Stephania Bell: Wilson Ramos

Nationals third baseman Ryan Zimmerman is acutely aware of how much his struggles with his right (throwing) shoulder affected him last season. The pain, which limited his hitting early on, and the restriction in his AC joint, which affected his ability to throw, were well known. The mental strain brought on by the situation was not as well-known but was equally difficult for Zimmerman.

"You're struggling in front of 50,000 fans," Zimmerman said. "As baseball players our place where we're comfortable is on the field. And then I wasn't. It's not something I had ever experienced before."

Zimmerman first began experiencing discomfort in the shoulder last spring, but it was mild and intermittent and he didn't think much of it. The pain worsened during the season, and the first area of his game affected was his hitting. "I was compensating by guarding to avoid the pain," Zimmerman said, demonstrating how he would avoid fully extending on his swing so he could keep his shoulder back in close to his body. (Incidentally, that position retracts the shoulder blade, or scapula, which also controls the position of the AC joint.) Two early cortisone shots did not help, and as the season progressed, Zimmerman knew something needed to change because he had become, as he calls it, "an easy out."

"We tried one more shot in a slightly different location," Zimmerman said, "and there was an immediate difference." At that point, hitting was no longer painful, and that was evident in the form of his sudden turnaround at the plate. But throwing became a huge problem.



Zimmerman said he couldn't feel where his arm was supposed to be to make a throw. He demonstrated moving his arm to different release points, searching for the right spot in space to position himself to throw the ball. The pain was no longer an issue, but restriction in the joint limited his movement and he experienced a lack of control and coordination of his arm. His defensive play clearly suffered as a result and Zimmerman just tried to get through the season, even taking one more injection to help diffuse the pain.

He knew surgery in the postseason was inevitable, but he wasn't sure until the October procedure was complete what exactly was required. Initial MRIs had shown inflammation in the area, but an MRI arthrogram (in which dye is injected into the region to better enhance the image) taken just before surgery hinted at a larger rotator cuff concern. Thankfully, the cuff turned out to be fine and the bulk of the problem was limited to the AC joint. Zimmerman says his surgeon, Nationals team physician Wieme Douoguih, essentially cleaned up the area by shaving down the edges of the bone and creating more space in the joint.

Zimmerman noticed the new motion right away, even remarking that he felt a little loose, especially near the front of his collarbone (where it attaches to the sternum or chest). As a result of overcompensating for stiffness at the far end of the joint, near his shoulder, Zimmerman's body had found a way to get more motion at the near end, not necessarily desirable. "I felt a lot of clicking in the front," Zimmerman said, pointing toward the sternoclavicular (SC) joint. He was quick to add that once he began to regain strength around his chest, upper back and shoulder, that mobility and the "loose" sensation have subsided. The joint now feels completely normal.

There is no longer any pain like before, according to Zimmerman, although he does acknowledge that he still gets sore and he is still regaining his strength. Hitting is not an issue at all, and his throwing is improving as he works through a progressive throwing program. Zimmerman appreciates that manager Davey Johnson has allowed him to increase his activity at a gradual pace, recognizing there are 162 games in the regular season and spring training is long.

On Tuesday, Zimmerman threw across the diamond for the first time since surgery and looked like he had indeed found that natural release point once again. The look on his face after batting practice said plenty, but he summed it up in a single phrase. "There's a lot more to smile about this spring."

Ramos returns behind the plate



Since tearing the lateral meniscus and ACL in his right knee last May, Wilson Ramos has been on the long road to recovery, culminating in Tuesday's appearance -- his first since the injury -- behind home plate. Ramos has done all the requisite drills. He's blocked balls behind the plate, he's run the bases, he even added sliding just last week. But until this week, he had not functioned as a catcher in a game situation in nearly a year.

