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.
CB Bucknor not having a good day....
Jesse Rogers [email protected] Yeah, there was plenty of chatter before the game about home plate ump today. Knew he would be a factor.
Jake Arrieta gives up first inning run
For the first time in a year, 33 starts.
Old news, sorry if it's 3/44-
J-Hey being classy by repaying an old teammate:
With Paredes moving to 3B, how do you see playing time shaking out between him and Galindo? Do you think Galindo gets starts at 1B? Galindo is more of a prospect than Paniagua, right?
Phil, your knowledge of the Cubs Minor League system is unbelievable.
This kid would be a key piece in a trade for a pitcher, imo.
This might be old news but Hammel was on ESPN 1000 and said that he changed his diet and workout routine over the off season and tweaked his delivery so it'd be more repeatable so he'd have a better second half. So...some cause for optimism anyway.
CHILDERS: RHSP Dylan Cease and LHSP Bryan Hudson are probably the top two SP prospects in the organization right now.
LHSP Jose Paulino has electric stuff (91-94 MPH fastball with sinking action and a mid-80's slider), but he also has trouble commanding it.
RHP Jose Albertos (2015 IFA - Mexico - $1.5M bonus) just turned 17 in November, and his fastball already sits at 95-96. He also throws a curve and a change-up, and is fairly advanced for a kid his age.
AZBOBBOP: Most of 2016 draft picks will get assigned to either Eugene or AZL Cubs, but the Opening Day Eugune roster will probably be almost 100% from the Extended Spring Training squad roster (pending the arrival of draft picks).
I think I can probably tell you which pitchers and players at EXST are in contention for roster slots at Eugene and which are in contention for slots with the AZL Cubs - AS THINGS STAND RIGHT NOW - (listed alphabetically):
* bats or throws left
# bats both
Eloy Jimenez atop the leader board for minor-league home runs in the Cub system, with seven. Tied with Balaguert and Vogelbach, two 24-year-olds. Jimenez won't be 20 until late November. Leads the Midwest League in SLG and OPS. Maybe he'll get promoted to the Myrtle Beach squad that visits Woodbridge, VA, in June or Frederick, MD, in August.
Watched two Pelican games at Frederick the other week. Was most impressed by Stinnett and Happ. Happ may swing harder than Javier Baez, though more compactly. (Also got to see Brockmeyer hit a bomb.)
E-MAN: Jose Paniagua isn't a string-bean, but I wouldn't say he necessarily bulked-up during the 2015-16 off-season either, He led the DSL Cubs in HR and doubles in 2014, and he showed XBH power when he arrived in Mesa last year, leading the AZL Cubs in HR, doubles, and RBI in 2015. It's just that he has taken his HR power to a new level this year.
Paniagua displayed plus-HR power in Cactus League Minor League Spring Training games in March, and that got him a slot on the South Bend Opening Day roster. But he was sent to EXST after only six MWL games.
More on the Cub Way.
Martinez is one of my least favorite pitchers in baseball. I'd love to see a game like yesterday's against him.
Send Soler down!
Awesome thanks AZ
Great report, Phil! This organization has so many hitters to be excited about.