Jim Hendry's Plan #44
Before I get to what's going on with Aaron Heilman's knee, I've got a few odds and ends to mention.
I've figured out what the heck Cubs GM, Jim Hendry, is up to this offseason. In a nutshell, in an attempt to beef up the middle of the lineup he wanted to add one of the all time great sluggers to the Cub lineup. Unfortunately Hank Aaron is just about to turn 75 years old. So this great idea came to him in a dream...swap out Hanks (Blanco, Williamson) and accumulate Aarons (Miles, Heilman). Voilà, plan #44!
The newest acquisition (Aaron Heilman) grew up as a Cub fan. It seems that this is the first directive from Tom Ricketts, all new organizational members must be diehard fans.
On to Aaron Heilman's medical issues. I've not been able to find a precise diagnosis to his 2008 left knee ailment other than it being labeled tendonitis. This LINK goes to an article from Sept 12th, 2008 discussing what problems Heilman was dealing with last year.
Last night on WGN radio, David Kaplan interviewed Aaron Heilman and specifically asked him about his knee problems. All we got was "athlete speak." It does seem that they have a therapy treatment plan that was worked out for him to address his issues this offseason.
Kaplan: In terms of your knee. I'm reading an article on ESPN today, it said knee pain played a role in your 2008 struggles. Would you agree that your knee was a problem and how is it today?
AH: Right now it's great. I feel healthy, everything feels good. I struggled a bit early on in the season trying to figure out a routine that would work best for me. By the end of the year I had figured that out. It certainly took a lot longer than I thought it would and that I hoped it would. It certainly wasn't 'the' factor that caused me to have a year I wasn't particularly pleased with. When you are going through something like that, you're trying to figure it out, you're trying to do different things every day, you don't really quite have a routine because you're not sure how you're going to feel the next day, that can play a role into it. We've got all those issues hammered out. I'm looking forward to staying with a good program, staying healthy all year and just going out there and competing.
Tendonitis refers to inflammation of a tendon and there are several tendons around the knee. The largest two are the quadriceps tendon (which inserts into the patella/kneecap) and the patellar tendon (which goes from the patella to the tibia below the knee). Tendonitis of either one is common. There are also hamstrings (medial or lateral) and even the gastrocnemius which is more of a calf muscle but the tendons go behind and above the knee attaching to the femur.
My guess is it was a patellar tendonitis (aka Jumper's knee) as it's probably the most common of these conditions. In a pitcher, this would a significant problem for both push off or landing from a mound. Heilman played through it most of the season, meaning it was nagging but not incapacitating . It wasn't disclosed to the press until the 2nd week in September where there are multiple articles (see the link above for one of these) explaining why they hadn't used him as much in early September. Of course blowing 5 of 8 save opportunities might just be a better excuse to skip calling him from the pen.
I'm sure they had MRI imaging on him as that would be useful to rule additional conditions inside the knee that might make the tendonitis a secondary problem (like a torn meniscus). The treatment is the usual rest and non-steroidal anti-inflammatory medications, better shock absorption in shoes. Therapy includes stretching and controlled exercises also various heat modalities to the inflammed area. In a pitcher it's unlikely to resolve until enough rest can occur, which means the off-season.
He didn't have this in 2007 so I'd expect him to be OK in 2009. I saw that he did have right (his pitching elbow) tennis elbow surgery immediately after the season on 10-23-06. Tennis elbow (aka lateral epicondylitis) is an inflammation of the tendons responsible for wrist extension and originate just above the outside/lateral aspect of the elbow. It develops from repetitive resistance to wrist extension activities hence it's nickname, tennis elbow came from the added resistance of using a tennis racquet. Dr. David Altchek (he's quite a famous NYC Sports Orthopod, who did similar surgery on Carlos Delgado that same week) performed the surgery and although it's obviously unrelated to his knee issues, it is an example of a chronic tendonitis that rarely needs surgery but ultimately he needed it (and presumably got better from the surgery). His stats in 2006 (74 games, 3.62 ERA, 1.16 WHIP) were better than 2008 (78G, 5.21 ERA, 1.59 WHIP) so I guess it was the same nagging thing but he put up with it pretty well. He probably had a bunch of therapy, ultrasound/deep heat rxs and a few cortisone shots for it before the elbow surgery.
