Before panic sets in regarding the news that Baltimore Orioles catcher Matt Wieters has tendinitis in his recently reconstructed throwing elbow, it’s worth noting that this is not an entirely unusual occurrence.
In fact, it’s more expected than not that throwers will feel something approaching soreness at some point along the road to recovery; occasionally it happens even after they have returned to competition. Pitcher Joe Nathan returned to the mound 11 months after his 2010 Tommy John surgery only to go on the DL shortly thereafter due to forearm tightness. Nathan told me it was while he was on the DL receiving treatment to loosen up his forearm that his elbow began to feel “amazing.” When he made his subsequent return to the mound, he knew he had physically approached “normal.”
Wieters underwent Tommy John surgery on his throwing (right) elbow in mid-June of 2014 after an attempt at conservative rehabilitation failed. While it is certainly less common for position players to require this surgery as compared to pitchers, Wieters’ particular throwing demands as a catcher place repetitive stress on his elbow, which might have contributed to his injury. It is understandable, then, that his return to throwing, like that of a pitcher, needs to be performed in a controlled, progressive manner with attention given to how the elbow responds at each phase. If something crops up that isn’t quite right, the progression is put on hold.
When I visited Orioles camp just one week ago, Wieters told me his progress to date had been remarkably straightforward. He had zero issues with the elbow as far as swinging a bat or hitting nor had he experienced any discomfort with his throwing program. His only limitations revolved around the intensity and volume of his throwing. As of last week, he had been limited to throwing at 80 percent, something he described as “just not putting that last little bit of tension on the ball.” He was eager to test his arm working behind the plate, even as he knew he wouldn’t completely cut loose on the throws.
In his first Grapefruit League appearance Tuesday, Wieters caught six innings in a matchup against the Minnesota Twins. There were no attempted steals during his outing (which would have required harder throws) and his fielding opportunities were limited. In other words, it was an ideal first outing from a situational standpoint. There were no reports of any soreness until the following day, which is often when the response to the next-level demand on a surgically reconstructed elbow makes itself known. According to Orioles manager Buck Showalter, Wieters had felt a little “achiness” on a couple of throws -- nothing severe, but enough to warrant precautionary measures.
Local soreness and inflammation is not unexpected as a player resumes higher-intensity throwing; the key is proactively taking steps to quiet the symptoms before they turn into a larger problem. It appears that is what the Orioles are doing in the hopes that Wieters can resume activity within the span of a week, give or take a few days.
Although Opening Day had been shaping up as a possibility, it was never an absolute. The big picture of Wieters’ elbow health has always been at the forefront of the plan for both him and the team. With that in mind, there’s hope that this is just part of Wieters’ normal recovery process, happening sooner rather than later.
The Toronto Blue Jays may have the most unusual rash of spring training injuries among all 30 teams, some more devastating than others.
On the day I visited camp, the mood was overwhelmingly positive. Outfielder Michael Saunders had just taken swings in the cage for the first time since undergoing meniscus surgery on his left knee and was feeling great. A bizarre injury that could have sidelined him for multiple months (his foot planted on a sprinkler on a practice field on the first day of camp while he was shagging balls) looked as if it might not cause him to miss much, if any, time at all. Shortstop Jose Reyes, no stranger to soft tissue injuries throughout his career was upbeat about how his legs were feeling heading into his age-31 season. Edwin Encarnacion's back flare-up was expected to sideline him a few days but did not appear to be serious. There were smiles all around.
The joy was short-lived however, tempered by the news that young pitching ace Marcus Stroman had torn his left ACL, fielding a bunt of all things. When GM Alex Anthopoulos made the somber announcement he pointed out that Stroman was injured doing something he’s done “a million times.” The unexpected nature of this type of serious injury to a pitcher (his ACL, not his UCL) combined with the simple means by which the injury happened seemed to leave the club stunned.
The good news for Stroman is that he is young and is considered one of the best athletes on the team. The rehab process is arduous, but he is well-equipped to endure it. There aren’t a lot of comparisons available to us as far as pitchers returning from ACL surgery, but there is no compelling reason to think Stroman won’t have success. Perhaps the most notable ace to tear his ACL and stage a successful comeback was Yankees closer Mariano Rivera. Rivera tore his ACL while shagging fly balls in the outfield in May 2012 ... at 42 years old. But No. 42 returned the following year, at age 43, to put his signature on a historic career, amassing 44 saves during his final season.
Rivera was a closer, however, and Stroman is a starter. What about the comparison there? Well, longtime Milwaukee Brewers starter Yovani Gallardo, now with the Texas Rangers, tore his right ACL in May 2008 in a game situation (specifically a contact injury resulting from a collision at first base). Gallardo, who was 22 at the time, not only returned successfully, he returned the same season, for one regular-season and two postseason starts.
