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.
...I want to reinforce the observation that there was no sea of red in the crowd. The usual Cardinal fans roaming the stadium were few and far between.
Also, almost every 2 strike pitch brought the fans to their feet. Good for those in knee rehab.
"1st team hit hit 6HR in a game in the postseason." rises above obvious...i checked it with the official fact-finding commission of Douche, Douche, and Douchestein. they agreed with you, but they're a bunch of f'n douches so who cares?
btw, the cubs are 2-1 in the post-season series.
I should be able to watch the game on the NFL replay app, whatever that thing is called. I've got it on my iPad. This is the first year I haven't forced myself to somehow watch every game - no I take that back, last year was - in quite some time. Last year was so unbearable, no pun intended.
You make some good points about Cutler, and I was a holdout defender of Cutler for a long time. I gave up on him a bit after one too many dumb interceptions, but last year doesn't count. Trestman was the worst coach in Bears history.
Nice little reportage there!. I think you're older than me. Considerably older. Maybe several generations. Working out is so essential, especially as age kicks in, isn't it? I still lift weights, and so I'm confident that when I get to be at the hip breaking age, mine won't be a statistic. But I have a ways to go for that to be a concern.
What was impressive to me is that the Cubs won despite poor base running, several defensive miscues, Russell leaving due to injury, Arrieta having an off game and getting knocked out early, and Rondon giving up 2 runs in the 9th. If they can win a game like that...
I was there too. The crowd was absolutely electric. People were standing for every big and semi-big moment, from the first inning on. It felt incredibly strange and exhilarating to see the Cubs (the Chicago bleepin' Cubs!) score playoff insurance runs on the Cardinals. What a game. One to remember.
14 in attendance. What's the record for attendance in the fall? I guess I should ask what the record attendance listed is in one of your recaps.
I was there too, with my grown son. This is my miracle year-- I rose to the top of the season ticket list after eight years, completely unexpectedly, and my wonderful wife agreed to put the ticket fee on the emergency credit card. The whole point of course was that the Cubs were going to be good this year, and then for a while, so to get season tickets with the guaranteed shot at the postseason was incredible timing. We got to the remote lot at 4:10 after stopping at Nhu Lan for our usual banh mi sandwiches, only to find the lot full, way earlier than normal.
Wrigley was electric tonite
Not many card fans
Video board was great, they played "there goes my hero" by foos over ryno highlights before he came out. Spectacular
Good times hopefully they win tomorrow but think Lester will beat poopy pants on Wednesday.
Happy 4th anniversary of Theo's signing
Go Cubs !
Yeah. "Goodbye!" is a lame HR call.
I miss Len and JD -- although, driving home from a friend's, WBBM played all 6 HR calls in a row -- and Len got to call the Bryant/Rizzo back-to-back. Very fun.
Lackey has been a beast against us. His stats on 3 days rest, however, not as nice. There is plenty of hope.
And, no dreadlocks grown yet.
Captain Obvious Strikes Again!!!
In the wild card game he mentioned that aram started with the Pirates, then played for the Brewers, and now he's back with the Pirates. Uhhhh, missed a step there, guy.
i like ron darling the person, the interview, and the studio desk guy...but him calling a game can lead to some really stupid stuff coming out of his mouth.