Roy Halladay's trip down rehab road has officially started after Wednesday's surgery in Los Angeles went as well as could be expected, according to Phillies team physician Michael Ciccotti.
Neal ElAttrache, the team physician for the Los Angeles Dodgers, repaired Halladay's shoulder and rotator cuff in an arthroscopic procedure. ElAttrache also removed the bursa that cushions the shoulder. A bone spur that was found in Halladay's shoulder did not need to be removed.
"The major attachment sites of the rotator cuff - the cable, we call it - in the front and the back, they were still attached," Ciccotti said during a news conference Thursday at Citizens Bank Park. "So he did not feel that he needed any sutures placed in his rotator cuff. It was really the best-case scenario in our minds."
Halladay will go through his rehab in Philadelphia, and the hope is that he will begin a throwing program in six to eight weeks.
"Roy is feeling very good," Ciccotti said. "He will be out of his sling very quickly. He'll start on a rehab program that we'll coordinate here. He'll be doing range-of-motion exercises, followed by strengthening. And we will really see how he progresses. If he gets to the point where he feels like he can pick up a ball and start tossing, then that would be our hope. And that will be dependent on how he feels. But it could be anywhere from six to eight weeks from now. And then his progression from that point will obviously be how he is with his throwing."
Halladay said during the Phillies' West Coast trip last week that he hopes to return to the mound before the end of this season. He also said that he was told the procedure could "turn back the clock two or three years" for him. The two-time Cy Young Award winner turned 36 Tuesday and can be a free agent after this season.
Recent history suggests it will be difficult for Halladay to recapture the form that made him one of the greatest pitchers of his era. According to FanGraphs.com, pitchers who suffered shoulder injuries at the age of 35 or older do not generally recover well. The web site's study found that 62 pitchers 35 or older have been placed on the disabled list with a shoulder injury since 2002. Of those 62 pitchers, 32 never pitched again, and 12 more did not reach 50 innings for the rest of their careers.
Only six beat the odds and pitched more than 100 innings. They were John Smoltz, Pedro Martinez, Kenny Rogers, John Burkett, Tim Wakefield, and Orlando "El Duque" Hernandez.
"The combination of a rotator cuff injury and a labral injury is a challenging injury for a professional pitcher to navigate through," Ciccotti said. "But again, given what was identified at the time of the arthroscopy, that he had fraying of those structures but not detachment, not tearing, and given the kind of athlete that Roy is and the kind of person he is - he's focused and dedicated and motivated and hardworking - those are the things you put together that are most likely for success."
Ciccotti said earlier examinations of Halladay's shoulder revealed that the bone spur did not need to be removed because it would not impact his ability to pitch. He also said the bursa that was removed will grow back.
"There are different types of bone spurs that occur in the shoulder," Ciccotti said. "Some of them are what we call adaptive. He does not have the classic or traditional type of spur that we would think of that's rubbing down on the rotator cuff. He never had that and does not have that."
Ciccotti said the Phillies will proceed with caution during Halladay's rehab process.
"Roy wants to be a part of this team, but he needs to meet certain milestones along the way before he can progress to the next level," Ciccotti said. "If he achieves his range of motion and if he's strong . . . and if he progresses to a very specific throwing program . . . he has to pass each of those tests along the way. If he doesn't pass them in a way that we're comfortable and he's comfortable, then we're not going to allow him to go out on a mound and pitch the way he would not want to pitch."