MLB Disabled List

Hello Everyone,

I’m sure it comes to no surprise to anyone, but I’m kind of a nerd. Yes… its true.  I spend far more time than I probably should checking the MLB website to see who is hurt, and what injuries have sidelined them.

Buster Posey: photo from http://www.azgphotography.com/.... check out the website...

While mourning the loss of Buster Posey, I spent some time today looking at the current Disabled List, and I found a few things kind of interesting that I thought I’d share.

Now bare with me on the nerdy numbers…. I promise I didn’t spend too much time crunching numbers.

There are currently 171 Players on the Disabled List. Not surprisingly 23% of those are injuries to the shoulder and 20% are elbow injuries. The next most common injuries are to the leg and knee, making up 14% of all the DL. This includes things like hamstring strains and knee pain. After that, which is what I find so interesting, is that 8% of the players on the DL are there due to Oblique injuries.

Nearly HALF of major league teams have a man on the DL with an oblique strain.

Nate McLouth out with a strained Left oblique

After that about 7% are ankle and foot injuries and 6% hand and wrist injuries.  However, it is the tremendous, and seemingly increasing, amounts of players straining and tearing abdominal muscles that I find so interesting. This is in part due to the fact that pitchers are throwing harder than ever before, and this puts even more stress on the body. However the injury happens to pitchers as well as hitters and may be due to more than just the increased intensity of pitching. I chatted with my friend Matt Antonelli ( AAA for the Washington Nationals) about this very topic a few weeks ago, so if you didn’t get a chance to check it out here it is:

http://www.youtube.com/watch?v=jEtG0_k-Z3c&feature=player_embedded

 

 

 

 

 

 

 

 

I knew this was becoming an increasing problem, but didn’t realize how bad it was getting. If HALF of teams have a player out with an oblique strain, I think its something that needs to be looked at a lot closer.

Go Giants,

House

Advertisements

“Home” by Ken Burns

It’s a beautifully designed game.  Timeless, but always changing. It’s a game in which the defense always has the ball; and a game in which every player is measured by the ghosts of all who have gone before.

 

For more than 150 years, baseball has been a mirror of the complicated country that gave it birth.

 

From California to the New York islands, through good times and bad, through wars, depressions, and civil strife, it has entertained us, it has inspired us, and sometimes, it has even transformed us.

 

We pass it down from mothers to sons, fathers to daughters, as every generation invests itself in the sweet hope of springtime and endures the painful realities of fall.

Its essential dimensions never change, yet nothing ever happens the same way twice. It is a game in which the person scores, not the ball; where the objective, always, is to come home.

Home, where no asks where you come from or who you voted for.

Home, where all season long, we congregate to cheer and plead, laugh and cry in the magnificent cathedrals of our game – the places, the poet Donald Hall says, “where memory gathers.”

 

Home, where every October, baseball’s greatest stars do battle.

 

Nothing in our daily life offers more of the comfort of continuity, the powerful sense of belonging, and the freedom from time’s constraints than does our National Pastime.

 

It is the place we always come back to – home.

 

 

Vicente Padilla: Radial Nerve Injury

This is a rare occasion.

Yes, its true I’m going to talk about a Dodger, but only because I find his injury so interesting and something worth talking about. Padilla is a right handed pitcher that has been a starter / long reliever in the majors for over ten years. He has bounced around several teams in that time and also had a battle with injuries over his twelve year career.

His most recent bout of injury has intrigued me. In April of last year (I know this because I’m an uber nerd that keeps track of this kind of stuff), Padilla started complaining of forearm tightness and soreness in his pitching arm. Not an uncommon complaint of pitchers, however the tightness was enough that the Dodgers had to place Padilla on the DL and he was diagnosed with radial nerve irritation. He came back, but struggled with tightness and weakness the entire year, and only started 16 games for the Dodgers (good news for the Giants though… and Aaron Rowand)

This radial nerve irritation kept him sidelined into spring training this year, and in February he had a surgical release of the nerve. By April, he came back to replace the struggling Jonathan Broxton (he’s going to be a whole different blog….) as the dodgers closer, pitched a few games, and then was placed BACK on the DL again MAY 14th  with more “radial nerve irritation.”

The radial nerve passing through the Supinator muscle (Ss being the superficial and Sd being the deep heads of the muscle).

