Stephen "Tommy John" Strasburg


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   Stephen Strasburg was considered the next big thing when the Washington Nationals selected him first overall in the 2009 MLB Entry Draft. He was to pitching prospects what LeBron James was to NBA hopefuls when he took the league by storm in 2003. If ever a player was considered "can't miss", Strasburg was it.

As the projected savior of the franchise (until Bryce Harper was drafted a year later), Strasburg entered professional baseball surrounded by previously unseen levels of hype. His major league debut in 2010 was considered remarkable for such a young pitcher, as he struck out 14 Pittsburgh Pirates, setting a new team record. He seemed certain to become one of the sport's biggest stars until he would tear a collateral ligament in his pitching elbow, requiring offseason Tommy John surgery.


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To a baseball player, pitchers in particular, Tommy John Surgery can be one of the most frightening propositions one could encounter. The procedure involves replacing a ligament in the medial elbow with a tendon from elsewhere in the body. The recovery process is long and arduous, lasting about a year for most pitchers and six months for position players. The procedure was first performed in 1974 by Dr. Frank Jobe on pitcher Tommy John himself.  Jobe originally estimated John's chance for a full recovery at 1 in 100. The surgery was successful, and today the success rate falls around 85%. Of course, the Nationals were apprehensive about risking their most expensive player, but they approved Strasburg's surgery anyway. He missed nearly all of the 2011 season rehabbing, and was successful enough to return to the majors exactly a year after his operation took place. What happened next, in advance of the 2012 season, has been a major topic of controversy ever since.

Nationals General Manager Mike Rizzo, after meeting with Strasburg's agent Scott Boras, formulated a plan during Spring Training in 2012 to shut Strasburg down sometime toward the end of the season in order to preserve his surgically-repaired arm, the biggest financial investment in the entire organization. By the time the 2012 season began, Strasburg was already 18 months removed from his surgery. Most health officials reasoned that his arm, if properly rehabbed, was not at risk of re-injury. Many wondered why the Nationals would do this to their fans and their players. The Nationals were projected to contend in the National League with rookie phenom Bryce Harper now in the lineup. If they had a successful season and were headed to the playoffs, how would people react when the men in charge removed the team's best player from the field? To some, it just didn't seem fair.

Sure enough, Washington would win more regular-season games than any other National League team in 2012. They were headed to the playoffs for the first time since the team moved to D.C. and fans were more excited than they had ever been. Rizzo refused to budge from his initial plan, though, and ended Strasburg's season in September before the postseason had even begun. Sure enough, the Nationals lost in their first playoff series against the St. Louis Cardinals without the help of their ace. Fans were outraged. Nationals' players publicly questioned the loyalty of team management and their responsibility to put their best players on the field. If players sensed that the team was willing to sacrifice their ability to win in order to protect, or overprotect, their prize asset, they may not want to be a part of such an organization.

Were the Nationals responsibly aiding their top pitcher through an extended rehab, or were they cheating their fans and players by not allowing him to pitch through the entire season?

The Nationals claim that the decision was not entirely based on Strasburg's Tommy John surgery, but rather on the fact that he had never pitched a full season in MLB, and that he needed to condition his arm appropriately to that sized workload. Famed sports doctor James Andrews agrees with the National's cautious approach, saying "The re-injury rate is highest in the second year, so standard procedure is to watch the fatigue factor the first year back." He claims that the repaired ligament is very weak up to 24 months after the procedure as it regenerates.

Another injury to the ligament would mean a second Tommy John surgery, something that no pitcher would like to experience. The success rates of second surgeries are drastically lower than the rate of the first surgery, at about 25%. This scenario would certainly be a nightmare for both Strasburg and the Nationals, lending credence to Rizzo's plan for his long-term investment. Another surgery would require more drilling into already weakened bones and scar tissue.

Baseball has seen its fair share of pitchers that experience great success early on, but flame out a few years later because their arms were overworked at a young age. Many young pitchers at the youth and high school level are on mandated pitch counts designed to protect their still-developing growth plate, ligaments, and tendons. Strasburg is similar in that his repaired arm was still growing toward full strength again.

