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How will Stephen Strasburg return from Tommy John surgery? It's anybody's guess

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Stephen Strasburg addressed the media Friday afternoon, hours after it was revealed that he will require Tommy John surgery and will miss the next 12 to 18 months. Strasburg sat next to General Manager Mike Rizzo.

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By Thomas Boswell
Saturday, August 28, 2010; 1:49 AM

Everybody wants a reason. Everybody wants someone or something to blame. Everybody wants to know how to feel. And everybody wants to know what Stephen Strasburg's future will be.

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Sorry, just like Strasburg's right elbow, we're all out of luck. It's bad enough that the best pitching prospect in many years is gone for at least 12 months after only 12 major league starts. But it's even more galling that absolutely nobody can give you an exact reason or a particular culprit or a proper emotional reaction.

And nobody can do better than give you rough odds on what kind of pitcher Strasburg will be by opening day of 2012.

This rehab game, dramatic and vital to the Nats and Strasburg as it will be, has no daily scoreboard. As the months pass, we won't even know exactly what inning we're in. But, unlike almost any other injury recovery in sports, the stakes in Tommy John surgery are incredibly high because all outcomes - including a "new elbow" and a better pitching career - are actually possible.

There's at least a 10 percent chance that Strasburg will come back better than he's ever been. He'll have a tendon that's wound several times, in a figure-eight pattern, between holes that will be drilled in bones in his upper and lower arm. If the body accepts the tendon, it's actually thicker and stronger than the original ligament.

Also, because Strasburg was injured at a young age (22), he'll have 18 months to grow into his lanky body and strengthen his pitching core. His shoulder, which sent him to the disabled list with inflammation, will almost have completed its mature growth. Shoulders kill careers, seldom elbows. Strasburg will actually miss one of the most precarious times in his shoulder's development.

Such rosy thinking - and we're hearing plenty of it from the Nats - is just a possibility, far from a probability. The most likely outcome, perhaps 75 percent, is the Strasburg we've watched in 2010 will be almost indistinguishable from the Strasburg we enjoy in 2012.

But there won't be a Strasburg of 2011. That's 100 percent bad. The growth in interest that has encircled the Nats this summer will be put on hold. Even if the Nats re-sign Adam Dunn and Livan Hernandez, which now seems virtually essential to holding their fan base, they'll still only appeal to baseball lovers when they say, "Come watch the development of Yunesky Maya, Wilson Ramos and Danny Espinosa." Bryce Harper's not coming next year.

Until Strasburg returns intact, a cloud will cover part of the sun on South Capitol Street. There's an 8-to-15 percent chance that Strasburg will never be the same again. Maybe he'd still find a way back as a mundane big-league pitcher. But no more Strasmas for us. Or him.

Some pitchers push too hard to come back quickly and re-injure themselves. After all, a tendon, which is meant to connect bone to muscle, is attempting to replace a ligament, which connect bone to bone. Some pitchers don't condition their arms hard enough and the "new elbow" isn't strong enough to take the load of professional pitching. And nobody can tell you exactly how hard is exactly hard enough. It's art, intuition and science.

Beyond acknowledging this worst-case outcome, let's not dwell on it. Such a day will be bad enough if it ever comes.


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