ptatc

QUOTE (Wanne @ Apr 23, 2014 -> 01:36 PM) THIS!!!!!!!! Every outing for him this early in the season has been 100+ 108 111 105 127 to be exact... i know the bullpen is putrid...but damn. Every outing should be 100+. This means he is pitching well.

QUOTE (Dick Allen @ Apr 23, 2014 -> 08:30 AM) That's the thing. If it truly is a flexor strain, maybe it a week or two thing. And perhaps the other example of a flexor strain, like Gavin Floyd in 2013, really wasn't a flexor strain. No injuries are truly alike. A flexor strain strain can be anywhere from a grade I (mild injury) to a grade 3 (complete tear) and anywhere in between. The difference is what happened when it occurred and what they do after the rehab. If they felt an immediate pain during the game and kept trying to pitch, it could be a strain of the muscle. However if the muscle wasn't functioning properly due to the strain the ligament could have been stressed to much and had an injury as well. This is a secondary ligament injury. Thus, one lead to another. If the muscle soreness came on after the game, it is likely soreness for over exertion and the ligament may not have been stressed because the muscle was fine during the game. This seems to be Sale's case as he has reported "usual game soreness only more so." He is not "out of the woods" yet though. Another way that the ligament can have a secondary injury is if the muscle is not functioning properly when he returns to pitch. This is where taking the extra time helps and where many pitchers injury the previously uninjured ligament. He needs proper rest of the muscle to heal then needs to regain the strength but more important control of the muscle. The exercises needed are eccentric or negative contraction to re-teach the muscle to work properly to hold the humerus and ulna together. If the pitcher comes back too soon or hasn't had the proper rehab the previously uninjured ligament takes too much of the stress and a secondary injury can occur. From the given scenario and the experience of the medical staff, odds are the situation will turn out fine. The key is Sale needs to be completely honest and do the work. Some pitchers want to get back earlier and aren't completely honest about the state of the muscle and go back whe it isn't ready.

QUOTE (raBBit @ Apr 22, 2014 -> 03:54 PM) From what you hear (and ptact if you're around I'd obviously love to hear your opinion as well), is it possible the PRP treatment is aimed towards limiting this soreness in the future with less concern for an immediate turnaround? It's conceivable, considering the state of the team, that they would rather deal with this lingering injury upfront now, rather than have the same thing happen again next year when it has the potential to be much more detrimental. No, it's for immediate healing for damaged tissue. It is not to prevent further injury. The fact that it's being reported he did not have one makes me feel better about it.

QUOTE (Jake @ Apr 22, 2014 -> 03:04 PM) Good points. I suppose my statement was based on the possibility that if they suspected a UCL tear, they wouldn't say anything. I spent a lot more time than a week (over a month I believe) on the shelf when I had a PRP FWIW, but that was also 1. shoulder and 2. in the offseason. They could be hiding it. I am taking them at their word. If the ligament is involved it's aminimum of 6 weeks. The elbow is a little different as the muscle stability is more responsive than the rotator cuff tendon stability in the shoulder.

QUOTE (RockRaines @ Apr 22, 2014 -> 02:13 PM) From what I understand they would like the inflammation to heal quickly and because they decided to shelve him a few extra days it made sense in the hopes it kept it from coming back. That's the idea. However, they usually don't do the PRP for mild inflammation. It's usually for greater damage like a grade II or III strain. As I said before maybe they are just being very cautious and were planning extra time for rest anyway.

QUOTE (Jake @ Apr 22, 2014 -> 01:54 PM) Doesn't PRP sound like something you might do with a UCL tear that you're not sure requires surgery (of course, it seems like they're always not sure, but then always need surgery) Yes, they do it for all soft tissue injuries. So it could be used for either a muscle or UCL injury. However, as stated they should have a good idea if the UCL is involved and so far they say no. The key is to build up the strength and proprioception of the flexor muscles so that when he comes back, there is excessive stress on the UCL so it doesn't tear.

QUOTE (RockRaines @ Apr 22, 2014 -> 01:45 PM) The Sox have used multiple tools to examine his UCL. They should know already about the UCL. I'm more worried about using the PRP with the muscle. If they did use it, it generally implies greater damage than inflammation.

QUOTE (southsider2k5 @ Apr 22, 2014 -> 01:00 PM) That isn't anything that could be done as a precaution, or to aid the healing process? I have no idea what the procedure means. PRP is platelet rich plasma. Basically, it is an attempt to take a large dose of platelets which contain the body's own healing factors and increase the amount in the injured area. They do this by taking blood from the body and spinning out the blood plasma and then injecting it into the injured area. It usually done in an area of significant damage or chronic tendonopathy. It's not normally done for mild inflammation as just the injection in the involved area will cause some inflammation and tissue damage. Maybe it is just very conservative and overkill but that isn't the normal procedure. It could also be that since they put him on the 15 DL, they were comfortable with shutting him down for 5-7 which you would need safter this procedure. But if that's the case, it is more involved than "he could have pitched Sunday but we thought we would wait."

QUOTE (Marty34 @ Apr 22, 2014 -> 11:17 AM) If that's the case pushing him back until you have a team ready to compete makes more sense. We've had this discussion. You cannot do that and expect to have a healthy effective pitcher. It's like not running for 6 months then deciding to run a marathon. It would not end well.

QUOTE (southsider2k5 @ Apr 22, 2014 -> 09:06 AM) Some good details in here. http://bleacherreport.com/articles/2037473...-on-aces-injury If he is truly having a PRP injection, there is more than some flexor inflammation going on. This article makes me more worried than hopeful. That is not a procedure done for minor inflammation.

