Tag Archives: Ryan Zimmerman

Platelet Rich Plasma Injections – Treating chronic injuries in top athletes

In the recent years, elite athletes like Alex Rodriguez, Closer Joe Nathan and golfer Tiger Woods have undergone the new fad in rehabilitation called Platelet Rich Plasma Therapy. Rodriguez underwent a treatment of these injections last month in Germany for chronic problems in his knee and shoulder. In Europe, and now recently in the United states, an increased trend has emerged of using  the PRP injection because its promising alternative to surgery and decreases time on the DL. So I thought I’d write a quick little note about it since you’ll start to hear more and more about this treatment in baseball and other sports.

So first of all lets start with what the heck are platelets?

Basically blood has 3 components: red blood cells, white blood cells and platelets. Plasma is the liquid component of the blood, mostly its made of water (which is why you should drink it more!) Platelets are mostly thought of as clotting agents…they help form the scab sick people like to pick. However they do so much more than that by removing dead tissue, promoting healing, and regenerating healthy tissue.  Normally 6% of blood is made of platelets, however PRP works by increasing the percentage to 94%.

The idea is that if you put a concentrated amount of the good stuff into an area thats not healing, good things will happen.

In the baseball world, the injection is being used for players with chronic tendonitis in the knee, shoulder, wrist, elbow and ankle. When tendons have to overwork ( like throwing 90 miles an hour over a hundred times) time and time again, they can thicken and become injured. The injured tendons heal by scarring down, which actually makes the tendon less able to perform a task like throwing a baseball. Tendons have very poor blood supply and therefore don’t heal well. So what sports medicine doctors are doing is drawing blood from the player, spinning the blood and removing all the red and white blood cells, and injecting the platelets into the specific tendon that has scarred down. This then jump starts healing.

Players that have the injection are usually then instructed to not move or use the joint for up to 6 weeks. After that they are freed to go back to baseball activities. The benefits are that you are using your own blood, and it can be a much quicker recovery than having surgery. Of course PHYSICAL THERAPY is a very important step before and after the injections to prevent the problem from coming back.

Keep your eye out this season for the PRP injection….



Athletic Pubalgia – Nick Markakis and Ryan Zimmerman

A surgery this week to Baltimore Orioles outfielder Nick Markakis caught my attention. His case is very interesting and something I thought I’d share with you all. Markakis initially injured himself last September while stealing 2nd base when his belt buckle dug into his pelvic area and caused him immediate pain. This injury was re-aggravated while diving for a catch in right field on the last game of the year, causing him the inability to remain in the game. After the season was over Markakis had an MRI and was diagnosed with a bone bruise and instructed to rest. After adequate rest time, and no change in his symptoms, another MRI was perform and muscle tears in his rectus abdominus (Athletic Pubalgia ) were diagnosed, and recently surgically repaired.

Baltimore Orioles - Nick Markakis

Earlier in the 2011 season Washington Nationals third baseman, Ryan Zimmerman, underwent a similar surgery to repair torn muscles in his abdominals. Zimmerman didn’t have a specific injury to his abdominals, however continued to have persistent abdominal pain that progressed and was eventually diagnosed as Athletic Pubalgia.  Although he was told 6 weeks, it was nearly 12 weeks before Ryan Zimmerman was back in action for the Nationals.

Although Athletic Pubaligia, is often called a “sports hernia” it is not a hernia. The term “sports hernia” is sort of an umbrella term that refers to any tear of muscle, tendon or ligament in the lower abdomen or groin. These tears can occur with quick sudden changes in direction, forced hip movement with the foot planted, or with forceful exertion of the abdominal muscles. It is commonly found in athletes who participate in sports that involve repetitive twisting and turning such as football, baseball, soccer, ice hockey, rugby and tennis. It can cause abdominal/groin pain, increased pain with sprinting or twisting, pain with coughing or sneezing, pain during and after activity and minimal pain at rest.

Muscles and Tendons Involved in Athletic Pubalgia

There are several muscles of the abdomen and groin that attack to the pelvic bones and serve to stabilize the joint during twisting motions. In the picture to the left you can see the rectus abdominus (your six pack muscles ) attach to the bone of your pelvis, as well as your External Obliques, the hip flexor and groin muscles. You can see that with repetitive swinging, tremendous amount of stress will be placed on this structures and eventually micro tears and tears can occur. It has been theorized that an athlete may be prone to this injury if muscle imbalances are present with strong adductor (groin) muscles and weak abdominal muscles. The strong going muscles can create a pull that can overpower the abdominals and make these muscles prone to tears.

The surgery to repair these torn muscles is similar to reconstruction of the knee. The surgeon with re-attach the muscles down to the bone using sutures that will provide stability. After the surgery, the athlete can expect to be walking the same day, however will be limited in lifting and baseball activities for up to 6 weeks. The most important part of rehabilitation for Nick Markakis, as well as anybody else, is to address the imbalances that contribute to this injury. If those imbalances are not addressed in rehabilitation he may continue to have pain and possibly re-tears in the future. This could be the reason it took Ryan Zimmerman longer than expected to return. Markakis will be focusing on stabilizing with his abdominals (rectus, obliques and transverse ) more, and firing his going muscles less.  My guess is Markakis will be at 100% be the second week of the regular season, should everything go as planned in rehab.

Thats all for now. Hope that makes sense.

Football playoffs means baseball season is right around the corner. GO NINERS.




Sueki, Derrick, and Jacklyn Brechter. Orthopedic Rehabilitation Clinical Advisor. Maryland Heights, MO: Mosby Elsevier, 2010. Print.

“MLB News | MLB.com: News.” The Official Site of Major League Baseball | MLB.com: Homepage. Web. 08 Jan. 2012. <http://mlb.mlb.com/news&gt;.

Home Page. Web. 08 Jan. 2012. <http://coreperformancephysicians.com/&gt;.