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Medical Corner: Elbow Concerns – Corey Seager and The Wonderful Mets Rotation

Dr. Mike Tanner has treated patients with orthopedic injuries for over 10 years as a board-certified specialist and physical therapist. He is currently pursuing a Ph.D., educating physical therapy students and conducting research.

Corey Seager, Los Angeles Dodgers

Seager’s elbow injury is becoming a more significant concern than initially believed. Bill Plunkett of the Orange County Register reported that manager Dave Roberts said that Seager is still limited in the “volume and distance” of his throwing.

To put Robert’s comments into a meaningful context, players returning from an elbow injury follow a very regimented throwing program. The program includes multiple levels of throwing. First, shorter distances, then longer, then throwing more often, etc. A player “passes” from one level of the program to next only if he completes the session without pain or soreness within 36 hours. What Roberts said translates to the fact that Seager hasn’t progressed due pain/soreness when throwing too far or too much. Seager had an offseason to rest and heal, but his elbow is still a problem.

Keep an eye on this. The conservative and incredibly deep-rostered Dodgers may elect to give Seager routine days off and possibly multiple DL stints to manage the unhealed elbow. No one would ever accuse the Dodgers of resting players with DL stints, right? Chris Taylor can play shortstop,  Alex Verdugo/Joc Pederson are capable center fielders, and the Dodgers want Seager healthy in October. You do the math. I am a die-hard Dodgers fan, but his ADP of 32 is too risky for me.

The Mets Rotation Part 1 (Matz, Wheeler, Syndergaard, and deGrom)

Medical research shows there are a few correlating factors to getting injured:
1) The higher the pitching velocity, the higher the injury risk (more so in younger pitchers).
2) Pitching consistently near your max velocity increases your injury risk. League average is 92 mph.

Steven Matz – Avg Velocity – 93.1, Max 94-95

Matz is coming off back-to-back years where elbow injuries shut him down prematurely. In 2016, it was bone spurs, and in 2017 it was ulnar nerve irritation (compression).

Ulnar nerve transposition isn’t as scary as it sounds. Surgeons just move the nerve out of a groove where it has a tendency to get compressed to a spot where it gets irritated less. Athletes successfully return over 90% of the time. Players who undergo “Tommy John” surgery frequently have their ulnar nerve relocated as part of that surgery.

The surgery isn’t a big deal. deGrom returned to elite form from it last year. The more significant problem is that Matz’s body is communicating loud and clear that it can’t handle pitching (or at least the volume of starting pitching). Opposing hitters consistently shelled Matz after he posted glowing 2.12 ERA through his first five starts last season. We later found out he experienced numbness in his fingers around the time things went south. He’s a max-effort pitcher with a high likelihood of re-injury. Bullpen, anyone?

Zack Wheeler – Avg Velocity – 94.6, Max 97

Why on earth was Zack Wheeler injecting bone medications into his stomach this offseason? It is less strange than you might think.

When a Tommy John surgery doesn’t go well, it is typically due poor bone healing. The ligament is replaced, usually from a tendon near the wrist, so the ligament doesn’t have to recover. To insert the new ligament, the surgeon drills multiple holes in the bones near the elbow, and 10% of cases result in a bone-healing problem. That’s the reason for the bone injections into Wheeler’s stomach to improve the healing in his surgically repaired elbow (over two years later).

Additionally, Wheeler he had two biceps injuries in 2017 that ended his season prematurely. The biceps’ job during throwing is the slow the arm down after release, which it wasn’t ready to do because of how hard he throws. Wheeler’s Tommy John surgery didn’t go as planned, and the surrounding muscles are failing to compensate for the fragile elbow.

Noah Syndergaard – Avg Velocity 98, Max 101

See research correlations 1 and 2 above. Good luck. Syndergaard is elite, and most everyone knows he is an injury risk. With an ADP of 31 overall, I just need a little more security, but I won’t fault anyone for drafting him. All pitchers carry risk, but Syndergaard and Luis Severino lead my list of pitchers with expected lengthy DL stints in 2018.

Jacob deGrom – Avg Velocity – 95, Max 99

deGrom’s “back issue” is troubling, but the fact that he was throwing a bullpen one week later is promising. It may mean that exams were clean and the shutdown was precautionary. More news to come if the Mets disclose further details about his injury or permitted activities. For what’s it worth, I do have shares of deGrom this season.


Dr. Mike Tanner

Doctor of Physical Therapy

Send injury questions to @DrMikeTanner on Twitter.

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