Jose Reyes, New York Mets’ infielder, left Sunday’s game against the Mariners in the fifth inning after being hit on the left forearm by a 98 mph fastball. X-rays were reportedly negative. Though Reyes noted by end game that he was able to move his fingers, something he wasn’t able to do in the immediate aftermath of the injury, the area remained very sore. Amazingly, reports noted that – due to the absence of fracture – Reyes hopes to return to the lineup as early as Tuesday. That seems unlikely.
The area of the impact to Reyes’ forearm was near the wrist, a region with little soft tissue to soften the blow. Since the injury was to his left and he throws right-handed, it is hitting that will clearly pose the greatest problem. Despite being a switch-hitter, everything from cocking the wrists at the early phase of hitting, to rotating the forearms (the upper pronates, while the lower supinates during the swing) could cause pain. Even simply having to absorb the impact of the ball on the bat – will stress the affected area. Whether he bats righty or lefty, demands will be placed on the extensor and supinator muscles that comprise the extensor (dorsal) surface of Reyes’ left forearm.
Though MRI findings were not reported, a bone contusion (in addition to more superficial bruising) is Reyes likely diagnosis. A bone contusion is a traumatic injury that is caused by forceful impact,
It entails disruption to the bone marrow that rests below the joint cartilage. Microfractures, hemorrhages and edema to the inner layers of the bone (known as cancellous bone) are the result. Since the outer, or cortical layers of bone and the cartilage that surfaces the bone (articular cartilage) are not affected, contusions are not referred to as fractures. MRI assists with diagnosis, as these injuries are not visible on x-ray. Interestingly however, even when initial x-rays are negative, fracture may not be definitively ruled out.
When nerves are involved, a contusion can result in tingling, numbness or burning sensations in the area of impact as well as distal to it (further away from the center of the body).
Time to healing varies and depends on the severity of the injury, the presence of other injuries and the demands placed on healing areas. Mild injury may heal sufficiently within three weeks, and almost half of sufferers have been found by some studies to exhibit no evidence of injury six weeks after insult. Other studies report up to six months to full healing after contusions. One in particular on the scaphoid (a bone at the wrist) demonstrated good outcomes for all patients studied, though eight of 41 subjects remained symptomatic at three months, four of whom continued to exhibit some degree of pathology. These also went on to complete recovery.
Returning to play too soon is likely to prolong recovery and may even result in concomitant pathologies. In the case of muscle contusions these can include excessive scar tissue formation and myositis ossificans. It isn’t worth it.
Injuries seem to keep the Mets in the news on an almost daily basis.
Monday’s lowlights featured the announcement that first baseman Daniel Murphy’s MRI revealed a Grade 2 MCL sprain that will keep him out for the remainder of the season. The team also announced that Jose Reyes had been diagnosed (yet again) with a mild left hamstring strain that will sideline him for an indeterminate period.
Naturally, these are two of the Mets best hitters, and what was left of their team’s season will likely limp
along in their absence. This only adds to the groaning that accompanied last week’s news that Johan Santana’s shoulder rehab had hit a glitch, and
that Ike Davis may be a candidate for microfracture surgery on his left ankle due to a stubborn bone contusion.
Santana’s return this season seems unlikely – why push it when the team won’t be playoff bound? And Davis’ career, not simply his season is now in doubt.
A muscle strain occurs when the excessive load applied to a given muscle creates undue stress in the tissue, resulting in injury. Reyes’ proclivity to recurrent hamstring strains isn’t unique amongst athletes who have a history of suffering even one significant strain. Vulnerability to re-injury requires vigilance in conditioning, and the nature of baseball puts a sensitive hamstring at frequent risk.
Reyes generates a lot of speed and power with his legs and he has not been quite as effective since his hamstring injury of early July. You may recall that Reyes also had surgery in 2009 to repair a torn right hamstring tendon (otherwise referred to as a Grade 3 strain). These issues are likely to plague him for the duration of his career.
Murphy’s injury is quite different. Ligaments connect bone to bone, providing stability at joints. A ligament sprain occurs with trauma when a ligament is stressed beyond its capacity to tolerate the load. Mild disruption of the fibers occurs with a Grade I sprain, a Grade II (like Murphy’s) causes more significant damage (considered a partial tear) and a Grade 3 is a complete rupture of the ligament.
