Twisted Blister: Rich Hill and Baseball's Biggest Little Injury

Al Leiter suffered from blisters throughout his pitching career: first as a member of the New York Yankees, then with the Toronto Blue Jays and Florida Marlins, and finally with the New York Mets. (Then, once again, briefly with the Marlins and Yankees.) But when I told him over the phone that I wanted to write a story about blisters, he thought I was crazy.

His exact words: "What the hell are you doing that for? You bored?"

Even in the admittedly narrow context of pitching-related Major League Baseball injuries, there are sexier topics than blisters. Big league pitchers are finely-tuned athletes. Their diets are regimented, their throwing mechanics are biometrically analyzed for inefficiencies. It long has been understood that the act of pitching is unnatural and damaging. Elbow ligaments snap. Shoulders are wrecked. After baseball, arms hang gangly for the rest of pitchers' lives. Professional pitchers go through extensive stretching and conditioning routines to prevent those kinds of injuries. Books are written about those kinds of injuries.

Blisters are not those kinds of injuries. Which makes it seem fairly ridiculous that a professional pitcher can be felled by something as paltry and mundane as a finger blister—something that is, by definition, a surface-level injury. And yet it has happened hundreds of times in MLB, if not thousands. If you throw a baseball very hard for a living, blisters are a ubiquitous workplace hazard.

Pitching is an act of extreme and violent athleticism. But it is also one of extraordinary finesse, especially at the point where the baseball departs from the hand. In order to pitch effectively, you need to be able to release the ball off your fingertips in a specific place, and with a specific amount of pressure, over and over again. When you have a blister, you can't.

"Have you ever had a blister on your foot, and you don't have a Band-Aid, and you're walking, and suddenly inadvertently you're limping because of it?" said Leiter. "You just can't help it. It's impossible to throw a ball if you have a blister. It hurts, it's sore, it's coming off your finger, it starts to bleed."

The most dramatic recent example of how a blister can derail a pitcher is newly acquired Dodgers starter Rich Hill, who popped a blister on the middle finger of his left hand in the first inning of a start for Oakland on July 17. At the time, he was leading the American League in ERA. Since then, he has yet to appear in a game for either Oakland or Los Angeles.

"To miss a couple weeks because of a blister is something else," Hill told the L.A. Times after he was traded. "But it's a big part of it. It's like the steering wheel of a car. You need it."

What makes blisters so challenging for pitchers to recover from? Why can't major league teams, with hundreds of millions of dollars and the world's best technology at their disposal, come up with a way to prevent or treat something so small?

As with just about everything else in baseball, there are different schools of thought about the prevention and treatment of blisters. Some of these schools are rooted in science, and others in something more accurately described as folklore. One of the sport's most terrifying blister prevention routines belonged to Hall of Famer pitcher Nolan Ryan, who suffered from blisters when he was breaking in with the Mets.

In 1979, Sports Illustrated's Bruce Newman wrote a profile of Ryan, then in his final season with the Anaheim Angels. The story begins with Ryan, perhaps the most durable pitcher of the liveball era—a man who would go on to throw more than 5,000 innings and dial up mid-90s heat into his mid-40s—taking a surgeon's scalpel out from his locker.

"Ryan went about his work slowly," Newman wrote, "drawing the blade painstakingly down each of the fingers as if he were peeling grapes. With each stroke the knife shaved away a layer of the pitcher's skin, removing his fingerprints, as if Ryan were a thief determined to leave no clues behind."

This is quite the compelling image, and not simply due to the otherworldly pain tolerance that it must require to casually shave your own fingerprints off with a sharp blade. For Ryan, minor self-mutilation was better than the alternative: blisters forming on the tips of his pitching fingers.

Earlier in his career, after a DL stint, a Mets trainer had told Ryan to try drying his fingers out by soaking them in pickle juice, but that didn't work. What worked was the scalpel. So he took it out before every start of his career.

