Lucas Seehafer PT

I've worked with a few athletic training and strength/conditioning staffs and I would say they are much more progressive than they were even 5-10 years ago, especially at the collegiate level, but the biggest thing holding them back is a lack of resources/funding. You're right on that the benefits of yoga, pilates, etc can be a boon for athletes, but a lot of the times athletes need to do it on their own time.

"Will be" is a little strong, in my opinion. Injuries, especially those muscular in nature, are just too unpredictable. Is it possible? Yes. But is it likely? Depends on your interpretation of the ~14% recurrence rate data point. I'm not sure we can say one way or the other.

Unlike fellow off-season acquisition Rich Hill, new Minnesota Twins’ third baseman Josh Donaldson’s injury track record isn’t eye-popping. There are no quasi-experimental surgeries, no double-digit trips to the injured list, and no potential career-defining injuries.For a player that has accumulated nearly eight seasons of service time, Donaldson’s injury history is fairly clean. Donaldson — who debuted in 2010 but did not stick in the big leagues permanently until 2013 — did not suffer a significant injury until a right calf strain landed him on the 10-day disabled list in 2017; he would ultimately miss 38 games, though he would still go on to hit 33 home runs with an accompanying slash-line of .270/.385/.559 for the Toronto Blue Jays. The following season, however, was an abject disaster. Donaldson battled right shoulder inflammation as well as a major left calf strain that ultimately limited him to a mere 52 games between Toronto and the Cleveland Indians. The severity of Donaldson’s injuries, particularly of the calf, led many to wonder whether or not they would rear their ugly heads — either directly as another flare up or indirectly as a “compensation” injury located elsewhere — during what would be his lone season with the Atlanta Braves in 2019. Luckily for Donaldson and the Braves this proved not to be the case, as he appeared in all but seven games, including the postseason, with numbers resembling his three-season run of terror during the mid-2010s in Toronto. A big question on the minds of many Twins’ fans — and also likely the Twins, at least to some extent — is whether or not his relatively healthy track record will carry over to the 2020 season and beyond. He recently turned 34 after all and players tend to get injured more frequently — and performance tends to decline more quickly — as age increases. To put it simply: Will Donaldson’s 2020 campaign look more like that of 2016 (All-Star, Silver Slugger, MVP votes) or 2018 (Did I mention it was a disaster)? Let’s first start by discussing the calf. The calf is a muscle group — also known as the triceps surae — that is mainly comprised of the superficial gastrocnemius and the deeper soleus. These two muscles join together near the ankle to form the Achilles tendon and control plantar flexion (pointing the foot down), which leads them to be major force producers as well as attenuators during activities such as running and jumping. The gastrocnemius also assists the hamstrings in flexing the knee as its two heads cross the tibio-femoral (knee) joint; the soleus, on the other hand, only crosses the ankle joint. The calf is one of the most commonly injured muscle groups due in large part to the vast amount of force it produces and is subjected to during athletic activity. Much like the Achilles tendon, the calf muscles are most frequently injured when the contraction they are undergoing quickly changes from eccentric to concentric, especially when the knee is straight and the ankle is dorsiflexed (foot pointing up). An eccentric contraction involves the muscle tensing while it lengthens, whereas a concentric contraction causes the muscle to shorten due to it tensing. This action and positioning are most commonly seen in baseball when the athlete is sprinting or moving laterally while fielding. A difficult aspect when discussing Donaldson’s calf injuries and their risk for recurrence is that very little research has been conducted on all athletes, never mind professional baseball players, when it comes to this type of injury. A 2017 study published in the British Journal of Sports Medicine found that age and previous calf injury were the most prominent links to the occurrence of future calf injuries. However, the systematic review was based on 10 studies with more than 5,000 total participating athletes who played football, rugby, basketball, and triathlon. In addition, all the included studies were deemed to have a high risk for bias. The authors of the article concluded that “the overall paucity of evidence and the trend for studies of a high risk of bias show that further research needs to be undertaken.” So are Donaldson’s calf injuries likely to recur? It would be truly difficult to say with any level of certainty. As the previously linked article alludes, an injured muscle will have a greater risk for injury compared to an uninjured counterpart. How long that increased risk lasts is largely unknown. Again, the research surrounding calf muscle strains is significantly limited. However, a previous study published in 2010 found that the recurrence rate for hamstring strains — a muscle group that is similarly susceptible to strains — hovered around 14% in track and field athletes over a two year period. Caution should be taken when interpreting these results and trying to apply the concepts to Donaldson, as the sample size was microscopic (165 athletes over a nine year period), the injured muscle group was not the calf, and the sport in question was not baseball. It would be unfair to expect Donaldson to appear in all 162 games this upcoming, or any future season for that matter, not only because he has yet to do so at any point during his career, but also because the Twins are fairly progressive when it comes to providing days off for their athletes. While there is some debate about whether or not scheduled rest days actually decrease an athlete's risk for injury (just google “Load Management” and you’ll understand), the current evidence suggests that they may be helpful. It would likely be wise for the Twins to continue with their progressive approach toward rest and recovery to help put Donaldson and the rest of the team in the best place to succeed, both in the short and long-term. MORE FROM TWINS DAILY — Latest Twins coverage from our writers — Recent Twins discussion in our forums — Follow Twins Daily via Twitter, Facebook or email Click here to view the article

