MLB 2016

[MUDPT]

Crazy crazy crazy that you think you know better than doctors that have actually seen his MRI, no?

Thanks for asking.

First, there is this study:  http://www.bmj.com/content/346/bmj.f232

Key Finding: "At five years, patients assigned to rehabilitation plus early ACL reconstruction did not differ significantly in patient reported or radiographic outcomes from those assigned to initial rehabilitation with the option of a later reconstruction."

So now it's been established that there is no significant benefit from having ACL reconstruction immediately after surgery.

Second, there is this study:  http://www.jospt.org/doi/full/10.2519/jospt.2010.3345

Key Finding: "Short-term progressive exercise therapy programs are well tolerated and should be incorporated in early-stage ACL rehabilitation, either to improve knee function before ACL reconstruction or as a first step in further nonoperative management."

So now we also know that an exercise program before surgery can help outcomes after surgery.  Other studies show the single best predictive outcome of ACL reconstruction is pre operative quadriceps strength, which can be worked on before surgery.

There is no reason to have ACL reconstruction right away and it's also been proved that pre-habilitation can help with post- operative outcomes.

Granted, these studies are not with professional athletes.  However there have been many athletes in the NBA and NFL (two sports where an ACL is more important than baseball) that have played without one.  I've treated athletes without ACLs back to sports successfully.  I've also worked with professional athletes and know that they are obviously way more likely to be able to compensate for an ACL deficient knee.

If it was my son with this injury, we would start with exercise, re-evaluate in 4 to 6 weeks to see how everything was improving.  If the knee felt more stable and was getting stronger, there is a chance he could come back this season.  If it wasn't progressing at 4 weeks, then time for surgery.  The only reason, in my opinion, for surgery now is a severe, severe knee instability (especially with the LCL tear).  But there is no way that they know if it is stable or not, because A: it's been less than 24 hours (no time for decrease in inflammatory factors) and B: he also had a sever ankle sprain and is 95% likely to be in a walking boot today. There is probably no way to tell the functional stability in that knee yet. 

Imaging is getting to be more and more useless in rehabilitation. We already know MRIs for low back pain are some of the biggest medical waste that we have.  There are numerous studies that show significant tears in shoulder rotator cuff tendons and labrum tears, without any symptoms.  With all of this information, I just hate it when we make orthopedic medical decisions without any objective, functional data.

[brandx]

On the flip side how about freaking Trevor Story!

I just think of all the guys who will get burned picking him up in fantasy Baseball next week.

He may go on to have a good year especially playing at Coors, but his minor league numbers don't foretell this success.

I will go out on a limb and state the obvious - this week will be the best week of his season, if not his career.

Other than that, good for the kid. I hope he becomes a solid MLB SS.

[ChicosBailBonds]

This new rule about breaking up a double play is for pu$$ies.

[brandx]

Thanks for asking.

First, there is this study:  http://www.bmj.com/content/346/bmj.f232

Key Finding: "At five years, patients assigned to rehabilitation plus early ACL reconstruction did not differ significantly in patient reported or radiographic outcomes from those assigned to initial rehabilitation with the option of a later reconstruction."

So now it's been established that there is no significant benefit from having ACL reconstruction immediately after surgery.

Second, there is this study:  http://www.jospt.org/doi/full/10.2519/jospt.2010.3345

Key Finding: "Short-term progressive exercise therapy programs are well tolerated and should be incorporated in early-stage ACL rehabilitation, either to improve knee function before ACL reconstruction or as a first step in further nonoperative management."

So now we also know that an exercise program before surgery can help outcomes after surgery.  Other studies show the single best predictive outcome of ACL reconstruction is pre operative quadriceps strength, which can be worked on before surgery.

There is no reason to have ACL reconstruction right away and it's also been proved that pre-habilitation can help with post- operative outcomes.

Granted, these studies are not with professional athletes.  However there have been many athletes in the NBA and NFL (two sports where an ACL is more important than baseball) that have played without one.  I've treated athletes without ACLs back to sports successfully.  I've also worked with professional athletes and know that they are obviously way more likely to be able to compensate for an ACL deficient knee.

