Our series continues with a look at the serious athletic injury most likely to make you giggle.
Athletic pubalgia (more commonly called sports hernias) have been getting more attention in the last few years, but reports often mistake them for inguinal hernias or otherwise misrepresent what they are. Despite the hernia connotation, this injury does not involve any actual herniation, which is defined as the protrusion of an organ or other bodily structure through the wall that normally contains it. Therefore, “athletic pubalgia” is a more appropriate term and encompasses any number of variants, including chronic adductor strains.
Football, soccer, and ice hockey have traditionally seen the highest number of cases of athletic pubalgia, but in the last few years we have seen numerous baseball players undergo surgery, including Stephen Drew, Josh Hamilton, Hunter Pence, Nick Markakis, and Kevin Youkilis. In today’s column, we’re going to look primarily at athletic pubalgia, but we’ll also discuss how they differ from inguinal hernias.
The Rangers risk losing two pitchers for the playoffs, Scott Sizemore feels the pain of playing a new position, Brett Lawrie fractures a finger, and Phil Hughes tries to hurry back.
Mark Lowe, TEX (Right hamstring strain) [AGL: 9(30 DL), ATD: -.015(-.012 DL)] (Explanation)
Lowe injured his hamstring before the game on Wednesday, supplying further evidence that injuries can occur at any time. He suffered a Grade II strain of his hamstring while performing sprints warming up and is now expected to be out for several weeks. His availability for the playoffs is in doubt, especially the ALDS, but the Rangers are trying to speed up the healing process with a platelet rich plasma (PRP) injection.
PRP injections do not work overnight—if they work at all—so his latest treatment is not a guarantee that he will be ready in time for the playoffs. The major milestones that need to happen before he is ready include a decrease in inflammation and a restoration of normal range of motion, strength, and function of the hamstring. Until these goals are achieved, Lowe will be at risk for re-injury. The Rangers are going to have a tough decision ahead of them when arranging their playoff rosters but should have a very good idea about the part Lowe will play in one week.
We finally learn what's really ailing HanRam, Josh Johnson is done for the year, J.D. Drew is up to his old injury tricks, and Jair Jurrjens' season is in jeopardy.
Hanley Ramirez, FLO (Left shoulder instability) [AGL: 16, ATD: +.030] (Explanation)
The full extent of Ramirez's problems have come to light, and as we expected, he was dealing with more than a simple sprain. It's now been reported that the MRI has shown shoulder “instability,” and Ramirez will be meeting with team physician Dr. Lee Kaplan to discuss the options from here. One thing needs to be cleared up, though: shoulder MRIs don't directly show instability. They reveal injuries and findings consistent with instability, such as sprains of certain ligaments or tearing of the capsule.
The reports of Ramirez not having any structural damage are also somewhat misleading, given the anatomy and lack of bony stability in the shoulder. There can be soft tissue injuries that don't allow a baseball player to function, but they aren’t considered structural issues. The diagnosis of instability relates to symptoms associated with abnormal looseness of a joint and is somewhat dependent on subjective reports of popping out of the shoulder, pain, and other symptoms. It's not like looking at a knee MRI and seeing a torn ACL.
Carlos Quentin sprains a shoulder doing something he's done many times before, Brian Wilson suffers a cascade injury, Jimmy Rollins strains a groin, Jason Berken fears the worst for his elbow, Pablo Sandoval and Paul Maholm nurse their shoulders, and Freddy Garcia and Rafael Furcal deal with faulty fingers.
Brian Wilson, SFN (Right Elbow Inflammation) [AGL: 36, ATD: -.037] (Explanation)
Wilson's beard may be a natural wonder of the world, but unfortunately, his elbow might not be. Back soreness last week may have altered his mechanics just enough to cause elbow inflammation and a trip to the disabled list this weekend. The move, retroactive to August 16th, came early enough that even if Wilson does not return in the minimum, he can still see a few weeks of action before the playoffs start.
Wilson hasn't suffered any major arm injuries since undergoing Tommy John surgery performed by Dr. Andrews while at LSU in 2003 although there were a few blips along the way. In 2007, he strained his triceps, and an infection in his finger during 2009 spring training sidelined him for a little less than two weeks. Wilson's mild flexor strain and resulting inflammation should clear up in within a month, although San Francisco feels that it may be a matter of about three weeks. In the interim, the Giants are going to have their hands full trying to keep the antsy Wilson from going crazy on the bench sitting alongside the MASH unit in San Francisco uniforms.
San Francisco faces an injury stack as Carlos Beltran is disabled, Chipper has more soreness, Chris Davis' season is over, A.J. Pierzynski pops his DL cherry, Garrett Richards goes down, Jon Rauch loses his appendix, and more.
Carlos Beltran, SFN (Right wrist strain) [AGL: 25, ATD: +.036] (Explanation)
After pulling out all the stops to try to get Beltran back in action, the Giants were forced to place him on the disabled list yesterday, along with Sergio Romo. Beltran's injury was described as a strain with resulting inflammation, not uncommon for acute injuries. On the outside of the wrist where his inflammation is—anatomically speaking, it's the inside aspect closer to the little finger—there are several structures that could be injured.
The most likely structures involved are the extensor tendons for the wrist itself. The tendons themselves can become strained, or a sheath of connective tissue covering the area and keeping the tendons in place can also be injured. This straining of the tendon is similar to Mark DeRosa's wrist, which obviously isn’t something most fans want to hear. It doesn't appear at this time to be as serious as the injury that DeRosa suffered and has continued to battle. The tearing of the sheath is similar to the injury that David Ortiz suffered back in 2008. Neither of these automatically requires surgery, but either could down the line.
Moylan's back is bulging, Martinez comes back too quickly, Braden proves they do suffer from shoulder stiffness in the 209, and the Cardinals take one step forward and two steps back.