Patellar tendonitis can be chronic (which isn't all that common) and then the tendon can be surgically explored or consideration is occaisionally given to (ESWT) extracorporeal (ultrasonic) shockwave treatment, which is more often used to treat resistant plantar fascitis (arch inflammation). ESWT is not like ultrasound in a physical therapy center which is mostly a way of delivering deep heat to tissues. ESWT is more like what they use to break up kidney stones (lithotripsy). It actually traumatizes the tendon collagen and brings in new blood supply which then promotes healing of the damaged tissue.
Update: based on a nice pickup from reader ankeith15, it looks like Heilman did undergo ESWT treatment. This LINK from a mets.com archive on November 20th confirms his diagnosis was patellar tendonitis and goes on to say:
After a loss in September, Manuel disclosed that Heilman had pitched much of the season troubled by patellar tendinitis, a malady that affected his landing leg, restricted his conditioning and non-game throwing, and reduced the sharpness of his pitches. Heilman since has undergone a noninvasive ultrasound treatment that has reduced the pain in his knee.
ESWT was used off-label on Magglio Ordonez during his free agent year when he was diagnosed with avascular necrosis of the femoral condyle (dying bone in the knee due to damaged local blood supply). I think Mags had to go to Vienna, Austria to get that treatment as ESWT wasn't being used like that in the US then. Ordonez knee did recover apparently enough to hit .298 with 24 HR's and be the ALCS MVP with a memorable walk off 3 run homer to end that series.
A variant on such an example of surgical treatment of a chronic tendonitis was the chronic achilles tendonitis in Cliff Floyd who had surgery (also at the same hospital/same week that Heilman had surgery, but a different surgeon) on it the offseason before he signed with the Cubs.
Of course if you have HMO insurance, they just tell you to change shoes.
vogelbomb debut for tacoma (AAA SEA)... 3-3, 1bb, 1 HR, 1 double...DH'd.
while he mostly played 1st considerably more than DH for AAA CHC, DJ Peterson is probably going to see most of the time at 1st for AAA SEA.
Carl Jr.! Very nice!
Baez with another "WTF?" play trying a delayed steal with a runner on 3rd and one out.. Remarkable talent, needs to make better decisions.
m.montgomery up in the pen with a man on 2nd, 2 out, and rondon 20 pitches into the inning.
...and rondon ends it 22 pitches in with a popout to RF.
I gotta say with the crappy defense the Brewers have displayed outside of Fowler I'm pretty disappointed the offense hasn't shown more and Rizzo seems to be very swing happy lately. That said my god am I happy Madden has finally given Carl Edwards a chance after multiple times up with nothing. I don't think he could handle a starting role with his body frame but his stuff plays so well in a relief role and he seems to be able to handle high stress situations very well.
2nd at bat. Fowler is good for the Cubs run differential.
welcome back fowler.
More slow news...
Did Davey Martinez have to bring the shotgun?
glad to see almora going to AAA to get work.
.265/.291/.422 through 86PA...2hr, 7 doubles.
i don't expect too much of an improvement when he's taking over CF next year, but the team doesn't really need him right now as much as they need him to get regular work (imo).
CHITOWNMVP01: The Cubs MLB Reserve List (40-man roster) has had one slot open since 7/6 (when RHRP Joel Peralta was Designated for Assignment).
The problem with the September roster is all of the pitching changes. They should find a way to limit pitchers to twelve except for extra inning games. More pinch hitters or pinch runners do little to slow the game down and are more fun than endless calls to the bullpen. I also think the fans get cheated when they use position players to pitch because employed a half dozen pitchers with righty-lefty switches. Having as few as four positions players on the bench to start a game also leads to some pretty ugly defensive substitutions.
CHITOWNMVP01: Joe Nathan's 30-day Article XIX-C minor league rehab assignment expires tomorrow, but he doesn't have to be reinstated from the 60-day DL tomorrow.
Also, I think 40 man roster should be full, not at 39, unless I counted wrong. I'm in a hurry to leave the house.
Dexter Fowler is back! "You go, we go!"
He's being activated for tonight's game. Almora down and Montgomery replaces Patton.
Also, doesn't Nathan have to be activated tomorrow? Pitchers aren't allowed to spend more than 30 days of rehab and he was sent to rehab assignment on June 23rd. Tomorrow is July 23rd.
Yeah, last night was a bummer. I clicked on the espn Gamecast just in time to see the 5-2 score change to 5-5.
Their next 10 are Dodgers, Mets and Marlins.
Slow news day...