Jim Hendry's Plan #44
Before I get to what's going on with Aaron Heilman's knee, I've got a few odds and ends to mention.
I've figured out what the heck Cubs GM, Jim Hendry, is up to this offseason. In a nutshell, in an attempt to beef up the middle of the lineup he wanted to add one of the all time great sluggers to the Cub lineup. Unfortunately Hank Aaron is just about to turn 75 years old. So this great idea came to him in a dream...swap out Hanks (Blanco, Williamson) and accumulate Aarons (Miles, Heilman). Voilà, plan #44!
The newest acquisition (Aaron Heilman) grew up as a Cub fan. It seems that this is the first directive from Tom Ricketts, all new organizational members must be diehard fans.
On to Aaron Heilman's medical issues. I've not been able to find a precise diagnosis to his 2008 left knee ailment other than it being labeled tendonitis. This LINK goes to an article from Sept 12th, 2008 discussing what problems Heilman was dealing with last year.
Last night on WGN radio, David Kaplan interviewed Aaron Heilman and specifically asked him about his knee problems. All we got was "athlete speak." It does seem that they have a therapy treatment plan that was worked out for him to address his issues this offseason.
Kaplan: In terms of your knee. I'm reading an article on ESPN today, it said knee pain played a role in your 2008 struggles. Would you agree that your knee was a problem and how is it today?
AH: Right now it's great. I feel healthy, everything feels good. I struggled a bit early on in the season trying to figure out a routine that would work best for me. By the end of the year I had figured that out. It certainly took a lot longer than I thought it would and that I hoped it would. It certainly wasn't 'the' factor that caused me to have a year I wasn't particularly pleased with. When you are going through something like that, you're trying to figure it out, you're trying to do different things every day, you don't really quite have a routine because you're not sure how you're going to feel the next day, that can play a role into it. We've got all those issues hammered out. I'm looking forward to staying with a good program, staying healthy all year and just going out there and competing.
Tendonitis refers to inflammation of a tendon and there are several tendons around the knee. The largest two are the quadriceps tendon (which inserts into the patella/kneecap) and the patellar tendon (which goes from the patella to the tibia below the knee). Tendonitis of either one is common. There are also hamstrings (medial or lateral) and even the gastrocnemius which is more of a calf muscle but the tendons go behind and above the knee attaching to the femur.
My guess is it was a patellar tendonitis (aka Jumper's knee) as it's probably the most common of these conditions. In a pitcher, this would a significant problem for both push off or landing from a mound. Heilman played through it most of the season, meaning it was nagging but not incapacitating . It wasn't disclosed to the press until the 2nd week in September where there are multiple articles (see the link above for one of these) explaining why they hadn't used him as much in early September. Of course blowing 5 of 8 save opportunities might just be a better excuse to skip calling him from the pen.
I'm sure they had MRI imaging on him as that would be useful to rule additional conditions inside the knee that might make the tendonitis a secondary problem (like a torn meniscus). The treatment is the usual rest and non-steroidal anti-inflammatory medications, better shock absorption in shoes. Therapy includes stretching and controlled exercises also various heat modalities to the inflammed area. In a pitcher it's unlikely to resolve until enough rest can occur, which means the off-season.
He didn't have this in 2007 so I'd expect him to be OK in 2009. I saw that he did have right (his pitching elbow) tennis elbow surgery immediately after the season on 10-23-06. Tennis elbow (aka lateral epicondylitis) is an inflammation of the tendons responsible for wrist extension and originate just above the outside/lateral aspect of the elbow. It develops from repetitive resistance to wrist extension activities hence it's nickname, tennis elbow came from the added resistance of using a tennis racquet. Dr. David Altchek (he's quite a famous NYC Sports Orthopod, who did similar surgery on Carlos Delgado that same week) performed the surgery and although it's obviously unrelated to his knee issues, it is an example of a chronic tendonitis that rarely needs surgery but ultimately he needed it (and presumably got better from the surgery). His stats in 2006 (74 games, 3.62 ERA, 1.16 WHIP) were better than 2008 (78G, 5.21 ERA, 1.59 WHIP) so I guess it was the same nagging thing but he put up with it pretty well. He probably had a bunch of therapy, ultrasound/deep heat rxs and a few cortisone shots for it before the elbow surgery.
Patellar tendonitis can be chronic (which isn't all that common) and then the tendon can be surgically explored or consideration is occaisionally given to (ESWT) extracorporeal (ultrasonic) shockwave treatment, which is more often used to treat resistant plantar fascitis (arch inflammation). ESWT is not like ultrasound in a physical therapy center which is mostly a way of delivering deep heat to tissues. ESWT is more like what they use to break up kidney stones (lithotripsy). It actually traumatizes the tendon collagen and brings in new blood supply which then promotes healing of the damaged tissue.
