Tag: Under the Knife

Can Yankees’ CC Sabathia Still Be an Impact Pitcher After Latest Surgery?

There’s seldom good news when a player is ruled out for the rest of the season. For CC Sabathia and the New York Yankees, there’s actually very good news in the announcement that he’ll miss the remainder of the 2014 season due to impending knee surgery, as noted by Bryan Hoch of MLB.com.

Sabathia has been out since mid-May with knee problems. He made a rehab start and had a setback. Instead of heading back to Dr. James Andrews, Sabathia checked in with several surgeons, leading many to expect Sabathia to have microfracture surgery. Instead, the Yankees announced that Sabathia will have an articular cartilage debridement, which is a cleanup and smoothing. This type of procedure is far less problematic than microfracture

Sabathia saw several surgeons, but when it was announced he was seeing doctors that did not specialize in microfracture, such as Dr. Dick Steadman, who pioneered the procedure, there was some hope. After seeing Yankees team physician Dr. Chris Ahmad and Rangers physician Dr. Keith Meister, Sabathia chose to go with Dr. Neal ElAttrache

All are qualified surgeons, but ElAttrache has a great track record with knees. One of ElAttrache‘s best known cases is not in baseball, but the return of Tom Brady after an ACL reconstruction is one of the best results we’ve seen. ElAttrache also put Zack Greinke’s collarbone back together aggressively, getting him back on the mound quickly, and repaired Kobe Bryant’s ruptured Achilles.

The normal recovery period for this type of surgery is varied. In some situations, a player could return in as little as two months, but the Yankees realize that Sabathia’s size and the internal damage in his knee are significant enough that rushing him back for this season would be counterproductive. Instead, they’ll focus on getting him ready for next season, much as they did with Derek Jeter late in 2013.

“Because we’re in July, I think he’ll come into spring training, in theory, ready to go,” Yankees general manager Brian Cashman said via Hoch of MLB.com. “Given the number of things that have gone on, we’ll have to be careful with him nonetheless.”

The rehab for this type of operation is relatively straightforward. Sabathia will have around eight weeks of normal therapy as they focus on making sure the knee heals up well after the procedure. There will likely be a focus on making sure his secondary stabilizers are strong and that his pitching mechanics will not put an undue stress on the repaired portion of the knee. 

Past that, the Yankees will focus on maintenance. Making sure Sabathia doesn’t have problems between starts or at least making sure the problems are manageable will be key. Overall conditioning is not likely to be a major concern, but if any specific mechanical changes are needed, the Yankees want to give Sabathia plenty of time to adjust.

The fact that Sabathia has avoided microfracture is a major positive. While the procedure has been used for nearly 20 years in helping certain knee issues, it still has a very low percentage of success in baseball. There’s really no explanation for that, but the fact remains that there are few successes. Avoiding the procedure, at least for now, gives the Yankees one less thing to worry about heading into 2015. 

The best comparable situation in baseball is not a pitcher. Instead, it’s Chase Utley, the Philadelphia Phillies second baseman who had two straight years of problems with damage inside his knees. The Phillies struggled to get Utley back to function, unable to find a maintenance program that would keep him on the field without significant swelling.

It took some time, but Utley has been very solid since coming back. Utley faces a different situation than Sabathia. He has less specific demands on his knees, but he has to play every day in the field. Sabathia will have the normal off time between starts, so some swelling wouldn’t be devastating, though it would indicate that there are further issues.

While the Yankees can’t count on having Sabathia back for 2014, they certainly have to feel better about the chance of having him take his turns in 2015. If they can get Sabathia at the top of the rotation alongside Masahiro Tanaka (who is still hoping to avoid Tommy John surgery, per Howie Kussoy of the New York Post) and keep them both healthy, they’ll be a far better team.

To do so, New York’s medical staff will have to overcome a lot of challenges and show better results with maintenance than it has in the past. As Mike Axisa of RiverAveBlues suggests, Cashman and the Yankees should take a hard look at their plan for 2015.