Unlike tears of the anterior cruciate ligament (ACL), which are generally repaired surgically, medial collateral ligament (MCL) tears are more often managed conservatively.
The MCL connects the femur (of the thigh) to the tibia in the lower leg, at the inner, or medial compartment of the knee joint. Laxity of the MCL permits excess motion at the inner joint (allowing the foot and lower leg to angle outward). Therapy will focus on controlling any inflammation and swelling, restoring range of motion, muscle strength and flexibility, balance, and ultimately on movement, agility and plyometrics (jumping, etc). Throughout, he will work to maintain his cardiovascular endurance.
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ets shortstop Jose Reyes, a switch-hitter, is reportedly expected to return to the lineup today after missing the series against Florida in San Juan and the end of the road-trip in Washington.Â Reyes is said to be out with a right internal oblique strain that he first noted during batting practice last Wednesday. Fortunately for the Mets, another of their switch-hitters, outfielder Angel Pagan, was back on the field last Friday after missing only two starts due to soreness in his right side.Â Pagan also first noticed his pain while at bat after fouling off a pitch.
What are the Internal Obliques and why is Reyes planning to bat righty against a right-hander?
The Internal Obliques are one several muscles that comprise the abdominals.Â They have several points of attachment â€“ at the low back and pelvis, and running diagonally up to the base of the front of the lower ribs and midline of the abdominal group.Â The diagonal orientation of the internal obliques is key to understanding their function.Â When they contract (shorten), the internal obliques act to side-bend and rotate the torso toward the same side.Â In other words, if Jose Reyes and Angel Pagan were to bat left-handed, their right internal obliques would be forced to contract forcefully to rotate the trunk to the right as they move into the swing and follow-through. Since the muscle is already sore due to a strain, this would aggravate the condition. Reyesâ€™ solution for now?Â Bat only from the right side so that the right internal obliques donâ€™t have to kick into high gear.Â Of course, that is only part of the answer, as he continues to undergo treatment.
Another important function of the internal obliques is to assist in respiration (breathing).Â They work when we exhale (breathe out) to push the organs up, thereby forcing air from the lungs.
What are the other abdominal muscles?
The External Obliques
If there is an internal (inner) oblique, it means that there must also be an external (outer) oblique.Â And so there isâ€¦Â Lying just above the inner layer are the external obliques, which basically have the opposite functions.Â The external obliques also run on a diagonal, but they are aligned perpendicularly to their more internal counterpart.Â These muscles assist in side-bending and rotating the trunk toward the opposite side. That means that the right external obliques take over to swivel the trunk to the left when a batter bats right-handed.Â They also serve a role in respiration to assist with inspiration (breathing in) by pulling the chest downward and compressing the abdominal area to allow for expansion of the lungs with air.
Because they have opposite functions with respect to side-bending, when either the external or internal obliques of each side contract together, they simply aid in flexing the trunk forward.Â When you do diagonal crunches for strengthening, you are trying to isolate your obliques.Â By bringing your right shoulder toward your left hip, you are emphasizing your right external and left internal oblique muscles.
This is the innermost layer of the abdominal muscles.Â The fibers of this muscle run (more-or-less) horizontally to wrap the front and sides of the torso.Â It is thought to act as a supportive sling and is likened to a natural weight belt.Â Â
These are the muscles most commonly thought of when you picture the abdominals.Â They are the most visible group and the ones you work on to get that six-pack you long for.Â The rectus, located at the front of the abdominals, runs vertically.Â The upper end of the muscle is responsible for flexing the trunk forward as well as stabilizing the trunk as the arms are moving.Â The lower portion of the rectus acts
to flex the pelvis toward the torso and to stabilize the trunk as the legs are moving. The lower portion tends to be weaker than the uppermost section and so including it in your core program is recommended.
All the muscles of the core serve as stabilizers.Â They are crucial to all movement to protect the low back from excess demand that can cause injury.Â In addition to strains from overuse, the abdominals can be stressed due to the explosive motion involved in batting and even in throwing.Â Another common abdominal injury in sports is the
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sports hernia.Â This will be addressed in a later column