The most profitable of these activities was the last one, of
course. By chance, one of the books stacked up alongside my horizontal
prison was one I’d ordered from a mail order discounter, but had
yet to do more than dip into since its arrival. This volume, entitled

Why Michael Couldn’t Hit and Other Tales of the Neurology
of Sports

, by Harold L. Klawans, was even more
riveting that my malady. I recommend it highly, even to those
of you who are mercifully free of back pain.


Klawans is a neurologist (as you might have suspected from the subtitle), and
  while he does occasionally stray into jargon, he is mostly an excellent translator
  of medical terms, and in seventeen engaging chapters (six of which relate to
  baseball) he is a most sympathetic and astute guide into the nervous system
  of sports.


The book is filled with information that will be new to even
the avid "science of sports" reader. Klawans has an
especial affinity for boxers, and his chapters devoted to that
sport (on Muhammad Ali, Primo Carnera, and the obscure
"Battling" Bill Browne) are filled with fascinating
nuggets. For example, Ali’s chapter explains why Parkinson’s disease
is a malady that separates us from our hominid relatives, and
demonstrates why the man known as "the Greatest" was
ravaged by this disease while other boxers were not.


One of Klawans’ most fascinating asides occurs in his essay on Lou Gehrig,
  which in some ways is the least accomplished of the collection. Discussing the
  genesis of diseases related to the malady—amyotropic lateral sclerosis—known
  as Lou Gehrig’s Disease, he touches upon the inherent toxic nature of food,
  and thus the most basic reason for a varied, balanced diet. It’s an arresting
  image that redeems an otherwise rote essay that relies on a biostatistical study
  of Gehrig’s last full season that isn’t supported by the actual data (see sidebar). border="0" naturalsizeflag="3">


align="LEFT" border="0" naturalsizeflag="3">For ideologues and others fascinated by the neurological and
vascular issues involved in throwing a baseball, Klawans has two
chapters that offer a harrowing glimpse into the nature of this
most unnatural act. The medical facts behind three different but
related injuries ending the careers of J.R. Richard, Whitey
and Bruce Sutter are dissected with chilling precision.
What it all comes down to is a fact that is as incontrovertible
as it is unacceptable: our bodies were not designed to throw thousands
of pitches per year at the force and speed required by major league


Klawans provides us with an elegant summary informed by the
strictures of hominid evolution:


There had been a remarkable change
  in the ground plan of the upper body and its basic geometry. This variety of
  "genetic engineering," in the original sense, had to involve the entire
  shoulder girdle as well as the nerves, arteries, and veins that had to get back
  and forth from the trunk to the arms. These had to move laterally (meaning away
  from the center of the trunk) and blaze a new, previously uncharted pathway
  in order to maintain access to the arm. In so doing, they had to pass out of
  the chest cavity through a small outlet formed by three bones: the clavicle,
  the oft-fractured collarbone of fastball players; the scapula, better known
  as the shoulder blade; and the first rib. This three-cornered space is known
  in anatomy as the thoracic outlet.


The smallness of this outlet, combined with the downward
pull of the arm, might suggest that we should all get problems
from this anatomical arrangement. Most of us, however, never have
any problems because the support given by the various muscles
of the shoulder girdle is sufficient to keep the thoracic outlet
open. But sometimes the support isn’t sufficient to do the job.
It certainly wasn’t in J.R. Richard’s right thoracic outlet.


In other words, overdevelopment of ligaments and muscles as
a result of pitching literally squeezed the neural and vascular
facility from J.R. Richard’s arm. Years of pitching exacerbated
the condition until arterial damage became severe enough to produce
shards of dried blood, which formed clots and precipitated a series
of strokes.


Klawans then relates the less tragic but no less instructive
story of Whitey Ford, whose artery occlusion was treated via different
means in 1964, and essentially permitted him to pitch for a little
more than another full season before the blockage returned. It’s
here that Klawans gives us a glimpse of the Darwinian element
in baseball’s most unnatural act:


Thoracic outlet syndromes are not restricted to great pitchers.
In fact, the reverse is more likely true. Great pitchers become

in part because they are less prone to this problem

[emphasis mine]. The dimensions of the outlet vary from
person to person, too. Those in who there is the least amount
of space never get to be even average pitchers, much less major
leaguers. They give up pitching very early during their baseball
experience. Significant thoracic outlet syndromes have been reported
more often in teenagers pitching baseball than in major league
pitching stars. Such teenage players usually become outfielders.


None of the above is, of course, meant to discourage the idea
that pitchers in general, and young pitchers in particular, should
be monitored closely with respect to workload and health issues.
It just merely points out that all pitchers are inherently survivors
of a harsh evolutionary process—one that is essentially antithetical
to human anatomy.


Two of Klawans’ best essays close the book—one on myasthenia
gravis, and the other on the woman who may well have been the
greatest all-round athlete of the twentieth century: Babe Didrikson
. In this last essay, Klawans returns full-circle
to his opening essay on Michael Jordan and speculates that
women may have more ability to acquire athletic skills beyond
the early cutoff points in life that explain why the brilliant
basketball superstar was such an abysmal failure as a hitter.


Admittedly, I was a captive audience, but a better word for
it would be captivated. I think you’re quite likely to
have the same reaction should you read this book. Even if you
already know "why Michael couldn’t hit," it’s a safe
bet that there are many other things contained here that you don’t.


Don’t wait until your back goes out to read it.


Don Malcolm Posted: April 25, 2001 at 06:00 AM | 1 comment(s) Login to Bookmark
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   1. Tom Austin Posted: April 25, 2001 at 12:04 AM (#603709)
Great article, Don. Especially enjoyed the comments on the thoracic outlet.

Although I was disappointed that the article, and I presume the book, fails to explain why -I- can't hit. Or given me some exercises to reduce my reaction time and increase my bat speed. And while I'm at it, shave a few minutes off my home-to-first speed.

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