imagesFollow-up on Stephen Strasburg:

Not surprisingly, the Nationals placed Stephen Strasburg on the DL because of persistent symptoms from his Grade 1 lat strain. Strasburg reportedly played catch but was unable to take a scheduled bullpen session yesterday. More shocking is that he’d been expected to try, as well as start this weekend if he’d pulled it off.

Strains, even mild ones, can be stubborn injuries. The latissimus is a broad muscle in the back that extends from the pelvis, sacrum, spine, ribs and tip of the scapula (shoulder blade) all the way up to the front of the shoulder. No shock that a strained lat would have an impact on a pitcher’s effectiveness and mechanics, or that working through pain would exacerbate the injury and prolong recovery.

Studies have shown that the latissimus acts primarily to extend and internally rotate the humerus in the later phases of the pitching motion. It is integrally involved in the preparation for, and execution of, the acceleration that occurs before the release of the ball. The lat’s other functions are considered to be of lesser importance to the overall pitching motion. The lat is thought to be most vulnerable to injury during the cocking phase of pitching when it contracts eccentrically – acting to extend while also lengthening.

Gray350Follow-up on Bryce Harper:

Preceding his teammate on the DL, Bryce Harper took a different route. He did try to play injured. Again. And he retrospectively regretted that decision.

Harper collided with the Atlanta outfield wall on April 29th and sustained an injury to his side. Another run-in with the wall, this time at Dodger Stadium on May 13th, reportedly resulted in the knee injury reportedly most responsible for his current detour. Harper continued to play aggressively but with less productive results until aggravating his knee injury in a headfirst slide on May 25th. It was reported that he had been walking with a limp, even while continuing to play. Never a good idea.

The diagnosis is bursitis. Harper has spoken of having persistent swelling and pain and didn’t hesitate to mention that, were it a more critical time of the season, he would play anyway.

So what exactly is bursitis?

Bursae are sacs filled with gelatinous like fluid that surround and sometimes open into the joint cavity in many joints of the body. They essentially serve as an interface between tendons and their bony attachments, or between skin, ligaments and bone. Bursae cut down on friction in the areas where they are positioned, allowing for greater ease in movement. In doing so they provide a mechanical advantage that heightens the effectiveness of the surrounding structures while reducing stress to the tissues and bone. Bursitis is simply inflammation of the bursa.

This diagram depicts only several of the 14 bursae located in the knee region, some of which are located on either side, while five are located in front of the joint. It is likely that Harper injured the prepatellar bursa, located at the front of the knee, from colliding with the wall and his headfirst slide. Another name for prepatellar bursitis is “housemaids knee” because of the obvious mechanism of injury due to pressure from prolonged kneeling. Another common cause is gardening. In Harper’s case, the initial trauma may have caused the injury, but continuing to play didn’t help. He is slated to come off the DL on June 11th but if he still isn’t walking without pain, it isn’t likely he’ll play.

Postscript: June 7, 2013 – Harper is scheduled to see Dr. James Andrews for a consultation on his left knee. Don’t look for him to return to the field on the 11th as planned. Another case of optimism not founded on the reality of a player’s recovery.

Follow Abby on Twitter @abcsims.


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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