Hektoen International

A Journal of Medical Humanities

Eye-brain-extremity coordination and enduring sports achievement

Marshall Lichtman
Rochester, New York, United States


Rafael Nadal known for his sports achievement in tennis
Rafael Nadal. Photo by Carine06. 2016. Via Flickr. CC BY-SA 2.0

Neuroscientists have imaged the brain of athletes, looking for changes related to the sports they played, whether principally aerobic or anaerobic. These efforts have suggested expansion of the gray matter in certain anatomical areas of the brain in elite athletes. These analyses have been crude by necessity, as the tools for more refined analysis of matters such as eye-brain-extremity action, coordination, and split-second decision-making, are much more difficult problems to confront experimentally. Extraordinary achievement in certain sports is the most visible evidence of abilities related to the transfer of perceptions from the eye to the brain and then to action, notably the coordination of upper and lower extremity responses.

Years ago, I read a survey of sports experts who were asked in which sport was it the most difficult to reach an elite status. The top three were baseball, golf, and tennis in that order. Golf and tennis are individual sports, dependent on the skill and commitment of one person for success. Baseball is a team sport, but the achievements of individuals are tracked exhaustively. In baseball, it is not unusual for an unsuccessful team (few or no pennants or World Series wins) to have an extraordinary player.

Brain-eye-arm and leg coordination is essential in the three sports. In baseball, the ability to hit a sinking fast ball or hard breaking curve ball approaching a hitter at 90 to 100 mph, and to do it consistently, is so difficult that if one can do it three times out of ten, that player is likely to be considered for the Baseball Hall of Fame. Outstanding, sustained excellence in pitching and fielding over a career have their own challenges.

In golf, with the distances required to get from tee to hole, a few degrees difference in the angle at which the ball leaves the club head can result in missing the fairway, requiring extra strokes to reach the green. In addition, remarkable coordination is required to avoid underhitting or overhitting shots from the fairway to the green. In recent years, muscular development to achieve very long tee shots has been added to the coordination required to shoot low scores. Putting on a sloped or undulating green requires exceptional targeting of the path and speed of the ball to have highly competitive scores.

In tennis, the remarkable power off the racquet of elite players on their serve or ground strokes requires quickness and agility to get to the ball and make the return in such a way as to keep the ball in play, make the shot a winner, or to force an error. This rapid decision-making about the placement and power of the shot requires exquisite brain-eye-body coordination and placement, often made on the run. The play of multiple sets of tennis, sometimes at high ambient temperature, requires extraordinary fitness and endurance to maintain high performance.

Although most sport records are made to be broken, one of the exceptions to that rule is the baseball hit streak of Joe DiMaggio in May 1941, now eighty years ago. It has never even been approached. Growing up in the Bronx, I was a devoted, indeed fanatic, Yankee fan. I lived one block from the original stadium and could see it from my bedroom window. The Yankees had become a storied team from the time they acquired Babe Ruth and he was joined by Lou Gehrig. They had won an unequalled four World Series in a row from 1936 to 1939. Then, in the prime of my boyhood, ages seven (1941) through sixteen (1950), they won the World Series in 1941, 1943, 1947, 1949, and 1950. The Yankees in those years had one star player after another, although many were gone during the years of World War II, resulting in the loss of two or three years of play in their prime. In 1944 and 1945, baseball had few notables, as most players were in military service. The Yankees’ star was Snuffy Stirnweiss, a diminutive infielder, who was voted fourth- and third-most valuable player in the American League in 1944 and 1945. He is now lost to posterity.

