Dr. Joseph Hecht's Archives

Stretching: The Truth

I'm planning on a series of articles to update our readers on some of the current concepts in pitcher related injuries and diagnoses that most fans have not heard much about.

We've all had our fill of reading about pitchers with rotator cuff and glenoid labrum tears. There are some interesting trends in sportsmedicine that have lead to changes in exercise programs throughout the majors and minors in an attempt to protect pitchers from a cascade of preventable injuries most fans don't know about.

Diagnoses such as:

GIRD: (Glenohumeral Internal Rotation Deficit...not to be confused with the stomach malady also known as GERD which Cubs fans get from watching too many losses). Pitching (both cocking phase and deceleration phase) leading to a tight or thickened posterior shoulder capsular ligament plus a loose anterior capsule and loss of internal rotation of the shoulder. Extra external rotation of the shoulder develops at the expense of internal rotation.

Scapular Dyskinesia: Shoulder blade weakness with altered kinematics.

Internal Impingement: Thought to be related to posterior shoulder contracture from GIRD with subsequent instability of the shoulder as the humeral head (ball of the shoulder joint) which shifts back/posteriorly and upward/superiorly). This is a different entity from subacromial or rotator cuff impingement which is more common and typically occurs from friction outside the shoulder joint.

...and finally connecting the dots, sorting out how the the injured or weakened shoulder (scapula) leads to severe strain on the elbow and tearing of the Ulnar Collateral Ligament (aka the Tommy John injury).

My attention to this topic started last summer, when  I heard a remarkable interview on XM radio with renown Orthopedic Surgeon, Dr. Craig D. Morgan with hosts Jim Memolo and Rob Dibble. The focus of the interview was Stephen Strasburg's shoulder tightness and the subsequent ulnar collateral ligament elbow injury that lead to "Tommy John" reconstruction of that ligament last summer. Dr. Morgan said that he had predicted elbow problems in Strasburg by watching the way he held his shoulder.

More on how the arm bone is connected to the...after the jump.

More Ivy at Wrigley?

With yesterday's trade for Matt Garza, the by-product that caught my eye is the fact that the Cubs seem to have cornered the recent market on Ivy Leaguers. Fernando Perez studied creative writing and received a degree in American Studies at Columbia and now joins the exclusive Cub club of four.

Perez has published in Poetry Magazine.

Perez says he turns to poetry when he's "after displacement, contrast" from the game of baseball. "The thick wilderness," he continues, "of, say, late Ashbery can wrangle with the narrowness of competition."

From his Poetry Magazine article, titled: Para Rumbiar

Like poetry, baseball is a kind of counter culture. The (optional) isolation from the outside world (which I often opt for); the idleness about which—and out of which—so many poems are written or sung: I see this state of mind as a blessing.

...and if you haven't seen the Fernando Perez You Tube video on "The Working Poor" here's the link.

"nobody talks about the Fernando Perez(s), Jason Nix(s), Emilio Bonafacio(s), all these great players, playing for the minimum, that keep these guys (the stars like ARod) afloat."

Growing more Ivy, after the break...

TEN

Thoughts and tears.

#10. Third Base-MAN. Love of Wrigley Field. Putting his favorite charity, JDRF and Juvenile Diabetes on the map to show that athletes can deal with the disease. Ron's partner, Pat Hughes (Ron's been in the booth since 1990). Brant Brown, that gut wrenching, "oh-no" overlapping Pat's "he dropped the ball".  Aw, Jeez.  Entrepreneur and Restauranteur. Ron Santo Pizza. Acapulco Taco Pie. Williams-Santo-Banks. Rebel pal Randy and the real highlight of fantasy camps. Roomie Glen Beckert. Flaming Gamer, Pat: "there's smoke billowing out of the top of his head" (audio link). The classic Jack Brickhouse call was music to my ears: "back, back, back, Hey-Hey, a homer by Santo."  Harry Caray asking Ron, "when you go to bed at night with your lovely wife do you wear your toupee?" Cub captain.  Leo Durocher. Don Young. Belly flop slides into second base. Clicking Heels. Pat Hughes broadcast introduction: "Along with nine time All-Star, five time Gold Glove winner and Cub Legend..."