QUOTE (pittshoganerkoff @ Apr 22, 2014 -> 08:41 AM) Exactly. We're all just supposing and assuming. But, based on history, it seems more likely that it's his throwing motion than pitch count. His motion has been a concern since...well, since forever. Sale might be the kind of pitcher that needs the breaks and/or a DL trip each year. But none of us know. We can assume and point fingers and scream all we want. All we really should be doing it hoping right now. It's probably both. Fatigue with odd mechanics equals too much stress in a small area, which is when injuries occur.

QUOTE (GreenSox @ Apr 22, 2014 -> 12:05 AM) How could anyone possibly question 127 pitches in week 3 of the season. it's as ridiculous as questioning running out of pitchers in the 14th inning. Hire a professional manager, please, Rick/Kenny/Jerry. Easily. He's done if before and he'll do it again. This far into the season he should be fairly fresh. The first deadarm period should have past, if he gets one. Even for those who think pitch counts are the way to judge a pitcher's fatigue, 127 isn't that many. Now, could it have caused it, sure but there is know it ahead of time.

QUOTE (sammy esposito @ Apr 22, 2014 -> 01:19 AM) If Sale pitched 127 it was because he wanted to win the game. He probably told Robin and Coop that he felt fine. I am guessing that Sale did not want to give the ball to any other reliever because he doesn't trust them like all the rest of us who watch the Sox already know this from watching their games Sale and his response is only a part of it. They watch him as well. Look for signs of fatigue, if his arm slot changes,his stride shortens or if he is getting under the ball. They do many other objective things other than just listeningto him. The Sox have been very good with preventing overuse type injuries over the years.

QUOTE (southsideirish71 @ Apr 21, 2014 -> 11:28 PM) Dusty Baker is on your side. He feels that pitch counts are over rated as well. He did it on a consistent basis. There is a difference.

QUOTE (fathom @ Apr 21, 2014 -> 11:07 PM) Last year, Gavin Floyd's initial MRI came back clean and diagnosed as a flexor strain. On the bright side, Hahn seems very optimistic about Sale. As I said, MRI are not the definitive answers. The manual tests are generally more reliable in these cases. They'll know more when he tries to throw again.

QUOTE (Buehrle>Wood @ Apr 21, 2014 -> 09:36 PM) This never ends well There's no guarantee but they were right the last time it happened.

QUOTE (caulfield12 @ Apr 21, 2014 -> 10:37 PM) Other than the fact that signing him at "Boras Dollars" would mean we couldn't sign 75% of our other draft picks... This wouldbe theonly reason not to.

QUOTE (Bigsoxhurt35 @ Apr 21, 2014 -> 10:03 PM) Didn't Garcias MRI in Colorado come back clean? Usually the MRI will detect that much damage. I think the x ray was clean and that's to be expected.

QUOTE (fathom @ Apr 21, 2014 -> 10:03 PM) So what's next? Rest for 10 days or so to see if the pain goes away? Yes. This is the very conservative route. They could gowith 4 or 5 days rest but I bet they go more like 10.

QUOTE (fathom @ Apr 21, 2014 -> 09:51 PM) Feels like there's been a few guys of late with similar situations/clean MRI that ended up getting TJS a few weeks later. MRI are pretty unreliable. The only thing they really see is inflamation or fluid. In the elbow the ucl and muscles are so close together that you can't always differentiate them. This is whyi tell students that MRI stands for More Radiographic Income.

QUOTE (Feeky Magee @ Apr 21, 2014 -> 09:49 PM) Thanks. So theoretically it could well be down to throwing a lot of pitches? It's possible that fatigue caused it. The good part is thatif itwas fatigue, it's mostly likely not caused by the ligament being involved.

QUOTE (Feeky Magee @ Apr 21, 2014 -> 09:28 PM) Aren't flexor muscle strains typically from overuse? My brain is telling me so but I'm not sure where I'm actually getting that information from. The wrist flexor muscles sit on top of the UCL. You can strain them two different ways while pitching (insert wrist flexion while on the computer joke here). One is to over exert the wrist flexion or pronation or turning the hand palm down. This usually comes from fatigue. The other is when there is stress on the elbow in a valgus motion during the throwing motion. This is when the humerus leads the forearm too much and you can injure the UCL or strain the muscles which are trying to help the UCL hold the medial side of the elbow together. They hope that the muscle strain is not from the UCL loosening and the muscles need to do the work. Ideally it's an isolated strain and it's 2-3 week rehab.

QUOTE (ptatc @ Apr 21, 2014 -> 06:45 PM) It's possible but I would think that Cooper knows him pretty well by now. ............and maybe not. Hopefully just precautionary.

QUOTE (southsider2k5 @ Apr 21, 2014 -> 06:43 PM) Maybe I am wrong, but I look at it as conditioning. There are guys conditioned to run a marathon and others for the 400. But you have to be in the right shape to do so. I don't think Sale is in 'shape' to go that far this early in the season. It's possible but I would think that Cooper knows him pretty well by now.

QUOTE (Stan Bahnsen @ Apr 21, 2014 -> 06:04 PM) How about the 127 being a career high so early in the season? Does the timing of it matter, or no? It all depended on how his body has reacted to the previous starts. Between ST and the beginning of the season they (Cooper) should have a good idea of his conditioning. I don't have a problem with 127 pitches as long as it isn't consistently done.