Stephania Bell

  (11:04 AM)

Good morning Sports Nation and welcome to the Friday chat where we focus on the injuries plaguing our favorite teams. There is already a long list of questions so we'll get right to them...

Thaddeus (Denver)

Stephania, with regards to Tulo, is there any chance he will progess in his recovery to be back in the line-up before mid-July, or is it wise for the Rockies to bring him back slowly even if he is ahead of schedule. Also, what sort of impact will this sort of injury have on him after he comes back? In other words, will he be able to perform at a top level immediately or could it take several months to get everything going again? Thanks.

Stephania Bell

  (11:09 AM)

Hi Thaddeus: This injury obviously hits close to your home in Denver, but there are many questions about Tulo today, and understandably so. This is not the most common presentation. Typically when we hear about rupture of a quad tendon, we think of the tendon that crosses the knee that anchors the quad to the tibia (shin). (Think Cadillac Williams). But Tulo apparently ruptured the tendon at the proximal end, near the hip. The report is that there will not be surgery but there is bleeding and swelling that has to subside before more intense therapy can begin. The wide range of return timeframes really reflects the uncertainty about how long it will actually take for Tulo to come back, but I would think longer rather than shorter. Injury near the tendon may take longer to heal, and the quad contracts with such explosive force that it has to be well healed before putting those demands on it again, or it will be re-injured. I think it will tkae him some time back after being absent for potentially several months before he hits his stride and before he has confidence in the leg - you're really looking at the second half of the season here.

Ehren (White Plains, NY)

Hi Stephania, Phil Hughes Question: How much of his struggles this year have been because of the injury? Is he hurt, not ready for prime-time or possibly both?

Stephania Bell

  (11:12 AM)

Hi Ehren: Hughes is another popular topic today. Hughes has a stress fracture in his 9th rib, and that result surprised Hughes himself who did not think it was that serious. Apparently no one is sure how it happened although I have heard that it may have been from coughing (which actually is not uncommon). I doubt that this is the reason that he has struggled and Hughes does not think it is. Unless he has had the pain for a significant time - and it doesn;t sound that way - I think that it was more coincident than anything. That being said, sometimes the time off like this (and they plan on at least two months absence) allows you to reset, come back fresh and essentially do-over the start of the season.

Erbe, Milwaukee

Did you see the Gallardo injury? Do you think there will be any possible effects after something like that...that looked like he would be out the year when he landed

Stephania Bell

  (11:16 AM)

Erbe: I did not see it actually but apparently Gallardo twisted his right knee - and it sounds from the way you described it that it did not look good. After the game the team said his knee was just "sore" and they expect him to make his next start. One god thing is that it was his right knee (the left one is the one he recently had surgery on). So - sounds like he escaped a serious problem this time.

Chris(Teaneck, NJ)

Since there is severe inflammation and swelling in John Smoltz' shoulder is it reasonable to expect that a couple weeks off is all it will need to subside? Getting him back to being a reliever should prolong his career(although he is in his 40's) and I think it is defenitely the way to go? Do you expect this to be something that bothers him all year or should the switch from starter be enough to save his shoulder?

Stephania Bell

  (11:20 AM)

Hi Chris: Great question. The rate at which that subsides is highly variable. The team hopes for a couple weeks, but really won't know until they rest him, then attempt to have him resume some activities. Keep in mind that at his age after all the pitching he has done, there is no way his shoulder looks normal. In other words, even if he had no pain, an MRI would likely show damaged tissue in the biceps and rotator cuff - it is just a by-product of being a pitcher for this long. The amazing thing is that these pitchers can have shoulders that look terrible, but they can function very well, in the absence of acute inflammation - so ultimately the key is getting the inflammation to settle. Yes, moving to reliever will ultimately mean less demand on his shoulder (particularly in number of pitches thrown on any one outing) and I think it is the way to go. He is a smart guy and will get out in front of this so that he can keep the team informed as to how his shoulder is faring. It has the potential to bother him off and on all year, but I think he will be proactive in helping keep it from being season - ending, to the degree that he can.

Bill (Boston, MA)

Any word on BJ Upton? Does it look like hes going to go on the DL?