Ronnie's gone. He slipped into a coma Wednesday and passed away in the early hours of the morning on Friday reportedly due to complications of bladder cancer.

Paul Sullivan has one of the earlier confirmations online but I've listened to WGN radio interviews with David Kaplan and Spike O'Dell reminiscing. Overnight host on WSCR, Les Grobstein clearly struggled with his sadness when he heard the news.

In one of the greatest tributes a son can give his dad, Jeff Santo's movie "This Old Cub" gave us the insight as to just what made Ron tick. Ron Santo was what loving the Cubs is all about.

Thank you to Ron. We are honored that you shared so much of yourself with us.

UPDATE: Rob's thoughts after the jump, just trying to keep all this in one place.

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Medical Sabermetrics

MAJOR NEWS UPDATE:

Lou Piniella will resign after today's game vs Atlanta. His mother's health has not improved and instead of going the medical leave of absence route again, he's handing over the managerial chores to...THE FORMER IOWA CUB MANAGER... drumroll, please...[[[Mike Quade]]]. Pfffft.


There is a segment of the news reporters who actually cover medical meetings and try their hand at using medical lingo on their readers. I found this article online (and several other sources picked it up including the LA Times) but it originates from a news feed that the American Orthopaedic Society for Sports Medicine provided after their 2010 annual meeting from Providence, RI.

This is clearly an epidemiologic study. I'm thinking medical sabermetrics is a better term.

The study was based on data from MLB's disabled list published online data from 2002-2008, so it didn't really need a doctor to do this, it probably was done by a doctor who is a baseball junkie. Hmmm.

Dr. (and Major) Matthew Posner took the raw information and tabulated the frequency and distribution of injuries by anatomic site, position, AL vs NL and time of season (before or after the All-Star break). Nicely done. Clean and simple.

"Even though baseball is a passion of many people and our national pastime, there is very little information about the epidemiology, characteristics or distribution of injuries in Major League Baseball,” said Maj., Matthew Posner, MD, orthopaedic surgeon at the William Beaumont Army Medical Center in El Paso, Texas. “This study attempts to evaluate Major League injuries over the period of six years.”

On to Dr. Posner's findings after the jump...

Twenty-Six Runs per Hour

Manager Ryne Sandberg's Iowa Cub lineup SCORED 4 runs in 9 minutes? I LOVE THIS STAT! That translates to 26.6 runs per hour. Thankfully, they suspend games in triple-A rather than just wash them out and make it a do-over. The RPH just might go up when the game resumes in a month.

Manager Lou Piniella's Chicago Cubs GAVE UP runs at a similar velocity. After last night's 17-2 debacle vs the Rockies in an 8th inning that saw 11 consecutive hits (13 total hits but 11 hits with 2 outs) and 12 runs score...that's what I'm talking about, RUNS PER MINUTE. The only problem is that the Chicago National League franchise's role model has been Captain Peter Wrongway Peachfuzz. It was too painful for me to use a stopwatch on that fiasco. The last time the Cubs gave up 12 in one inning was Sept. 24, 1985 vs the Expos. The Expos won that game 17-15 and Expo hat wearing Andre Dawson went 4-6 with 8 rbi and 3 homers. Oddly, a pitcher named Ray Fontenot took the loss for the Cubs. At least those Cubs scored 12 runs over the last 3 innings, which is more than this inept group could claim.

Why can't the I-Cubs just play out their schedule at Wrigley and hide the lame ducks in Des Moines?

As far as the trading deadline ending later this afternoon, the Saturday morning latest says Lilly is still on the block with the Dodgers, Twins, Tigers and Yankees for some reason showing interest. "Minor sniff's" on Xavier Nada and Little Babe Ruth are out there per Ken Rosenthal. Something about interest in DBack Kelly Johnson too. If they wanted him now, it seems they missed the boat since he would have come for less when he was a free agent nobody wanted last off-season. Did Jim Hendry misread the saying as buy-high and sell-low? I hate it when we get stuff bass-ackwards.

and a bit more detail on runs-per-minute after the break...