Just to give you a quick anatomy break down, the radial nerve runs through the deep muscles of the forearm, and splits right at the elbow into a deep branch (PIN) and superficial branch (SR). This is the most common site of nerve entrapment because the nerve has to run directly through the Supinator muscle. When the supinator gets inflamed, or overused with repetitive movements, it can compress on the deep branch of the radial nerve and cause severe pain and weakness in the forearm.

I guess the next question would then be; why or how does the Supinator muscle get inflammed? Well, supination of the forearm is the motion that brings your palm up towards you (like you are asking for soup is how I remember it), whereas pronation makes your palm face down. This is important because when pitchers throw a breaking ball (slider, curve, cutter…) his hand is supinated when the ball is released. The opposite would be true for a change up, where the ball would be released with the hand pronated. So he could have caused irritation in that supinator muscle by over throwing breaking balls. Possible. However, a lot of pitchers throw a lot of breaking balls and yet this is not a common injury. The other cause for a muscle getting overused, is the weakness of other muscles, causing one particular muscle to do the work, which is probably more likely his case.

The common treatment for pitchers is for a surgeon to make a small incision, find the place where the nerve has been getting entrapped, and simply make more room for that nerve so it isn’t being compressed. This is what they did with Padilla in February. Now, his nerve has been compressed for some time now (at least since last April), so its no surprise that even after surgery he continues to have problems with it, and had to go back on the DL. However, if he doesn’t address the cause of why this happened to begin with, he will continue to aggravate it no matter how much room they give that nerve.

Hope that makes sense.

By the way…..congrats to FC BARCELONA on the Champions League Title. Someday I will marry David Villa…just saying.

House

Thoughts on Buster Posey

Hello All,

Two nights ago, as the Giants came back with a great 4 run bottom of the 9th to extend a game against the Marlins, I lay in my bed watching the game on my Ipad, and hoping it would end soon so I could go to sleep. An hour later, the worst happened.

Scott Cousins and Buster Posey collided with the play at home, and in an instant the entire season for the SF giants changed. As a Giants fan, it was gut wrenching to watch our best offensive player, our leader behind the plate, and a genuine and tough player clinging to the dirt as he experienced excruciating pain. As a baseball fan, it was sad to see the season of the reigning rookie of the year cut short. As a physical therapist though, it was difficult knowing the long road ahead of him and the challenges he faces as he goes through rehab.

Posey and the rest of the baseball world found out the next day he would be dealing with a broken fibula and torn ligaments in his left ankle.  The fibula is the smaller of the two lower leg bones, and there are several ligaments that surround it to give the ankle joint stability. Any physical therapist will tell you they’d much rather see an athlete with just the break; the torn ligaments complicate things so much more, and prolong the injured athletes comeback. To give you a quick overview of the ankle, check out the picture below.

When looking at this picture, you can see that no matter what the direction the fibula breaks in, the chances of escaping the incident without any damage to the ligaments is very small because there are ligaments in all directions of the bone. The Anterior Talofibular ligament (ATFL) is the most commonly torn ligament in the ankle and makes up an estimated 14-33% of all sports related injuries. Judging by the mechanism of Posey’s injury, it is my guess that he tore more than just his ATFL. The specifics of which ligaments are injured doesn’t really matter at this point; whether its 1 or 4, he still has the same road ahead of him.

Although a fracture seems scary, it is actually much easier to come back from a broken bone, than ligament injuries. A broken bone takes about 6 weeks to heal. Bone has a really good blood supply, and because of that it can heal pretty quick. Unfortunately, ligaments don’t have as good a blood supply and therefore can take a lot longer to heal. Surgery is indicated, especially for athletes that need to get back faster, to jump start that ligament healing.

What can Posey and Giants fans expect? Well, depending on the specifics of his specific structural damage and surgery, Posey will be unable to bear full weight for 4-6 weeks. That’s best case scenario, but weight bearing precautions can last up to 8-12 weeks. He could continue to work on upper body and core strength through this time, and even keep his swing up if he has a sweet contraption like this.

 

From there the most important thing for Posey will be to get his full range of motion back in his ankle. After being in a cast or boot following the surgery, the ankle joint will be very stiff. For a catcher the range of motion is especially important because he needs to be able to squat for prolonged periods of time, and that range may take a while for him to get back. Without a doubt, the Giants physical therapist and trainers will be be aggressive with that. After that, the strength and balance should come pretty easily. At best, Posey would be able to play first base in rehab assignments at 12-14 weeks, which is rapidly approaching the end of the season.