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Bryce Harper Making Progress after Thumb Surgery, Back to Nationals Soon

Bryce Harper is making progress. Nationals fans should be paying attention to Josh Hamilton, who’s had a relatively simple return from his similar thumb surgery. Hamilton has made it through this process normally and not much is ever normal for Hamilton. News today from Dan Kolko of MASN was very positive, with Harper progressing to soft toss and two-handed swings. It doesn’t sound like much, but it’s a big step. 

Most clearly it shows that Harper is advancing quickly after surgery. He’s able to grip the bat, meaning he’s been able to keep muscle tone and that his thumb is healing well. Assuming all goes well over the next few days and no setbacks for the thumb, Harper will likely progress to batting practice and live hitting quickly.

That could put him on track for a rehab assignment within the next 10 days. He shouldn’t need much time there, just enough to get his confidence back and show Nats officials that he’s ready to be back in the bigs. The key is bat control.

For any hand injury, a loss of grip strength and fine muscle control will often lead to more swing-and-misses. Hamilton’s done well with this, so there’s a chance that Harper can as well, especially if there’s been some change in the rehab process. (No, I don’t think PlayStation is that change.) 

Look for Harper to start at a low level, but for the Nats to show less restraint with him than they have with others. Harper is tougher to hold back, and the team knows that his bat can be a difference-maker. They will have some questions regarding what happens with Ryan Zimmerman once Harper is back, but no one’s going to hold Harper back because Zimmerman’s looked decent in the outfield. Once Harper shows any signs of power, get him back in your lineup if not before.

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MLB Concussion Policy Helping Buster Posey, Michael Brantley Return Healthy

A few years back, MLB was confronted by a new problem. Well, concussions weren’t “new” but the focus on them was. As players, especially catchers, were seen to have problems, MLB did something. Led by Athletic Trainers and several ex-players, including Mike Matheny, a new policy was quickly put in place to diagnose and monitor concussions throughout baseball.

The system has, for the most part, worked. There are always issues, but with any system, there will be exceptions. The seven-day concussion DL and the protocols in place for clearing a player to return after a concussion have been a success. The NFL is still iterating its system and not showing the same results that MLB has so far.

There were two concussions this week that bring the issue back up, showing the two key mechanisms. Buster Posey took a hard foul off his mask and was lifted from the game once he complained of symptoms. Posey wasn’t back in the lineup until Tuesday, according to NBC Sports (via Yahoo! Sports), and the Giants figure to watch him closely. Shifting him to first will help some, but that’s been part of their plan all along.

Michael Brantley was kneed in the head on a slide, a similar mechanism to what we’ve seen with Justin Morneau and others in the past. The play is simply awkward, and some think that changes in the “neighborhood play” with replay have made this even more dangerous. It’s far too small a sample to make any informed decision, but this would be easy to tweak if necessary. 

Catching concussions are a tough problem, though advances with helmet technologies are promising. For sliding players, there’s a more simple fix. Players should wear tighter helmets, which is easily correctable, but we may need to shift to a dual-cushion system. Perhaps there will be batting helmets and “sliding helmets” in the future, since the forces of a hard ball to the mask and a knee to the head are far different.

Posey was able to return quickly, but Brantley is still undergoing tests, according to the AP, via ESPN.com, after suffering both head and neck issues. Both players are well served by MLB’s concussion policy, and we can only hope Brantley is back as quickly and easily as Posey.

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Rays’ Wil Myers’ Stress Fracture in Wrist Puts Power at Risk for Rest of 2014

You know those mutual fund ads that end with something like “past performance does not guarantee future results?” The Tampa Bay Rays medical staff, historically one of the top staffs in terms of results, is having a tough year. Its latest bad break is losing Wil Myers, its young slugging outfielder, for two months to a surprising stress fracture in his wrist, according to MLB.com. That could mean that Myers will be down on power for the rest of 2014.