If it was my son with this injury, we would start with exercise, re-evaluate in 4 to 6 weeks to see how everything was improving.  If the knee felt more stable and was getting stronger, there is a chance he could come back this season.  If it wasn't progressing at 4 weeks, then time for surgery.  The only reason, in my opinion, for surgery now is a severe, severe knee instability (especially with the LCL tear).  But there is no way that they know if it is stable or not, because A: it's been less than 24 hours (no time for decrease in inflammatory factors) and B: he also had a sever ankle sprain and is 95% likely to be in a walking boot today. There is probably no way to tell the functional stability in that knee yet. 

Imaging is getting to be more and more useless in rehabilitation. We already know MRIs for low back pain are some of the biggest medical waste that we have.  There are numerous studies that show significant tears in shoulder rotator cuff tendons and labrum tears, without any symptoms.  With all of this information, I just hate it when we make orthopedic medical decisions without any objective, functional data.

All very meaningless. He plays a sport at the highest level almost 8 months out of the year. And maybe 30-40 of those games he will need to crouch down 100-120 times in a 3 hour span.

You have no idea of the severity of the injury so it seems as though you're saying that every ACL injury is equal .

He also tore his LCL which is on the outside of the knee to keep it from bending outward. It provides stability in the rotation of the knee, which comes into play maybe 2000 or so times swinging at pitches over the course of a season. If this is more than a minor tear, any doctor worth his salt will recommend surgery.


Edit: If it was just an ACL and happened to a non-athlete, your idea may make more sense than immediate surgery.

[jesmu84]

All very meaningless. He plays a sport at the highest level almost 8 months out of the year. And maybe 30-40 of those games he will need to crouch down 100-120 times in a 3 hour span.

You have no idea of the severity of the injury so it seems as though you're saying that every ACL injury is equal .

He also tore his LCL which is on the outside of the knee to keep it from bending outward. It provides stability in the rotation of the knee, which comes into play maybe 2000 or so times swinging at pitches over the course of a season. If this is more than a minor tear, any doctor worth his salt will recommend surgery.


Edit: If it was just an ACL and happened to a non-athlete, your idea may make more sense than immediate surgery.

Making a big assumption here, but you realize you're arguing with someone who is likely an expert in the field? At minimum, I have no doubt he knows what an LCL does.

[NavinRJohnson]

What's worse is surgery pretty much guarantees arthritis in his knee, limiting his ability to catch in the future. Rant over.

Not worse in any way. He had about as much future ads an MLB catcher as I do. He was never going to catch. Now, long-term damage to the knee is still a major concern, and perhaps a bigger concern than the impact on the team this year. Could definitely change the trajectory of his career. He already appeared destined to be destined for a DH role. This would seem to strengthen that likelihood.

[Vander Blue Man Group]

Not worse in any way. He had about as much future ads an MLB catcher as I do. He was never going to catch. Now, long-term damage to the knee is still a major concern, and perhaps a bigger concern than the impact on the team this year. Could definitely change the trajectory of his career. He already appeared destined to be destined for a DH role. This would seem to strengthen that likelihood.

Completely disagree that he was destined to be a DH.

[brandx]

Making a big assumption here, but you realize you're arguing with someone who is likely an expert in the field? At minimum, I have no doubt he knows what an LCL does.

I agree that he probably is pretty well versed as it was an intelligent post.

But, I trust the opinion of a doctor who deals with these kinds of injuries over someone who had seen neither the severity of the patient's injury nor the results of an MRI or other tests on Schwarber's knee.

The poster gave a "one diagnosis fits all" answer. No doctor would say that the treatment for every broken arm should be the same - so why would it be different with a knee injury?

[NavinRJohnson]

Completely disagree that he was destined to be a DH.

Perhaps. Injury or no injury, he had no future as a catcher however.

[buckchuckler]

This new rule about breaking up a double play is for pu$$ies.

Seems to be a terrible rule. 

[buckchuckler]

I just think of all the guys who will get burned picking him up in fantasy Baseball next week.

He may go on to have a good year especially playing at Coors, but his minor league numbers don't foretell this success.

I will go out on a limb and state the obvious - this week will be the best week of his season, if not his career.

Other than that, good for the kid. I hope he becomes a solid MLB SS.

Wait, so you don't think he is going to hit his pace of 240 (or so) homers?!?!?   

And as for fantasy, even if he only hits 15 more homers this season, that is still reasonably good for a SS.

[GGGG]

Seems to be a terrible rule. 