If Posey simply had a broken bone, I would have said he’d be back by August. The ligaments and surgery though make me think he’s not coming back, at least not at the catcher position, until next year. Even then, 30% of people with torn ankle ligaments have persistent problems with their ankle that can last a year to forever. Now, after working with the padres rehab last year, I know there are 2 different types of rehab players. There are guys that GET though rehab, and there are guys that WORK though rehab. Posey seems like the kind that will WORK through rehab. I have no doubt that although he has a long road ahead of him, he will do everything in his power to get back to the squat; catching one of the greatest pitching staffs in baseball.

A Bend in the road is not the end of the road, unless you fail to make the turn. The giants have a little overcoming of adversity to do. They’ll get it done.

Have a great holiday weekend everyone !!!

 

 

 

TEAB – Oblique Strains

Talking with Nationals 2B MATT ANTONELLI about the current issue of oblique strains in professional players.

http://www.youtube.com/user/TouchEmAllBaseball#p/u/6/jEtG0_k-Z3c

Whats Wrong with Phil Hughes ??

Hello Everyone,
So the last two days I’ve been stuck at home, unable to move more than just a few feet from the toilet, seeing as everything on the inside of me would much rather be out. I’m not sure I can recall a time in my life I’ve ever vomited so much. I know ya’ll really wanted to know that, but it has given me some time and I was watching MLB network this morning when a conversation about Phil Hughes came up that I found interesting. They mentioned that Phil would be going in for an MRI to rule out a circulatory cause of his recent loss in his velocity.
Of course, my nerdy brain thought more into it. And as much as I don’t like talking about the Yankees I think he is someone worth writing about.

If you don’t know, Hughes is a right handed starting pitcher for the New York Yankees. He was drafted in the first round out of high school in 2004 and made it up to the majors by 2007. He is well known for his nasty 1-7 curveball and has a 4 seam fastball that averages around 93 mph but can get up to 95-96 mph. Last year, his first full season as a regular starter, he went 18-8 with a 4.19 ERA.
During spring training this year, scouts began noticing a drop in his velocity. A drop in velocity is almost always the first sign of injury in a pitcher. Pain can also accompany a drop in velocity, however most pitchers are experiencing some sort of pain at any given time (they throw a ball overhead at over 90 mph) so it may be difficult for them to differentiate a new pain. Hughes continued to pitch into the start of the season where he went 0-1 with a 13.94 ERA in only 10 1/3 innings with a fastball that was only averaging 89 mph. Hughes problem? He complains that after just a few pitches his arm feels fatigued.
“The first few felt all right, and then there was nothing there,” Hughes said. “It’s sort of the feeling you  get after 110, 115 pitches — I normally should feel that way. It’s way too soon.”
So yes something was wrong. Placed on the DL with “shoulder inflammation” Hughes was put on a strength and conditioning program. No MRI performed. According to Joe Girardi (yankees manager )
“Usually, if a guy says he has pain, you go for an MRI,” Yankees manager Joe Girardi said. “He just said he felt like it was dead and there wasn’t a lot coming out. We figured that maybe he needed to be  built up. We put him on a program, and now that the program didn’t seem to work, we go get an MRI.  He still says he’s not experiencing pain.”

There is this diagnosis in the baseball world called “dead arm.” The idea behind dead arm is that right after the ball is released (like in the picture) , when your elbow isnearly fully extended and the forearm is pronated there is a distraction force on the shoulder joint itself. There are ligaments and muscles in the posterior shoulder whose job are to apply a compressive force to oppose the distraction. However over time, these structures can become faulty and pitchers can have pain, loss of velocity of loss of control. These types of forces can also cause a tear in the labrum called a SLAP tear. Players at greatest risk for these types of injuries usually have a significant loss of internal rotation at their shoulder joint; deficits that should be picked up by pre season physicals.
Now Phil may or may not have a SLAP tear, only the MRI can really determine that. Usually this type of injury does also come with a lot of pain in the acceleration phase of throwing, however, I would not be surprised if he did. Because he isn’t having pain thought, there are other common things that could cause his symptoms. When a player complains merely of loss of velocity with no pain like Hughes is, I’m thinking a nerve injury or entrapment which can cause the weakness without the pain. Circulatory causes could also be the case, like Thoracic Outlet Syndrome, which means his brachial artery is getting caught somewhere. This could give him the sensation of fatigue without pain.

Either way I just wanted to write about this because I think its an important lesson. Guys like Phil Hughes don’t just lose 4 mph on their fastball at the start of the season because they need to get stronger. A drop in velocity like that should be a red flag that something else is going on.
Have a good day everyone,
Go Giants,
Katy