The Rays only got half of the good news they were looking for. The team had been hoping that Myers could avoid surgery, and that looks to be the case now. However, the wrist is a very complex structure and if the fracture doesn’t heal perfectly, surgery may be necessary down the line. The key here is that something overstressed one of the bones, and that causation will need to be addressed.

The wrist appears simple from the outside, but it is a very complex joint, needed both for the hinging between the arm and hand and also for small movements, rotation and finger movements/grip. It is a structure of small interconnected bones lined with tendons, ligaments and cartilage, and all can be thrown off by even minute changes. 

Fractures are common and are difficult to heal due to the shape and positioning of the bones. Moving any of the connective structure can cause problems, and the area tends to have issues with scar tissue, which can alter the structure’s delicate balance. Worse, the problems can linger, especially with tendon or ligament involvement.

The most common problem after return from any wrist problem is a loss of power. Even surgically repaired wrists tend to show a short-term loss of power, likely from impeded motion leading to a loss of bat speed. That short term tends to last about six to eight weeks.

The best example of this is Pablo Sandoval, who has had both wrists fractured and repaired surgically. In both cases, he came back fine once time passed and the wrists were back to normal. Even gap power or “loud outs” are a positive sign if you’re watching to see when Myers might be ready to return to his normal level. 

In the short term, the Rays will use a combination of Ben Zobrist (himself just returned from the disabled list), Matt Joyce and Jerry Sands in right field. Joe Maddon will have to adjust his roster and potentially lose some flexibility with Zobrist in the outfield, but the team needs to maximize the situation.

Watch to see if Maddon finds ways to get Kevin Kiermaier into the lineup. The speedy defensive specialist is caught behind Desmond Jennings but has both power and stolen base potential if used. 

With the Rays in a disappointing slump and losing Myers for an extended period, plus his likely power drop, there are concerns that the team will consider trading off players like David Price or smaller pieces like a resurgent David DeJesus. I’ve known that front office a long time, and the Rays never act rashly, so I don’t think a six-week injury to even a star like Myers will change its plan. 

For Myers, his 2014 will be a down year. While he will likely return to the lineup sometime in mid-to-late July, his power may not return until near the end of the season, if then. His slash line and peripheral stats are already quite disappointing, but an injury takes away some of his chance to turn that around.

 

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Mark Teixeira’s Wrist Injury Could Shake Up the Entire AL, Not Just Yankees

The New York Yankees aren’t sitting back and waiting for the results of Mark Teixeira’s latest tests on his surgically repaired wrist. According to Jon Heyman of CBS, the Yankees have approached Kendrys Morales, who could sign as soon as Thursday evening.

Morales has been held hostage by the rules of baseball. As one of few free agents that was given a qualifying offer of $13.3 million by his former team, signing Morales would have cost his new team their first-round pick.  Since the Yankees have already signed one of these players in Brian McCann, the Yankees would have to surrender their second-round pick, their highest, which would push them back from selecting 55th. Signing Morales before the draft would mean that the Yankees would not pick until 91. 

However, initial reports on Teixeira’s chronic wrist problem are positive. Daniel Barbarisi of the Wall Street Journal reports that Teixeira got good news from the doctor and could be back as soon as Tuesday. Reports have varied on which doctors Teixeira was seeing, but sources tell me that the answer was “all of the above.”

Teixeira saw not only Yankees team doctors and his surgeon, but he also called in at least one consulting surgeon for an opinion, thought to be Dr. Thomas Graham, the hand surgeon that worked on Bryce Harper’s thumb among others. Wrist problems like this normally do not recur after surgery, but the structures of the wrist are very fine. Even a small problem like scar tissue or inflammation can upset the entire anatomic structure, creating pain and weakness as Teixeira has dealt with.

