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April 11, 2011
More on the Core
We somehow got through the weekend without any other hitters requiring an appendectomy. However, the other type of injury that has hit the headlines again and again in the early going—having claimed Evan Longoria, Corey Hart, Brian Matusz, Brian Wilson, and others already in 2011—returned in full force, so we'll start there.
J.J. Hardy, BAL (Strained left oblique)
Erick Aybar, LAA (Strained left oblique)
It appears as if oblique injuries have been on the rise lately, but a large part of that apparent trend stems from an increased distinction between oblique strains and generalized side strains—the two injuries are being diagnosed correctly more often. It is an important distinction to make, as the greatest number of days lost for injuries of each type differs greatly (34 days for intercostal versus 100 days for oblique).
There are two oblique muscles on each side of the body, for a total of four internal and external obliques. The external obliques (obliquus externus abdominis) are the largest and most superficial of the muscles in the area, arising from the front inferior portions of the eight lower ribs. From there, they wrap around in a fan-shaped downward angle to attach on top of the hip bone and blend into a strong membranous structure connecting multiple muscles on the front of the abdomen. The internal oblique (obliquus internus abdominis) is thinner, smaller, and lies underneath the external oblique. The internal oblique runs at an opposite angle (forming an “X”) to the external oblique. It starts at the hip bone and runs upward and diagonally to attach to a different portion of that same strong membranous structure along the front cartilaginous portions of the lower ribs.
The actions of the obliques are complex, and like most actions in the human body, they never occur in complete isolation. The external oblique of the left side and the internal oblique of the right side work together to rotate the left shoulder to the right hip. Conversely, the external oblique of the right side and the internal oblique of the left side work together to bring the right shoulder to the left hip. The majority of the actions by a right-handed thrower and hitter in baseball involve this motion of bringing the right shoulder to the left hip.
The obliques and other abdominal musculature also are a relatively weak point in the kinetic chain between the large muscles of the hip and legs and the larger muscles of the chest and back. Significantly more emphasis has been placed upon improving stability of the core (along with overall strength improvements) over the last decade, but clearly that hasn't been enough to eradicate injuries to the area. In order to propel a baseball 90-plus mph or hit a baseball 400 feet, a player must be able to transfer energy all the way from his feet to his shoulders and arms in an instant—all without getting fatigued. For throwers, this involves a large stride and rotational torque through the hips, core, and upper trunk before activating the shoulders. Hitting, of course, also requires that same rotation of right shoulder to left hip (albeit without quite the same diagonal component) to provide torque progressing from the lower legs to the shoulders.
To inject some data into the discussion, we looked at past oblique ailments in our injury database, considering only disabled-list transactions at the major-league level in order to tease out the differences between “soreness,” “tightness,” and “strain,” as well as to exclude injuries suffered in combination and injuries that didn't require time off. Right-handed throwers and batters went on the disabled list 84 times with left oblique strains versus 12 instances of right oblique strains for lefties—compare this to the 22 times that right-handers suffered right oblique strains versus nine left/left combinations.
What does this mean for Hardy and Aybar? Like most injuries, there is a wide spectrum in terms of potential time lost. Both are expected to fall within a normal range, however, with initial reports for Hardy suggesting a loss of six weeks (depending on the results of an MRI), and Aybar expected to miss right around the minimum.
Ronny Paulino, NYN (Anemia)
Anemia is a new one to us as far as DL stints go, but the effects are certainly dangerous and need to be controlled. Anemia occurs much less often in males than in females. There are several types of anemia, ranging from mineral deficiencies to life-threatening acute and chronic diseases. Symptoms of anemia include weakness, shortness of breath, fatigue, constipation, diarrhea, split nails, racing heart, and restless leg syndrome, to name just a few of the unpleasantries.
After reportedly dealing with stomach and colon issues, Paulino had blood work done that revealed abnormalities, so further testing took place. Biopsies were performed (to rule out the more serious issues) and medications were prescribed. Anemia can sometimes be an easy condition to deal with, but it could be a season-long issue. There aren’t too many known comps for players with anemia, but Danny Tartabull did miss 15 games back in 1986 with vitamin deficiency anemia.
Kevin Slowey, MIN (Right shoulder biceps tendinitis with bursitis)
Slowey has now been on the disabled list four years in a row, and he owes his most recent stay to biceps tendinitis and bursitis. In 2008, he suffered a biceps strain, missing 34 games, though he pitched well in the two months following the DL stint. However, that was before he suffered subsequent injuries to his wrist, elbow, and biceps (again), so nothing is guaranteed once he returns from the DL this year.
As we discussed when talking about rotator cuff injuries, eliminating pain and inflammation is the most important concern, and can often take the longest. It is not clear whether Slowey will be ready on April 20 when he is eligible to return.
Scott Kazmir, LAA (Lower back stiffness)
Aybar's isn’t the lone injury of the day for the Angels, who would have eight players on the disabled list simultaneously if not for the activation of reliever Scott Downs this weekend. Kazmir was placed there retroactive to April 4 due to his lower back stiffness. Kazmir’s velocity was down in the spring, and he felt stiffness in his lower back in his last spring training game on March 29, but he and the Angels figured it would loosen, since it felt like normal stiffness. Unfortunately, he experienced residual stiffness throughout the first week of the season, including his start on April 3. Lower back injuries are awfully difficult to manage; given Kazmir’s injury history over the past several years, he is going to have to be careful so as not to risk a separate injury to another area.
Flesh Wounds: Hanley Ramirez left Saturday’s game with what looked like a serious injury to his left leg, reminiscent of Nishioka’s injury just a few days ago. X-rays ruled out fractures, and Ramirez was given the diagnosis of a moderate-to-severe bruise. He is aiming to return tomorrow, but severe contusions can linger. … Ross Ohlendorf was placed on the disabled list with a right posterior shoulder strain, in a similar area to the latissimus strain he suffered last year. It’s not in the exact same spot, but close enough to merit a mention. ... Ryan Zimmerman suffered another abdominal strain and supposedly will not go on the disabled list. He’s considered day-to-day, but he has suffered two abdominal strains already this year. ... Andres Torres came into the clubhouse in a boot and crutches after straining his left Achilles on Saturday—he is day-to-day for now. This protection is common procedure, regardless of the degree of suspected Achilles injury, until an MRI can be performed to evaluate the integrity of the Achilles. … Yunel Escobar returned to the lineup on Sunday after suffering a head injury earlier in the week—still no one placed on the 7-day disabled list. … Matt Holliday returned on Sunday, setting the bar for least amount of days lost (nine) due to an appendectomy. ... Adam Dunn is already attempting to better that mark after taking batting practice on Sunday.