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

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.

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.

"In a way, it's good that it happened now, instead of when we're going to the postseason or getting ready for a World Series," Strasburg said in what I'll cherish as the epitome of the rookie quote.

Everybody's got a theory on what went wrong. Strasburg deserves the first shot: "What happened the other night is something that I felt before [in college]. Nothing was torn then. Personally, I don't know what the doctors think, but I think it might have been more something that happened over time."

Add me to that camp. I don't think the Nats brought him along too fast or slow. I don't think his pitch limit or innings load was a mistake. It's all an educated guess. I don't even think Strasburg's improved "circle change-up" this season, which acts akin to a screwball, created the problem, though the pitch can cause pronation of the elbow that strains the ligament that got torn. It all depends how you throw the circle change. For decades, it was also called "the window-shade change" because you pulled straight down, like closing a shade, causing little elbow strain.

With hindsight, the easy second-guess is that the Nats should have shut Strasburg down for the season after he went on the disabled list with shoulder stiffness last month. Not because his shoulder hurt, but because favoring discomfort in one part of the arm sometimes causes injury elsewhere. File under: It seemed like a good idea at the time.

My contribution to the causal guessing game comes from direct observation. I've never seen a young pitcher put under a fraction of the big-game pressure Strasburg faced. It's nobody's fault. But I think it helped snap an elbow.

Strasburg started three games in spring training, 11 in the minors and a dozen for the last-place Nats. And all 26 of them felt, for Strasburg, like a postseason playoff game.

Extraordinary athletes can rise to unique moments. Strasburg's 14-strikeout, no-walk debut proved beyond doubt he was in that category. How many other times, with national TV cameras on, did he try to approach those heights in Viera, Harrisburg and Syracuse? In the majors, the torque just twisted tighter.

In Florida in February, Nats General Manager Mike Rizzo watched the Strasburg circus and said: "All innings aren't the same. They don't put the same stress on a person or on an arm. For a young pitcher, some innings are more like an inning-and-a-half. I count them that way."

How much did every Strasburg inning this season take out of him? Or, for that matter, what about the toll of every inning he pitched since he became a national sports celebrity at San Diego State?

Assuming he comes back a healthy Strasburg in '12, maybe 18 months of celebrity detoxification won't be so bad for a modest, determined young man.

Strasburg will never be "just another pitcher." But when he returns, with his fallibility firmly established, maybe he will blend into the fabric of the game more, not stand above it - heralded as the future face of the Nats and, perhaps, of the whole sport, too.

For someone so special, with a gift so rare, we can wait.

Like we have a choice.

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