MIAMI – Early on in his rehab process, Alek Manoah found himself reflecting on a tradition he’d enjoyed as a kid. This was months ago, before he’d gotten back into games or even resumed throwing – a time when he was simply letting his right elbow rest and recover from the ligament replacement surgery he’d had in June of 2024.
It wasn’t easy to wait – he likens that initial recovery period to sitting alone in a dark room – but it prompted him to think back to a different time. As a kid, Manoah’s parents helped instil what he calls a ‘tiger mentality’ in him and his brother, Erik, and along with that came a desire to recognize what the boys did well.
“If you hit two home runs in a game or three home runs in the game, (my dad) would go grab a baseball and he’d write on it and he’d have us sign it as if we were big leaguers,” Manoah recalled from the dugout at loanDepot Park last weekend. “Even though we’re eight years old or 10 years old.”
A couple decades later, his parents still have those baseballs at home, and they got Manoah thinking: maybe he should revive the idea for himself to commemorate each step taken during his injury rehabilitation.
“I’m like, you know what? This is going to be my tribute to my parents of all the times that they’ve written on baseballs for me and created those really special moments,” Manoah recalled. “Because who cares if you hit three home runs in a 10-year-old game, right? But my parents just found a way to make everything a big deal. And now that we get older, we might want to downplay some things but it’s still really cool to keep that little tradition going.”
Now he has a new set of baseballs documenting his rehab process, each bearing an inscription like: “DAY 1 Throwing,” “1st Bullpen,” “First Live,” and “First Game Action!!” They’re reminders of where this surgery and recovery have taken Manoah, “little mile markers and little shots of dopamine that keep you excited and keep you happy for the process,” as he puts it.
That process isn’t complete for Manoah, who continues rehabbing at triple-A with another start slated for Sunday, but recognizing these milestones has helped keep his mindset positive as he pushes closer to the major leagues. The tiger mentality is still there, but as Manoah prepares for his return to the Blue Jays, he’s seeing the big picture, too.
“He’s been – I don’t want to say better than I thought, but he’s been through a lot,” said manager John Schneider. “From (third in Cy Young Award voting in) 2022 to a down year to a hurt year to rehabbing to getting back with some mixed results … Rehab can be a dark place when you’re coming off of that surgery. I really think he’s in a good spot.”
Manoah says he’s also in a good place physically. His reconstructed elbow feels good, and he’s working to improve his mechanics. In his most recent triple-A rehab start, he pitched 5.1 innings without allowing an earned run while striking out five, walking two and building up to 85 pitches.
Yet getting to this point has required dozens and dozens of smaller steps over the course of the last 14 months. “So many little things,” like sealing up the scar on his right elbow, making sure there’s no infection, waiting for the ligament to heal, throwing off flat ground, returning to a mound, refining his mechanics and finally reintegrating game-speed challenges like holding runners or using his slide step.
It’s a comprehensive process, and he’s embraced it.
“It’s been a long, fun journey,” Manoah said. “The way I’ve looked at it is I have about four off-seasons in one. If I’m able to make a lot of progress in a four month off-season, how much progress can I make in a 12 month span, or 14 months?”
Speaking in his hometown of Miami over the weekend, Manoah expressed gratitude for those who have supported him throughout his rehab, including his parents, his wife and his newborn son, Thomas. During this process, they’ve reminded him progress isn’t linear and urged him to give himself grace whenever there’s been a small setback.
Manoah also credits his teammates, including fellow starters Kevin Gausman, Jose Berrios and Chris Bassitt, for their support. Bassitt shared videos from his Tommy John recovery in 2017 as a way of telling Manoah that better days are ahead. There have been times this year that he’ll get a text when he’s about to do some work on a Florida backfield – and he feeds off the support.
“It’s just amazing,” Manoah said. “You guys are in the middle of a 162-game season worrying about your own stuff, and you’re texting me ‘good luck’ before a live BP. Those things mean the world to me. Nobody can do this by themselves.”
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The support’s been necessary for Manoah, because he’s had to re-learn a lot since last June. In 2022, when he posted a 2.24 ERA and finished third in AL Cy Young voting, he wasn’t thinking about fielding his position or whether he was generating power with his front side. He just did it.
Now, everything’s new again: even a simple comebacker to the mound.
“At first you’re like, ‘Dude, I’m an athlete, I can catch a ground ball easily,’” Manoah recalled. “And then you’re like ‘Whoa, hold on, did I forget how to catch a ground ball?’”
He likens the experience to building something for his son. If a toy breaks down after a few uses or a crib isn’t coming together as quickly as he’d like, Manoah doesn’t panic. He just takes the pieces apart and starts from the beginning again.
“It’s kind of the same thing with pitching,” he said. “You’ve done so many things that you don’t have to think about it. They come like muscle memory. They come natural. And then you have an injury where you have to reteach yourself again and you’re like, ‘Oh, that’s what I did that made that so great.’ Or, ‘Holy cow. I can’t believe I used to do that. That’s not good.’ You can even find the flaws as well. And I don’t ever want to do it again. So let’s do it right.”
Along with the highs of pitching in the All-Star Game and earning Cy Young votes, Manoah has experienced some significant lows, too. The Blue Jays optioned him to the minors when he posted a 5.87 ERA in 2023, and after a strong start the following year his elbow gave out.
But having emerged from the “dark room” that was early rehab, he’s seeing things differently now.
“There was so much that went into that process and being stuck in that room, and going through those things,” Manoah said. “So for other people it’s ‘how’s he pitching?’ But for me this is the big picture. I want to have a really long career. I’ve been playing this game since I was three years old. I love everything about it. And nobody wants to get hurt, but you re-fall in love with so many different things.”
Right now, there’s no clear timeline for Manoah’s return to the majors. The Blue Jays have extended his rehab window once and can do so up to two more times if needed. Schneider says the Blue Jays “want to keep him as a starter” and like having him around the big-league team when possible.
The way Manoah sees it, his job is to keep his focus on recovery and performance. It’s gotten him this far, so why stop now?
“Focus on my work, focus on my progress, focus on my process and make sure I’m just putting myself in a better position every week to go do better and better,” he said. “And once the big dogs make the decision, I’m just making sure I’m ready for anything.”
Including adding another baseball to his collection.
