Injury Expert Weighs In On Headstrong Nats Starter

By Abby Sims
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The news out of the “Stephen Strasburg Watch” in Washington is that he won’t miss a start in spite of the slight stiffness and soreness reported in his throwing forearm after Tuesday’s game, in which he threw 93 pitches.

Though by all accounts the starter’s elbow and arm are structurally sound, even Scott Boras, Strasburg’s agent, had acknowledged the symptoms, which Nationals manager Davey Johnson said might be due to a nerve irritation from the electrical stimulation used pre-game. Though I have no firsthand knowledge of the situation, I highly doubt the treatment was the cause.

Johnson also reported that Strasburg has not had any trouble with his pitching mechanics.

Strasburg, a prodigy who is apparently a perfectionist and wants no coddling, famously underwent Tommy John surgery in September of 2010 and was benched against his wishes before the playoffs in 2012 to safeguard his arm.

Though the 24-year-old phenom has already learned he is not indestructible, I hope Strasburg’s youth and desire won’t stand in the way of his listening to his body if symptoms persist or worsen.

You may recall that Tommy John surgery repairs a tear in the ulnar collateral ligament (UCL), which is the primary stabilizer of the elbow. However, the undue stresses pitchers place on the medial (inner) elbow, and the excessive loading of this region can impact not only the UCL, but can also create inflammatory conditions in all of the structures in the area. These include the wrist flexor muscles (which are in the forearm but attach at the inner elbow), the forearm pronators (which turn the palm downward), the elbow joint capsule, and the ulnar nerve. The repetitive demands of pitching and the nature of the motion itself – particularly the acceleration phase – are the primary culprits. If not heeded, persistent pain, which is a reflection of an issue, leads to weakness, breakdown and altered mechanics.

Even mild forearm soreness and stiffness may be significant for a pitcher.

Hopefully Strasburg’s is as mild as he claims and will be as transient as he anticipates.

Follow ortho/sports physical therapist and injury expert Abby Sims on Twitter @abcsims

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