It’s a debate that has been simmering all season. As the Washington Nationals approach the end of the regular season with baseball’s best record, it seems everyone — including players, coaches, writers, and even the mayor of the District of Columbia — has voiced an opinion. Should the Nationals 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 has a 15-5 record and 2.85 ERA after beat the Atlanta Braves on Tuesday night. 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. Rizzo has publicly discussed shutting Strasburg down for the season when he reached a predetermined number of innings, rumored to be from 160-180. He’s at 145.

Rizzo’s resolve hasn’t quieted his critics. Former Atlanta Braves pitching coach Leo Mazzone blasted the plan. “I think it’s absolutely pathetic. 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 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. 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.

There is no easy answer. While I am a staunch advocate of 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.

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 Magazine article 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?

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?

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 mph 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.

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. 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 wait to see when Rizzo officially ends Strasburg’s season. We 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.

Dr. David Geier is an orthopaedic surgeon and Director of MUSC Sports Medicine. For more information about baseball injuries and other sports medicine topics, go to Dr. Geier’s blog at