News came down Friday that injured Mets closer Jeurys Familia had surgery due to a blood clot in his shoulder and will miss several months. Given the conversation I had earlier Friday with sports injury expert John Gallucci Jr, president of JAG Physical Therapy, I wasn't too surprised.
Gallucci is currently the medical coordinator for Major League Soccer, overseeing all 20 teams nationwide, as well as the chair of the New Jersey Governor's Council on Physical Fitness and Sports. He has served as the head athletic trainer for several professional sports teams.
We'll start with Familia, as it just happened and it's an injury we don't really hear about all too often. Gallucci cited David Cone having the issue in the 1990s.
"If we go back and look at athletes that had situations like this, usually there's about a four- to five-month progression," Gallucci said, noting that in Familia's specific case he can't be sure, not knowing the extensiveness of the blood clot.
With Cone as a guide, though, we can see that he missed exactly four months between outings. He pitched on May 2, 1996, and came back on Sept. 2 of the same season. So while Familia's return this season is in doubt, in no way should we consider it a done deal that he won't be back. There's a definite possibility in his return late.
Let's move on to Syndergaard, who a few weeks ago refused an MRI on his balky biceps and then went down for a while with a lat injury early in his next start. Why would anyone refuse an MRI?
"Most athletes at a professional level are truly, in their mind, superhuman and they're pretty strong," Gallucci said. "They train every day and they're pretty fit.
"I think there's a lot that goes into that, psyche-wise, on the rationale of why they wouldn't want to just run to get an MRI. As we know in working in pro sports, an MRI has become the gold standard of getting a diagnosis -- every now and then an athlete doesn't want to know the diagnosis.
"The denying of the MRI probably goes back to him thinking he's not hurt. When he's at rest, it probably didn't bother him. The lat muscle is such a large muscle that functions in so many different ways that you sit there and say to yourself, 'Well, heck, if I'm driving my car or I'm reading a book or I'm hanging out with my family, it doesn't bother me at all.'"
Knowing what we know about Syndergaard, this is pretty easy to square up. He throws over 100 mph and he has embraced the "Thor" nickname. He always wants the ball. He's a gamer. Of course he thought he was fine.
Of course, in going out with a possibly injured biceps, it's possible he injured the lat by trying to compensate.
"We as physical therapists always look at what we call compensatory patterns," Gallucci explained. "If there's an injury on one aspect and you're favoring it, you're putting other muscles around the joint in a compensatory pattern that can fatigue. For example, a hamstring injury usually causes a tremendous amount of tightness in your hip flexor, it usually causes a tremendous amount of tightness in your quad as you're rehabbing from your hamstring injury."
Speaking of hamstring injuries, how about Yoenis Cespedes? He was out a few days with a hamstring injury and then aggravated it while running to second base on a double. He likely came back too quickly and put himself at further risk.
"Of course," Gallucci said when asked if you can make a minor injury a major one by coming back too early. "Any soft tissue injury, if it's not at a point of function can be made worse. You gotta remember, when you look at the strains of a muscle, there's a first degree, a second degree and a third degree. So if somebody has a first-degree strain, which is a functional strain, maybe a little bit of bleeding in the tissue -- not so much fibrous -- there's now a weakness there. So if you progress too quickly and you open up and do the same action, you could possibly go to a component of straining it more and possibly causing more of a fibrous tear of the tissue."
Many,, have come down pretty hard on the Mets in general for their handling of injuries in the past few years and into this season. I stand by that, but Gallucci does add a few wrinkles that we should consider.
First up, everyone heals at different rates, so there's never a set timetable for a return on a certain injury.
"The unfortunate thing is the human body is pretty entertaining in that everybody heals differently, so I could take three hamstring injuries that are the same hamstring injuries and rehab them the exact same way, one person -- it might be based upon hydration or eating habits or sleeping habits -- could possibly not regenerate or heal as quickly and could fatigue quicker and possibly take a little bit longer. We see that throughout all sports."
Secondly, the medical people can't feel how the athletes feel, so they are at the mercy of the athlete's feedback.
"They keep telling you they feel good," he said.
In the case of someone like Syndergaard or Cespedes, they are itching to get back on the field and probably even lying to themselves about how they feel physically, based upon the competitive drive. It's definitely something to consider in the midst of all the "LOLMets" bashing.