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October 10, 2011

Collateral Damage

Division Series Injury Updates

by Corey Dawkins

Ryan Howard, PHI (Left Achilles Surgery) [AGL: 17(87 DL), ATD: TBD (-.287 DL)] (Explanation)
On the final play of the Phillies season, it was quite apparent something was wrong with Howard.  During the follow-through of his swing, he planted his left leg outside of the batter’s box and tried to race down the first base line in an attempt to extend his team’s season.  Unfortunately, something popped, and he never made it down the line. Howard ruptured his left Achilles tendon, something more often seen in middle aged basketball, tennis, or squash players.  In Howard’s age population it is more common in American football than in baseball, but there have been multiple instances (six so far) of ruptured Achilles before that required surgery in baseball.

The vast majority of ruptured Achilles tendons occur in field players or runners as the calf is forced to contract forcefully while being lengthened.  Termed an eccentric contraction, these can produce forces much greater than when you consciously tell the muscle to contract. In relatively healthy baseball players of this age group, there is usually some sort of underlying tendon damage that weakens the area.  In Howard’s case, his chronic inflammation in and around the tendon this season likely contributed to his injury. The inflammation breaks down and weakens tissue on a microscopic level, especially when it occurs for some time.

Howard now faces surgery once the swelling has gone down in the area, likely within the next several days. These cannot be delayed for too long or the damaged end of the tendon will become retracted further into the calf, making a repair much more difficult.  Estimates are that Howard will miss between six to twelve months, but six months sounds overly optimistic. In the database, none of the players returned in the same season that they were injured, not even with the surgery in early May. The fastest we have anyone returning is Gabe Kapler, who did it in a little under nine months between the 2005 and 2006 seasons.  Howard is obviously much bigger than Kapler and will have significantly more force directed through his Achilles with each step.  As such, we’d be hesitant to say he will be ready before the start of the 2012 season and has a good chance to miss a significant chunk of the season.

Cole Hamels, PHI (1. Left elbow surgery – loose bodies    2. Inguinal hernia)

  1. Elbow  [AGL: 16(90 DL), ATD: TBD(+.062 DL)]
  2. Inguinal Hernia [AGL: TBD(TBD DL), ATD: TBD(TBD DL)]

Howard is the most severely injured of the Philadelphia Phillies but certainly not the only one. Hamels is scheduled to undergo surgery on his left elbow to remove loose bodies that have accumulated over time.  He has a history of elbow problems, including a sprain of the UCL in his elbow, likely leading to some looseness. Over time, some bone chips or pieces of cartilage have broken off and are now becoming an irritant in his elbow—although you wouldn’t be able to tell by looking at his stats.  The procedure is usually quick and minimally invasive, meaning he should have more than enough time before the start of spring training.

That’s not all though for Hamels. He’s also facing potential surgery on an inguinal hernia that has developed and given him problems.  A few other Phillies are facing sports hernia surgeries, which are slightly different than inguinal hernias. Both types of hernias involve a part of the abdomen called the inguinal canal, but there is one main difference between the two. In sports hernias, the muscles of the abdomen wall are weakened, leading to pain and discomfort, while in inguinal hernias there is an actual pouching through the abdominal wall.

Even with both the elbow and hernia surgery, Hamels should be on track for the 2012 season. Neither should limit his performance in any way going forward either.

Magglio Ordonez, DET (Right ankle fracture) [AGL: 56 DL, ATD: -.006]
There is some initial debate as to what exactly was going on with Ordonez’s ankle, and none of it was good. The team has now released information about it, and Ordonez responded to questions from reporters that his ankle “is broke”.  After having to come out of Saturday’s game following rain delays, Ordonez underwent x-rays and a CT scan that showed the fracture. It’s in the same area as his ankle fracture from last year, and given his feelings about retirement earlier this year, Ordonez may have played his last game in the majors. He was replaced on the postseason roster by Clete Thomas, who hasn’t exactly been a bastion of good health himself over the years.

Delmon Young, DET (Left strained oblique) [AGL: 6(23 DL), ATD: +.001(+.008 DL)]
Young suffered the strained oblique in the clinching Game Five of the ALDS and was subsequently left off the roster for this series. He hasn’t been ruled out for the remainder of the playoffs yet, but obliques are tricky to deal with, as we all know by now. Detroit’s health has really taken some hits in the last week with the loss of both Young and Ordonez, but they still managed to keep Game One close. We’ll see if Young is able to return in the World Series if Detroit is able to advance.

Skip Schumaker, STL (Right oblique strain) [AGL: 6(23 DL), ATD: +.001(+.008 DL)]
Speaking about obliques, Schumaker has to deal with one of his own for the Cardinals. Schumaker too is off his team’s active roster for the league championship series after straining his right oblique during Game Five of the NLDS.  Making it a little more difficult than in Young’s case is the fact that Schumaker plays multiple positions: second base and centerfield. With Matt Holliday improving but still at a high risk of reinjury, positional versatility gives the Cardinals flexibility in their roster construction that always seems to play a role in the postseason.  Schumaker seemed to feel that it wasn’t a severe strain, and he could be back for the World Series if the Cardinals advance.

Flesh Wounds
Two other Phillies – Hunter Pence and Placido Polancowill undergo repeat MRIs to evaluate their sports hernias. Polanco will most likely have surgery and be down for approximately three to four months, but Pence still may be able to avoid surgery… Ivan Nova suffered a mild right forearm strain during the Game Five loss to Detroit… Ross Gload is expected to undergo surgery on the torn labrum in his hip… John Axford suffered a bruised forearm after a line drive off Jon Jay’s bat. X-rays were negative.

Corey Dawkins is an author of Baseball Prospectus. 
Click here to see Corey's other articles. You can contact Corey by clicking here

Related Content:  Surgery,  Elbow

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