The Nationals also had a track record of their own to rely on. They limited another of their starters, Jordan Zimmerman, to 161 innings the year before, when Zimmerman was two years removed from his own Tommy John procedure. A fully recovered Zimmerman in 2012 ranked at the top of the National League in earned run average, and showed no adverse effects from his past surgery. Their patience had been rewarded once before, and they hoped to see a repeat of those results with Strasburg.

At the end of the day, Strasburg is a human being. The Nationals' own team doctor's recommended that he sit after a set number of innings, so it would be hard for management to neglect that advice in good conscience. Strasburg's future health should not have been unnecessarily risked for the sole sake of a title. As much as fans and national "experts" bash the Nationals for sitting their best player, they made the right decision. Fans do not have access to the specifics of Strasburg's recovery like team doctors do, just another reason why the team's GM is more qualified than anybody to make the decision, based on the information he receives.  Is there going to be a quicker cure?  What is exactly wrong with these tendons/ligaments? How are we improving on ACL/MCL tears (Adrian Peterson) but yet this is still a huge issue for a non contact sport? Just remember Nationals fans: there's always next season.


Sources

http://www.washingtonpost.com/blogs/nationals-journal/post/stephen-strasburgs-innings-limit-a-refresher/2012/08/15/2c4c7dae-e6a0-11e1-8f62-58260e3940a0_blog.html

http://www.theatlantic.com/entertainment/archive/2012/08/why-the-nationals-are-right-to-shut-down-stephen-strasburg/261451/#

http://en.wikipedia.org/wiki/Tommy_John_surgery

http://www.google.com/imgres?num=10&hl=en&tbo=d&biw=1366&bih=611&tbm=isch&tbnid=WpWfGc-WwPHL6M:&imgrefurl=http://www.whatistommyjohn.com/2010/01/16/what-is-tommy-john-surgery/&docid=-tgBAGSs8XhvDM&imgurl=http://whatistommyjohn.com/wp-content/uploads/2010/01/tommyjohn.jpg&w=492&h=337&ei=6V3BUISPKam60QGm7oHgDg&zoom=1&iact=rc&dur=443&sig=107234481165166227351&page=1&tbnh=139&tbnw=203&start=0&ndsp=21&ved=1t:429,r:9,s:0,i:114&tx=40&ty=53


2 Comments

I've heard people say that Tommy John Surgery can actually increase a pitcher's velocity following the surgery. A part of me wants to believe this is the case because the rehab required from the surgery results in a stronger arm than the pitcher originally had. Another reason behind this theory may be due to the simple fact that there was a reason the pitcher needed the surgery in the first place. If a pitcher's elbow is injured to the point where Tommy John is required, then their arm probably isn't as strong as it potentially could be. The reconstructive surgery corrects the deterioration in the elbow. By replacing the ligament in the elbow with a new one and rehabbing properly, I'm sure the pitcher could see improvements in velocity as a result. Kerry Wood, former pitcher for the Chicago Cubs, was quoted as saying that Tommy John Surgery helped his velocity significantly. He claimed to have hit the highest speed of his career following the surgery. Whether the myth of Tommy John Surgery being a competitive boost is true or not, it's hard to argue against a first hand point of view when Wood said it helped.

http://usatoday30.usatoday.com/sports/baseball/2003-07-28-cover-tommy-john_x.htm

Comparing the ulnar ligament to the ACL is a good comparison in that both of them seem like they were "made" weakly. However, something to consider throughout all of this is that a pitcher's motion is entirely un-natural to the human body. A softball pitcher for example, can throw under hand until the Apocalypse, and an overhand pitcher (such as Strasburg) has to be constantly watched so as not to hurt their arm. My questions regarding this lead me back to the Japanese pitchers who throw an unbelievable amount of pitches, without straining their arms. What are American Baseball coaches doing to negatively effect their pitchers when it seems like they're constantly monitoring each and every throw?

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