When Jonathan Papelbon, the virtually unhittable closer for the Boston Red Sox, hurls a baseball at nearly 100 mph, his right arm becomes a fantastic and ferocious blur, rotating at about 7,500 degrees per second. If it were to keep going, spinning like a pinwheel, his limb would complete nearly 21 revolutions in the time it takes to say "Jonathan Papelbon." Adhering to the baseball adage that pitching wins games, the Red Sox have spent more than $43 million this season on Papelbon and other enviable arms. The team has been keenly aware of another adage as well: Pitching is a game of attrition. Over the grueling 162-game season, bending the arm way back and accelerating it forward, the fastest recorded human motion, is hard on shoulders and elbows. In fact, pitchers make up half of major-league rosters yet account for 7 in 10 injuries. To protect and maximize its investments, Boston has adopted a startlingly different approach. It originated off the field, 1,176 miles from Fenway Park, in the operating room of Dr. James Andrews, a groundbreaking orthopedic surgeon in Alabama. The idea is this: Prevent injuries by predicting them. The program, which Boston guards closely as a competitive advantage, is built upon a multitude of biomechanical breakthroughs from Andrews's practice. Sox pitching coach John Farrell, rehabilitation coordinator Mike Reinold, and their staff apply science to a realm long defined by hunches. "Instead of saying, 'He looks tight' or 'He looks loose,' we measure everything," says Reinold, who joined Boston in 2007 after eight years with Andrews. He and Farrell prescribe each pitcher a customized routine based on quantifying strength, fatigue, and flexibility; Papelbon and starter Josh Beckett focus on different muscles, because their bodies and pitching mechanics differ. Much like the Moneyball strategy employed by Oakland Athletics general manager Billy Beane, in which teams comb through unusual stats to better evaluate undeveloped talent, the Red Sox hope that Andrews's brand of unconventional testing will crack the mystery of injuries.
For more than three decades, Andrews has been a leader not only in spurring cutting-edge research but also in pioneering and refining operations and therapies that return athletes to action. Along with free agency and TV, this evolution of sports medicine has transformed sports from pastime to megabusiness. Andrews Sports Medicine and Orthopaedic Center in Birmingham functions as a powerful lever, a multimillion-dollar enterprise that affects multibillion-dollar leagues. An injured player is the equivalent of a dormant assembly line: If he isn't filling seats, he isn't generating revenue. Yet he's still getting paid. Last year, MLB teams spent $337 million — almost 14% of payroll — on players too hurt to play. When Andrews repairs those athletes (or helps them avoid injury), teams can optimize their investments, and players can extend their careers, reaping free agency's rewards. Take it from superagent Scott Boras, who estimates that his clients have signed about half a billion dollars in contracts after being treated by Andrews.
If you could assemble a superstar, Frankenstein-style, from Andrews's patients, it would have repaired knees from quarterbacks Peyton Manning and Donovan McNabb; a hip from dual-sports sensation Bo Jackson; shoulders from Michael Jordan and Charles Barkley; and elbows from the New York Yankees' Andy Pettitte and the Chicago Cubs' Kerry Wood. "I've always liked fixing people," Andrews says. "I want to get these athletes back to doing what they did before."
Like winning and earning. Greats such as Roger Clemens and Troy Aikman wouldn't have had the chance to become legends if Andrews's surgeries hadn't revived their early promise. Andrews treated Clemens in the Rocket's second year as a pro, Aikman in his third. "Andrews repaired something that other people had no idea how to fix," says Will Carroll, author of Saving the Pitcher, referring to Clemens's shoulder. Clemens and Aikman went on to make more than $200 million combined and win five world championships. In fact, in the last 20 years alone, Andrews's patients have led their teams to 20 World Series, Super Bowl, and NBA titles. Andrews has treated or advised thousands of players, and trained hundreds of doctors and therapists who've worked on thousands more. Between player contracts, revenue, and team valuations, his total financial impact on sports runs well into the billions.