It may seem counterintuitive, but blisters form on the hands and feet because they are the places where our skin is toughest. The type of friction throwing a major league slider requires would simply cause an abrasion if occurred on the skin of your forearm. Instead, on the fingers, that same friction—exacerbated by heat and moisture—causes fluid buildup under the surface.

The top layer of skin gets irritated, then pushes down and disrupts the bottom layer. A gap between them is formed and fills with fluid, and the outer layer of skin degenerates. So you get a big old, tender, watery blister—and when it pops, it takes a bunch of skin with it.

Why are certain players afflicted and others spared? It might be as simple as biology. They sweat more. They have more sensitive skin. Bad luck.

You might think that pitchers whose arsenals require them to place more pressure on the seams of the ball are more likely to get blisters. For example, guys who throw hard sliders or cutters. But when Baseball Prospectus ran the numbers a couple years ago, they found this wasn't the case. The best predictors of future blisters, it turned out, were previous instances of blisters, and a heavy workload.

Leiter recalled his first major league blister, which came on July 21,1988 in Detroit. He was starting for the Yankees in what turned out to be an absolutely insane ballgame—the temperature at game time was 87 degrees.

"Billy Martin was my manager," he said. "It was in Detroit, and I hadn't had a win in a few starts, and it was Monday Night Baseball when they still had Monday Night baseball on ABC. I was facing Jack Morris and we're winning like four or five-nothing, it's in the 5th inning—and the whole thing comes off. (Editor's note: it was the fourth.)

"Mine was always the middle finger, because I threw my four seam fastball, my slider, my cutter off of it. And I started dabbing the blister on my leg because it was bleeding. Billy Martin looked at me and came out and ripped me a new asshole and said, 'What are you doing?' And I'm telling you I was on the DL at least six weeks, maybe two months for a blister, because I never allowed it to heal and come back 100 percent."

This is the kind of pain that Hill is likely feeling now. After repeated attempts at pitching in which he continued to re-aggravate his blisters, the Dodgers sent him to their spring training facility in Arizona, where his fingers could recover in more arid conditions. He is tentatively scheduled to debut Wednesday against the San Francisco Giants.

But one problem for Hill might be that he is—or at least was—going about this the wrong way. He told reporters after the trade that he was waiting for his fingers to develop calluses. That might seem logical: you want your skin to be tough and not break every time you throw a pitch. But calluses can be disruptive as well, by ever-so-slightly altering the way a pitcher releases the ball. And counterintuitively, they can make you even more prone to blisters. Ryan found that calluses made the scar tissue from his previous blisters more sensitive and likely to crack. That's why he shaved his fingertips off before every start.

"The whole misnomer of growing a callus is bullshit," Leiter said "You don't want a callus, because the ball pushes up against the callus and you get a blister underneath. You've got layers of skin. It wasn't the outside that would blister, so now you have the blister underneath the callus and that whole piece of skin would peel off, which is probably where Rich is now."

Mike Marshall, the Cy Young-winning relief pitcher turned kinesiologist, told VICE Sports that ideally, a pitcher should have soft and supple fingertips. He also can't believe that major league pitchers still struggle with blisters, because there's a simple solution.

"Getting blisters is a matter of whether or not they have their fingernails the right length," he said. "It's as simple as that. If the baseball comes off of a fingernail, it creates heat, and that's how you get a blister. You'd think they'd know how to do that by now."

Marshall recommended daily nail trimming, sanding down calluses, and making sure to apply lotion to the fingertips.

"If you toughen up the skin, it's more liable to have a blister or pain than if you use hand lotion, making sure again that the skin is able to be pliable," he said.

The trick, he added, is keeping your fingertips soft, but not allowing them to become moist. It's a delicate balance, but Marshall believes that with proper grooming, every pitcher can avoid blisters.