Ramos was clearly beaming when I spoke to him at his locker. Not only did he say he was "excited" about playing in a game at least five times, but the smile on his face conveyed how much he had been anticipating this moment. He acknowledged that today represented a big step. "It's not the same as blocking, bullpens," Ramos said, adding, "It's faster, you are more excited." He gestured with his hands and looked around as if he were scanning the field to make his point. "Thinking about plays, where the ball is coming from, where you need to throw ... it's more ... excited."

The play that sent Ramos to the DL for months was so seemingly minor; he still appeared bewildered that the result was so drastic. He leaned over casually to scoop up a ball when his knee collapsed. The next thing he knew, his season was over. After meniscal repair in June, Ramos underwent ACL reconstruction approximately six weeks later. The main focus in therapy initially, as is typical, was regaining motion. "Up and down, up and down with my knee," said Ramos. As he moved through the phases of rehab, he could feel his knee getting stronger but remained apprehensive about performing some of the higher-level drills.

"I was nervous about sliding," Ramos said, "because I always bend my right knee, not my left." But after he got through slide drills and realized he was fine, Ramos was eager to get back behind the plate. He says the power in his right leg is not quite the same as his left, but that is to be expected. So is the stiffness he still feels in the morning, which disappears as he warms up. The knee will continue to improve even after the regular season is underway.

Tuesday marked a major milestone for Ramos as he caught three innings, even if the opponent was a largely minor league Houston Astros squad. He moved freely behind the plate, blocking several balls by dropping to his knees without hesitation.

And that is a good reason to be excited.

Haren gets in better shape



Dan Haren went on the DL for the first time in his career last season due to back stiffness. Despite his stoicism, the ailing back was clearly impacting his performance. He was able to return shortly after the 15-day minimum and remained relatively healthy across the remainder of the season, even if his results on the mound were somewhat inconsistent.

Haren stayed on a rehab program throughout the offseason, working several days a week with a physical therapist in California. He seemed to clearly grasp the importance of maintaining a combined strength and flexibility regimen to keep himself healthy going forward. "I like to understand what's going on," Haren said regarding why he took such an interest in the particulars of his rehab program. "Then I can report back to the [athletic] training staff what works and what doesn't."

He also recognized there was more to the issue than his spine.

"As you know, with back problems, you're not just treating the back, you're treating everything around it," Haren said. He worked on flexibility for his hips in particular. (His hip was said to be a reason some teams shied away from trading for him at the end of last season.) He also targeted core strengthening and he lost some weight. Most importantly, he says he feels great this spring and he intends to maintain his new regimen. Haren knows firsthand that regardless of how durable he has been, with age comes the risk of the wear and tear of the job catching up to the body. He's hopeful that his attention to his rehab and conditioning program will keep that at bay a while longer.

Uh-oh. Matt Kemp, one of the game's most durable players, who was off to an amazing start this season with a batting average of .359 through his last game played on May 13, has been felled by a hamstring injury. That most nagging injury of injuries has sent him to the DL, ending his consecutive-game streak at 399, an incredible accomplishment in this day and age. (Consider that next in line when it comes to active players is Prince Fielder with 216, according to Elias.)

[+] EnlargeMatt Kemp
Jayne Kamin-Oncea/US PresswireMatt Kemp hopes to miss just the minimum 15 days.
As recently as two days ago Kemp said, "I'm definitely not going on the DL; that's not going to happen. ... The team needs me. I don't think this is a 15-day thing." Kemp was right about one thing; his team needs him. As in, the Dodgers need him for the better part of the season, they may really need him late in the year in the event of a playoff run and they will definitely need him to be at full strength. So the decision to rest him, despite his objections, is wise in terms of the big picture. The hope is to avoid turning what may well be a minor injury that needs only a few days of rest into something that requires weeks or even months to heal. While it is discouraging to see the injury bug catch up with an athlete who has done so well to elude it, the sensible side of managing his health long-term has won out.

Nationals catch run of bad luck

It is difficult to recall a more unusual string of devastating injuries in seemingly back-to-back fashion on one team than what the Washington Nationals have faced this season. They stand out not only because of the number of players who have landed on the DL this season but also because of the serious and unusual nature of many of their injuries. And the catchers are at the top of the list.