Andrews, 66, seems like an unlikely character to play such an outsize role. His regular-guy manner suggests a pickup truck and bass boat. His office uniform isn't a white doctor's coat but a Sunday-best suit and tie. For all his digital-age ingenuity, he doesn't do email. He greets both high-school athletes and Major Leaguers, "Hey, big man," in a Louisiana twang, a reassuring hand on the shoulder. Beyond the unpretentious demeanor, though, Andrews, like the athletes he treats, has big-ticket tastes. Think Bentleys, Ferraris, and the America's Cup, in which his yacht, Abracadabra III, competed in 2000. He hopscotches to football games and to his Alabama and Florida clinics on his private jet, a Falcon 10. And then there's his intensity: He speed-walks like a New Yorker, even after quadruple-bypass surgery two years ago.
He'll insist, in aw-shucks mode, that he's not a businessman. Yet he's built his world-renowned practice with the unwavering passion, networking savvy, natural charisma, and insane hours of a Silicon Valley veteran. He has assembled a team of experts — the James Andrewses of physical therapy and of biomechanical research, if you will — to make his vision a reality: integrated health care that reshapes lives, rosters, games, salaries.
The good doctor says he doesn't keep track of his patients' postsurgery windfalls, but he's not oblivious, either. "It was reported once that Dr. Andrews got a commission on all the contracts," says Lanier Johnson, executive director of Andrews's Birmingham research institute, his unofficial publicist, and a former knee patient. "We only wish that was true."
• • • • • • • • •
There Will Be (a Little) Blood
"Game time. Let's do this Major Leaguer."
Dressed in bright blue scrubs tucked into scuffed white rubber boots and with two pairs of glasses dangling around his neck, Andrews marches out of the surgery lounge at St. Vincent's Birmingham hospital and heads for the operating room. It's the first week of baseball season, and his schedule is light — just four operations (three elbows) — before he flies to California for a meeting of the American Orthopaedic Society for Sports Medicine, of which he's president-elect.
In baseball, Andrews is best known for performing ulnar-collateral-ligament reconstruction, the career-saving elbow graft called "Tommy John surgery" (named for the first patient, in 1974, the fine Los Angeles Dodgers pitcher). Although Andrews didn't invent this clever fix, which replaces the torn ligament with a tendon, he has done it more often than anyone else — 2,500 times and counting — and performs the hour-long procedure nearly 300 times a year. Even Dr. Frank Jobe, the Los Angeles orthopedist who invented the surgery, didn't anticipate how common it would become. (He told John his chances of returning to the game were one in 100; John came back to win another 164 games, pitching to the age of 46.) "Andrews was one of the first to recognize the surgery's importance," Jobe says. Since his first in 1980, Andrews has fine-tuned the diagnosis, surgery, and rehabilitation, establishing a recovery rate of 85%. "A lot of players think it's 100%," he says, "but nothing is."
Mike "Bronco" Zagurski, a relief pitcher for the Philadelphia Phillies, lies on the operating table, anesthetized. A week earlier, while throwing a slider during spring training, he felt a pop in his elbow, followed by a sharp, burning sensation. It was his ulnar ligament, the thin band of connective tissue that connects the arm's upper and lower bones. Over time, hurling a baseball at high velocity can cause it to fray and eventually snap. A generation ago, Bronco would've been finished. "I'll be on the shelf about 12 months," Zagurski says the day before surgery.
In the OR, Andrews dons what a colleague calls a "game face like no other" and, using his scalpel, traces a line several inches along the inside of the elbow, then pries open the skin. Because of the tourniquet on Zagurski's left arm, there's remarkably little blood, allowing Andrews to cut quickly through the white tissue, stretchy like spiderwebs, and follow a familiar road map. First stop, the ulnar nerve, then on to the injury itself. He points out the ligament, a yellowish cord, to the Phillies athletic trainer watching over his shoulder. "Here's where it tore," Andrews says. He's matter-of-fact, as if repairing a toaster instead of the arm that could earn Zagurski millions, given the demand for left-handed relievers.
"I'm sure you have physicians who say, 'Oh, I could do that,' " says Dr. Champ Baker, an orthopedist and former colleague. "But when some superstar shows up in their office with the TV cameras outside and the agent on the phone, they get gun-shy. Jimmy can block all that out." (Except, Andrews admits, when he looked down at Jack Nicklaus's knee and thought, "I hope I have the right one.")
