Yankees cautious with Pettitte's injury
July, 19, 2010
By Stephania Bell | ESPN.com
The All-Star break has not been kind to the New York Yankees. First, they lost their iconic owner on the very day of the All-Star Game. As the team mourned George Steinbrenner when play resumed, there was at least comfort in knowing they were atop the American League East with a solid slate of starting pitchers.
Or at least it appeared solid, until last weekend. It was bad enough that the Yankees lost A.J. Burnett early in Saturday's game as the result of a self-imposed injury borne out of frustration. (Burnett has said, however, that he will make his next scheduled start.)
The bigger loss came the following day when lefty Andy Pettitte, off to perhaps one of his best starts to a season ever (11-2, 2.88 ERA), made an early exit with what was later revealed to be a Grade I groin strain. Pettitte left in the third inning after feeling what he described as a "burning sensation" in his left groin, according to the Newark Star-Ledger. The team has indicated that they expect Pettitte to miss approximately four to five weeks and the question for all fantasy owners naturally is, "Is that realistic?"
Jim McIsaac/Getty ImagesAndy Pettitte is expected to miss at least a month of action, which is in line with similar groin injuries.
The answer, quite simply, is yes.
In fact, for this type of injury to the push leg of a pitcher, it would not be surprising for the range to extend in some cases up to six weeks. While the time frame itself is fairly straightforward, the rationale for it is more complex.
Here are some of the factors that need to be considered when evaluating the impact of this injury on Pettitte:
1. The injury has been reported to be a Grade I (mild) strain. Of the three grades of muscle strains (I, II, III), I is the least severe. While it is certainly better to have a Grade I strain (where pain is present but typically there is minimal loss of range of motion and strength) than either a Grade II (which would indicate more extensive tissue damage) or a Grade III (which would represent a complete tear and would be season-ending), there can still be significant variability among mild strains. The size and extent of injury, while minor overall, can still differ within this classification, with bigger ones being more problematic. Some strains will have more inflammation associated with them than others, which may project to more healing time. These variables influence the projected return to play time for an athlete.
2. The "groin" is not an isolated muscle. In fact, the term "groin strain" is used to represent injuries to any one of the six adductor (inner thigh) muscles. It may also be utilized in reference to a deep lower abdominal strain. The attachments of some of the adductor muscles and lower abdominals are very close to each other and an injury to any of them can result in pain in the groin area. Depending on which muscle is involved and how it contributes to the athlete's function at his position, the timetable for return to play following injury can vary substantially. One of the benefits of the athlete undergoing imaging testing such as MRI is to help localize which muscle or group of muscles is involved and to what extent. Pettitte underwent an MRI before the team issued its timetable, suggesting that what they saw contributed to their overall assessment.
3. The groin muscles have a very complex function in a pitcher, especially on the push leg. While a groin injury on either side would be problematic for a pitcher, it is perhaps more so when it is on his push leg, or the leg that is on the same side as his throwing arm. The adductor muscles are generally thought of as muscles that "adduct" the thigh, or bring it inward across the body. When the leg is in the air, that's true. For instance, a soccer player who kicks the ball across his body -- from left to right -- with his left leg, is using his left adductors in this way.
When the foot is on the ground, however, particularly in one-legged stance, the adductors take on a whole new but critical role: stabilizing the entire leg and pelvis. The lower abdominal muscles also contribute to stability of the pelvis and trunk.
Picture Pettitte going through his pitching motion. As he moves from his start position through his windup phase, he transfers all his weight to his back (left) leg, on which he must balance as he raises his right leg in front of him. He is also rotating during this motion, meaning the groin muscles are dynamically contributing to his stability and balance as he moves on a narrow (single leg) base of support.
As he moves through his stride phase, the groin muscles have to continue to control his stability as he begins to transfer energy from the leg up through the trunk to the throwing arm, all while his body weight is shifting toward his lead (right) leg. As the legs separate during the stride phase, the groin muscles have to continue to contract to control stability, while simultaneously lengthening to allow the stride. This dual demand on the muscles makes this a vulnerable point for injury.
The burden of muscular work for the lower half of the body transfers to the lead leg as the pitcher has to bring his body weight up and over during ball release and follow through. Any weakness or limitation in the push leg, however, can render the lead leg more vulnerable if mechanics are impacted in this phase.
The bottom line here is that there is far more involved in returning a pitcher to throwing effectively following a groin strain than simply waiting for the initial pain to improve. Consequently the timetable has to allow for a progression of activity from simple exercise to playing catch to throwing with intensity to allow the muscles to gradually adapt.
4. Incomplete healing of muscle strains at the time of return to play can lead to setbacks. Second-injury setbacks are often more serious in nature and can result in extended down time. As a result, more and more teams are erring on the conservative side when it comes to these types of injuries as a means of ensuring that they do not lose a key player for an even longer period or at a critical (read: playoff) time.
With all these factors taken into consideration, it appears that the timetable issued for Pettitte is indeed reasonable. It's also worth considering that Pettitte is 38 years old, which means the healing probably comes a bit slower. It is possible that he could beat the time frame, but even if he does, it's likely to be by a matter of days, not weeks. The risk of an extended absence due to a second injury would be far greater than the reward of one extra start. Besides, the Yankees want Pettitte to come back when he's ready to resume the form he's already shown in 2010.
Fantasy owners should be patient. After all, isn't that what we all want, too?