The worry now is that Teixeira’s wrist is a chronic problem. Even with the positive reports and a possible quick return, there’s no guarantee that the wrist won’t act up again. Even with ace rehabber Mark Littlefield focused on Teixeira’s maintenance, this episode has Girardi and his staff worried about how much Teixeira will play, let alone hit.

Manager Joe Girardi told the press Monday that he was tired of playing a man down, intimating that he would like to see Teixeira on the DL. If Teixeira is able to play quickly, I’m sure Girardi would welcome him back, especially if he gets a good look at the Scranton roster that offers little in the way of quick fixes.

Morales would not be available until Thursday at the earliest, though it is much more likely that he will need a quick trip through the minor leagues. That is what Stephen Drew did after signing late and returning to the Boston Red Sox after being trapped by the same situation.

Signing Morales would lock up the DH slot and not offer much in the way of help for first base. Morales’ chronic ankle problems have limited his mobility greatly. It would also hurt the flexibility of a roster that is already inflexible and further tax a medical staff that is dealing with several players that require extensive maintenance and pregame routines.

There’s also the worry that Derek Jeter, now in his final season, will need the DH slot more if his ankle becomes problematic. Jeter has already been benched more than expected in order to keep him available during his victory lap, but that taxes the roster even more. 

While the Yankees aren’t out of the AL East race by any means—they currently carry a 41 percent chance of making the postseason according to Clay Davenport—the addition of another solid bat has to be tempting for a team like the Yankees. 

There’s one other piece of timing that needs to be mentioned, and that is the 90-day elimination period that is in place on Mark Teixeira’s insurance. The Yankees would have to wait that 90 days before they would be able to collect any money to alleviate the cost of Teixeira’s absence. The clock restarts if Teixeira plays even one game, so they will need to have some comfort level with his wrist before putting him in the lineup.

With the return of Teixeira and Carlos Beltran, who is currently trying to avoid surgery to remove bone spurs in his elbow, the Yankees wouldn’t need Morales. That would leave several other teams, including the Kansas City Royals, Texas Rangers and the inevitable “mystery team” that comes with a Scott Boras signing. A decision will likely be made shortly and the wait over for Morales just after the Houston Astros make their pick Thursday evening.

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Matt Wieters’ Elbow Making Progress, Helped by Controversial Injection

Matt Wieters is making progress. A trade for another catcher was taken as a sign by many that Wieters might be heading for surgery, but Dan Connelly of the Baltimore Sun corrected that thought. While Wieters hasn’t begun any baseball activities, the thought that he’s getting closer is not only a positive, but it shows that the direction he’s taken may be correct.

Wieters is doing a standard elbow rehab at this stage, focused on range of motion, stability and secondary stabilizer strength. With a damaged ulnar collateral ligament (UCL), the concern will be that the elbow will have additional laxity and that the scar tissue that’s rebuilding the damage will need to be protected until the ligament is stronger. 

Another big advantage that Wieters had was a platelet-rich plasma (PRP) injection delivered directly into his elbow. PRP is made by drawing blood out of the patient, spinning it in a centrifuge and then injecting it back into the patient in the joint space where the problem exists. For Wieters, that was the elbow, of course. 

PRP has been used for several years, but there is no consensus on why or even if it works. The scientific studies are very vague and have mixed results. There’s agreement that using the body’s own product in concentration does no harm, at the least, and most surgeons say they have seen some gains in some cases. Dr. James Andrews once stated that he was going to use PRP on all elbows he saw. “If it doesn’t hurt, it can’t hurt to try,” he explained to an audience at his ASMI conference. 

PRP is also being lumped in with other therapies, such as extracting stem cells from the body or adding things to PRP, such as the Regenexx therapy that is becoming more widely used in American sports. The term “biologics” is taking hold, though it’s still a very vague label. Stem cells were recently used to help CC Sabathia’s knee, though it is too early to tell how well it works.

These injections may not be well understood, but they are not illegal. Some have been confused due to the use of HGH and other substances in some injections, but in a tested environment, doctors know not to use those substances. Dr. Anthony Galea was caught using some performance enhancers in his injections, but the guy was arrested for a reason.