There is one difference, however. Both Rivera and Gallardo tore their right ACL and both are right-handed throwers, meaning the injury was to their push leg. In Stroman’s case (also a right-handed thrower), his injury is to his left knee, making this an injury to his landing leg. Not that it makes Stroman’s successful return any less likely. The demands on the landing leg have more to do with control and balance, as opposed to power and drive, requiring slightly different emphasis in return to play functionality. Without a doubt, those elements will be specifically targeted in the course of Stroman’s rehabilitation.
The key for any pitcher returning from a significant lower-extremity injury is restoring normal strength, power, balance and mobility prior to aggressive throwing to ensure there are no compensations that travel upward to the throwing arm. (See: Garrett Richard of the Los Angeles Angels who is returning this season from a patellar tendon rupture in his left leg. Incidentally, the injury is also to Richards’ landing leg.) Assuming all progresses well through the course of his rehabilitation, Stroman should be on track to start next season.
It didn’t end with Stroman. The latest Jay to suffer an unusual injury is outfielder Kevin Pillar, who sustained a Grade 1 (mild) oblique strain while sneezing. Although oblique strains can be resistant to healing, the most minor variety -- which it sounds like is the case for Pillar -- can resolve within a week to 10 days, leaving the possibility open that Pillar could be available for the start of the season, barring another hard sneeze.
In the meantime, the Jays can take comfort in the solid progress of Saunders. He told me the way his knee has progressed since surgery he would be “shocked” if he weren’t ready by Opening Day. Saunders reiterated, however, that he would do what his knee "tells him to do." Ultimately, no specific date is a lock for his return, rather he will see how his knee responds to each more aggressive test. This week, Saunders is expected to DH in a game, the next measure of ramping up for him. After a 2014 season with injuries aplenty, Saunders is eager to stay on the field once he returns.
And the Jays must be hoping this string of unusual injury events is behind them.
By now everyone is aware that the New York Mets have lost their young pitcher Zack Wheeler to a torn ulnar collateral ligament. On the date of my visit to camp, Wheeler had merely been scratched from his start because of tenderness in the elbow. It was later determined that he had actually torn the ligament. Wheeler is now expected to undergo Tommy John surgery and will miss all of the 2015 season.
On the same day, the Mets were on the verge of receiving bad news with regards to Wheeler, there was also good news to be found. Veteran third baseman David Wright hit his first home run of the spring. It also happened to be his first home run since July 2014. It didn’t just creep out of the park either. It was a smash over the centerfield wall, a signal perhaps that the power that eluded Wright and his injured left shoulder in the second half of last season might just be returning.
This display of power is significant because Wright’s diagnosis, at least on the public face of it, was vague. That’s not necessarily atypical of shoulder conditions, particularly when inflammation in one area can impact surrounding tissues causing the entire joint and the supporting musculature to be problematic. When there is not a clear-cut “fix,” as is the case, for instance, with Tommy John surgery to reconstruct a torn ulnar collateral ligament, the outcome of a global rehabilitative approach is seemingly less predictable. That is not to say there cannot be excellent outcomes but the combination of the often multifactorial nature of shoulder problems and a non-specific injury make for a trickier path.
Wright first began having problems with his shoulder after a headfirst slide in a muddy field in June. He played through it, but his power was clearly impacted. A series of cortisone shots in July followed by movement in and out of the lineup in July and August eventually culminated with Wright undergoing an MRI and being shut down in September. At the time, Wright was dealing with “persistent inflammation in the rotator cuff in the left shoulder,” according to the Mets. Wright later underwent an MR arthrogram (using contrast dye to enhance imaging), revealing ligament involvement, contributing to shoulder instability for Wright. This would help explain the intermittent nature of the problem as well as the chronic pain, inflammation and functional loss of power Wright was experiencing.
Rest definitely helped with the pain component and Wright said he was completely pain-free in January, focusing at that time on continuing to build up strength in his shoulder. The real test for how the rest and rehabilitation would work, however, would not come until Wright began taking spring at-bats in game situations. The home run on March 14 showed Wright still has it in him to deliver the power, the remaining question is whether that can happen on a consistent basis.
There is no reason to think otherwise, barring re-injury. The most likely method of re-injury? A headfirst slide or a diving play where the shoulder ends up in a vulnerable position. According to ESPN New York's Adam Rubin, Wright, now 32 years old, acknowledges that avoiding headfirst slides might be wise. He and Mets manager Terry Collins also seem to agree that targeting less than 162 games is reasonable, with strategically-placed days off here and there as part of Wright’s health management.
