CLEVELAND (AP) — Shane Bieber pitched until the pain stopped him.

Cleveland’s ace will have season-ending Tommy John elbow surgery, a major blow to the Guardians and the 2020 Cy Young winner, who had looked like his dominant self in two strong recent starts.

Bieber struck out a league-leading 20 and pitched 12 scoreless innings in starts against Oakland and Seattle despite the elbow getting progressively worse.

“Sheer toughness and grit,” Guardians president of baseball operations Chris Antonetti said in describing how Bieber managed the pain and performed.

The 28-year-old Bieber, who was limited to just 21 starts a year ago due to elbow issues, experienced pain following his opening-day start against the A’s. The Guardians were concerned and gave him an extra day off while offering him additional treatment before facing the Mariners.

Bieber decided to make the start anyway, battling through six innings while the soreness and inflammation intensified.

He returned to Cleveland for more imaging tests and consultation. Dr. Keith Meister and Dr. Neal ElAttrache, the renowned orthopedist who did surgery on Browns quarterback Deshaun Watson’s right shoulder, recommended elbow reconstruction.

Bieber made the decision to have the operation on Friday night, knowing he’ll need up to 16 months to recover.

“He’s devastated by it,” Antonetti said on a Zoom call. “He feels as though he is letting a lot of people down. And I tried to reassure Shane that couldn’t be further from the truth because he embodies what it means to be a professional, what it means to be a great teammate and a great leader.”

Antonetti said Meister will perform Bieber’s surgery in Dallas in the near future.

Because he had bounced back so well in Arizona, the Guardians allowed themselves to feel positive the injury was behind Bieber.

They’re facing a harsh new reality.

Bieber is entering his final year under contract with the Guardians, who are off to a 6-2 start under first-year manager Stephen Vogt heading into Saturday’s game in Minnesota.

“It’s hard to deal with this,” Vogt said during his pregame availability. “I just first and foremost feel for Shane. The amount of work that this guy’s put in over the last few years, the things that he’s pitched through, that’s a testament to who he is.

“The amount of empathy and pain that I feel with Shane, for Shane, that’s really what speaks the loudest right now. This guy powered through a start the other night and was elite. The things that he can do, even when injured, are really special, so my heart goes out to Shane and his family. This is devastating news for them.”

The 28-year-old Bieber is 62-32 with a 3.22 ERA in 134 career starts with Cleveland. He led the majors in wins, ERA and strikeouts in the pandemic-shortened ’20 season. Bieber made the All-Star team in 2019 and was named MVP when the Guardians hosted.

Bieber’s injury is the latest for Cleveland’s pitching staff. Reliever Trevor Stephan recently had Tommy John surgery, and Gavin Williams has been sidelined since spring training with elbow soreness but should be fine.

The Guardians are hoping to contend in the AL Central, and will need others to step up with Bieber no longer anchoring the staff.

This is the first major setback Vogt has had to navigate as a manager. There’s nothing easy about it, and as a former player, he understands the emotional impact Bieber’s injury can have across the clubhouse.

He urged the Guardians not to run from their feelings.

“Let it hurt. You don’t have to be OK,” he said. “It’s OK to not be OK. But this is what it is. We have an opportunity to still go out and play every day. The next-man-up mentality is what we have to be thinking about. You can’t replace Shane Bieber, but we do have guys that can step up and give us meaningful innings and get a lot of quality outs for us as we move forward.

“We’re all hurting. We love Shane. He’s such a big part of our team, our clubhouse, our culture, obviously our on-field success. That’s why my heart just goes out to him right now. We’ll support fully what he’s doing.”