Wilson Ramos, who endured a harrowing kidnapping experience in his native Venezuela last fall, suffered a season-ending ACL injury in his right knee Saturday. Ramos was scrambling to grab a passed ball when he had one of those awkward non-contact-knee-collapsing-inward moments that often signal an ACL failure. After he was helped from the field, an MRI confirmed the nature of the injury. The expectation is that Ramos will undergo surgery but the plans for the next steps have not yet been announced by the team.





With Ramos out, the Nationals called up 23-year-old Sandy Leon, a fellow Venezuelan, from Double-A Harrisburg to take his place. Leon, who initially did not know the injury to Ramos was the reason for his call-up, expressed sympathy upon learning the news. According to the Washington Times, Leon said, "I feel bad for him because he's from Venezuela and he's my friend. It's bad for him but it's good for me." Oops. It turned out to be not so good for Leon either, forced from his major league debut in just the fourth inning after a collision at home plate. The team reports the injury as a high right ankle sprain and Leon was immediately placed in a protective boot. Watching the injury called to mind San Francisco Giants catcher Buster Posey's injury last season, when a collision at home plate resulted in a twisting motion of his (in his case, left) ankle, tearing ligaments and fracturing his fibula. No word of the severity of Leon's injury, though.

In addition to Ramos and Leon, eight other Nationals are either on the disabled list currently or have been there this year, and it's easy to see how exasperating the season has been. One minute it's electrifying Bryce Harper highlights, the next minute it's the devastating loss of yet another player due to injury. And most of these injuries have time frames well beyond 15 days. Outfielder Jayson Werth suffered a broken wrist less than two weeks ago and is expected to miss several months. Pitchers Drew Storen (elbow) and Brad Lidge (sports hernia) are recovering from surgery and have begun light throwing. And then there's outfielder Michael Morse who suffered a setback with his torn right latissimus dorsi muscle in April while on a rehab assignment but hopes to return in June. (For a more detailed update on their rehab activities, check out this recent post by Amanda Comak in the Washington Times.)

Duffy is done

The Kansas City Royals can certainly relate to the Washington Nationals in the injury department. They have seen their fair share of players go down with serious injuries and have just added their young up-and-coming pitcher to the list. Danny Duffy, who had complained earlier this season of tightness in his left elbow and had a history of injury to his ulnar collateral ligament, now appears to be headed for surgery.

Duffy exited his most recent start after facing only three hitters. On his second pitch, Duffy felt what he said was "a tugging sensation and pain" in the elbow, according to the Kansas City Star. Duffy had missed a start a couple of weeks prior but seemed to be feeling better over his most recent outings, until last Sunday. Duffy is headed to consult with Dr. Lewis Yocum but it sounds as if Tommy John surgery awaits.

And finally ...

Comebackers can be hard on a pitcher ... literally. Tampa Bay Rays pitcher Jeff Niemann took one to the right ankle and testing ultimately revealed a small fracture to his right fibula (skinny outer lower leg bone that forms the outer side of the ankle), according to Marc Topkin of the Tampa Bay Times. Niemann likely will be out for well over a month as the bone has to heal, then he will have to build up his throwing. ... Meanwhile, Ivan Nova of the New York Yankees also absorbed a comebacker to his right ankle Monday night. He stayed in the game for three additional innings, then seemed to come down awkwardly when fielding a bouncing ball hit his direction. So far, no word of anything broken, but the team has called it an ankle contusion and a foot/ankle sprain. For now he is day-to-day. ... Meanwhile, closers continue to drop around baseball. Yankees interim closer David Robertson felt pain in his left side after throwing Friday night. The soreness lingered beyond what was hoped and he underwent further testing Tuesday. The result? A trip to the DL. If it follows the standard time frame for these types of injuries, expect him out for approximately a month.