Are the Astros previous DL stints a cause for Concern: Part III

Can I stay healthy?

In what was originally planned to be a single post about injury histories, it has grown to a two part series into a three part. Yesterday's post was supposed to encompass the outfield Martinez duo but got too lengthy and Fernando earned his own post since we haven't dived into his injury history too much. Part I can be found here.

I probably left a sour taste in your mouth (if you didn't already have one) yesterday with the return of Brandon Lyon and I hope this post will be a little more promising, but we will just have to wait and see.

Fernando Martinez has a very extensive injury history that dates all the way back to 2006. He has been given the injury prone tag and that tag is pretty appropriate when you look at how many games he has missed in his short professional career. Health is big part of a players value and his health has brought his value down so far that the Mets were willing to part with him and his development, despite having the ability to option him to AAA for seasoning one more time. That doesn't speak very well for him at all. The guy has tools and if he can put it together and at least stay semi healthy, claiming him will be a steal.

So, lets look at his injury history and try to draw some conclusions.

Fernando's first major DL stint was in 2006 when he went down with a bone bruise and strained ligaments in his right thumb. It'd doesn't take a doctor to know that pain in the thumb that allows us to do everything we do will cause you to not perform and require time off. Now, I don't know how he got a bone bruise (which takes a lot of force to create), but it is painful and wouldn't surprise me if he was hit by a pitch. That would make a lot of sense. The strain could be from the same incident or have been caused by the bone bruise weakening the ligaments structural integrity. Or, this actually could be the other way around, as the strain ligament damaged the bone enough to cause a bruise and an influx of blood and inflammation. This is likely one of those freak accidents that can happen to any player in the wrong place at the wrong time.

Oh wait, he went on the DL again in 2007 for another right hand injury? Are these related? I'm going to say no! The injury was actually a broken hamate bone (think Telvin Nash) which is on the ulnar side of the hand (pinkie side) and not connected to the thumb. Could it be a compensation for the injury to the thumb? I really doubt it as the hamate is a carpal bone and doesn't have much movement and there't not really a way to compensate for decreased stability, strength, or endurance in the thumb. The broken bone is not necessarily concerning as for health, but the fact it is a hamate bone can be damaging to power development, which is still in question to an extent. However, within approximately a year he has two significant bone injuries in the same hand does indicate a potential weakened skeletal system, at least in the hand.

His left wrist then went on to land him on the DL once again last season as he strained it. Obviously with four years in between the wrist injuries, they can't be a compensation type injury, nor can they be related. I couldn't find anything stating whether it was a muscle (most commonly referred to as being strained) or a ligament (anatomically makes more sense). So, it's hard for me to determine if the the strains can be indicative of being weak ligaments.

Moving up the arm, we find a right elbow strain in 2009, and we run into the same issue with what was the structure. Once again it makes more sense to be a ligament. Two years separate this from the hamate injury so it makes them unrelated. However, elbow strains can be common from guys who are prone to making long and hard throws (right fielders, center fielders, third baseman) without regular mechanical work (pitchers). We now have approximately three ligament injuries in five years in the upper extremities. That's not a good sign for his ligament integrity overall.

That is the extent of his upper body injuries, and we will now move on to his lower body injuries, which are much more extensive. I'm going to switch from taking the injuries from joint to joint, into taking these in chronological order as this will now be a little more informative for finding relationships.

The first lower extremity injury came in 2006 when he sprained his right knee. There are several ligaments to choose from in the knee, and each contributes to stability in different directions. If sprains aren't handled properly, they can have some long term effects with several type of injuries above and below the knee. However, it was two years later before he had another lower extremity injury which leads me to believe it was handled properly and the following injuries are not directly a result of the sprain.

In 2008, Martinez went on the DL twice with a right hamstring strain and the second was likely the result of him being rushed back to play. However, the original injury could have several factors that include the Mets rushing or pushing him too hard because of his talent (and that's what the Mets have a history of doing) or Martinez pushing himself too hard to live up to his hype. It also could be just a random injury, but I would suspect the sprain has a very minor involvement.