After drilling holes in the bones, Andrews makes three incisions in Zagurski's forearm and wrist, and extracts a nearly foot-long tendon, the palmaris longus, which resembles thick dental floss. He weaves the graft through the bones in a figure eight so that the tendon will become a new ligament. Fittingly, the red scar, Andrews's signature, will form a smile in the crook of the arm.
"Let's see his flexibility," Andrews says, bending the exposed joint back and forth. "Okay, big man, that's it."
• • • • • • • • •
Surgeries That Pay Off
If sports fans know Andrews, it's because they've heard SportsCenter anchors drop his name as a knowing reference, or have seen his frequent, ominous sports-page cameos, such as this summer's report: Atlanta Braves pitcher John Smoltz is traveling to Birmingham to see Dr. James Andrews. But these only hint at his relevance. Because Andrews treats players on nearly every team and in nearly every sport, his reach is greater than that of any athlete, coach, or even commissioner. The totality of his work — redirecting careers, changing the fortunes of teams, even cities — makes a compelling case that he's one of the most influential figures in all of sports.
The Yankees won four World Series between 1996 and 2000, in large part because of pitchers Clemens, Jimmy Key, David Cone, and David Wells, whom fans could lionize, with a nod to Babe Ruth, as "the arms that Andrews rebuilt." The team went from a $225 million franchise in 1991 to one currently worth $1.3 billion. In the 1990s, Andrews operated on Aikman, Emmitt Smith, and Michael Irvin, the stars who led the Dallas Cowboys to three Super Bowls. The team's value, $140 million prior to those championships, is $1.5 billion today. And in 2006, when Andrews alumni Drew Brees, Deuce McAllister, and Will Smith led the New Orleans Saints to their first-ever conference championship game, the Times-Picayune asked, "When the New Orleans Saints divvy up their playoff money, will James Andrews be voted a share?"
Only a fraction of his patients have been identified in published reports. In an analysis of 40 baseball players who are known patients and whose salaries could be obtained, Andrews's career-extending work has led them to garner almost $1.3 billion in guaranteed money. Ten NFL quarterbacks whom Andrews treated went on to secure more than $333 million in contracts.
"Doc saved my career," says Brees, one of those QBs. "What he was able to do with my shoulder was truly amazing." While playing in the San Diego Chargers' 2005 season finale, the All-Pro dislocated his shoulder and had his rotator cuff nearly torn in two after a bulky defensive player drove him into the ground. A few days later, Andrews put 12 anchors in Brees's shoulder to reattach tissue, the most he'd ever used. The Chargers released Brees. Most in the NFL believed the 27-year-old was done, but the Saints, reassured by Andrews, took a gamble. In 2006, Brees and his surgically repaired shoulder came through with his — and the franchise's — best season.
It's impossible to measure what that Saints' run meant emotionally to New Orleans as it recovered from Hurricane Katrina. But you can quantify Brees's payday — a six-year, $60 million contract — and the economic impact on the city, which totaled more than $600 million.
• • • • • • • • •
From Jock to Doc
Andrews understands athletes because he was one. He grew up in Homer, Louisiana, a speck of a town near the Arkansas line, playing several sports. His senior year, he and the Homer Ironmen reached the state football finals. Half a dozen teammates went on to play for Louisiana State University, but Andrews, a wiry 150-pounder, went to LSU on a track scholarship and flourished as a pole-vaulter. In 1963, he won the Southeastern Conference championship.
While Andrews was away at college, his father, who ran a dry-cleaning business, died at 43. Determined to provide for his mother and younger sister, Andrews applied early to LSU medical school and skipped his senior year. His grandfather, a farmer and self-taught country doctor, had long nudged him toward medicine, telling the boy, "You're going to be my doctor." The idea took hold. "I never had any other career in mind," Andrews says.