Update: based on a nice pickup from reader ankeith15, it looks like Heilman did undergo ESWT treatment. This LINK from a mets.com archive on November 20th confirms his diagnosis was patellar tendonitis and goes on to say:
After a loss in September, Manuel disclosed that Heilman had pitched much of the season troubled by patellar tendinitis, a malady that affected his landing leg, restricted his conditioning and non-game throwing, and reduced the sharpness of his pitches. Heilman since has undergone a noninvasive ultrasound treatment that has reduced the pain in his knee.
ESWT was used off-label on Magglio Ordonez during his free agent year when he was diagnosed with avascular necrosis of the femoral condyle (dying bone in the knee due to damaged local blood supply). I think Mags had to go to Vienna, Austria to get that treatment as ESWT wasn't being used like that in the US then. Ordonez knee did recover apparently enough to hit .298 with 24 HR's and be the ALCS MVP with a memorable walk off 3 run homer to end that series.
A variant on such an example of surgical treatment of a chronic tendonitis was the chronic achilles tendonitis in Cliff Floyd who had surgery (also at the same hospital/same week that Heilman had surgery, but a different surgeon) on it the offseason before he signed with the Cubs.
Of course if you have HMO insurance, they just tell you to change shoes.
Two 97+ win teams in a do-or-die, great bullpens, overpowering starters, plenty of pop--hard to believe that game wouldn't be tense. A 4-0 lead is not a blowout, especially in that situation and with the Cubs' young bullpen. Not only would a defensive play here or there make a difference, but you get the win there also on the home plate umps strike zone (generous strike calls for Arrieta, including a couple Ks), and on Schwarber sitting on the right pitch at the right time.
I just noticed the Dodger's payroll today. It is just absurd. $300,000,000+!!
Here is where just some of their money is for 2015:
Carl Crawford $20MM
Brandon McCarthy $17MM
Bronson Arroyo $3.5MM
Darwin B $2.2MM
Dan Haren $10MM
Matt Kemp $18MM
Brian Wilson $10MM
Ryan Webb $2.2MM
Dee Gordon $2.5MM
So I think tomorrow will be the most important test of how far we can go. We can win it all with two pitchers since Arietta has shown he can carry over his success to the post season. If Lester can be dominant also then I think we can go far no matter how Hendricks or Hammel do.
And in terms of pitching just went through to see how we could maximize Lester and Arietta and came up with this (Lester would be going on 4 days rest three times and Arietta twice):
i still can't believe that crawford contract (7/142). all that loot and years for a LF'r who's entire hitting game revolves around his legs and line-drive power. those triples that raised his value are deceptive as hell to his true power, but it helped him get paid.
there's also pause about a guy who's ob% is almost totally driven by hits rather than walks. BOS got lucky unloading that crap deal.
I think the Cubs take Berry and Soler off playoff roster and add Hammel & Ramirez. Believe Maddon will find Denorfia & Jackson defense too hard to lose.
O & B: I like the one-game Wild Card heart attack game, but I'd actually like to see a best two-out-of-three LDS played in the home parks of the two division winners with the best records, and then the LCS as a best two-out-of-three in the home park of the division winner left standing with the best record, and then let's get to the World Series already.
I...don't know. If chanting would help the Cubs beat the Cardinals in the next series or ultimately the World Series I think I'd be ok with it lol. I'm not supportive of saying insulting things to opposing fans or throwing things but loud noise and chanting seems appropriate to me.
I also grew up in France though and that kind of thing is par for the course at soccer and rugby matches and I love it. I find crowds too passive here.
Enjoyable read on David Ross.
Er, they won the first one. My bad. Carry on.
With last night's win in Pittsburgh, the Cubs have tied the Pirates with 98 wins, and are only 2-1/2 games behind the Cardinals. No reason why the Cubs can't finish the post-season with the best winning percentage in baseball (regular season & post-season combined).
BOB: I doubt very much that Matt Szczur will be on the Cubs LDS roster.
If he wasn't on the Wild Card roster (when the Cubs went with 15 position players), he won't be on the LDS roster (when the Cubs will go with 13 or 14 position players).
As it is, at least one of the three RH hitting outfielders who were on the Cubs WC roster (Denorfia, Jackson, and Soler) could get bumped off the LDS roster (probably Soler).
I want my baseball team to win by playing better baseball. I don't want umps, fields, or fans to have anything to do with it.
Just with the chanting thing it worked to rattle Cueto last year where he dropped a ball and gave up a HR next pitch so you can't really hate on the fans for trying it again in this important of a game.
I felt the same way, too, but...
I was very disappointed with Pittsburgh fans. At Wrigley a few weeks ago, they were very obnoxious guests, the cockiness on Twitter, and what's the deal with chanting Arrieta's name during the game? Very bush league. Add that up with Rodriguez's poor sportsmanship and you quickly have a team that you don't mind beating 4-0 in a do or die game.
Absolutely-It was tense. And when the Pirates couldn't push any runs across, you could see the frustration boil over.