When I wrote an article about the future of sports medicine for Popular Science a few years back, many of the doctors I spoke with pointed to biologics as one of the big possibilities. If Wieters and others can have a low percentage rehab like his aided by their use, it’s a win-win proposition for everyone. 

Right now, the Orioles are operating on a calendar, not a clock. They’ll be as patient as they can be with Wieters in his rehab, but for every day they wait before surgery, they’re taking a day off his 2015 season. They’re gambling on the possibility of the biologically aided rehab working and risking some lost time in the future. 

There’s no indication at all that Wieters will be back to catching in the short term. The trade for Nick Hundley seems to be intent on getting more production from the position in the short term, but it may also be needed in the longer term if Wieters has to shift to DH. With Chris Davis at 1B, that’s not a long-term option unless Davis moves on. 

The next step for Wieters will be taking swings. He’s weeks away from live batting, and again, this is not an assured step. Even a small setback could force him to undergo surgery, ending his 2014 and perhaps eating into his 2015. The Orioles hope that biologics and hard work can keep Wieters on the Albert Pujols path, avoiding surgery and maintaining production. 

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Yordano Ventura Latest Victim of Arm Injury, but Royals Rookie Escapes Worst

The Kansas City Royals received good news on Tuesday after the MRI results on rookie phenom Yordano Ventura came back. Royals general manager Dayton Moore told MLB Network (via Matt Snyder of CBS Sports) that Ventura would miss only one start, though he declined to offer specifics about the injury.

Ventura worried Royals fans when he left his Monday start holding his elbow tightly to his side. Ventura had not shown his normal velocity, causing manager Ned Yost to ask if he was throwing changeups, according to Andy McCullough of The Kansas City Star. Ventura has been clocked at the magic 100 mph mark several times this season, so the drop-off was very noticeable. 

Initial reports came from the mouth of Yost, who said that all of Ventura‘s pain was on the lateral side of the elbow, which can be confusing to many due to anatomical positions used to describe the elbow. While the ulnar collateral ligament is on the medial side—it is also called the medial collateral ligament by some, including Mets team physician David Altchek—there are cases of referred pain. 

The lateral aspect has many possibilities, including an olecranon fracture, bursitis or bone spurs. With Yost also saying that Ventura was “banging his fastball,” there’s the possibility that Ventura is literally banging the bones of his upper and lower arm together on every pitch. (Go ahead and try this at home. Gently (!) extend your arm. If you push just past a comfortable lock, you will feel the bones touch.)

Since X-rays are quick, the fracture and spurs are unlikely to be the culprit.

Instead, the short-term timeline and lack of a differential diagnosis leaves us with the vagaries of inflammation. The Royals have yet to elucidate us on causation, which makes me wonder whether they know. It’s easy to rest Ventura and get the inflammation out with ice and anti-inflammatory medication but harder to fix the cause, especially if it’s unknown.

Many, including Jeff Passan of Yahoo, question whether or not Ventura‘s velocity is the problem, citing issues with other hard throwers. The problem is less about velocity and more about stress. Can a pitcher create huge forces without transferring too much load? We know that some pitchers create over 60 Newton-meters of force on a ligament that breaks at about 32 Newton-meters.

An analogy to this would be a race between two cars. Imagine taking your car and running it alongside a Ferrari around the Indianapolis Motor Speedway. Sure, your car is probably nice, but I’m guessing it’s not a Ferrari. Both can probably do 100 mph around the track, but one of them will be taking a Sunday drive while the other is likely going to be bouncing off the red line and screeching around the turns. Pitchers are the same way; some deal with the stress better, though we don’t know why. 