The decision to give up his final year of track propelled him into sports medicine. He could relate to the sidelined athletes, because he missed competing, too. And the challenge of fixing high-performance bodies appealed to him. During his second year of residency at Tulane University, he learned about Dr. Jack Hughston, of Columbus, Georgia, a pioneer in the emerging field of sports medicine. Hughston would examine football players at Auburn University, even watch games from the sidelines, which was unorthodox back then. (It wasn't befitting a surgeon's stature, the thinking went, akin to ambulance chasing.) With a professor's help, Andrews wrangled a visit during which he accompanied Hughston to a high-school game and assisted in surgery.
When he got a job offer from Hughston in 1973, Andrews "got my toothbrush" and drove all night to report for work at 5 a.m. The boss, a knee guy, happily handed off pitchers with baffling "dead" arms to the young hotshot. Exploratory surgery could provide answers, but the resulting scar tissue virtually guaranteed retirement. Andrews turned to arthroscopy, then an experimental technique. It involves inserting into the injured area long metal rods, some with a camera and light, others with instruments for cutting and stitching. As fiber optics improved, he became one of the first surgeons to fix labral and rotator-cuff tears using the minimally invasive procedure that allows pitchers to fully recover.
Andrews also began to hone a therapeutic mastery that even today distinguishes him from his peers. In a matter of minutes, during a folksy conversation, he'll process a flurry of factors: What's the injury, and what are possible outcomes? What are the athlete's immediate and career goals? How committed is he to rehab? What's his pain tolerance? What are the other emotional factors — his contract status, family pressure? "There's no cookbook," the Andrews-ism goes, when it comes to advising when, and if, to operate. "It comes down to reading a patient," says Dr. Lyle Cain, one of Andrews's two partners. "He's a master at figuring out what to do at the right time."
When Jack Nicklaus came to Columbus in 1984 with knee problems, Hughston was against exploratory surgery. Andrews convinced the legendary golfer to undergo arthroscopy. Two weeks later, Nicklaus was back playing, kneeling over putts to the TV announcers' amazement. Two years later, he nabbed his sixth Masters.
After Clemens's astonishing comeback from shoulder surgery in 1986, Andrews's phone started ringing more, not only from players but also from hospitals courting him. Hughston, his longtime mentor and father figure, was approaching 70. "I made the mistake of asking Dr. Hughston, 'Who's going to carry this on?' " Andrews recalls. "He said, 'You're trying to get rid of me.' " When Andrews left Columbus in 1986, he and Hughston weren't on speaking terms. "It was like having a son who's going to take over your business," Andrews says, "and then the son decides he's going to go somewhere else."
That somewhere was Birmingham. Andrews found a partner willing to help him create a Hughston-like clinic of his own, and develop plans to make it even bigger.
• • • • • • • • •
The Yankees are calling, again. It's a spring Friday, and Andrews is in Florida, checking messages with his Birmingham office. Although the Yankees have a staff doctor, they want the most sought-after second opinion in sports. They've already sent an MRI to Alabama. "He's their starting catcher," Andrews tells a staffer.
He's talking about Jorge Posada, of course, the veteran catcher who has injured his shoulder. "Just leave the MRI on the front porch," Andrews says. "I'll look at it when I get home tonight."
The Andrews brand is built on not just expertise but also extreme customer service. He understands what sets apart this particular breed of customer: the sense of urgency and high stakes. In Birmingham, an SUV picks up star patients at the airport, and at the clinic they're ushered through a back entrance to a private room. In addition to the player, Andrews talks to the agent, team doctor, general manager, and sometimes even the coach. "Do you have my number?" he constantly asks. "Call me." Which they do. "It's all the time," says his wife, Jenelle. "If we're at dinner, he keeps his phone on vibrate, but he can hardly wait to see who it is."
Could be Boras, the agent, who has Andrews's cell on speed-dial. "You better believe I do," he says, "and he has mine." Boras has been sending stars to Andrews for more than 30 years. "You might have a team physician who says, 'I don't think this guy can play,' and Jim's saying, 'He's an outfielder. With a treatment plan, he can make the throws.' Both doctors can diagnose the defect, but only one can tell you whether or not it'll affect the player. That diagnosis may mean a $100 million contract."
