A spokesperson for President Bush confirmed his back surgery, saying, “President Bush isn’t one to make excuses, but that’s true — he did have fusion surgery on his lower back early this year.” Despite the surgery, he is recovering well.

Notably, this wasn’t President Bush’s first time throwing the first pitch at a World Series game. He famously threw a perfect strike in 2001, a month after the 9/11 attacks. He also threw the first pitch at the 2010 and 2017 World Series alongside his father, former President George H.W. Bush.