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The prognoses for David Wright, Victor Martinez

16h
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David Wright diagnosed with spinal stenosis

Adam Rubin discusses Mets' third baseman David Wright's diagnosis of spinal stenosis, how it affects Wright moving forward and the Mets as a franchise.

Editor's note: Stephania appeared with Eric Karabell on the the Fantasy Focus Podcast to discuss the injuries to David Wright and Victor Martinez. Here are her extended thoughts on both injuries.

Remember when the main health concern for David Wright coming into the 2015 season was his left shoulder? After limiting him intermittently throughout last season, the big question this spring was whether an offseason dedicated to rehab would allow him to return to form. A home run in a spring game in March seemed to answer the question about his potential to restore his power. When the season opened, everything for Wright appeared to be in order.

Until it wasn’t.

The shoulder was no longer an issue; instead it was a hamstring injury that sent Wright to the DL in mid-April. It did not look good as Wright got caught in an awkward position on an attempted steal, but appearances are sometimes deceiving when it comes to injury severity, and reports suggested a mild strain. On the plus side, Wright was certainly familiar with the rehab course for a hamstring strain after being sidelined by a significant one for over six weeks (also to the right leg) in 2013. The Mets indicated they expected he would be ready to return to action within three weeks.

Until he wasn’t.

Now an episode of back pain interrupted Wright’s hamstring rehab course. This isn’t an unusual occurrence, given the common association between lower back dysfunction and hamstring issues, especially when an athlete has a history of prior low back and hamstring injury, as Wright does. After the team indicated this was specifically not a recurrence of a spinal stress fracture (the injury that sidelined Wright for more than two months in 2011), there seemed to be optimism this would be a quick resolution.

But it isn’t.

Wright has been diagnosed with spinal stenosis, and he is being further evaluated by noted spine specialist Dr. Robert Watkins in Los Angeles this week. Watkins oversaw Wright’s care following the stress fracture. While the term spinal stenosis sounds daunting, there is a wide range of presentations from mild to severe, depending on the specific case.

First, there are two primary types of spinal stenosis. Congenital spinal stenosis is a condition present from birth. It describes the narrowing of the spinal canal, the bony canal formed by the vertebral column that houses the spinal cord. It is rarely diagnosed until or unless the individual experiences an episode of neurologic symptoms that hint at the condition, which is then confirmed by imaging. The symptoms -- typically brought on by an extreme motion of the neck -- range from burning or tingling to numbness and weakness, and are present in multiple extremities (both arms, both legs or arms and legs).

This type of stenosis is often revealed in a contact or collision sport such as football. Once recognized, the treatment typically involves surgery and precludes further participation in high-risk sports. It has prematurely ended the careers of athletes such as Sterling Sharpe, David Wilson and Cooper Manning (brother of Eli and Peyton).

The other form of spinal stenosis is acquired, and this is most likely the condition affecting Wright. While congenital stenosis most often presents in the cervical or neck region, lumbar or low back spinal stenosis is usually the result of changes over time to the local anatomy as the result of injury, chronic postures and/or wear and tear. The decreased dimensions of various regions of the lumbar spine can result in neurological compromise, which leads to the symptoms the patient experiences most often: Pain, numbness and tingling into either or both of the lower extremities, although there can also be localized back pain. The symptoms tend to be most provoked by extension (arching) or rotation/twisting movements, movements necessary to swing a bat effectively.

The treatment is also variable, depending on the source of the stenosis. If an acute inflammatory episode is contributing to the condition, then resolution of the inflammation -- whether through oral medication or injection -- should help quiet the symptoms. If there is local functional instability -- which is sometimes the case following a prior stress fracture in the spine -- then local strengthening targeted at the specific muscle groups that control functional spinal stability (think: deep abdominals) is the treatment focus. Altering spinal mechanics to adapt to the condition is a primary objective.

While the specifics of Wright’s case have not been made public, it would not be surprising if he is dealing with a form of this lumbar spinal stenosis. The rehab course would be familiar to him (as it would be similar to what he engaged in following the stress fracture), and barring an unexpected development, he should be able to progress back to a return to baseball. The timing of the issue is the challenging aspect, given the wide range of time frames for recovery and the fact that it is often nonlinear. Setbacks or even brief plateaus along the way are not unheard of, making a timetable projection difficult, but it is likely one of weeks, not days. The most telling information regarding the next steps should come after Wright consults with Watkins.

Victor Martinez

Wright wasn’t the only veteran entering the major league season with an injury concern. The 36-year-old Martinez underwent surgery to address a torn medial meniscus in his left knee in early February, the same knee on which he had major surgery in January 2012.

Martinez made a quick recovery this time around. He was taking batting practice a month after surgery, was performing agility drills at five weeks and was in spring games just six weeks post-op. Martinez was in the Tigers’ Opening Day lineup, despite some residual knee soreness ... which may have hinted at some of the challenges to come.

Since Opening Day, Martinez has had a couple of minor episodes with his surgically repaired knee, including feeling a “pinch” in the back of the knee on a swing and a miss in the first week of the season, and a similar “pinch” while baserunning just more than a week ago. The latest setback led to the team placing Martinez on the DL, and he is currently rehabbing in Florida.

The most telling aspect of how Martinez’s knee has impacted him so far may not be in the "pinching" episodes, but in his performance at the plate. He has had decidedly different success when batting from the right versus the left side of the plate, and it shouldn’t come as a huge surprise. When batting left-handed, the power and drive for the swing is coming largely from the left leg, which for Martinez is his twice-surgically-repaired leg. And, he is struggling to generate power from that side. His average against righties sits at just .141 against (compared to .462 against lefties), and his slugging percentage is just .153 (compared to .654 against lefties) on the year. It is the contrast in his performance from the two sides of the plate that implicates the left knee as a significant factor.

The key for his return will not solely be about the comfort level of his knee; Martinez has proven himself to be an incredibly tough player who will push through discomfort to be on the field. The key will be whether he can generate enough strength through that leg to translate to effectiveness at the plate. It may be a challenge to try to recoup that strength in just a few weeks, given that it has already been more than three months since the procedure, and the integrity of the knee joint is not what it once was, just by virtue of having undergone multiple surgeries. Intermittent joint irritation and swelling, not unusual after multiple surgeries, can inhibit muscle performance no matter what the strength capacity is.

It’s certainly too soon to say that Martinez can’t regain his duel-sided efficiency this season, but it’s also reasonable to have concern about whether it can be re-established on a consistent basis.