When Andrews was with Hughston in Georgia, he made house calls — in his own house. Football coaches throughout the state and in Alabama would bring injured players over after the clinic had closed. If they required immediate surgery, Andrews put them up. Later, after the family moved into a sprawling Italianate mansion in Birmingham, Andrews's six children got used to famous faces staying in the guesthouse during rehab, including Bo Jackson, who became the doctor's quail-hunting buddy.
Ask Andrews how he makes it work — the countless calls; leading a medical practice with nearly 40,000 patients annually; the Fridays, Saturdays, and Sundays on football sidelines; and the never-say-no philosophy typified by his oft-uttered phrase "Come on" (as in "Come on down, and we'll fit you in") — and he reverts to self-deprecating mode. "To this day, I don't know how I manage to do it," he says.
Of course, Andrews knows exactly what he's doing. His practice, like most businesses, is rooted in relationships, and he has systematically exploited his network to great effect. "You'd never want to play Jimmy in chess," says Dr. William Clancy, the inventor of an early ACL repair and a surgeon in Andrews's practice. "He'd be 10 moves ahead of you." In the 1970s, Andrews and other young surgeons started the Herodicus Society (named for the ancient Greek physician, considered the father of sports medicine) to collaborate on surgical techniques and develop the next generation of leaders. He cultivated a high profile outside the OR, coauthoring textbooks and research papers and headlining conferences. ("He fills the house," says one equipment maker.)
Andrews understood early on that taking care of high-school, college, and minor-league athletes would create a vast web of referrals and lead to the professional ranks. In Alabama, where you're practically required by law to choose between Auburn and the University of Alabama, Andrews attends both schools' football games, treating Tigers and Crimson Tide alike — even when they play against each other. In Columbus, he bought the local minor-league affiliate of the Houston Astros and most likely became the only team owner to operate on his players.
The network effect of all these marketing efforts is continuous. This summer, Shaun Micheel, the 2003 PGA Championship winner, had Andrews arthroscopically repair his torn labrum because, yes, Nicklaus endorsed him. As 1976 U.S. Open golf champion and grateful patient Jerry Pate attests, "I've recommended Jim to hundreds of people. Hundreds."
The only time Andrews's nonstop networking and ambition has gotten the best of him came in 2003, when he found himself implicated in the HealthSouth accounting scandal. His partner in Birmingham was the high-flying chain of rehabilitation hospitals, and Andrews served as the company's national medical director, responsible for overseeing quality of care. He was good friends with CEO and founder Richard Scrushy, who helped fund Andrews's America's Cup effort. When federal agents uncovered a $2.7 billion fraud, Andrews says he didn't know about the inflated revenue. "It was a shock to me," he says. "They screwed up the company." But last December, he paid a $450,000 civil settlement that stemmed from allegations that by referring patients to HealthSouth facilities, he'd violated a self-referral law; he was never charged and he wasn't the only doctor to settle. (HealthSouth paid a $14.2 million settlement for its part.)
When the HealthSouth center closed abruptly, his dream of opening a chain of Andrews-designed sports-medicine clinics evaporated. He scrambled to find a new home, leasing space at St. Vincent's. His practice's annual revenue, reportedly $60 million under HealthSouth, shrank by about half; the number of surgeons on his team dropped from 12 to 6.
What saved Andrews was the referral network he'd built. He has become the sort of hub that's rare in any field. Even when another doctor is seeing a big-time athlete, Andrews often has a connection. The team physician or medical director will be a former surgical fellow, one of the young MDs who worked with Andrews for a year before going into practice (with the Cincinnati Reds and Green Bay Packers, among others). Or someone will have collaborated with him on a textbook (New England Patriots and New York Mets, among others). The rehab coordinator (Red Sox) or director of sports medicine (University of Georgia) might have honed his skills at the Birmingham clinic or spoken at one of Andrews's annual conferences (New Orleans Saints).
As a surgical resident in Boston in the late 1980s, Dr. Tim Kremchek followed Andrews's work closely, then spent a year as one of his fellows. The experience, he says, "changed my life and how I wanted to practice medicine." He learned Tommy John surgery from Andrews and after moving to Cincinnati, replicated much of the Birmingham clinic, down to the fellows program. "He gave me the blueprint, and now I'm teaching people," Kremchek says.