The problem is that teams also don’t know. Yordano Ventura has never had a biomechanical analysis done, so the Royals have no idea how much stress he’s creating with every pitch. To continue with the car analogy, the Royals are buying a Ferrari without getting the Carfax. That analysis would cost $199 at the University of Missouri’s lab, far less than the loss of even one start of a minimum-salary player like Ventura

If Ventura really is going to miss only one start, he’ll have limited rest. He would need to be back on a mound shortly after his missed start, doing side work to keep himself in shape. With limited time to beat the inflammation and none to make any mechanical changes, the Royals must either believe this is very minor or have reached new levels of self-delusion. 

Ventura will not go on the disabled list now, but this is a low-risk move. The Royals will retain the possibility of placing him on the DL at any time, with a retroactive move to Tuesday. Ventura is too good to drop in any format, so wait and see is the only move. 

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Washington Nationals Lose Another Player as Gio Gonzalez Sidelined by Shoulder

The Washington Nationals have lost Gio Gonzalez for the next few weeks. The Cy Young contender has what the Nationals are calling soreness and inflammation in his pitching shoulder and will give him time to let that calm down, according to Adam Kilgore of the Washington Post.

Gonzalez was diagnosed after having an “enhanced MRI.” This is another term for a contrast MRI, which is a normal tool for orthopaedists. A dye is injected into the joint, allowing for a clearer view of the structures, as the video here shows. The Nats said there was no structural damage seen on the enhanced MRI.

So we know what it’s not, but pain and inflammation don’t just happen. Gonzalez has something wrong inside his pitching shoulder, and absent a structural cause, the usual diagnosis is either impingement or bursitis. Bursitis could be easily seen on a contrast MRI, so it’s safe to assume that the Nats aren’t playing word games with us. 

Add in another piece of evidence, in that Gonzalez told the Washington Post that he was having trouble finding a consistent arm slot, the lean would be to impingement. That indicates a generalized inflammation that is causing some of the structures inside the shoulder to be restricted from their normal movement or even squeezed inside the shoulder.

With Gonzalez on the disabled list, the Nats will go to work trying to remove the inflammation. Rest and treatment should get him more comfortable and at the point where he can get back on the mound; the hope is that his arm will comfortably go back to its natural position. Oddly, comparing his last two starts, it appears that Gonzalez was actually raising his release point, which is opposite of what a pitcher normally does when his shoulder is sore.

The Nats historically have issues keeping their pitchers healthy. While the team was actually in the top 10 for the first time since moving to Washington in terms of injury stats last year, their back in their normal spot early this year. The team has lost about $19.3 million worth of value so far this season. In terms of pure days lost, they’re near the bottom again. (Data from my proprietary Injury Database.)

Losing Gonzalez for a short period of time shouldn’t devastate the Nationals, but their overall problems with health are one reason that they consistently underperform their expectations and talent. 

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Matt Harvey’s Return Timeline from Elbow Surgery Puts Mets in Tough Position

Rehab timelines aren’t very flexible. Physical therapists work through a protocol and when an athlete can do all the necessary tasks, they move on to the next one. If they can’t, they repeat. Where things get a bit more flexible is once an athlete is past the rehab timeline and into the return timeline. That’s where Matt Harvey is now and that fact has oddly put the New York Mets in a tough position.

Matt Harvey is ready to throw from a mound. In a perfect world, he’d be starting a rehab assignment sometime in late June or early July. That would put him on track for a return around Aug. 1, enough time to get the “six or seven starts” Harvey told Tom Verducci of SI.com he would like to make. This would be very akin to the return of Stephen Strasburg a couple seasons ago, something of a cameo appearance that gave equal parts confidence and a tease for potential season-ticket holders.

Where things get odd is that the Mets don’t want to see Harvey back at Citi Field this season. The team long since decided that their goal is to have Harvey back at full strength for 2015, not just pitching at the tail end of 2014. The Mets’ brain trust is an intriguing combination of old-school and new-school baseball minds, but they are also very data-driven and have shown that they are willing to take a long-term focus.