Stephania Bell

  (11:27 AM)

Hi Bill: This is also a response for Zach who noted that this is the second time Upton has done this (and apparently he's done it even while in the minors so several times now). Upton grabbed his left arm after fouling a pitch but it sure looked like the "batter's shoulder" symptoms that hitters get when they have a big swing and a miss. A hard swing that results in a lot of shoulder motion at high speed with no contact can cause a shoulder that is even mildly loose to slip in the joint and create pain. This is similar to what Hanley Ramirez used to experience until he had surgery in the offseason. Now ramirez also had a partially torn labrum and Upton has no specific tissue damage that we're aware of, but I suspect his shoulder is a little loose, knowing that this has happened a couple of times. Upton did say that his shoulder felt better faster after this episode than it has previously so it does not sound, at least right now, like he will miss any time. If he has an increased frequency of episodes or the pain gets more severe, then it may require looking further into what is causing the problem.

Stephania (CT)

Great name! Anyway, what exactly is the story with Jimmy Rollins' ankle? My first round pick is killing me!

Stephania Bell

  (11:33 AM)

Stephania - I rarely see someone with the same name - so welcome! Rollins' ankle is behaving in a finicky manner that is not altogether unheard of for a sprain. Sometimes you will hear in medicine people say that a sprain can be worse than a fracture. Part of the reason is that we know (mostly) that with a break, you immobilize it for a period of time, the bone heals, and then once you get your mobility back, you're good. With a sprain the symptoms can be very up and down. The ankle can feel fine with most activities but then cause sharp pain with very specific things. That seems to be the case with Rollins who says that although he feels better, he still has trouble rounding the bases at full speed (angular stress with load), not a surprising last hurdle to get over after this type of injury. It literally is a wait and see but right now it does not appear he will come off the DL on May 5 when eligible, but will need to tack on another week or two.

Nick (Greenwich, CT)

Stephania...Always love your chats! So informative! Do you have any concerns on the AROD injury, or will he be ready to go after the 2 weeks on the DL?

Stephania Bell

  (11:38 AM)

Hi Nick: Thanks for being a part of the chat. I always have some level of concern with these muscle strains because they are difficult to predict. I wish A-Rod had taken more time before he tried to come back, but then sometimes that is the only way that we see that the athlete is not ready b/c until they test it, it is a bit of an unknown. Grade 2 strains are so variable in terms of severity, that without seeing him firsthand it is tough for me to say that two weeks either is or is not realistic. As a fan, I would keep a close eye on what he is doing in practice. If he isn't running at full speed within a few days before he is scheduled to come off the DL, expect his time to be extended or him to return in a DH only role, something that would not surprise me in his case as they could use his bat power before he is able to do everything. Of course he strained the leg further coming out of the batter's box when he first injured himself, so that position is not without risk - but if he is mostly better, but not quite 100%, expect a DH transition.

Brad (Philly)

Stephania, nice work on TV during ESPN's NFL draft special. Recently, there's been positive news about Kelvim Escobar's throwing program. What do you make of his progress, and do you think he'll make a positive fantasy impact later this year? Thanks!

Stephania Bell

  (11:42 AM)

Hi Brad: Thanks for the comment. Don't get too excited though about the positive cpmment on Excobar. Yes he did throw for the first time since March but it is long toss from 45 feet, not much. He was just transferred to the 60 day DL because this throwing progression will be long and slow (throwing every other day only). Unfortunately, the torn labrum in a pitcher does not often respond well to a conservative program. Now it might - but I am not holding out great optimism. and even if he does get back this year, how long he can hold up is questionable. It is absolutely consistent with standard treatment that they go the conservative route first, b/c there are no guarantees after complex surgery either, but in this case, I am not feeling overly optimistic.

C (Omaha)

Stephania, Bedard's last outting wasn't as dominant as one would like to see. Is this a sign of lingering injury or just rust? Should you and fellow Bedard owners be worried? Thanks!

Stephania Bell

  (11:46 AM)

C: It may be a little of both. Seeing as how Bedard has not pitched since 4/8 until this last outing, it is conceivable he could be rusty, Supposedly he did not complain of any problems after this last start, but I am not totally convinced the hip issue is entirely behind him. As a Bedard owner I am still concerned and will watch his next outing before I put him back in the lineup. Even then, it will lurk beneath the surface in my mind until he goes a few months wihtout problems.

Anthony (Ridgewood, NY)

Stephania - anything new on Posada? Seems like all the news is cautiously positive, but the fact they keep going for all these tests is scary. If he has to have surgery, is he done for the year?

