Thursday, May 9, 2013
What's Halladay's outlook after surgery?
By Stephania Bell
It is never good news when a pitcher says he is headed for shoulder surgery, given the inconsistent results and uncertain outcomes associated with procedures in that area and in that population. So when Philadelphia Phillies ace Roy Halladay announced Wednesday that he will undergo surgery on his right (throwing) shoulder to address a bone spur, fraying in his labrum and a partial rotator cuff tear and said he thinks this is "very good news," it took everyone by surprise. Halladay added it is his understanding that he has a "good chance" of returning this season.
"I have a good chance to come back and pitch this year and hopefully be a lot more effective," Halladay said. "They said that my range of motion will be better, my location will be better and hopefully the velocity will be better."
So which is it? Gloom and doom, or sunshine and roses? The truth, as they say, is somewhere in the middle.
Roy Halladay (2-4, 8.65 ERA) informed the media Wednesday that he has a bone spur in his right shoulder but still hopes to pitch again this season.
There's no denying that it is never desirable to operate on a thrower's shoulder. The results are all over the map. As ESPN's Jayson Stark wrote, for a pitcher facing shoulder surgery approaching age 36, the future could be "ominous." Stark cites data published in a recent FanGraphs article by Eno Sarris as proof of the grim outlook for pitchers in Halladay's age bracket who went on the disabled list for a shoulder injury.
Part of the challenge, however, in evaluating comparables when it comes to pitchers and shoulder pathology is that the injuries themselves can be highly variable. The extent of damage to the soft tissues -- such as labrum, biceps tendon and rotator cuff -- and the precise location can influence recovery. The health of the shoulder joint and the strength of the musculature both directly and indirectly responsible for shoulder function play a role. And just as the anatomical variants are unique to each pitcher, so are the intangibles -- the work ethic, the mental toughness, the belief in one's own recovery -- all of which likely contribute to a return to play in a manner that is impossible to quantify. So yes, it is concerning that Halladay is headed for surgery, but it isn't necessarily a career death sentence.
And what about the upside?
While any surgical procedure on a thrower's shoulder carries inherent risk, it is entirely possible, likely even, that this is the treatment option that could allow Halladay to extend his already impressive career. The findings Halladay described (labral and cuff damage) are not uncommon in veteran throwers who have pitched more than 1,000 innings, much less the 2,700-plus innings he has racked up over his professional career. If indeed the presence of a spur -- a bony growth typically formed in response to repeated stress -- is accelerating the soft tissue damage, taking down the spur should provide some relief to that tissue. Cleaning up the associated soft tissue structures also provides reinforcement to the thrower's shoulder. The strengthening regimen Halladay undertook during the offseason targeted the musculature supporting his shoulder with the goal of preserving his health. Although it couldn't completely prevent the inevitable given the degenerative changes in his shoulder, it may help speed his recovery following this procedure. Consider it "learning" that his shoulder girdle has already acquired and can build upon following surgery.
Combine the recently acquired strength with the overall physical health Halladay has exhibited across his career. Three DL trips were entirely unrelated to his throwing arm. They included a leg fracture as a result of being hit by a ball (random), an appendectomy (not a durability issue) and a groin strain (a minor ailment that resolved quickly). Problems with his throwing arm have landed Halladay on the DL three times in his career. The first episode was tendinitis in 2004, perhaps an early flicker of the more profound problems he is facing currently. Last year's trip to the DL with a lat strain seemed to foreshadow the consequences of wear and tear that Halladay can no longer avoid. Suffice it to say Halladay has put in far more days on the mound than many of his peers and has an outstanding health track record for a pitcher. This bodes well for his ability to recover.
As do those intangibles. Halladay is not speaking like someone who is concerned that his career is in jeopardy. He sounds like someone who is setting a goal of returning this season and who, barring an unexpected discovery during surgery, plans to achieve it. It is not automatic that he will return this year, but based on what Halladay outlined as the planned procedure, it is also not impossible to think he could come back late in the season. We do not typically hear of pitchers returning from shoulder surgery better than before; rather we hope for them to be able to return to close to their prior form. Yet Halladay spoke Wednesday of turning back the clock via surgery. The athlete's mindset is not insignificant when it comes to accomplishing rehab goals, and Halladay certainly has the necessary outlook.
There is little doubt that Halladay's range of motion will be better after surgery, just as he predicted. The unknown until he retakes the mound will be whether his location and velocity will be restored to the point where he can be dominant once again. History tells us that the odds of returning to form following shoulder surgery are not in a pitcher's favor. History also tells us that Halladay has defied the odds thus far in his career. It seems like the greater risk may be in betting against him.