Why is that?  The end of the Brewers / Astros game is exactly what the rule is trying to prevent.  Rasmus never touched the bag and slid right past it.

[NavinRJohnson]

Why is that?  The end of the Brewers / Astros game is exactly what the rule is trying to prevent.  Rasmus never touched the bag and slid right past it.

Your correct about this. It is complicated by replay, that takes away any discretion on the part of the umpire as to whether the fielder is in any danger. Then again, that's probably the point, to eliminate the possibility all together. Slide into the bag, or don't slide at all. I don't have a problem with last night's call. Awkward because its new, but I don't really see anything wrong with it.

[buckchuckler]

Your correct about this. It is complicated by replay, that takes away any discretion on the part of the umpire as to whether the fielder is in any danger. Then again, that's probably the point, to eliminate the possibility all together. Slide into the bag, or don't slide at all. I don't have a problem with last night's call. Awkward because its new, but I don't really see anything wrong with it.

The rule has been called properly, that isn't the issue.  The issue is that this is the big leagues, and breaking up 2 should be able to be part of the game.  It isn't good when guys get hurt.  It should be up to the umpires discretion.  If the ump thinks it is beyond normal break up protocol, call him out.  I think the "Posey" rule is terrible as well.  Though at least with the "Utley" rule there doesn't seem to be confusion about it among the umpires. 

[brandx]

Wait, so you don't think he is going to hit his pace of 240 (or so) homers?!?!?   

And as for fantasy, even if he only hits 15 more homers this season, that is still reasonably good for a SS.

I was speaking more about the uncertainty of what happens with Reyes if/when he comes back. Without knowing what MLB will rule as far as a suspension, Colorado is on the hook for $22 million in 2016 and 2017 before a buyout is available.

I think Colorado hopes he gets a long suspension to save them millions this year and they can just let the rookie play.

[GGGG]

The rule has been called properly, that isn't the issue.  The issue is that this is the big leagues, and breaking up 2 should be able to be part of the game.  It isn't good when guys get hurt.  It should be up to the umpires discretion.  If the ump thinks it is beyond normal break up protocol, call him out.  I think the "Posey" rule is terrible as well.  Though at least with the "Utley" rule there doesn't seem to be confusion about it among the umpires. 

I just don't like "umpire's discretion" because that is what leads to inconsistency.  Everyone knows what the new rule is.  I'm all for "easing" the rule a bit, but I just don't like too much discretion as part of that.

[Vander Blue Man Group]

Perhaps. Injury or no injury, he had no future as a catcher however.

I think that's less likely, certainly.  However, he was never going to be a full-time catcher.  I assume it depends on the damage they find when they get in there.  I still wouldn't completely rule out him catching 1-2 games per week down the road if everything goes well.

He's more athletic than people realize.  He covered a fair amount of ground before that collision - too bad he wasn't a step slower. 

[ChicosBailBonds]

Seems to be a terrible rule.

It's a classic overreaction to one play.

[MUDPT]

All very meaningless. He plays a sport at the highest level almost 8 months out of the year. And maybe 30-40 of those games he will need to crouch down 100-120 times in a 3 hour span.

You have no idea of the severity of the injury so it seems as though you're saying that every ACL injury is equal .

He also tore his LCL which is on the outside of the knee to keep it from bending outward. It provides stability in the rotation of the knee, which comes into play maybe 2000 or so times swinging at pitches over the course of a season. If this is more than a minor tear, any doctor worth his salt will recommend surgery.



Edit: If it was just an ACL and happened to a non-athlete, your idea may make more sense than immediate surgery.

Talked to someone last night that used to work in MLB.  Said 90% of what is said in media is pure speculation, so the time table that has been repeated is probably guess work at best. But I'll address some of the things that were said in your post.

1.  Squatting is one of the safest exercises you can do post-operatively for ACL reconstruction. It's the first exercise we do with a patient standing up.  There's little stress on the ACL in a full squat position, the reason that you see most ACL injuries in a "hyper-extension" position.

2.  Not all ACL's/ patients are equal and that's exactly my point with this whole post.  I'm not sure where you got that idea.  I explained how if it was my son, I would be completely monitoring the process and at the first set back or weren't progressing to goals, surgery would be the best course. I loathe the individual who looks at a scan and makes a definitive diagnosis without ever actually talking/ examining the patient and in my case, I really don't know what's going and shouldn't speculate.  My bad. If I had to guess, there couldn't have been any functional testing to see how he was walking, let alone anything athletic. So to rule him out until next year, is a little hasty, why I was mad.  I will say, a family friend's college basketball career was severely impaired by the ignorance of an orthopedic physician, so skepticism level will always be high on my part.