Stephania Bell

  (11:49 AM)

Hi Anthony: Still wait and see with Posada. Sonds like he is doing the sensible thing and getting several opinions. Sometimes they find minor things on imaging that could be construed as problematic, but yet aren;t really enough to definitively explain the symptoms. It sounds like this is the case with him. No surgeon wants to say that surgery is indicated when it is not absolutely clear that surgery will indeed fix the problem. and yes, surgery now would likely end his season b/c rehab for shoulders is lengthy. Consequently they want to approach it in the most sensible manner, and information is the best place to start. Even after all that Posada might come away without a satisfactory explanation and will just have to go by symptoms.

Amy (San Diego, CA)

Noah Lowry - reports are that he's still feeling pain and will visiting with Dr. Andrews soon. His injury was rare; do you know if it's something that can be recovered from, or is this going to be an ongoing concern for him, maybe endangering his career?

Stephania Bell

  (11:53 AM)

Hi Amy: When Lowry had the procedure done, my one concern at the time was that they really got to the root of all of his symptoms. The surgery was done to relieve compartment pressure - or tight tissue around the nerves going into his forearm and hand. Sometimes there can be contributing factors from higher up, above where the surgery was performed, or there can be scarring near the release site that then contributes to the same symptoms. I expect that Dr. Andrews will be evaluating these things. I think that if they get to the bottom of it, Lowry can fully recover from this and go on to have a complete career - but addressing it fully and accurately is the key.

Tony (New Jersey)

Seeing some reports that Harden is throwing again. How long will he play until he is disabled again? Is it the mechanics thats making him so injury prone or just bad luck

Stephania Bell

  (11:58 AM)

Hi Tony: Harden is throwing again and it looks like he has a tentative return date of around 5/11. I think he has a very loose shoulder (some throwers have more laxity than others) and it is very sensitive to muscular control. If there is any minor imbalance, things go awry and he develops pain. He came into this season in better overall shape with his shoulder than he has in a long while and I think the A's are just being extremely cautious with him on this return, extending the rehab starts to be sure he does not get back into the rotation too fast.

Paul (IL)

Have you heard anythign about Ralphael Soriano's elbow? Is there something we dont know going on here or is he expected back soon (before Smoltz?). Probably lost his job anyways.....

Stephania Bell

  (12:00 PM)

Paul: It just seems that each time Soriano starts to make strides, he develops discomfort during a throwing session and his return gets pushed back. Originally it looked like he might return Tuesday, then soreness, now it looks to be a couple more weeks. I think the Braves will welcome him back when they get him but can't count on a timeline at this point.

Jack (Columbus Oh)

Anything new on Howie Kendrick and his slow progress?

Stephania Bell

  (12:05 PM)

Hi Jack: this is just another example of a finicky muscle strain. I think fans and fantasy owners get frustrated because you see an athlete have what is described as a "minor" injury, he doesn;t go on the DL (b/c the team is trying to see if he can avoid it), then he needs to go on the DL to really get it better, and although it's slated for 15 days, it is really a day to day evaluation to determin readiness to return. Any minor "soreness" or slight "pull" means the team gets a little nervous and pulls back on the workload, and then maybe on the return date. I have to say that when looking at the big picture for the rest of the season, this makes sense. Kendrick may only be feeling a little bit in these rehab starts, but a little signals something that could become big - so the team reacts accordingly. Yes, it's frustrating - for the athlete, the team and us.

Parag(Boston)

Hows Lackey progressing?

Stephania Bell

  (12:06 PM)

Parag - and everyone else asking about Lackey: He is tolerating his rehab starts well - looking to come back from his strained triceps by May 14th.

Jason, Charlotte, North Carolina

Scott Kazmir, Assuming he pitches well this weekend is he back and should be starting in all formats or do we still wait him out a little longer?

Stephania Bell

  (12:08 PM)

Hi Jason: I don't normally say this with pitchers, but I would start Kazmir right away. The reason? He has had extended rehab and I think the team has gone to great lengths to bring him back slower than he even felt he needed in an effort to be sure he was 100%. He has pitched without an ounce of elbow pain, feels he is 100% and I think he's ready to go.

Stephania Bell

  (12:09 PM)

OK gang. I have to turn it over now. Thanks so much for coming and I appreciate all of your outstanding questions. Look for me to post a couple of them in my injury blog over the next week as a way of trying to get a few more answered. Have a great weekend - and may your fantasy teams stay healthy!!!