As the Reds' team physician, he is fast becoming one of the top arm specialists in the country. Technically, Andrews created a competitor. But that's not how he regards Kremchek and nearly 300 former fellows in practice. They're spokes in an expanding network, more and more doctors returning athletes to the game.
• • • • • • • • •
This Joint Is Jumping
Even more than the OR, the physical- therapy clinic above Andrews's surgical practice represents the essence of his holistic approach. "Surgery is just an opportunity," he says. "Rehab is often more important." Regaining range of motion, strength, and endurance hinges on months, and sometimes years, of daily conditioning. That's why physical therapy chief Kevin Wilk is critical. Wilk, who has worked alongside Andrews for 19 years, is the yin to Andrews's yang, his easygoing, reflective demeanor ideally suited for helping Brees, McNabb, and others make the arduous journey from the operating room to the field.
On Wednesdays, Andrews, dressed in a suit that gives him the bearing of a deacon, and Wilk, wearing khakis and a short-sleeve golf shirt, conduct checkups. The mix of patients on this day is typical: two NFL players, a Major League infielder, two minor-league pitchers, two high-school baseball players, a 13-year-old female gymnast, and more than a dozen regular patients (some have flown in from around the country). Despite the panoply of athletes, two-thirds of Andrews's practice consists of everyday patients. They might think they've stumbled into a sports bar, thanks to the TVs tuned to ESPN and the framed autographed jerseys on the walls. Except, of course, for the exercise equipment.
A high-school catcher surveys the room, bug-eyed: "Is that Kenny Irons?"
The former Auburn standout, now a running back for the Cincinnati Bengals, lies two tables away, text-messaging, his reconstructed knee in a brace. Eschewing Cincy's training facility, Irons rented an apartment in Birmingham, joining a handful of out-of-town athletes. "It's like a New York or Chicago nightclub," Wilk says. "The more people we have, the more athletes want to be here."
For two months, Irons has been exercising twice a day under Wilk's supervision and hanging out with fellow rehabbers, including a cornerback who, if all goes well, will be trying to tackle Irons this fall. He's upbeat, pleased with his progress. "[Bengals running back] Rudi Johnson told me, 'You gotta see Andrews,' " Irons says. "He's done so many guys' ACLs, it makes me feel comfortable."
During checkups, Andrews, Wilk, a primary-care physician, a couple of surgical fellows, and athletic trainers form a semicircle around each patient. Anyone who has experienced the uncoordinated handoff that constitutes health care today can appreciate what an extraordinary sight this is. Each person responsible for care is present. Asking questions. Listening. Conferring.
When the group reaches the pro infielder who had arthroscopic surgery the day before, Andrews whips out his cell phone and gives a team official the play-by-play. "Kevin [Wilk] is right here stretching him," Andrews says. Later, the player lifts weights despite his heavily bandaged shoulder. It's just a few pounds, but still. Less than 30 hours ago, Andrews was rooting around in his rotator cuff, manipulating the tools like huge knitting needles.
"To get back to normal, an athlete has to feel pain," says Boras, the agent. "When Jim tells him, 'You're going to be okay,' that creates confidence. He gives his patients something that few doctors can give: physical and psychological healing." This is why the broken All-Stars and hopefuls make the pilgrimage. Get fixed, be the next comeback story, and earn space for a signed jersey on Andrews's wall.
• • • • • • • • •
Preventing Injuries — and Surgeries
Between 1996 and 2006, Andrews witnessed "an epidemic" of arm injuries among teenage baseball players. The number of Tommy Johns he performed on kids 18 years and younger jumped from several per year to several dozen. Kids' elbow ligaments can't withstand the constant wear and tear of pitching. When young arms tire, their muscles do less work, shifting more force on the ligament, says Glenn Fleisig, head of biomechanical research at Andrews's nonprofit institute. The ligament is then 36 times more likely to rupture than under normal force. Last year, as a result of a campaign spearheaded by Andrews and Fleisig, Little League adopted their recommendations to impose pitch counts on its more than 2 million participants.