The trade-off would certainly be a welcome one if it helps Wright -- who has dealt with severely limiting hamstring and shoulder problems the last two years -- be more productive across a broader spectrum of the season.
After all, the most obvious element of Manning’s physical struggles in that game was the flu-type illness he was battling throughout the contest. Visibly uncomfortable to the point of vomiting intermittently, it was remarkable that he not only finished the game but also managed to pull out a win. It appeared he might not return after halftime, but restoration of fluids during the break, along with a dose of that vintage Manning elixir that allows him to persevere -- part stoicism, part stubbornness and a heavy quantity of work ethic -- kept Manning out on the field.
It turned out the illness was not his only physical adversary that day, however. Manning also injured his right quad in the second quarter on a rollout play to Emmanuel Sanders. While he didn’t discuss it much in the postgame media session, Manning did blame his thigh injury on dehydration, noting he needed four IVs between the evening prior to and the morning of the game to replace the fluids he had lost from being sick.
The team referred to Manning’s injury as a thigh strain in subsequent injury reports, but his official questionable designation heading into Week 16 reflected the seriousness of the problem. Outside of the year he spent recovering from neck surgery (anterior discectomy and fusion) and the nerve impairment that accompanied it, Manning had never missed a game in his 17-year career, a remarkable statistic for any NFL player, regardless of position. The fact that the team was listing him as only 50-50 to take the field because of the thigh injury indicated the level of concern. Despite being less than 100 percent healthy, Manning did play in Week 16, to the surprise of, well, no one. There isn’t a soul who expected him to sit out a game with a thigh strain, even if it compromised his mobility, as long as he was functional enough to perform his quarterbacking duties and to protect himself from more serious injury. In other words, in the absence of a complete quadriceps tear that would leave him unable to walk normally, much less run in any capacity, Manning was going to play.
So why should we be surprised to learn the day after the Broncos’ playoff loss to the Indianapolis Colts that Manning was battling a significant injury for the past few weeks?
We shouldn’t be, although recent details provide further context. According to ESPN’s Adam Schefter, Manning’s injury was a torn right rectus femoris. The rectus femoris is one of the four muscles that comprise the quadriceps, the large muscle group on the front of the thigh. Specifically, it runs from an attachment at the pelvis toward the knee where it blends with the other quad components, forming a broad tendon that passes over the kneecap and attaches on the front of the tibia (shin bone). The rectus can both flex the hip and extend the knee. A significant injury to the muscle would lead to the bleeding and bruising that has now been reported and, just as was evidenced by Manning’s limited practice sessions, would limit his mobility and strength through the lower extremity.
From the beginning, the injury was reported to the degree required by the league. Manning was listed on the Broncos’ injury report daily since sustaining the injury in Week 14 with the appropriate body part (thigh) listed by his name and his level of practice participation was properly documented. Manning has never been one to speak in much detail when it comes to his injuries. And as is the case with all NFL players, once Manning was deemed healthy enough to meet the medical criteria for taking the field, he was active. The level at which he would be able to perform -- and sustain that performance for four quarters of an NFL game without an in-game setback -- was unknown. (See: Rodgers, Aaron. He also entered a divisional playoff game with question marks after nursing a muscle injury for several weeks.) Game conditions, particularly in a game that has the opponents coming from all directions at top-flight speed, simply cannot be accurately replicated in the rehab or practice setting. Players do their best to recover between outings to the point of being highly functional, but that does not necessarily translate to full recovery.
With an eye on getting as close to full health as possible, Manning did not participate in the team’s two practices during the Broncos’ playoff bye week. In fact, he didn’t even appear on the practice field, a highly unusual occurrence for Manning, instead spending time in treatment. While many of his teammates took advantage of a four-day weekend during the bye, Manning reportedly stayed in town to continue his treatment. He returned to practice the following week and participated daily. ESPN.com Broncos reporter Jeff Legwold said Manning appeared “more comfortable” moving on the practice field last week than he did prior to the team’s regular-season finale against the Raiders, although he still didn’t look to be quite himself. Still, those reports didn’t foretell the performance that would unfold on Sunday.
Perhaps they should have. Manning’s neck surgery provided him with added spinal stability, at the (necessary) expense of some mobility. This, combined with the extensive time needed to regain upper-body strength, likely required Manning to increasingly rely on the strength and torque through his lower body and core to help deliver the football. Consequently, teams have approached defending Manning a bit differently of late, according to Legwold, in a way that could make an injury like the one to his thigh far more limiting.
