Sunday, March 8, 2009
Yankees fast-tracking A-Rod rehab
By Stephania Bell, ESPN.com
Just when it seemed that Alex Rodriguez might be headed down the path of conservative management (aspiration of the cyst followed by rest and rehab), his treatment course took yet another turn.
The Yankees have now announced that Rodriguez will undergo a surgical procedure on his problematic right hip that should have him back on the field within six to nine weeks. Six to nine weeks? Just a few days ago we were saying a 10-week projection was optimistic, especially given that Chase Utley and Mike Lowell are rounding the four-month mark following their respective hip surgeries, and they're still not locks for their Opening Day lineups.
So how is it possible that Rodriguez could return from his hip surgery so quickly?
The only plausible scenario, which the Yankees have confirmed, is that Rodriguez's intended surgery will be less complex, at least for now.
Simply put, many labral repairs also require some bone work or resurfacing of the joint. A condition known as FAI (femoral acetabular impingement) often exists in conjunction with labral tears. In basic terms, it describes a scenario in which the femur (thigh bone) and the acetabulum (the bone that forms the hip "socket" for the femur) repeatedly come into abnormal contact in certain hip positions as a result of an athlete's particular anatomy combined with the demands of his sport. That repeated abnormal contact, or impingement ("pinching"), can lead to bone issues such as spurring, and over time, can ultimately result in damage to the labrum, as well as the cartilage surface.
The bone can be burred or remodeled to eliminate the presence of impingement, but the bone is more fragile initially after this procedure, and thus the rehab is slowed accordingly to allow proper healing. The time frame for healing (normally given as four to six months for return to sports) incorporates adequate time for the bone to heal, along with the labral repair. This is the timetable that has framed Utley's and Lowell's rehabilitations.
One of the biggest challenges A-Rod faces in his rehab is the ability to make the throw from third to first while pushing off on his repaired hip.
Surgery to repair the labrum alone, without addressing any underlying bone issues, results in a shortened time frame. During surgery the damaged piece of labrum is either repaired or resected (removed), depending on the extent and location of damage. Since the labrum does provide some protection for the joint surface itself, surgeons aim to preserve as much of the healthy tissue as possible. Following surgery, the athlete is required to go through a "protective" phase, during which the amount of weight-bearing is limited to allow the tissue to heal, and range-of-motion and strengthening exercises are increased incrementally. Later in rehab, the athlete returns to weight-bearing exercises, which then get more complex in scope (meaning they start to look sport-specific -- baseball-type exercises, in Rodriguez's case -- as opposed to basic leg-strengthening exercises). Once the athlete has demonstrated sufficient strength and stability, he can return to sports drills and eventually return to play. Complete recovery from a labral resection or repair typically ranges from 10 to 16 weeks. This scenario allows Rodriguez to return for the majority of this season, with the announced second surgery in the postseason to address any bone issues.
Perhaps most important, it appears that the Yankees, Dr. Marc Philippon (the hip specialist who will perform the surgery in Vail, Colo.) and Rodriguez have carefully evaluated the options and come to a consensus as to the best approach. For Rodriguez as a patient, this is the most significant component in moving forward.
Let's face it: Rodriguez is an amazing athlete who will no doubt work diligently to get back as quickly as possible, but it is still a challenging rehab schedule that presumes zero setbacks. It is worth bearing in mind that Rodriguez has sacrificed the majority of his spring training while dealing with his hip problem. It is a fact of baseball life that most players need a month or so to shake off the rust of the offseason. So is it reasonable to expect Rodriguez to hit the ground in midseason stride?
It's certainly possible, but consider all the tests his hip will have to pass. He needs to be able to turn, with power, on a high-speed fastball, something he acknowledges he has been struggling with since the hip became problematic. He needs to be able to rush bunts from third base. And perhaps the biggest challenge for that right hip will be turning and pushing off it to make that tough throw from third to first. If his hip muscles have been weakened because of the presence of the paralabral cyst (which has since been aspirated), it may take extra time to get that strength back.
The Yankees have said they will be very aggressive in getting Rodriguez back on the field, but that is different from saying he will be back right away to the elite level we're accustomed to seeing. Because he's Alex Rodriguez, the Yankees are likely willing to let him get into game shape while in the lineup, so don't be surprised if the initial on-field results are less than spectacular. However, once he's cleared every hurdle, we can expect to see the A-Rod of old finish the season.