The mission of Andrews's institute is to understand and prevent the sort of injuries that Andrews repairs. For instance, tearing an elbow ligament occurs because a pitcher is "doing something wrong again and again and again," says Fleisig, a 21-year Andrews vet. "A repetitive injury is beautiful for us, because we can study it, unlike football collisions." Over the years, this wonky, dry-witted baseball fan with a PhD in biomedical engineering has produced definitive studies on curve-ball-related injuries and the mechanics of pitching.
That work is also affecting baseball at the Major League level. Each spring, a handful of teams send young pitchers to Andrews's lab in Birmingham. Using motion-capture technology similar to that employed by video-game developers, researchers dissect the throwing motion into about 100 measurements, such as elbow flexion and hip torque, then compare the results with data from injury-free pitchers. The anomalies point to potential injuries.
Ross Atkins, director of player development for the Cleveland Indians, calls the 10-page analysis "the most thorough exam out there," though the coaching staff is still evaluating how to use it. They're more likely to correct a younger pitcher's mechanics, but even then, it's tricky. "If you're affecting rhythm, you're affecting conviction in throwing a baseball to a certain location," Atkins says. The analysis is also threatening to baseball's old guard. "We're getting feedback on things you can't see with the naked eye."
It's not hard to imagine how teams might eventually use this kind of predictive data for leverage in contract negotiations. The Indians aren't there yet. "But," Atkins says, "the fact that we're spending this much time on it is very telling."
The Red Sox, who also send young pitchers to the lab, are further along. Reinold, the team's rehab specialist and a Wilk protégé, is applying what he learned in Birmingham to Boston's pitching staff, creating a new kind of insurance. Through "pathomechanics," Reinold studies Papelbon and his teammates' deliveries to determine the points of maximum force, which are most vulnerable to injury. That's where each pitcher focuses on building strength and stamina. The data also allow the coaches to deploy pitchers in a game partly based on test scores, not guesswork.
The methodology is still evolving, and the Sox are one of the few to embrace the high-tech analysis, so they won't divulge too much. Suffice it to say, they believe they have an advantage on their hands. Literally. The proof, Reinold says, is "the large ring I'm wearing on my finger." The inscription: 2007 World Series Champions.
Andrews, however, isn't secretive about his innovations. His open style of practicing medicine furthers knowledge while feeding his business. In mid-April, at his annual conference on football injuries in Florida, he addresses more than 200 athletic trainers, physical therapists, and doctors from the NFL, colleges, and high schools. He describes case after case, detailing the injury, diagnosis, and treatment in a PowerPoint presentation.
Click. A 26-year-old strong safety, nicknamed "Terminator," who played hurt. "He's got a fracture the size of a quarter," Andrews says, setting up his punch line. "And he's complaining of a little tightness." Andrews relishes sharing what he's learned over 35 years, or just last week. He can come off as a generous teacher or a shrewd marketer. Truth is, he's both.
If they do sports medicine right, he tells the crowd, heck, it doesn't even feel like work. And for the small-town doctor whose small town is big-league sports, it's not — even as his empire expands. This fall, his Birmingham clinic becomes the centerpiece of the new six-story $30 million Musculoskeletal Institute at St. Vincent's. The new home will let him add more surgeons and continue rebuilding his practice. With two former fellows in place as young partners, he hopes to avoid the succession problems his mentor Hughston experienced.
During a break at the conference, Andrews speed-walks through a tour of his other new facility, the $56 million, 127,000-square-foot Andrews Institute for Orthopaedics & Sports Medicine in nearby Gulf Breeze. As he reaches the palatial mens' locker room, Andrews, a longtime consultant for the Washington Redskins, tells Bubba Tyer, the team's director of sports medicine, a few surgeons, and another half-dozen folks, "You got to see this. It looks like something [Redskins owner] Dan Snyder would do!"
After a quick change into scrubs, Andrews meets his guests in the observation lounge. There, one can watch four operating rooms at once; TV monitors display the surgeries close up. Tyer and the others shake their heads in admiration. And then, Andrews is on the go again. He has to fix a college pitcher. "Well, all right," he says and bounds into the OR. Another elbow awaits James Andrews's signature.
A version of this article appeared in the September 2008 issue of Fast Company magazine.