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For Hill, Lots of Pain, but No Gain

By Chico Harlan
Washington Post Staff Writer
Monday, March 9, 2009

VIERA, Fla., March 8 -- This past week, again, Shawn Hill's right arm hurt, and again the question was why. Doctors didn't know. In previous years, as one injury linked to the next -- the elbow, the radial nerve, the forearm -- those who examined Hill's arm agreed on only one thing. The pain was clear. The origin was not.

Bone scans, MRI exams and nerve studies uncovered no structural damage. The trip last year to the specialist at Duke University proved nothing. Same with visits to three Mayo Clinic doctors. Orthopedist James Andrews removed some bone chips from Hill's elbow last September, but when Hill felt forearm tightness this week, the pitcher flew to Andrews's clinic in Pensacola, Fla., for a follow-up visit. Andrews saw, more or less, a normal arm.

So on Sunday, Hill was back at the Washington Nationals' complex, one day away from resuming a throwing program and one step closer to accepting a daunting possibility. Maybe, Hill admitted, the pain in his arm will never go away. And maybe an answer will never come. Even a week ago, Hill, 27, had hoped for a pain-free 2009 season -- to heck with five years of injury history that suggested it couldn't happen. But the first setback of spring training occurred after a bullpen session one week ago, when Hill felt not only forearm tightness, but also slight lower biceps and elbow discomfort.

Why? Who could say? And the question, in the wake of more uncertainty, became less about what caused the pain, and more whether Hill could forge a career in spite of it.

"For what's on the line for me, for my family, for my livelihood -- and with what I think I can accomplish in this game -- they are going to have to roll me over until I can't take the pain," Hill said. "No matter what, I have to try. And I'm pretty good at dealing with pain, so it'll be either, 'Let's go, I'm throwing until I physically can not throw,' or I'm just getting hit so incredibly hard that you're going to take the ball away from me. One of the two is going to have to happen for me to stop."

In most moments, Hill is a realist. He'll take the prescribed anti-inflammatory medication and keep pitching, he said, because the money is good. After he throws today, he'll try again Wednesday. Then, fingers crossed, he'll throw a bullpen session on Friday. Maybe within a week or two he can be back in game action. "It might not look like I'm having fun," Hill said, referring to possible discomfort, "but I'll be out there."

In some moments, though, Hill allows himself to contemplate the perfect resolution. Maybe, Hill said, "somebody out there knows what is going on, but it's so out there that nobody has thought of it yet." Or maybe, Hill said, he'll throw a pitch one day, feel a pop, break up the last bit of scar tissue, and feel exactly as he did six years ago.

"You hope somebody, at some point, comes along and says, 'Here's what you need to do.' Whatever it is," Hill said. "That's a possibility. Or maybe one day I wake up and whatever I did the day before fixed it. I was throwing too much, too little, whatever."

Concocting what-went-wrong scenarios has become just as much a part of the Hill story as guessing his future. Some familiar with Hill's history believe that his first major arm injury -- in 2004, Andrews performed elbow ligament replacement surgery -- triggered everything thereafter. Perhaps the surgery created some near-imperceptible change in Hill's biomechanics, prompting one body part over-compensating for the next. For his career, Hill has never topped 100 innings or 16 starts. He was on the disabled list once in 2006, once in 2007, and twice in 2008. He's had surgeries to decompress his radial nerve, clear out scar tissue, and remove bone chips. But those were all minor things, not procedures to address a root cause.

Hill has his own theory, and sees no link between the '04 elbow ligament replacement surgery and his problems since.

Rather, Hill links his current problems to the one seemingly unrelated injury -- a left shoulder (non-throwing) strain in 2007. That injury first happened on April 20 against Florida, when Hill, in a rundown, slid into third. Two starts later, he aggravated the injury, straining for a throw while covering first.

He started twice more in the next 10 days, and then missed three months. Hill's theory: By messing up his left side, his right arm took on more strain.

"I honestly believe that if I hadn't torn my shoulder, none of this would have happened," Hill said.

If Hill is able to resume throwing this week, Washington will give him every opportunity to crack its Opening Day rotation. Manager Manny Acta, in more optimistic moments this spring, described just how much it would mean to have a healthy Hill pitching every five days. But an unhealthy Hill? An imperfect Hill? Under those limitations, Hill will have to discover and prove his worth.

"Because if the doctor says there is no structural damage, he will just have to take some anti-inflammatories and go out there," Acta said. "This is the point. He's probably going to have to go out there and deal with it."

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