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Colorado Rockies shortstop Troy Tulowitzki underwent surgery in Philadelphia Thursday with Dr. William Meyers to address an injury in the left groin region. The injury has been described as baseball pitcher/hockey goalie syndrome, one of the many variants of a cluster of injuries that fall under the header "athletic pubalgia." The word "athletic" is easy enough to understand. "Pubalgia" refers to pain in the pelvic region, specifically injuries involving the abdominal and pelvic musculature in the front of the pelvis that are not part of the ball-and-socket hip joint. Injuries in this area have commonly been termed "sports hernias" in the past, but the medical experts who treat these conditions seek to do away with the term. The sports hernia is not a true hernia at all, nor is it one single injury but rather myriad syndromes that require careful evaluation and individualized treatment. The more descriptive term "core muscle injuries" is preferred by experts such as Meyers to describe these ailments, instead of the less accurate "sports hernia" or more difficult to pronounce "athletic pubalgia."
|This will be the third time in the past five seasons that Troy Tulowitzki has missed at least 40 games.|
Core muscle injuries in this athletic population most often represent tears or defects in the abdominal or groin musculature. Baseball pitcher/hockey goalie syndrome was so named because of the athletes who typically suffered the injury. The repetitive twisting and torque-inducing motions that go along with their sports seemed to render them vulnerable. Clearly the injury is by no means exclusive to this group, and shortstops like Tulowitzki perform repeated quick lateral movements and cross-body throws that impose similar demands.Tulowitzki's recovery has been projected at about six to eight weeks. The rehab is not particularly different from that of a significant muscle strain. Controlled activity in the early stages with a focus on mobility is followed by gradually increasing intensity of workouts and an eventual return to baseball-specific activities. The key is achieving a balance of flexibility and strength throughout the entire core system and the lower extremity muscles. Tulowitzki's history of a torn quadriceps in 2008 is not insignificant here, as it may have led to compensations that contributed to this injury. The hope is that the surgery will provide some immediate relief, but maintaining core stability and flexibility going forward will be key to keeping Tulowitzki on the field.
Brandon Beachy's partial ulnar collateral ligament tear turned into a full-blown ligament reconstruction surgery Thursday. Beachy underwent Tommy John surgery with Dr. James Andrews after consulting with the renowned orthopedist just the day before. The swift move to surgery suggests there was little doubt that the confluence of findings made surgery the only option for Beachy. After all, the 25-year-old had been performing well for the Braves this year, with a 5-5 record and a major-league-leading 2.00 ERA. An abrupt halt to a strong season is rarely recommended unless the evidence points clearly in that direction.
We often hear of pitchers with partial tears opting for a rehab-first course of treatment, which typically involves a period of rest followed by a gradual return to a throwing program. Sometimes the pitcher is able to return to competitive pitching (e.g., Adam Wainwright, who had a partial tear in 2004 during his minor league days and not only returned to pitching but moved up to the majors for five years before his elbow finally gave out in 2011, requiring Tommy John surgery). Other times the ligament fails during the rehab course and surgery is then required (e.g., Jamie Moyer, who, after injuring his elbow in 2010, attempted to return until his elbow gave out completely during an outing in Dominican winter ball). Either way, the opportunity to attempt a course of rehabilitation helps ensure that should the time come for the pitcher to undergo reconstructive surgery, he is convinced there are no other alternatives and is committed to the lengthy recovery process.
Sometimes, however, the circumstances are such that the need for surgery is immediately apparent. Contributing factors may include imaging suggestive of a substantial ligamentous tear, perhaps in a critical portion of the ligament or accompanied by other tissue damage in the area, a clinical exam (series of movements and tests the surgeon puts the athlete through designed to reproduce pain and/or instability) that confirms the injury, the athlete's history (such as underlying discomfort or difficulty throwing for a period of time prior to the actual injury episode) and his current ability to function in the presence of the injury. Any or all of these variables can point to surgery as the best option for an athlete, even in the presence of a tear classified as partial.
The good news for Beachy (there's always good news) is that youth is on his side and surgery now allows for the possibility of a return next year. Allowing for a timetable of approximately one year, Beachy could potentially be a second-half contributor in 2013.