The approach the Nationals are taking — shutting Strasburg down once he reaches a yet-to-be-decided cap, possibly between 160 and 180 innings — is being scrutinized and studied carefully by many across the sport.
“It’s been conservative, more conservative than what we’ve done in the past,” said Kevin Wilk, whose group, Champion Sports Medicine, handles rehabilitation for the practice of James Andrews, one of the nation’s foremost orthopedic surgeons. “But this may turn out to be the model that teams use as a result of it. It’s very interesting to watch, especially because it’s such a high-prized player and the Nationals are doing so well.”
Since the surgery was first performed on the elbow of Los Angeles Dodgers pitcher Tommy John in 1974, broad timelines have been hammered out, mostly by trial and error, over how to treat pitchers in their first full season after the procedure.
There’s no proof that limiting the number of innings for a pitcher in his first full season back from the surgery will prevent another injury, but some leading medical experts on the subject agree that being cautious and limiting the workload of a talented, young pitcher such as Strasburg, 24, is a sound practice.
Recovery from Tommy John surgery is typically a two-year process. Pitchers don’t start throwing at full throttle off the mound until eight to nine months after surgery, and don’t start pitching competitively until nine to 12 months after. In the first full season back, or the second year of the recovery, a pitcher starts to feel completely comfortable with the reconstructed elbow, the feel of pitching and grip of the ball, and finds consistency. But there is no way to truly tell when the transplanted tendon fully becomes a new ligament, nor is there a consensus on when the restraints on a pitcher can be fully removed.
“There is no book, no number, no magic, no ‘you can pitch all the way until October,’ ” said Timothy Kremchek, the Cincinnati Reds’ team doctor. He performs nearly 60 Tommy John surgeries a year on major and minor league pitchers from across the country. “Nobody knows that and many of us are afraid to take the chance with these guys.”
Template for shutdown
The Nationals have used fellow starter Jordan Zimmermann as a model for their approach with Strasburg. Zimmermann had Tommy John surgery to replace his torn ulnar collateral ligament in 2009 and pitched 1611
3 innings last year in his first full season back, just over his prescribed 160-inning limit. While that proved successful for Zimmermann, who has emerged as one of the league’s best pitchers, Strasburg won’t be held to the same number.
The worst-case scenario would be if the tendon graft is damaged, but that’s a rare occurrence since the surgery is extremely successful if performed by a capable surgeon and rehabilitated correctly by the player. (According to a 2010 study, 83 percent of athletes studied returned to the same level of competition or higher within a year of surgery.) But experts worry that tendinitis could develop or a pitcher could become fatigued by overuse, possibly leading to poor mechanics or more serious shoulder injuries.