Andy McPhail snubs Ryne Sandberg

Orioles President Andy McPhail, of the royal baseball McPhail lineage (grandpa Larry, dad Lee) had a chance to snag another ex-Cub and went another direction today by hiring non-nonsense manager, Buck Showalter.  Recent speculation by Tribster, Steve Rosenbloom, had Sandberg on Andy's speed dial but it seems it wasn't so. The O's beat writer for mlb.com said the short list was former O's catcher Rick Dempsey, former Indians manager Eric Wedge and Bobby Valentine, who has recently volunteered his services as the next Cub manager.

A Double-Dare to the Baseball Gods

It's official. I've double-dared (if I were Ryan Theriot, it would be a single dare) the Baseball Gods to invoke their wrath. All I can hope for is that they won't think about reversing reverse psychology.

My spouse loves to travel. I love baseball season. This has lead to 30 years of negotiating the avoidance of travel during just a few parts of the year. Early April and September-October.

I'm serious losing this battle. Last year we took a 3 week trip to China, breaking my string of being at Wrigley Field for opening day, a streak of over 30 years (I've been back in Chicago since college days).

The one absolute taboo was that we wouldn't take a major trip in September or October because that was the wrapup of the baseball season and playoffs. Her argument was September/October is the best weather for travel to many of her favorite places. For years, she checks in every so often asking that if the Cubs were out of contention, could we take a trip in September or October.

After taking this seasons beatings and holding out hope as long as I could, I've given in. The plane tickets are booked to southern France and I'm daring the Baseball Gods to beat me up, invoking the 1935 Cubs as my lesson on what I'm about to miss...

The Opposable, Not Disposable Thumb

 

Little Jack Horner

Sat in the corner, eating a Christmas pie;
He put in his thumb, and pulled out a plum...

Just to take our minds off the train wreck that the 2010 season has become, I'm going to tangent into just what made Aramis Ramirez so miserable this year. His left thumb injury (diagnosed as a deep bone bruise) may or not have been related to his season long slump or it just may have prevented him from coming out of it as the weather warmed up. He's been 'missing', even when present for most of 2010 which is somewhat different than his absence last season, starting on May 9th, 2009 from what happened at a similar point in the season, when he dislocated his left shoulder diving for a ball on May 8th in Milwaukee.

From a Gordon Wittenmeyer, Sun-Times article:

Ramirez, mired in a two-month slump, first hurt the hand on a swing-and-miss May 9 in Cincinnati. When it got worse two weeks later, the Cubs considered putting him on the DL, ''but I didn't want to do it because I thought I was good enough to play,'' said Ramirez, who got a cortisone shot instead. Manipulating his bat handle to take pressure off the top of the left hand also didn't work because it was uncomfortable, he said.

''This is the right time to do it. This is the right thing to do,'' he said.

He'll be eligible to return June 23 in Seattle, but a return then is anything but certain considering the down time that'll require before he is even allowed to resume normal baseball activities.

Supposedly, his injury was a deep bone bruise. I have not read any reports about an injured ligament. He has tried to play through the soreness but his thumb kept getting re-traumatized from his attempts at hitting. He didn't want to go on the DL until it was clear he couldn't shake the injury.

CSI Randy Wells and John Grabow's Magical Mystery Knee

A collective cheer can be heard in that state of mind known as Wrigleyville...

UPDATE: (tweet from Gordon Wittenmeyer) Grabow to DL, Cashner called up.


I wrote this piece before the update. Sometimes things just make sense.

Randy Wells, aka Buzz Lightyear "To Infinity and Beyond" (5 runs and no outs is an ERA of ∞) gets a DO-OVER. After Randy Wells failed on just about all of the 16 pitches (and 5 runs) he threw in the first inning 'bullpen' tryout on friday vs the Cardinals. He gets to show management that he actually can once again go deep into a game with a quick return to the first inning on the holiday-day game against the Pirates. His competition for that bullpen spot, Tom Gorzellany won the battle to the bullpen. Gorz matched Wells with five quick runs vs the Dodgers on Wednesday's game which was so disappointing that Com-Ed pulled the plug on the Wrigley light grid.

