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.
Kershaw uses his 132nd pitch for his 15th K (Marlon Juice Byrd, with the tying run at 2nd), and the Dodgers sweep the Giants. Also, Pirates lose to the Brewers for the 5th straight time. So...with 30 to play, we are 6.5 up on SF (7 in loss column) and 8 up on the Nats, and still in contact (4.5 back) of the Pirates. Man, what a roller coaster the last 2 days -- fantastic stuff.
Schlitter still pitching for Iowa? Guess nobody wanted him?
JOHN B: Pierce Johnson and Rob Zastryzny were likely 2015 AFL candidates (I mentioned them as likely candidates to get assigned to the AFL in an article about the AFL last month) because they are starting pitchers who missed part of the season due to injuries and they need to accrue more innings.
Also - what did Bosio say when we went to talk to Rondon? "OK, Hector, tie game, 9th inning, 2 outs, 2-0 count on the hottest hitter in the game. Let's try the ol' fastball right down the middle and see how that works, hmmm?" Terrible pitch. I've never been a fan of using closers in non-save situations -- they are used to pitching with adrenaline pumping and celebrating the last out of the inning. I realize it was a a swinging bunt and an error that caused the problem, but that may have been the worst pitch I have seen Rondon throw in a long time.
Ugly series save a few clutch Homeruns. 2 first inning Homeruns allowed. 2 complete innings (out of 27) with a lead (8th and 9th game 2). 6 Leads/Ties given up top half of the inning after scoring. 9 9th inning unearned runs. Brutal roadtrip coming up while SF plays 22 straight against teams with losing records. Like the Cubs odds, obviously, but long way to go.
No more f'n Pajama Parties, Joe! Losing a series at home to the Reds (who have a worse record than the Brewers) in September is not what we are looking for, gentlemen. 3 series losses in a row -- let's get that fixed immediately. Bad error by KB as Crunch describes -- almost like he was surprised the ball was hit to him. I think if he makes that play we win the game.
solid smack to him...right through his legs. he wasn't even in motion, totally stationary. no bad bounce, either. it was hit very hard, but also squarely wiffed...not even any glove contact. it happens...not a good time for it to happen with 2 outs, though. that was the inning ender, easy.
Can someone tell me about Bryant's error who saw the play? You cannot give the Reds (or most teams) 4 outs. In this case with Joey Votto coming up.
un...fucking...believable... tie a game in the bottom 8th, give up 3 runs in the top 9th...why the hell not. awesome.
DAT TIE THO.
Ugh Hammel...the new Haren. The 3-5 starters have imploded and killed yet another series.
Just about to type the same thing.....Augh!
5 times in the last 3 games, Cubs have taken the lead or tied the game in the bottom half, only to give up runs in the top half.
<p>I'd like to see stats on opposing pitcher batting average. It's probably not real, but seems like we give up hits all the time to f-ing pitchers. </p>
Tony Four Sacks # 27