LAKE BUENA VISTA, Fla. - What was left to say? After witnessing a pair of all too familiar elbow injuries suffered by his brightest young pitching stars, Braves general manager Frank Wren looked exasperated.
For Kris Medlen and Brandon Beachy -- each mulling a second Tommy John surgery before the age of 30 -- it was too late for explanations. Even if someone could give them one.
Is this how it's going to be from now on? Will throwing a pitch be like baseball's version of Russian roulette -- every windup another chamber clicking, with luck the only protection against catastrophe?
That's what it has felt like the past few weeks, with Medlen and Beachy joining others such as the A's Jarrod Parker, the Diamondbacks' Patrick Corbin and the Royals' Luke Hochevar on the growing list as candidates for Tommy John surgery -- some for the second time.
"It's absolutely crushing,'' Wren said. "On a professional level, and on a personal level, when you know how much these guys have put into it, how much they care, how much they mean to our team. To see a guy walk off the mound and know that he's likely facing a season-ending surgery, it's devastating. And it just makes you sick to your stomach.''
By the time that elbow ligament does snap, as it has with alarming frequency for a number of pitchers this month, the first question becomes why. But for those fortunate enough to avoid ligament-replacement surgery, famously named after its first patient, 288-game winner Tommy John, many tend to ask: Why not them?
"It kind of makes you scratch your head,'' said Red Sox manager John Farrell, who had two Tommy John operations himself during an eight-year playing career that ended in 1996. "You don't know what goes on in other camps, so you don't know how they're ramping guys up -- if that's a reason -- or if there's something pre-existing in there.''
How come David Wells can pitch for 21 seasons, rack up 3,349 innings and never need the procedure? Or Roger Clemens, with his 24 years and 4,916 innings? But Matt Harvey, five months into his second season, with only 36 starts on his resume, ends up going under the knife at age 24.
Put it this way: If anyone knew the exact answer, all of these elbows wouldn't be imploding at such a rapid pace. But there are trends to watch and data to be studied, with signs pointing back to the early days of a pitcher's development, when damage inflicted on a young arm might not show up until much later -- even years into a major-league career, as we've seen recently.
According to Dr. Alexis Colvin, an orthopedic surgeon, sports medicine specialist and associate professor of orthopaedics at the Icahn School of Medicine at Mount Sinai, there are a number of contributing factors. The overspecialization of youth sports, especially with the unhealthy workloads of young pitchers on multiple teams, is a good place to start. Also, the "kinetic chain'' of a pitcher's delivery -- from the legs, to the hips, to the core and shoulders -- has plenty of moving parts that can be corrupted.
Tommy John himself told The Associated Press last week that this surgery will "grow exponentially in the next 50 years'' because of the inherent dangers of pitching. But Colvin said this sudden pileup of ligament-replacement candidates shouldn't be thought of as an irreversible trend. Like other medical issues, the causes can be identified through more research, and greater action can be taken at the youth-sport level.
"With players, coaches and parents,'' Colvin said, "you're going to have to have more of a societal shift.''
That means a "global'' monitoring of pitch counts and starts among different entities -- such as travel teams, high school teams and AAU squads. Kids feel invincible as teenagers, but that armor can be stripped away in a hurry -- and without warning.
"Young, resilient arms seem to hold up,'' Wren said. "But as they get older, I think there's probably a cumulative effect.''
Yankees reliever Shawn Kelley knew what it was like to be bulletproof. Then, at age 18, as a freshman at Austin Peay, Kelley rifled a fastball that set him on the path to require not one but eventually two Tommy John operations.
"I felt great that day,'' Kelley said. "I was throwing hard. I just threw a pitch and my fingers started tingling. It didn't really hurt, but it didn't feel right. The trainers had me throw another pitch, and I just couldn't. I walked off. It was crazy how mine happened.''
What baffled Kelley is that he wasn't a classic case of overuse. He played three sports, switching from football to basketball to baseball with the seasons. He didn't play on multiple teams. But if that was a "freak'' occurrence for Kelley, the second time -- seven years later, while pitching for the Mariners -- taught him a lesson on what not to do as a Tommy John veteran.
"I was wearing down,'' Kelley said. "The problem with baseball players is that we have the mentality of just 'suck it up' and do your job. A lot of times we ignore the warning signs. I think guys just try to power through it, not knowing the difference between just being sore and having pain -- then trying to fight through that.''
Introduce a powerful pain-killing shot like Toradol and those warning signs can be masked, often leading to severe breakdowns.
Or maybe just the stamina to hurdle the physical roadblocks can work against the more vulnerable parts of the body, such as a rotator cuff or elbow ligament.
But with all of the technological advances going on in baseball, it seems that a closer examination of pitching mechanics -- or the development process itself -- probably is overdue. Finding a protocol to prevent a second Tommy John surgery is, too. If that's even possible.
"I wouldn't call it an epidemic,'' Mets general manager Sandy Alderson said. "But certainly it's something that bears more research.''