Few pitchers on the Astros major league roster are as polarizing to the fan base as Brad Peacock. Proponents point to his former prospect status and his ceiling to be a mid-rotation starter due to his above average overall stuff. Doubters point to his inconsistent results in both the minors and majors.
However you feel about him, surely the front office struggles with the same two sides internally along with the many opinions that go in between the two poles. Yet, the internal discussion was made more complicated several weeks ago when it was announced that Peacock had undergone surgery to repair a torn labrum in his hip.
The labrum in the hip serves the same role as the labrum in the shoulder. The hip is a ball and socket joint just like the shoulder. However, the hip has a much deeper socket than the shoulder which reduces the range of motion of the hip as compared to the shoulder. The labrum is a cartilaginous tissue that acts to increase the size of the socket to prevent dislocation.
Extreme ranges of motion, laxity of the capsule anteriorly (capsular tightness posteriorly is usually the cause of this) and trauma are the main causes for tearing of the labrum. It's also thought to possibly also be a result of friction from the tendon of the iliopsoas muscle group rubbing on the front of the labrum.
As it pertains to a pitcher, all but trauma are likely have an impact. The delivery involves extreme range of motion with hip abduction, extension, and external rotation. In fact, a pitcher can exceed the range of motion in those planes during their delivery than what they can go through passively. Now, when you go into hip extension, and with same with the other two motions depending on how well the posterior joint capsule moves, the iliopsoas tendon rubs across the anterior joint capsule creating friction and possible tearing.
If there is a tear in the labrum, the hip joint will not move properly and increases the risk of dislocation/subluxation.
Now, I could go into a lot more detail on the hip and how this could have occurred. However, this would get too long. I will say that the hip is extremely important in how I treat my own patients. This injury is uncommon, but some of the issues such as posterior capsule tightness are common. I see it regularly in my patients. This issue can also be indicative of some hip strength imbalances, primarily with hip abductors.
The interesting thing for me is that Astros GM Jeff Luhnow characterized the procedure as "fairly routine."
I'll respectfully disagree with that.
Labrum surgeries are not classified as "fairly routine" operations within the medical field. There is a reason that there are a limited amount of surgeons within the United States that even perform this surgery. In fact, there are only two in the state of Tennessee that do. One of which is Dr. Thomas Byrd, which is the one who performed the operation on Peacock.
Dr. Byrd and his staff have put together a very specific protocol to follow in the rehab process. It's not a simple rehab and it's not a routine rehab.
That said, it is something that recent history has shown to be successful. The most prominent example for Astros fans is Brett Myers what had the same surgery and returned to perform quite well. I wouldn't expect the rehab to go longer than anticipated, however sometimes things can go a few weeks longer.
Hips can be very tricky for pitchers, but recent history has been a little kinder than previous examples.