It’s a debate that has been simmering all season. As the Washington Nationals approached the end of the regular season with baseball’s best record, it seemed everyone – including players, coaches, writers, and even the mayor of the District of Columbia – voiced an opinion. Should the Nationals have shut down star pitcher Stephen Strasburg?

In case you have missed this controversy, Strasburg is arguably one of the most dominant pitchers in the game. In his first full season since his Tommy John surgery in the fall of 2010, Strasburg finished with a 15-6 record and 197 strikeouts. He is the clear ace of one of the best teams in baseball.

Nationals’ General Manager Mike Rizzo intends to keep the young stalwart healthy for years to come. Even as of late last year, Rizzo had been publicly discussing his intention to shut Strasburg down for the season when he reached a predetermined number of innings. It had been rumored that the magic number was somewhere between 160 and 180. Despite Nationals players lobbying for Strasburg to pitch through the season and into the playoffs, Rizzo never wavered.

Even when questioned by the pitcher’s father, Rizzo emphasized that the decision was his to make alone. According to The Washington Post, Rizzo told Strasburg’s dad, “I promised you when I was in your house trying to sign your son that I would take care of him. And I’m going to do it.”

Rizzo’s resolve hasn’t quieted his critics, who haven’t been shy about voicing their opinion. In a radio interview on 95.7 The Game in San Francisco, former Atlanta Braves pitching coach Leo Mazzone blasted the Nationals’ plan. “I think it’s absolutely pathetic to be honest with you. I think they have an opportunity to go to the World Series and they have an opportunity to have one of the best rotations in the game with Stephen Strasburg leading the way and to shut him down would be totally ridiculous and I don’t think it has anything to do with arm problems whatsoever.”

The logic behind Rizzo’s 160-inning limit seems to be based on a fear that Strasburg could reinjure the ulnar collateral ligament by pitching too much this season. He points to historical data and the advice of Dr. Lewis Yocum, who performed the surgery on Strasburg and those of every Nationals’ pitcher in recent years. Yocum reportedly believes that a shoulder injury, and not just reinjury to the elbow ligament, can end a pitcher’s career in the early years after this procedure.

Baseball Pitcher
Overuse and poor pitching mechanics are thoughts to be the most common causes of ulnar collateral ligament (Tommy John) injuries.
From my perspective, there is no easy answer. While I am a staunch advocate of safety and injury prevention measures, this innings limit appears somewhat arbitrary. There is no scientific data to support 160 innings as some sort of threshold below which Strasburg is guaranteed to stay healthy.

Too much pitching is a known risk factor for tearing the ligament in the first place. Overuse with poor pitching mechanics can be a recipe for disaster, in the opinion of renowned orthopaedic surgeon Dr. James Andrews. “The No. 1 risk factor for UCL injuries is poor mechanics. The No. 2 factor is overuse. And if you overuse with poor mechanics, you’re doomed.”

A recent ESPN the Magazine article by Lindsay Berra quoted pitching coaches and biomechanics experts, many of whom feel that Strasburg’s delivery predisposes him to shoulder and elbow injury. Now many of these same experts worry that without changing his mechanics, he risks tearing the ligament again. Strasburg himself resists the calls for him to change. “I’ve been throwing this way my whole life. I’m not going to try to reinvent the wheel.”

If his delivery and arm position are faulty, one wonders why the Nationals coaches don’t try to correct them now. Why did no pitching coach try to correct them earlier in his career?

What do his mechanics mean for his innings limit this season? If he places too much stress on his shoulder and elbow with his delivery, then why only limit him this season? Why not shut him down early or spread out his innings every season?

Youth Pitcher
Young pitchers should try to avoid risks for overuse injuries of the shoulder and elbow.
One bright spot of this debate could be the example it could set for young pitchers. Kids and their parents and coaches shouldn’t view Strasburg as a pitcher who throws 100 mile-per-hour fastballs after recovering from a devastating elbow injury. They should watch him and try to do everything they can to prevent suffering his injury in the first place.

Also read: The misperceptions of Tommy John surgery

Young pitchers need to follow pitch counts for games and entire seasons. They should take three months off from pitching every year. Coaches should try to fix bad mechanics early, and even utilize formal video analysis of the throwing motion if possible. While many Major League pitchers have returned successfully, sports medicine surgeons have shown that the rates of successful return to pitching is much lower for younger throwers.

Now we know when Rizzo officially ended Strasburg’s season. We will wait to see if the Nationals can claim a World Series title without him. And we wait to see if Strasburg can stay healthy this season – and many more.

The Dr. David Geier ShowWere the Nationals correct to shut down Stephen Strasburg: That’s Gotta Hurt segment from Episode 55

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Note: The Washington Nationals have officially shut down Stephen Strasburg for the season. During and after the decision, I did many media interviews discussing my thoughts on the science behind the decision to try to protect him. Listen to the That’s Gotta Hurt segment below for some of those ideas. A modified version of the following post appears as my sports medicine column in the August 23, 2012 issue of The Post and Courier.