Originally posted on Feb. 28.
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Q. Are you a real doctor, or do you just play one on my LCD?
A. This isn't a court of law, a Franciscan Prompt Care Clinic or a national baseball site that has confused itself with a genetic-code research facility. This is a baseball chat.
As always, we defer to Gordon or Dr. Grumpy, if they care to chime in. Until then, I'm going to chat about the roto draft position of Taijuan Walker. You have two choices:
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Q. Pineda had a torn rotator cuff, which they called bursitis. Same thing here?
A. I doubt it. (Look up the definition of "doubt:" a feeling of uncertainty -- here, about the idea that Taijuan's rotator cuff is in jeopardy.)
The literature says that the rotator cuff is the group of muscles that holds your upper arm bone into your shoulder; the bursa sac is there to lubricate the rotator cuff. So you can see how the two ailments could get confused with each other.
Taijuan got on a plane, flew to California, and the second doctor said, "Yep. It's the bursa sac, not the rotator cuff." Also, they said the MRI (not the X-ray) is clean.
So, I have a distinct lack of conviction that Taijuan's rotator cuff is torn up and that he's in a Pineda situation.
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Q. Why does Taijuan's inflammation persist? This started in December?!
A. There are 9,000 possible reasons ... on "inflammation" my favorite question (not the objectively best, but my favorite question) pertains to food intolerances, actually. I've known many athletes who had sore knees from running, and they quit drinking Diet Pepsi, and their knees felt better. Seriously.
Inflammation is closely connected to your immune system. That especially includes inflammation from overuse injuries.
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As SSI has told you a billion times, Taijuan Walker's sports motion is unnatural and un-fluid. He looks like a basketball player pitching a baseball -- as opposed to James Paxton, who was born to pitch.
Taijuan comes over the top, and his throwing motion LOOKS like it would create a pinch between the end of the clavicle (acromion, it says there) and the upper arm bone. I think he's going to pitch in pain all his life.
(It is a given, by the way, that a sidearm/underhand throwing motion is easier on the shoulder. That's not my opinion; it's the consensus -- less-muscled girls can throw softballs very hard underhand with very few injuries. Overhand motions risk the pinching syndrome.)
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Q. How much pain can you take?
A. Let's say you're running track, and your left knee hurts ... sometimes you keep running and the pain reaches a certain moderate level and stays there. I'm all in favor of "pushing through" that. MLB pitchers in fact DO that.
If the pain's getting worse and worse, and the track times (fastball velocity) are dropping off, you do not push through that (which is exactly what Michael Pineda did).
It certainly sounds to me like Taijuan suffered a LITTLE BIT of PERSISTENT pinching in the shoulder. If that's the case, then you classify this whole episode as "being extra careful with a prize prospect."
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Q. Which leaves Taijuan where, roto-draft-wise?
A. This latest shutdown, it drops him way down the roto list at the moment. Right now you draft him pretty low ... it could easily be, that later in the spring he's throwing again, and gaining steam, and then he bounces right back up to 100% of his previous position.
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Q. How come the Mariners keep fouling up their young pitchers?
A. Like Bill James said. 90% of really young pitching prospects get hurt before they ever contribute anything.
Here's where it comes back into focus: if you could have cashed Taijuan in for a David Price, there was a whale of an argument to be made for it.
The Mariners don't ruin 20-year-old pitchers; baseball ruins 20-year-old pitchers.
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Q. Is there any good news? Do you still like the M's rotation without Taijuan?
A. Good news:
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Q. Are you this pollyanna about everything?
A. Emotionally speaking, I honestly don't invest in teenage pitchers. I'm invested after they kick tail in the majors for several months -- or after they're out of the age 18-23 danger zone.
If Taijuan never throws another pitch, I personally won't have lost much. I never figured we had much to count on, in the first place. Danny Hultzen, that bothered me ... K-Pax? :: shudder ::
Now, was K-Pax able to throw without pain today, did anybody hear?
Cheers,
Dr D
Yeah, I would think bursitis would probably the least worrisome thing possible that could cause shoulder pain as it is not related to any structural issues in the shoulder (with the usual caveats regarding diagnostic uncertainty despite clean MRI). However, it certainly can linger, flare up, cause pain etc. As this is a sports motion/ortho issue (where I have minimal experience) though, I'll defer to G.
Always a treat to have an M.D. (or Gordon with his extensive training) weigh in.
If not a diagnosis, you guys can at least provide a more sound framework for thinking about the athlete's injury. We 'net rats spend so much time speculating about medical diagnoses, it's a treat when we get some more grounded info.
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You say bursitis would be 'least worrisome thing possible.' Great, but ... How much do you buy the (for public consumption) statement that he's gotten two diagnoses, both of which say bursa inflammation?
I understand you to say that --- > bursitis undoubtedly IS the indicated diagnosis, but that diagnosis can always be wrong (whoever is giving it) because of the limitations of MRI's.
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Right. It's certainly favorable that two of the best opinions available agree. MRIs are not perfect of course, but I don't know what the false negative rate is for shoulder injury.
As a large man and a long distance runner (if half marathons are still considered long distance), I just always thought that was the case for all athletes. My wife is also a runner, and although she is a small woman, also experiences a lot of pain. Now of course there is a big difference between the usual repetitive motion pain and discomfort and an injury. I wake up every morning tip toeing around the house, wincing with every step because of Planters Fasciitis, which especially in the mornings before my feet have had time to warm up and loosen is VERY painful, but it doesn't mean I won't or shouldn't go on a run that day. Now my running buddy who has a half shredded Achilles... He gets to take the next 3 months off and wear a cool boot to bed :)
That's the key hope for Taijuan... that this is just a sore muscle, wait a week, stretch a little more in the hot tub, and take a couple Ibuprofen type of deal... :) Play through pain, treat an injury!
P.S. Does anyone have any good Planter Fasciitis tips... :)
1. Great post OBF!
2. Am sure you know more about it than anybody here, but ...
2b. My approach is the "tree" pose in hatha yoga (cf. "royal dancer" and "warrior III"), and/or the balance-on-one-foot exercise on those little half-discs you see in the gym?
The idea is that the ankle, and sole of the foot, you're not talking about muscles. You're talking about connective tissue, and for me it works to massage/stretch/strengthen that tissue via the balance-on-one-foot workout. Rather than just resting the connective tissue, or pounding it on the asphalt, you're stimulating it without stress to it.
Or not ...
1. Which, according to this link, is the same problem as diagnosed earlier -- the tip of the acrimion bone pinching the bursa sac and irritating it.
2. If that's the diagnosis, I'll buy it, because it sure looks to me like Taijuan has a very pinchy shoulder motion. He hasn't lost velocity, like Hultzen did, or started throwing wildly, like Hultzen did. He throws great, but feels pain.
3. Which is all the best news possible, from my standpoint, 'cause I'd written him off for 2014. Apparently not, though.