Now we start getting into the serious injuries. In 2009, he tore his meniscus in his right knee, resulting in surgery to repair it. The meniscus is a plate of cartilage that sits on top of the the plateau of the the tibia to cushion the weight of the femur. This structure is very important to the normal movement at the knee joint and even minor tears can cause the knee to lock-up, cause the knee to bend at inappropriate angles, and cause strain on knee ligaments. The meniscus doesn't repair well naturally as it has very little blood flow unless it is on the outer ring where there is some slight blood flow. Does this have a relationship with the sprain and hamstring? Quite possibly as the sprain could have temporarily decreased the stability of the joint enough to initiate some minor fraying of the meniscus that progressed over time and the hamstring tightened up the joint enough to pull the tibia posteriorly in a sliding movement instead of a rolling and gliding motion that is normal.

The surgery itself involves suturing or tacking the tear and allowing some cartilage to form over them. It has it's own risks as the surface may not be as smooth as it was before the tear, but is still better than a torn surface. The location of the tear is the most telling detail of the surgery as it lines out just how successful the surgery could be as well as the recovery outcome. The unfortunate issue is that part of the meniscus is found to be attached to the anterior cruciate ligament (ACL, think Jason Castro). This means, if the location is close to the ACL, future ACL type instabilities could be expected.

Fast forward to 2010 and you find a left hamstring injury. This is a classic compensation type injury. Remember the Castro compensation that resulted in his foot surgery? Same thing, except he strained his opposite hamstring. Also, it is another hamstring injury which leads me to now question hamstring/glutes/lower back flexibility and muscular balance between quadriceps and hamstrings.

We then find another DL stint to rest his right knee due to soreness and during this period, he was diagnosed with arthritis (cartilage inflammation) in his right knee. There are two main types of arthritis, osteoarthritis and rheumatoid arthritis. If it's rheumatoid, this guy's career will be short as there is no cure since it is an autoimmune (body attacking itself) disease and will eventually cause him to have to hang up his cleats at an early age. If it's osteoarthritis, we have a better outlook since it is a wear and tear type issue and can be managed. Either way, it's extremely early for him to have arthritis and that doesn't have a nice outlook. It also shows that his surgery was either too late to prevent wear on the articular cartilage or wasn't overly effective.

He reverted back to his hamstring strain again in 2011 which could be a clue that his arthritis/meniscus is not allowing for proper joint movement or that he is once again compensating from the left hamstring strain. But, following his return, he once again had a strain, but this time it was in his left hip flexors. This sounds like another compensation type injury as it is contralateral and moves the same joint (hamstrings are also hip extensors). But, this also bring into question his muscular balance from posterior to anterior musculature in the thigh as well as lower extremity flexibility.

Not pretty? Yeah, it really isn't. Conclusions that you can draw are that his right knee is in bad shape and he definitely has issues with compensating for injuries in order to protect himself. Short-term outlook says he can probably withstand a few years of everyday play in the outfield if he can stop his compensation injuries. But, that is assuming they are compensation injuries and not legitimate imbalances. Even if there are imbalances, these can be fixed with proper training, and that would be a better outlook. Although, you would expect that type of issue to be discovered and addressed at this point.

The upper body issues seem to be random for the most part although, I do doubt the strength of his ligaments to stand up over several years. They do seem to be fairly minor in degree and quite manageable. I think he was pushed way too hard in the early years (he's just 23 years and a handful of moths old), putting too much strain on his slowly developing body.

He physically could handle a few years in right field if his foot speed is not too overly diminished and definitely in left field. Although, his right knee scares me and I see him becoming a DH before his 30th birthday if his bat adjusts at the ML level. Even then, his right knee bothers me as it's his lead leg at the plate which does have significant torsion in a swing (think Tiger Woods knee problems). I would not expect him to be a mainstay in the Astros outfield long term and I am much more comfortable with the knees of JD Martinez in left field. But, we can at least have him DH long term if the bat develops.

But, for this to happen, the Astros have to make sure that they allow for his body to receive ample rest this season (in Houston or Oklahoma City) for his body to recover and not break down so that his body slowly adjusts to a season over one hundred games long. The training staff should already be at work checking his muscular balance and flexibility in his lower extremity.

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