Harvey is pushing to return at just 10 months after surgery, which is on the low end of return timetables, but is certainly not unheard of. The Mets are more comfortable seeing him at the far end, about 12 months, which would actually push his return into the offseason. That would make his actual return come at 18 months, giving him a full, normal offseason program and a full, normal spring training routine. 

There’s a hint in Harvey’s interview with the New York Post that his agent, Scott Boras, is against the quicker return, but Boras has never pushed himself into discussions like this in the past. While Boras isn’t hesitant to make his positions known to teams or his clients, hinting that he’s going to be a problem here has no history.

Harvey does say there are going to be changes when he returns, whenever that is. He’s put on some weight due to relaxing his workouts and he’s not going to do his full-go bullpen sessions that left him in a lather and his catchers icing their sore hand. 

Whatever version of Harvey we see later this year, there’s certain to be some tension about whether he’s going to make it back to the Mets this season. He’ll get some good crowds to Coney Island and Las Vegas, to be sure, but Harvey wants to pitch in the Big Apple. We’ll see whether that happens soon enough, once we see when he starts a rehab assignment.

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Joey Votto Quad Strain Will Challenge Reds, Raises Questions About His Health

The news came from Ken Rosenthal of Fox Sports. Joey Votto, the Cincinnati Reds star first baseman, stayed in Cincinnati for an MRI and a consultation with team physician Dr. Tim Kremchek rather than joining the team at the start of a six-game road trip.

The finding was that Votto has a strain in his distal quad, the part of the thigh muscles nearest to the knee. The injury is to Votto‘s left leg, the same one he had two surgeries on in 2012. The team will take the next few days to see how he responds to treatment and rest before making a decision about the disabled list.

The diagnosis of the Grade I strain is a positive given earlier indications of a knee problem, but it’s not good either. There is very clearly an issue with his movement pattern, and the injury will affect the stable base that Votto needs in order to hit well in his manner. It could be a discrete injury, but there has to be concern that the previous knee problems have caused changes that led to a cascade injury. 

In 2012, Votto had a simple meniscus tear. He had a meniscectomy and, during rehab, took things a bit too fast, leading to a need to go back in and repair the knee a second time. Votto struggled when he returned because he had a hard time finding a stable base for his swing. The extreme loss of power is certainly a worry in the short term with this latest injury.

The Reds medical staff will use all of their available modalities to help Votto, but most of this is going to be about his healing response. Votto has a tendency to be very reticent about injuries, trying to play through them until his performance has suffered, then trying to get back too quickly. If Votto shows some healing over the weekend, the Reds may try to let him come back with some restrictions. If they decide that he’d be better served by more time, they won’t hesitate to push him to the DL

With Votto‘s giant contract hanging over his head and potentially becoming a major issue for the Reds if his production drops, this latest knee problem is a major concern. At worst, Votto is beginning to have degenerative changes in his knee, which would likely reduce his availability and production. Votto had a major drop-off in power once he returned from surgery in 2012, and that could become permanent.

Votto has had a disappointing season, as pointed out by Cincinnati radio host Lance McAllister. Some of that may be due to the knee, especially if he has been trying to play through this. However, there’s been no real sign that Votto is having problems. He’s not a speed guy and has a lumbering gait when healthy, so this may have been impossible to see. 

The Reds are already without Jay Bruce, who recently had knee surgery to correct a similar problem. The fact that the team has two such similar injuries in a short period of time could be coincidence, but there’s also the possibility that there’s an issue with the movement patterns they are using. That’s unlikely given the stability in support and medical staff, but it’s something I’m sure the team is checking.

While Votto is out, the team will give Neftali Soto a look, with Brayan Pena being another possibility. Neither is a fantasy option, and both are a major downgrade at the position for the Reds.

Votto shouldn’t be out much longer than the 15-day minimum in the worst-case scenario, so the Reds will simply have to try to get offense elsewhere in the short term. Bryan Price, the new manager of the Reds, will have to show how adaptable he is offensively while missing his two biggest bats.

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