Strasburg Starts a Slow Journey Back to Pitching

A Little League slugger would have been licking his chops had he seen Stephen Strasburg’s first throws last month after undergoing reconstructive surgery on his elbow. The 22-year-old’s “soft tosses” marked a high point in a long recovery process that, unfortunately, still has the potential for plenty of lows—both physical and psychological.

“There’s an emotional roller coaster that goes along with this [rehab period],” says Cincinnati Reds head physician Tim Kremchek, who has performed around 1,000 “Tommy John” surgeries, in which doctors replace an elbow ligament from a tendon taken from somewhere else in the patient’s body.

Strasburg, by all accounts, has survived the first drop—the initial four months after surgery when the pitcher can do little more than shoulder and core-body exercises. “Your elbow feels great—you feel like you can do anything,” says Kremchek. “But you can’t, and you feel frustrated and get depressed.”

Next comes the second stage of rehab: “soft” and “long” toss. Recovering pitchers say it feels good to have the ball in their hand, but they don’t necessarily feel good throwing it. And then there are the whispers inside the pitcher’s head.

“About 90 percent of these guys are able to get back to the same level after the surgery,” says Washington Nationals head physician Wiemi Douoguih. “But that means that one in ten guys doesn’t get back, regardless of whether it was a perfect surgery or not. In their mind, they’re probably thinking, ‘I could be that one.’ ”

Just making it back to the mound isn’t the only challenge. Even when a fully recovered pitcher returns to the field, he rarely finds himself in the place he was before his injury. It takes time and patience to regain confidence and power and success.

Tim Hudson, a starting pitcher for the Atlanta Braves, rode this “emotional roller coaster” during his own rehabilitation from Tommy John surgery, beginning in August 2008.

“My first throw was probably more like a shot-put than anything,” he says. When the 30-year-old eventually progressed to the point when he could throw from the mound again, he encountered a setback.

“I had a strained biceps tendon,” he recalls. “It was really discouraging because it felt almost like I hurt my elbow again. The doctors and trainers said all indications were that it was just a strain. But, you know, obviously in the back of your mind you’re thinking, ‘I hope that’s what it is. I hope I didn’t strain my ligament again.’ ”

The Nationals declined to make Strasburg available for this story, but Kremchek says that if the budding superstar’s rehab has been a typical one, he has likely experienced similar highs and lows. The key to getting through them, Kremchek says, is having your teammates and coaches close at hand. Douoguih echoes that sentiment, saying Strasburg will be with the team from here on out.

“The people around you, the trainers and therapists and doctors,” says Kremchek, “have to be positive and reinforce to you the things you need to do and [remind you] that you will come back and play.”

According to Hudson, however, there’s only so much that teammates, coaches, and trainers can do. He recalls feeling disconnected from his team during the rehab process.

“Everyone is going out there and competing and helping the team win, and you’re in there with the physical therapist [lifting] five-pound weights,” he says. “When you get done with physical therapy, you start it all over again. You look up and it’s the fourth inning and your teammates are out on the field or in the dugout, and you get dressed and go into the dugout and hang out for a while. There’s a disconnect because you’re not helping your team win.”

While Strasburg’s recovery has so far been standard, in at least one way there’s nothing typical about it: Strasburg has the potential not only to lift a middling franchise into a new era but to become the face of Major League Baseball’s next generation of players.

That’s a lot for a young man to shoulder. For this reason, advice for the rising star has been coming from all corners of the country, including from Tommy John, the former Yankees pitcher for whom the surgery is named.

Kremchek, for his part, approves of the care and patience the Nationals have exercised during Strasburg’s rehab. If Kremchek were to give the injured player one piece of advice it would be this: Remember Jose Rijo. The former Reds pitcher underwent three Tommy John procedures in part because he thought he could defy medicine and return early after one of his surgeries. Kremchek, who worked with Rijo late in his career, said the pitcher was never the same after his injury.

Hudson, meanwhile, says that Strasburg should keep his expectations down if and when he returns to competition late this season, most likely for minor-league rehab.

“Even when he gets back out there, he may not feel like his old self,” Hudson says. “But [he shouldn’t] get discouraged if it doesn’t feel like it did when he was healthy and 100 percent. During the off-season, I had the chance to continue my rehab, and at the start of last season it was like night and day—it’s unbelievable how good it felt last spring.”

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