After Mets’ shortstop Asdrubal Cabrera reportedly injured a ligament in his left thumb on May 6th, he continued to play, though in a pinch-hitting capacity. He was said to be “testing” the thumb before succumbing to the DL 10 days later (retroactive to May 14th). He returned to the disabled list in mid June after aggravating the not yet healed thumb while batting right-handed. Reports conflicted on the specifics of the injury, with Cabrera noting that he had torn the ligament, while the Mets initially announced the MRI was clean, and more recently stated that the injury is joint and not ligament related. Cabrera will be eligible for re-activation tomorrow and is scheduled to resume playing in a rehab start.

Cabrera has a history of toughing it out and playing hurt. Many times. And for a variety of ailments. Perhaps that even plays into his growing list of injuries. Between his two recent DL stints, Cabrera received a cortisone injection before resuming competition. And so it goes…

Sweeny Murti of WFAN reported yesterday that Greg Bird, the NY Yankees’ first baseman, had been re-examined. It was determined that Bird continues to exhibit inflammation at the site of his right ankle contusion. The first-baseman has been out of action since May 2nd when he was placed on the 10 day DL. He also had played following the initial injury (which occurred at the end of spring training) before his sluggish performance forced a closer look at his ongoing symptoms. It is now 52 days since Bird hit the DL.

In his update yesterday, Murti told me that the Yankees announced Bird is likely to miss another three to five days after receiving a cortisone injection, though there is no definitive timetable for his return. As if something magical will happen in just a few days.

What might take place during that period is a cortisone-accelerated relief of inflammation that masks any underlying causes of continued symptoms. Also a false sense of recovery that may lead to all-out exertion and the loading of involved structures beyond their capacity to withstand breakdown.

Bone contusions generally heal within a four to six week window. However, the time required for athletes to return to sports after contusions – or frank fracture – is obviously greater than the healing time of the bone. It also entails restoring joint mobility that may be lost due to immobilization, as well as achieving all the parameters of healing and function required after other musculoskeletal injuries. Functional testing should precede return to play.

Injuries take time to heal. And though there are expected time frames for recovery, each person and injury is nuanced. There is no substitution for rest from activities that place undue demand on already inflamed, weakened or damaged structures. Those who continue to fight through risk further breakdown, compensatory injuries or worse. Acute injuries that become chronic because of continued stress become more resistant to healing. The time until complete recovery is typically extended. There is no point, particularly in light of the generally compromised performance that is demonstrated while nursing an injury.

It is also important to recognize that in returning to action too soon, the surrounding muscles and other structures – which are likely weakened and fatigue more readily – cannot provide the support, shock absorbency, power and endurance to optimize functional performance and minimize risk of additional injury.

And of course, there is always the fact that repeated cortisone injections to a given area are not without inherent risks.

That isn’t to say there isn’t a place for treatment intervention with cortisone, just that it is not a panacea. It might best be seen as a vehicle to accelerate the improvement of a recalcitrant inflammation so as to cautiously and effectively address other facets of recovery in a safe progression leading to an injury-free return to play.

For earlier posts on specifics related to the healing process and the recovery of soft tissue tensile strength, take a look here and here.


About the author

Abby serves as the Injury Expert for CBS New York where, since 2010, her Injury Breakdown Blog examines injuries in professional sports. She also blogs on health & fitness as well as sports injuries for Huffington Post, and Recovery Physical Therapy.com, where her blog earned a top ten mention for physical therapy blogs in 2012 @ WorldWideLearn.com. In a ranking of the Top 30 Healthcare Blogs for 2012, Top Masters in Healthcare also rated Abby’s blog in the top three in Physical Therapy! Abby is the founder of Fit-Screen and she welcomes your comments and questions!

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