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How do 'Tommy John' starters bounce back?

How do 'Tommy John' starters bounce back?

The news that right-hander Stephen Strasburg will likely undergo Tommy John surgery is both grim and unnerving, but the Nationals phenom has a relatively positive track record on his side -- and varying examples around him.

For a success story, Strasburg doesn't have to look any further than his own division -- the National League East -- where Josh Johnson has been one of the top pitchers in the game since returning from the procedure in the middle of the 2008 season. For somewhat of a cautionary tale, all he needs to do is step into the office of his manager, Jim Riggleman, who saw another side firsthand as skipper of the Cubs -- Kerry Wood's gradual shift from a dominant starter to a reliever after undergoing Tommy John surgery.

Named after the former Major League left-hander who won 288 games and was the first to undergo the procedure, back in 1974, Tommy John surgery involves the replacement of the ulnar collateral ligament in a pitcher's elbow and normally takes 12-18 months to recover from. How surgery would affect Strasburg's career is impossible to determine, but there is one certainty: Baseball fans everywhere will await the outcome with bated breath.

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"I know deep down inside that I'm going to work just as hard, if not harder than any of these guys that had to go through it before," Strasburg said on Friday. "I hope to be back here soon."

Johnson underwent Tommy John on Aug. 3, 2007, and returned only 11 months later, on July 10, 2008. Since then, the 26-year-old Marlins right-hander has not only reported a clean bill of health, but he has generated a scary pitching line -- a 33-11 record and a 2.98 ERA in 73 starts since the procedure.

"It's a very successful surgery now," Johnson said. "It's all about putting the work in. Sometimes, guys put the work in and it doesn't work out."

Wood actually enjoyed some success shortly after Tommy John, but other ailments quickly followed, and he never became the pitcher many foresaw after a dazzling Rookie of the Year season in 1998.

Following a year when he threw more than 100 pitches in 21 of his 26 starts, and 120-plus in eight of those outings, Wood underwent Tommy John surgery in Spring Training 1999. He then returned to a Major League mound in a little more than a year, posted a subpar 4.80 ERA his first season back, then posted a solid 3.47 ERA the four following seasons, from 2001-04.

But further injuries -- including an eventual torn rotator cuff -- made his career turn south and forced him to the bullpen shortly thereafter.

Riggleman and the Nationals were a lot more careful with Strasburg -- who hasn't put up a triple-digit pitch count in any of the 12 starts of his first big league season -- than Riggleman and the Cubs were with Wood.

Still, the same result occurred.

"It's depressing, but I look at the brighter side," Nationals general manager Mike Rizzo said on Friday during a conference call announcing that Strasburg has a significant tear in his ulnar collateral ligament. "I look to Tommy John as a surgery that has great success."

Rizzo is right about that.

As Dr. Michael Kaplan said on a television interview, "three-quarters -- 75 percent or so -- of elite pitchers come back to full pitching and their full potential" post-Tommy John.

Recovering from Tommy John
Notable starting pitchers that have undergone Tommy John surgery and returned as a Major League starter
Pitcher Time between starts ERA before ERA after
AJ Burnett 4/25/2003 - 6/3/2004 3.86 3.95
Chris Carpenter 4/1/2007 - 7/30/2008 4.10 2.55
Ryan Dempster 7/28/2003 - 8/1/2004 5.08 3.57
Tim Hudson 7/23/2008 - 9/1/2009 3.48 2.54
Josh Johnson 7/4/2007 - 7/10/2008 3.50 2.98
Francisco Liriano 9/13/2006 - 4/13/2008 2.74 4.39
Shaun Marcum 9/16/2008 - 4/5/20010 3.95 3.70
Carl Pavano 4/9/2007 - 8/23/2008 4.38 4.68
Jake Westbrook 5/28/2008 - 4/5/2010 4.31 4.54

Just take a look at some of the top starting pitchers in baseball right now. In addition to Johnson, Chris Carpenter, Carl Pavano, Francisco Liriano, A.J. Burnett, Shaun Marcum, Tim Hudson and Ryan Dempster all underwent the procedure and have found success, though to varying degrees.

"There are no guarantees with any surgery, but if you get the surgery done and have success with the rehab, he can go back and pitch the way he pitched with the same type of velocity," Dempster said. "My velocity is as good if not better [after the surgery]. It takes awhile. ... Even though you can come back in 12 months, it's an 18-month process."

Carpenter and Hudson were the oldest of the group to undergo the surgery, and their recoveries were the most impressive.

Carpenter had it in July 2007, at age 32, then came back in about a year and continued his dominance, going 31-10 with a 2.63 ERA since. Hudson underwent the procedure as a 33-year-old in August 2008, came back 13 months later and has posted a 2.54 ERA since.

"You have to trust the process and put in the work," Hudson said. "You get out what you put in. ... If you are younger, your body might bounce back faster. But the main thing is to be patient."

The youngest of the group was Liriano, who kicked off his career in a fashion similar to the 22-year-old Strasburg.

The Twins left-hander set the baseball world on fire during his rookie season in 2006, posting a 2.16 ERA with 144 strikeouts in 121 innings. But Tommy John reared its ugly head that November -- shortly after the lefty turned 23 -- and he didn't return until the beginning of 2008.

Liriano had a semi-successful first year back, then struggled in 2009, before regaining his fine form this season, in which he has gone 12-7 with a 3.41 ERA through his first 25 starts.

Perhaps for somebody as young as Liriano, recovery from such a procedure just takes a little longer.

"Last year, you could tell he didn't feel like himself," Twins first baseman Justin Morneau said of Liriano earlier this season. "Now, just walking around the clubhouse before games, you can see how focused he is, how he wants to go out there and how he feels like he's going to do well. It's fun to watch."

Which path will Strasburg take?

Will he have immediate success after surgery, like Hudson and Carpenter? Will he struggle mightily at the start, then eventually regain his form, like Liriano and Pavano, who posted a 5.20 ERA toward the end of 2008 and in '09 before having a solid 2010 campaign? Or is there a chance he might never recover completely?

The latter is difficult to find in the case of elite starting pitchers, but it happens. Mike Hampton wound up missing the entire 2006 and '07 season because of Tommy John surgery. When he came back, the left-hander posted a 5.12 ERA over the following two years, and then his career came to an end. Hampton was, however, 33 years old -- a 13-year veteran -- when he had the surgery.

"We have a big, powerful [22]-year-old right-handed pitcher with power stuff," said Rizzo, who in Jordan Zimmermann has another starter who made his return from Tommy John surgery on Thursday. "The success rate for guys coming back from Tommy John and retaining that stuff is very good."

Alden Gonzalez is a reporter for MLB.com and writes an MLBlog, Gonzo and 'The Show'. Joe Frisaro and Carrie Muskat contributed to this report. This story was not subject to the approval of Major League Baseball or its clubs.

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