We discussed yesterday why it is important not to rush back from concussions—a viewpoint that Major League Baseball agrees with, given its new disabled list policy for concussion victims—but let's not forget that patience is a virtue when it comes to even the most basic injuries. A certain off-season acquisition of the Tigers would have done well to remember that this weekend.
Peter Moylan, ATL (Low back strain/bulging disc)
Moylan recently underwent MRI testing, and a bulging disc was found in his lower back. Bulging discs, by themselves, are not that worrisome: most active people over the age of 30 have at least some degree of bulging in the discs of their lower backs and do not even know it. If the disc does not bulge to the point of compressing the spinal cord, then treatment is more focused on physical therapy and some activity modification.
Bronson Arroyo gets caught kissing, Brad Lidge becomes the latest fallen Phillie, and MLB strikes a blow against concussions.
The time for the optimism of spring is reaching its end, as teams have finalized their rosters in time for Opening Day. This means that a number of clubs have had to accept that some of the injuries that their players have dealt with throughout the spring are not going to heal in time for the games that count. It also means that the disabled list, dormant throughout the spring for even the most injured of parties, is now in use.
Duchscherer goes down, Bailey, Polanco, and Lidge hear echoes of injuries past, and the "big risk" jinx rolls on.
With one exception, the recent injury news in baseball has been more of the day-to-day or week-to-week variety—the kind of ailments that a club can handle with a few weeks left in spring training. In light of his history of elbow problems, Andrew Bailey put everyone through a scare when he was forced to leave a game yesterday, but he should be all right. However, we can't be quite as optimistic about a certain Orioles pitcher's chances of pitching soon.
A reminder that, like snowflakes, every injury and rehab is different, along with injury news from around the major leagues.
Rehabbing an elbow is always a difficult balance, but in most situations, doctors will tell you that it's always better to try and rehab through something before having the surgery. A surgery, even something predictable like Tommy John, has a defined period of loss, currently between 10 and 12 months. Using the example of Twins reliever Pat Neshek, the lost time in rehab might look like a loss—Neshek even told BP's Dan Wade that it "was the worst thing I could do" because of perception and the machismo of the locker room—but if Neshek had been able to come back inside the 2008 or 2009 seasons, it would have been a big gain. You can use the same equation I gave you in regards to why the Mets didn't put Jose Reyes on the DL, though the numbers get a lot bigger and the risks are hardly as well known. For situations like Neshek's and the hundreds of others—no, that's not an exaggeration—that face elbow surgery at all levels each year, the "right decision" is a moving target. Is it just to get the player back in the quickest amount of time? That does play into it, but does that mean "rehab might get him back in three months or might extend him out if surgery is needed"?
The Mets center fielder, out all season while recovering from microfracture knee surgery, begins a rehab assignment Thursday, along with other injury news from around the majors.
Carlos Beltran (arthritic knee, ERD 7/15) In what is sure to be a continuing series, the Beltran watch is now headed for a rehab assignment, which will start tomorrow at High-A St. Lucie. Beltran was watched by the Mets' top brass, including Omar Minaya, during an extended spring training game on Sunday and they felt the center fielder was ready to start his 20-day rehab clock. I've pushed the idea that Beltran needs to be up in Flushing as soon as he's physically able, but several people inside the game have told me that while there's merit in the concept, Beltran is human and needs a "spring training equivalent." The downside here is that he's going to be taxing the knee during that time. Of course, that's what rehab assignments are for. They'll be very controlled, perhaps not so much as the simulated games he's been in, but Beltran will have very specific steps and tests at each point. He'll have the DH option in most games as well, something he won't have when he makes it back to the Mets. Watching how often he needs to play there is going to be a big tell for his progress. The key will be how his knee responds and the Mets' ability to manage the inflammation and bruising that will inevitably occur inside the knee. The brace he is wearing is helping, but the continued idea that he's a center fielder is not. I'm most curious to see when that will be abandoned. One interesting concept that was tossed out by an MLB athletic trainer was the idea that Beltran could hit well enough to be in the lineup every day, but not play the field consistently. He wondered if there's a level and a cost where Beltran might make sense for an AL team. If Beltran were to show that, the idea of him being a modern-day Harold Baines would have to be intriguing for some teams as well as for the Mets escaping at least some of Beltran's contract. It's very equivalent to what the Twins did with Jim Thome, though he was a free agent.
The Dodgers will have to wait and see on Andre Ethier's broken pinkie, plus other MLB injury news.
Andre Ethier (broken pinkie, ERD TBD)
The Dodgers don't need an injury, let alone one to Ethier. Ethier injured the finger during batting practice, but it's unclear exactly where the break is. If it's distal (toward the fingertip) then it's less integral to the grip. If it's closer to the hand, it's tougher. As a lefty hitter, it's his bottom hand, so with each swing, it's going to be either pushed against the knob of the bat or have to edge over it and be even more exposed. It's going to be nearly impossible to splint the finger in a way that won't affect his swing. Then again, while we don't know exactly how the fracture occurred, it's reasonable to think that a padded glove might have prevented this. This week, I had the chance to ask a major-league athletic training coordinator if he thought that wearing a shin guard might help protect pitchers. His immediate answer was, "they wouldn't wear it." I understand that on one level—just look at the ridicule that David Wright and Francisco Cervelli have taken for wearing the best-available batting helmet. On the other hand, why is this about the player? A simple "protective gear" clause in a contract would be a pretty easy thing to do for a smart team. Ethier is going to wait a couple days and try to hit, seeing whether or not he can play with the pain and not make the fracture worse. Pain tolerance is a powerful force, so we'll have to wait for that test before knowing how long he's out. If he does go to the DL, it shouldn't be much over the minimum.