The Stephen Strasburg Dilemma: Baseball Pain Inside The Beltway—July 23, 2012

The Washington Nationals will end the season of Stephen Strasburg, their best pitcher who underwent Tommy John surgery almost two years ago, early, even if he's feeling healthy. Will caution come at a cost?

The Nats are facing an unprecedented dilemma. Their best pitcher, the phenom Stephen Strasburg, 24, tore up an elbow ligament at the end of his first season, in 2010. The injury required him to undergo Tommy John surgery, the all-too common arm reconstruction procedure named after the former New York Yankees pitcher (John was the first player to receive it).

The Nationals are proceeding with caution. Team general manager Mike Rizzo has remained adamant that at some point this season, the team will shut Strasburg down in order to reduce the risk of further injuries, and protect the team’s investment.

In research with high school-age pitchers, Dr. Stephen Fealy, a former college hurler and orthopedic surgeon at Hospital for Special Surgery in New York, found that as boys threw more pitches, fatigue messed with their mechanics. “The body does less work, and the arm does more,” says Fealy. That imbalance puts more load on the arm, and could lead to serious injury. “The Nationals are taking a common sense approach.”

But even Fealy says that as long as Strasburg shows no signs of fatigue, letting him pitch through the season is far from a reckless risk. No medical research, says Fealy, definitively concludes that pitchers who cut their workload after Tommy John surgery are less likely to get injured down the road. “There’s a whole lot we don’t know,” Fealy says. When it comes to determining the proper pitch limits, “we’re making up a lot of this on the fly,” says Fealy.

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