Wells also is returning to the scene of the crime from May 6th, his other ugly outing. As we recall, he also gave up 5 first inning runs in the first on two walks, two singles and two doubles. Lou didn't have quite the quick hook that day as Wells stayed in to give up two more runs in the 2nd inning in what was to be an 11-1 blowout to the Buccos.

Oh, oh Domino. Tom Gorzellany will be in the pen, ready to pitch mop up in the first few innings if history should repeat itself. Gorz, the newest long reliever supplants big Z in the bullpen. Zambrano is supposed to start Wednesday in Pittsburgh, although Z never did get stretched out in a game even as the opportunity presented itself in Wells "oopsie" friday.

With all the roster shuffling soon to occur, the questions are who goes away when Andrew Cashner arrives this week and why isn't Cashner coming today? Is it management indecision or can't they get the radiologist who read John Grabow's MRI  to review it again to see that there IS something wrong, very wrong.

From today's Sun-Times:

Grabow already has undergone an MRI on his left knee after experiencing discomfort, but no injury was found.

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  • "Like the Chapman deal for Cubs from on-field POV, wish I didn't now have to feel lousy following an otherwise likable Cubs team." @jonahkeri

    pretty much sums up my feelings

    Rob G. 5 hours 13 min ago view
  • You mean Yankees?

    QuietMan 5 hours 17 min ago view
  • Cards lose!

    billybucks 5 hours 24 min ago view
  • You do have a point. The TheoJed certainly would need to address this in a transparent way. Milton Bradley was no help to the team.

    The E-Man 5 hours 36 min ago view
  • FWIW, the Cubs would get a compensation draft pick between the 1st & 2nd rounds (around #35) if they extend a Qualifying Offer to Chapman post-2016 (probably about $17M), Chapman declines, and then he signs with another MLB club before next year's draft. 

    Arizona Phil 5 hours 42 min ago view
  • This all assumes Chapman doesn't want to be a free agent and possibly sign a $20MM+/year deal. We all know free agents get overpaid, sometimes dramatically (Hello, JayHey!). Not sure why Chapman would agree to the extension. If i'm is agent, I would tell him I could get I'm a $100M deal as a FA.

    billybucks 5 hours 50 min ago view
  • I'll root for the uniform and imagine it's left-handed Rod Beck or Randy Myers out there I suppose.

    Rob G. 6 hours 13 min ago view
  • Amen to this. I guess it's gonna happen and I'm gonna have to suck it up but I really despise domestic abusers with every bone in my body and cannot stand them on any team I root for.

    johann 6 hours 22 min ago view
  • I just prefer they don't  acquire players that choke their wives/girlfriends.

    Rob G. 6 hours 25 min ago view
  • So you'd rather go with Blown Save guy, when you can trade a prospect who is blocked for one piece that could get you over the top to the Big Dance? That is pretty old thinking. This is not a move that they cannot recover from if it goes south. But the upside is potentially historic.

    The E-Man 6 hours 35 min ago view
  • I'd prefer it not happen too.

    Rob G. 7 hours 1 min ago view
  • it's a hell of a blockbuster, but it's for a guy who pitches 1/3rd of a season at an extreme premium considering the guy being traded and if the early extension $$$ rumors are true.

    it's one of those things that is bringing a guy at the top his game, but something is nagging me that this trade piece could have been put to better use.

    a huge part of me is all "hell yeah, top of the line producer"...another part of me is "hmm, that for that?"

    crunch 7 hours 5 min ago view
  • Still don't want. Kinda hope they can't work out the extension.

    Charlie 7 hours 17 min ago view
  • obviously not, and I'm sure they did their homework...just hope they have some better answers than the Yankees

    Rob G. 7 hours 17 min ago view
  • Chapman 12+ Career WAR. Currently 4.7:1 k-BB. With Rondon/Chapman/Strop/Nathan/Montgomery/Wood...Its the best pen I can recall other than Sutter or Lee Smith handling things themselves.

    Its gonna suck if he gets injured, and it appears he's not the greatest of characters.

    But, he'll have another Cuban to hang out with on the team.

    The E-Man 7 hours 39 min ago view
  • I agree with the names you mention but there are lots of names being tossed around still and there's that small matter of Chapman agreeing to the extension.

    Old and Blue 7 hours 44 min ago view