By contrast, most of baseball's traditional blister remedies are meant to toughen up the skin by drying it out: pickle juice, dirt, placing the hand in a bucket of dry rice to soak up the moisture. Leiter tried all of them to solve his blister problem. He even soaked his fingertips in a cup of his own piss—a remedy that somehow remains popular, and that Leiter said came to baseball from veterans returning from service in World War II.

In the early 2000s, a Dodgers trainer named Stan Johnston, who had been a professional rodeo cowboy as a young man, developed a patented remedy that spread among major league pitchers. He called it "Stan's Rodeo Ointment," and tested it out on pitchers like the Dodgers' Ismael Valdez, who suffered from blisters early in his career.

"I just started mixing some things humans use and some things we used to use on animals," Johnston told the Wall Street Journal. Josh Beckett credited the ointment with saving his 2003 World Series MVP season.

What worked for Leiter was something more akin to Marshall's method. Since friction exacerbates blisters, he did everything he could to avoid it. "You have to limit your throws, with the friction of the seam and the ball on your finger, as much as you can prior to when it actually matters—which is the game."

When he was throwing between starts, or warming up before a game, Leiter would apply a few layers of a liquid bandage product called New Skin to his fingertips. Then he would take a Band-Aid (it had to be the Band-Aid brand; he tried them all), and remove the cotton from the middle, before wrapping it around his fingertip. That layer of protection between the ball and the skin kept the friction down and the blister at bay. Then, the day after he threw, he would take an emery board and file down his calluses.

Not as traumatic as pissing on your fingertips or cutting them off, but it worked.

As for Hill, there is no shortcut to recovery. The only way he can test whether his blister is gone is by pitching. But if it isn't gone, pitching is also the one thing sure to tear his blister open again. That's why his return from the disabled list keeps getting pushed back.

The Dodgers are certainly aware of this dilemma, and were when they traded three of their best pitching prospects to acquire Hill and outfielder Josh Reddick. But despite the considerable acumen of their front office and medical staff, they could not have predicted that nearly three weeks into his tenure, Hill would still not have thrown a pitch for them.

"We don't have an exact timetable on that, but obviously his availability in the short term was an important part of us moving ahead on this deal," General Manager Farhan Zaidi said at the time of the trade. "So we feel pretty good about it, but we don't have an exact date for when he'd be out there for us."

The Dodgers have a decimated pitching staff and are facing a competitive division race. And with Hill a free agent at season's end, they have no incentive to worry about his long-term recovery. All they can do is hope that the skin on his fingertip holds up enough that he can help them now.

Or, if the Dodgers get really desperate, they can turn to history for inspiration. In 1963 and 1964, when Ryan was still in high school, a pitcher named Harry Fanok made sixteen appearances for the St. Louis Cardinals. Fanok was supposed to be Ryan before Ryan. They called him "The Flame Thrower." He was wild, and his mechanics were a mess, but he led his minor league level in strikeouts for three consecutive years in the early 1960s.

"He threw the ball as hard as anybody I ever saw," his minor league roommate Joe Morgan (the utility infielder turned Boston Red Sox manager, not the Hall of Fame second baseman) told historian Rory Costello a few years ago. "There's no one today throwing the ball as hard, even [Joel] Zumaya with the Tigers. You heard me—no one."

Fanok, like Ryan, suffered from blisters throughout his career.

"You hear every now and again where a pitcher can't continue because of a blister on his pitching hand," he wrote in an autobiography for SABR. "Well, it was a rare occurrence that I did not have two blood blisters after warming up for the 20 minutes before going into a game when I was starting. One on my middle finger, and one on my index finger. That'll give you an idea of what kind of friction was being created from letting the smoke fly. Anyway, all I done was to get a needle from the trainer and alcohol. That's it! Drain the fluid and put the alcohol on it and go out and pitch. No big deal!"

Then again, Harry Fanok walked 24 batters in 33 and a 1/3 career innings. Maybe Hill and the Dodgers are better off waiting it out.

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