DiMaggio went into military service in 1943. Before the war, however, his base hit streak began on May 15, 1941. I was five weeks shy of seven years old when DiMaggio started his streak. Fifty-six games later, it ended. During the streak he got ninety-one hits, including sixteen doubles, four triples, fifteen home runs, and batted .408. He scored fifty-six runs in fifty-six games and batted in fifty-five runs. When it started, the Yankees were in fourth place in the American League and when it ended, the Yankees were in first place, six games ahead of the second-place team. After being held hitless in his fifty-seventh game, although he did get on base with a walk, DiMaggio went on another sixteen-game hit streak. His streak of getting on base was seventy-three games. As a San Francisco Seal of the AAA league, he had had a sixty-one-game hit streak. In his last season for the Seals, 1935, before being sold to the Yankees, he hit .398 with forty-nine doubles, eighteen triples, and thirty-four home runs, stole twenty-four bases out of twenty-five attempts, and was the most valuable player in the Pacific Coast League. His hit streak in 1941 made him, along with Ted Williams of the Boston Red Sox, who hit .406 during the 1941 season, the two premier hitters in baseball. DiMaggio was voted the Most Valuable Player in the American League in 1941 as a result of his streak and leading the Yankees to a World Series win. Although disappointed for not being selected Most Valuable Player, Ted Williams said of DiMaggio’s streak, “I believe there isn’t a record in the books that will be harder to break. It may be the greatest batting achievement of all time.”

Raphael Nadal’s thirteenth French Open tennis championship at Roland-Garros Stadium in Paris on Sunday, October 11, 2020, was something to behold. He trounced the number one player in the world, Novak Djokovic, in straight sets. He holds a match record of 100–2 at the French Open from 2005 to 2020 and is the only player to achieve this type of dominance at a Grand Slam tournament. He is the greatest clay court player ever to hold a racquet. Holding seven other Grand Slam titles, including playing on grass and hard surfaces, indicates his abilities are more broadly applied. Will this record on clay courts, which is not yet finished, and barring injury could be extended, ever be broken?

Consider Jack Nicklaus’s seventy-two Professional Golf Association (PGA) championships, which includes eighteen major golf tournament wins. Eldrick Tont “Tiger” Woods’ golf career wins, technically listed at eighty-two, include fifteen major wins, tied with Sam Snead for total PGA wins. Some argue the number of significant wins for Woods is actually greater, closer to ninety-five. Moreover, Snead has credit for wins in eighteen- and thirty-six-hole events that the PGA no longer recognizes; in the Woods era, the tourney must reach at least fifty-four holes to be official.

Michael Phelps has won eighteen Olympic gold medals in his swimming career and eight gold medals in one Olympics; both achievements exceed that of any past Olympian. What about Babe Ruth’s pitching and hitting accomplishments? Few appreciate his incredible dual career as a record-breaking pitcher for the Boston Red Sox and a record-breaking outfielder for the Yankees. Will Serena Williams overcome the wear and tear on ligaments and tendons of a long career and meet or exceed Margaret Court’s Grand Slam singles tennis wins? Consider, however, that Court won twenty-four Grand Slam women’s singles titles, nineteen Grand Slam doubles titles, and twenty-one Grand Slam mixed doubles titles.

There is also the matter of the greatest single performance (e.g. most points in a pro basketball game, a perfect game pitched in a World Series), the greatest performance in a season (e.g. winning all four golf majors or tennis grand slams), or being a champion in multiple sports (Mildred Ella “Babe” Didrikson Zaharias). Neuroscientists may have great difficulty providing an incisive or straightforward biological explanation for what underlies these human achievements. Of course, there is more than human neurobiology involved, since there is the personal commitment to training and practice that takes the natural gift and turns it into tangible accomplishment.



  • Marcori AJ, Okazaki VHA. Motor repertoire and gray matter plasticity: Is there a link? Med Hypotheses. 2019;130:109261. doi: 10.1016/j.mehy.2019.109261.
  • Durso J. DiMaggio. The Last American Knight. Boston, Little Brown and Company, 1995.
  • Magaret Court. Wikipedia



MARSHALL A. LICHTMAN, M.D., is Professor Emeritus of Medicine and of Biochemistry and Biophysics and Dean Emeritus of the School of Medicine and Dentistry at the University of Rochester. He has been a co-editor of Williams Hematology, editions 3 through 10. He has served on the Board of the American Red Cross and as a Trustee of the State University of New York. In 2017, he received the Wallace H. Coulter Award for Lifetime Achievement from the American Society of Hematology.


Summer 2021  |  Sections  |  Neurology

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