3. On a LHB, the LCL is not the primary stabilizer of the left knee.  If anything, there is a valgus torque that stresses the MCL.  And I've known physicians to allow close family members play football 3 weeks after torn ACL, because it was their final high school games. So not all physicians think in a single plane.  I want the Cubs to win the World Series this season and every decision should be made to reflect that.  I thought of 2 reasons possibly to rule him out: 1. 60 day DL to gain an extra spot on the 40 man roster, but I thought Kawasaki was already on it.  2. Psychologically to not have this thing overhanging the team all season that he might come back.  But like I said earlier, 90% is pure speculation.

4. The idea that a non-athlete would have an ACL reconstruction is borderline medical negligence.  The small risks from surgery: DVT, infection, death are so much greater than any benefit or increase in quality of life.

[ChicosBailBonds]

Too much confusion already and as I stated earlier, this is going to lead to MORE injuries.

http://nypost.com/2016/04/09/baffled-joe-girardi-called-joe-torre-over-chase-utley-rule/


http://nypost.com/2016/04/03/the-new-utley-rule-is-going-to-be-a-blight-on-baseball/


I loved Dallas Keuchel's response.....   “Are we even playing baseball anymore??? Unbelievable.”


“It’s a bad rule,” Braves manager Fredi Gonzalez said. “I get it. People are protecting the second baseman and shortstop. As a practical matter, it doesn’t translate.”

[buckchuckler]

I just don't like "umpire's discretion" because that is what leads to inconsistency.  Everyone knows what the new rule is.  I'm all for "easing" the rule a bit, but I just don't like too much discretion as part of that.

Yeah, why be able to add context to a situation when you can make it absolute. 

[brandx]

I just don't like "umpire's discretion" because that is what leads to inconsistency.  Everyone knows what the new rule is.  I'm all for "easing" the rule a bit, but I just don't like too much discretion as part of that.

Here is the rule in its entirety:

A runner who engages in a “bona fide slide” shall not be called for
interference under this Rule 6.01, even in cases where the runner
makes contact with the fielder as a consequence of a permissible
slide. In addition, interference shall not be called where a runner’s
contact with the fielder was caused by the fielder being positioned
in (or moving into) the runner’s legal pathway to the base.

Notwithstanding the above, a slide shall not be a “bona fide slide”
if a runner engages in a “roll block,” or intentionally initiates (or
attempts to initiate) contact with the fielder by elevating and kicking
his leg above the fielder’s knee or throwing his arm or his upper
body.


We all know a roll block on a defenseless fielder is meant to injure. The runner can still go in hard on a slide and he can still make contact with the fielder. That is still legal. He just has to slide at the base and can't elevate his cleats above the knee. Common sense.

If the umpire determines that the runner violated this Rule 6.01(j),
the umpire shall declare both the runner and batter-runner out.
Note, however, that if the runner has already been put out then the
runner on whom the defense was attempting to make a play shall be
declared out.

I don't see where umpire discretion is even involved any more than umpire discretion is involved in every single pitch of every game. Should we ban the calling of balls and strikes - every single one involves umpire discretion.

The rule only seeks to eliminate certain types of slides that are intended to injure Black and white. Any time this is called, there will be an umpire's review, so discretion does not even enter into the equation.

Any 10 year old could have called the one that ended the Brewer's game on Friday. The runner never slid toward the base, never touched the base, and never attempted to touch the base, sliding several feet past it.

[GGGG]

Yeah, why be able to add context to a situation when you can make it absolute. 

Because one umpire's "context" is different than anothers.

[buckchuckler]

Because one umpire's "context" is different than anothers.

So, then should MLB institute a rule where a pitcher who hits a batter with a pitch is automatically ejected?  Make it black and white.  Take the umpires judgement out of it. 

[GGGG]

So, then should MLB institute a rule where a pitcher who hits a batter with a pitch is automatically ejected?  Make it black and white.  Take the umpires judgement out of it. 

Right.  Because I said that judgement and context should be removed from EVERY play.