NL Central Injury Report

[mikechamp]

I don't plan on making this a weekly occurrence (partially because I didn't know this existed until this morning, and mainly because I probably won't remember to). However, if enough people enjoy it, I'll try my best.

=============

By Stephania Bell, PT, MS, OCS, CSCS
Orthopedic Clinical Specialist
Certified Strength and Conditioning Specialist

RotoWire Injury Expert

(Bell, PT, MS, OCS, CSCS (Orthopedic Clinical Specialist, Certified Strength and Conditioning Specialist), is a clinician, author and teacher in the area of orthopedic manual therapy and sports medicine who practices in the Bay Area.)

Prior's priors spell future troubles

If Mark Prior's injury history really were a rap sheet, his next offense would send him away for a very long time. As it turns out, Prior's poor performance in spring ball may have the Cubs sending him away – to the DL - at least for a while. Although Prior has suffered through a variety of injuries over the last few years (tendinitis, fractured elbow after being hit by a pitch), his struggles of late have revolved around his throwing shoulder. Last year Cubs trainer Mark O'Neal was quoted on the Cubs' website as stating that Prior had "laxity," which he further defined as genetic looseness, in Prior's shoulder. This set off a bit of a media buzz about this "laxity" condition that Prior was battling. The fact is that many successful pitchers have laxity in their throwing shoulders. Laxity, which basically means extra motion or "play" in a joint, often develops in the thrower's shoulder as a result of the repeated extreme (and unnatural) ranges of motion induced by pitching.

Every joint in the body has two interfacing bony surfaces that move relative to one another to allow for normal motion. The two bony ends are encased by fibrous tissue, the joint capsule, which helps stabilize them. The capsule can be overstretched – either traumatically (which is what happens when a joint dislocates, often tearing the capsule) or gradually, over time, as a result of repeated stretching (which is usually the scenario for the thrower). So in essence, the presence of laxity in a pitcher, especially at the pro level, is not uncommon, and may even be beneficial in terms of allowing more wind-up to produce greater forces when pitching.

So why is it a problem for Prior? The less inherently stable a joint is, the more that joint relies on the support of the muscles around it. In the case of the shoulder, several muscle groups, most notably the rotator cuff, must provide that extra support. Additionally the scapular muscles (muscles that control the movement of the shoulder blade) must provide a strong base of support for the cuff. If these muscles are not all working synchronously, the joint can feel like it is slipping or sliding and can become painful. If this goes on for long enough, abnormal forces at the shoulder cause further tissue breakdown, and this is how a pitcher can find himself going under the knife. The take-away message here is that the key to a healthy shoulder is excellent muscular support. In the absence of a gross defect in the shoulder that would clearly respond to surgical repair, the first choice for this type of problem is rehab. This helps explain why the three orthopedic surgeons who evaluated Prior last year all recommended intensive rehab as the best course of action.

It remains to be seen how effective Prior can be in his return. The glass half-full observer can celebrate the fact that Prior is pitching without pain. If he can continue to do so while rediscovering his command and adding some speed, he could be a force. It is a big "if," but it's an "if" with upside, and so we, along with the Cubs, must wait and see.

Wood Solid in Return

It's virtually impossible to talk at length about Prior without saving some room for his shoulder-injury plagued teammate Kerry Wood. Wood was shut down last season due to ongoing problems with his rotator cuff. He opted to go with the conservative rehab approach, and at the same time dropped about 30 pounds as part of an effort to improve his overall health. Wood emerged during spring ball to deliver some strong outings, including 95 mph fastballs. Most importantly from a rehab standpoint, he was playing without pain or stiffness in the arm.

Yes, Wood suffered a minor setback with a strain to his right triceps about two weeks ago. According to Wood, he extended his stride when trying to avoid a hole on the mound and felt a twinge in his arm. This is not necessarily an extension of his right-sided shoulder problems down into the arm. It may be simply a reflection of how delicate a pitcher's mechanics are – extend the stride by a foot and it changes how the force is transmitted through the upper arm. True, a younger non-injured thrower under similar circumstances might have felt nothing. But does it mean that all of Wood's troubles have returned? I think not. His speedy recovery seems to support that. He has already pitched a bullpen session where he was able to deliver all of his pitches and is scheduled to pitch in a game this Friday.

As with any thrower, age and injury-history are important factors to consider. Neither statistic is in Wood's favor. However, Wood's off-season rehab appears to have been successful in getting him back to the point of being able to deliver his pitches. As with any sport, the final extension of rehab is re-introduction to the game, which is why spring training is so important for someone like Wood. Also, the decision to move him to a middle reliever or closer position will help limit his pitches per outing, something that should enhance the longevity of his arm. Whether Wood is actually available as of Opening Day or whether the Cubs hold him back a bit longer shouldn't make us read too much into his seasonal projection. There is definitely some risk for Wood because of the factors noted above, and he may suffer these minor tweaks from time to time, but if he is utilized well in his new role, he may prove that he has enough left to be consistent and effective.

Other News of Note

Jason Isringhausen continues to impress with his performance this spring after undergoing a second surgery in the off-season on his degenerative hip. This type of arthroscopic procedure is essentially done to try to buy the athlete some time, as arthritis (wearing down of the joint surfaces) is not something that goes away. Isringhausen eventually will likely be headed for a hip replacement but there's no sign of that now. Last year, the pain in his hip was so severe that it would make his leg give out, altering his entire throwing mechanics. His end-of-year stats were probably more reflective of how much pain he was in than anything else. The pain-free Isringhausen is now throwing much better and with gradually improved control each outing. The amount of time he's bought is an unknown at this point, but as a closer his use is more controlled, which should help with his maintenance.

[Hungary Jack]

Jason Isringhausen continues to impress with his performance this spring after undergoing a second surgery in the off-season on his degenerative hip. This type of arthroscopic procedure is essentially done to try to buy the athlete some time, as arthritis (wearing down of the joint surfaces) is not something that goes away. Isringhausen eventually will likely be headed for a hip replacement but there's no sign of that now. Last year, the pain in his hip was so severe that it would make his leg give out, altering his entire throwing mechanics. His end-of-year stats were probably more reflective of how much pain he was in than anything else. The pain-free Isringhausen is now throwing much better and with gradually improved control each outing. The amount of time he's bought is an unknown at this point, but as a closer his use is more controlled, which should help with his maintenance.

This may sound callous and crude, but all I'm praying for is that Izzy's hip holds out through November.

[mikechamp]

This may sound callous and crude, but all I'm praying for is that Izzy's hip holds out through November.

Hey, you never know; he (and the Cards) might be, too.