Behind the scenes of Drew Rasmussen’s return to the Rays after third elbow surgery

ST. PETERSBURG — It’s understandable that last summer was a troubling and uncertain time for Rays right-hander Drew Rasmussen as he faced the reality of needing his third major pitching elbow surgery in seven years.

“There’s not a lot of players who have had three elbow surgeries and play in the major leagues, so I think that fear affected him a little bit,” Rasmussen’s wife, Stevie, said. “Because you go to the doctor and he says, ‘We’re going to try, but we don’t have a ready answer for you.’”

But once the July 2023 surgery, which included repairing Rasmussen’s flexor tendon (but not a third Tommy John procedure) and installing an internal orthotic, was completed, there was no doubt Rasmussen would do everything possible during the yearlong rehab to return to the major league mound.

“Once he decided to dedicate himself to rehab, that’s where his mental toughness came in,” Stevie said Friday from Seattle. “He was going to do everything he could. So it was going to be like that until somebody told him absolutely no. And thankfully, it never got to that point.”

“He kept going. It would take someone telling him, ‘You don’t have a job anymore,’ for him to give up. He wasn’t going to give up.”

When Rasmussen, 29, made a successful return Wednesday in St. Louis, retiring all six batters he faced and hitting 98.7 mph, he said there were a lot of people who deserved to be thanked.

The list started with Stevie — “This is also her third elbow surgery” — for her constant, unwavering support, the daily inspiration she and their almost 2-year-old son, Rhett, provide and the welcome respite from the routine of rehab that comes with the frequent family activities she plans. “Just waking up, seeing her, seeing him, it’s a different level of motivation,” he said.

Rasmussen’s father, Mark, a longtime middle school history and social studies teacher and multi-sport coach, instilled the family’s hard-working ethic. Hard-working teammates set the pace along the way, and Rasmussen felt challenged to keep up.

The Rays’ staff — coaching, athletic training, rehab and beyond — did the hands-on work, while the front office said they were invested and committed to Rasmussen’s successful return.

Sports psychologist Brian Cain, with whom Rasmussen began working after his May 2023 injury, “has been incredible for me,” the pitcher said, particularly in understanding what is and isn’t in his control. Extended family members and others who share his strong religious faith have also played a role in helping Rasmussen face and overcome his toughest challenge.

“I have a great support system,” he said. “God has put so many good people in my life who are always there to support me. Being able to count on people when you need them, I think that’s an easy answer. But it’s also the most obvious and true answer.”

Ultimately, it is Rasmussen who deserves the most praise.

First, for the tremendous physical work he put in, with comparisons to teammate Yandy Diaz, former Ray Nathan Eovaldi and others in what Rays manager Kevin Cash calls an all-time “elite” intensity of effort.

“We always joke that Drew’s jersey is always wet, but he’s not wet watching TV and eating a sandwich,” infielder Brandon Lowe said. “There’s a reason he’s wet, why he’s always sweating: because he’s always working his butt off.”

Rays pitching coach Kyle Snyder said Rasmussen showed great mental toughness in handling his latest cruel setback.

“I don’t know if there’s more than a handful of people in this game right now who could have put their heads down and gotten to work and said, ‘Look, I’m not going to just accept these medial elbow reconstructions as the end of my career,'” said Snyder, whose own pitching career was cut short by injuries.

“I felt different (Wednesday) in the two innings he pitched, maybe more than any other time in my career as a pitching coach. Part of it was what I’ve been through and the nature of understanding disappointment. But also the willingness to say, ‘I’m not done yet.’ I had a hard time not getting a little emotional.”

Current and former teammates were equally impressed.

“The work ethic he’s shown and the diligence he’s taken in taking care of himself to get back on the field, I don’t think anyone questioned what he’d be like when he got back,” said reliever Shawn Armstrong, whom the Rays traded to the Cardinals on July 30. “I’m super happy for Drew to do what he did. And anybody who watches the game or knows Drew should be happy, too.”

Andrew Kittredge, another former Rays reliever who now plays for the Cardinals, said: “I hope he gets what he deserves, which is success and health, because he’s had a tough time in that department. It’s always uncertain when guys have multiple arm injuries and are trying to come back from that, but if anyone’s going to do it, it’s going to be him. With his attitude and determination, I wouldn’t be surprised if he goes on to have a very long career.”

Rasmussen underwent his first Tommy John surgery in March 2016 as a sophomore at Oregon State University. He pitched well and was drafted with the 31st overall pick by the Rays in June 2017, but they declined to sign him, reportedly for health reasons. He underwent a second Tommy John surgery in August 2017.

He came back from those two setbacks, was a sixth-round pick by the Brewers in 2018, arrived in the major leagues in August 2020, was traded to — of all teams — the Rays in May 2021 (along with reliever JP Feyereisen in the deal for shortstop Willy Adames) and pitched pretty well for a while without any arm issues.

The May 11, 2023 start at Yankee Stadium was one of his best, with seven shutout innings with two hits and seven strikeouts, making the severity of the injury more surprising — and frustrating.

Rasmussen said his elbow “started barking a little bit” against his final hitter, and an initial MRI “showed something we didn’t want to see.” A follow-up MRI a few weeks later confirmed the flexor tendon injury, as well as a “partial” tear of the ulnar collateral ligament, which often leads to Tommy John surgery.

Only two pitchers have successfully returned to the major leagues after a third Tommy John surgery: Jason Isringhausen and Jonny Venters (with the Rays). Dr. Keith Meister, who performed Rasmussen’s second Tommy John surgery, had a different, less traumatic idea this time.

“At first, Drew was just worried that he wouldn’t be able to get his elbow fixed so he could be what he was supposed to be,” Stevie said. “And Dr. Meister is kind of a genius.”

With the physical issue resolved, Rasmussen would make sure the mental aspect was taken care of. Stevie saw his incredible positivity during his second Tommy John rehab, which included missing Oregon State’s 2018 national championship, and was confident he would handle the third rehab just as well.

“He will never feel sorry for himself,” she said. “He will not feel sorry for himself.”

How, given all the reasons for negativity and cynicism, could it be like this again?

“It’s not like there’s one answer for you,” Stevie said. “He’s just the best human being there is. I’m not just saying that because he’s my husband. He just is.”

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