“Opposing defenses are strategizing, trying to crowd the pocket and create traffic around his feet, giving Manning less room to stride and effectively making it harder for him to throw,” Legwold said. Manning has never been a running quarterback, and taking away his comfort zone will challenge his ability to be effective. Add into the mix an injured quad on Manning’s plant leg, and it is easy to see how his throwing, especially on the intermediate to deep routes, could be further compromised.
And so it was with Manning on Sunday. He appeared to struggle throughout the game, increasingly so as the clock wore on. Injuries have not been a big part of his narrative -- certainly not before his neck surgery -- but that may be changing. While most of the attention has been paid to his neck and arm in the time since surgery, it is the lower extremity ailments that have challenged him in the final weeks of the past two seasons, a high/low ankle sprain combination last year and a quadriceps injury this year. In the aftermath of Sunday’s loss, a 38-year-old Manning seemed uncertain about his future, saying he is still “processing it.” There is no reason to think he can’t fully heal from this latest injury; the bigger question may be whether another season-long physical endurance test is in the cards.
There is little doubt that Aaron Rodgers and his injured calf benefited from the extra week of rest that came with earning a playoff bye. There is also wide acceptance that he will not be 100 percent healthy by Sunday afternoon when the Packers host the Cowboys in a divisional playoff game
Everything else is unclear.
The last time the Packers played, Week 17 of the regular season against the Detroit Lions, Rodgers aggravated his calf strain but gamely returned to finish the game, despite his impaired mobility. There was no reason to think he might be in danger of missing the team’s first playoff matchup, especially with an added week of recovery. Rodgers’ continued absence from practice in the early part of this week, however, only led to further discussion about the severity of his injury and how it might potentially impact his performance.
Despite all the continued conversation, has anything really changed since Rodgers last set foot on the field?
The answer is simple: No, not really.
This injury has always been reported as a calf strain; initially Rodgers suffered an injury in Week 16 to the medial gastroc, or inner calf, followed by a more lateral pull a week later, according to ESPN.com’s Rob Demovsky. A strain is the term applied to injuries of a muscle or tendon. Strains, ranging from mild (Grade 1) to moderate (Grade 2) to severe (Grade 3), represent a continuum of tissue damage from microscopic in the most minor cases to complete disruption of the structure in the most severe. The severity of Rodgers’ injury has never been reported, but given his level of function -- including finishing his last game -- it’s fair to assume it was not a complete tear. Beyond that, only the medical personnel caring for Rodgers have information (such as imaging and physical examination) that indicates specifically where within his calf the injury is located and the extent of tissue damage.
Here’s why those details don’t matter:
At the end of the day, it has been and continues to be a question of how functional Rodgers can be on Sunday. Rodgers has relied on his mobility throughout the course of his career to extend plays, presenting the dual threat of a quarterback with pinpoint accuracy who can deliver on the move. Just how mobile he can be in the presence of a still-healing calf injury is unknown, both in terms of pushing off his left foot and in absorbing load through his left leg. The Packers are likely to make adjustments to help minimize some of the normal game stress on Rodgers’ calf. For instance, more snaps from the shotgun would decrease dropbacks and the associated footwork. His spontaneous movement outside the pocket is unscripted, however, and just how effective he can be there remains to be seen.
If there is a silver lining, the injury is on Rodgers’ left side, meaning the right “plant” leg he uses to drive the ball when he throws is unaffected. In fact, Packers quarterbacks coach Alex Van Pelt acknowledged one such glass-half-full observation for his star right-hander Thursday. “It’s better than a right calf [injury],” Van Pelt said. “As your plant foot, your right foot, it takes a lot of the pressure anytime you have an injury to your plant leg, it’s difficult to drop.”
All the treatment Rodgers has received thus far in conjunction with his activity restriction the past two weeks has been aimed at readying him -- to the degree that it is possible -- for competition this Sunday. Rodgers participated in a limited practice session Thursday, taking about 50-60 percent of the reps during team drills and did “everything we asked him to do,” according to head coach Mike McCarthy. Even if Rodgers were to put in a full practice, there is no way to fully simulate the demands of an actual game nor the adrenaline that comes with it, all of which can influence the stress on the injured limb and the ability to overcome any potential in-game setback. The Packers just have to hope those game demands will not exceed the healing that has occurred to date. Of course, the only way to know for sure will be if Rodgers gets through the weekend unscathed.
As for Rodgers, he seems to know there is no use in dwelling on uncertainties. When asked just how much he’ll be able to do Sunday, his answer was about as honest as it gets. “We’ll see,” he said.
He’s right. We’ll see.