Very good points. In all reality, I'd even take it a step further and say the likelihood lies somewhere between the 50% you stated and the 90% I stated. I think what tips in closer to the 90%, however, is that the collagen-dipped biotape is (theoretically) much stronger than the revised UCL would be, due to it being a synthetic material while the revised UCL would be a repaired/reconstructed version of a tissue that wasn't a ligament to begin with.

The research that has been done on the procedure seems to indicate that it is just as successful as regular T.J. surgery. I believe one of the articles I linked in the article stated that players have a 90% return to play rate; at the very least it was something high like that.

Thanks for all the kind words everyone! If there is another player on the Twins or in their minor league system that you'd like to read a similar write up on, let me know.

The Minnesota Twins entered the 2020 offseason with big plans, building a roster capable of springboarding off the success of the 2019 season — one of the single greatest seasons in team history — being at the forefront.While the team may have struck out on acquiring their top-tier starting pitching targets — Zach Wheeler, in particular — the acquisition of slugging third baseman and former league MVP Josh Donaldson helped freshen the bad taste left in the mouth by the beginning stages of free agency. However, one acquisition that has the potential to further cast the Twins’ offseason in a positive light is the signing of starting pitcher Rich Hill. Hill, a 15-year veteran who has split time between the bullpen and starting throughout his career, spent the previous three years and change with the Los Angeles Dodgers where he posted an ERA of 3.16 and struck out 427 batters in 361 1/3 innings. Hill, who signed a one-year, $3 million contract laiden with performance incentives, largely resurrected his career during his stint with the Dodgers. Prior to joining L.A., Hill’s career was defined and marred by injuries and inconsistency. Other than four semi-successful seasons with the Chicago Cubs to begin his career — he posted a 4.37 ERA across 337 2/3 innings — Hill never threw more than 76 innings for any of the other six teams he made appearances for. and those productive 76 innings came while he was with the Oakland A’s in 2016, who went on to trade Hill to the Dodgers later in the season. The majority of the injuries Hill has suffered during his career (see photo above) have occurred on the left side of his body, something that would be expected for a left-handed thrower; the throwing arm is subjected to an immense amount of force with each pitch and the muscle contractions within the push-off leg is the source of the power — itself a great amount of force — that serves as the foundation for every throw. The two most significant of Hill’s injuries both involve his left elbow. In 2011, Hill underwent Tommy John surgery to reconstruct the ulnar collateral ligament (UCL) in his left elbow. The UCL — along with the bony configuration of the elbow and the wrist flexor muscles — helps stabilize the elbow against valgus forces. A valgus force causes stress to the medial — or inner — elbow; if the soft tissue structures in the arm are unable to compensate for the vast amount of force placed through it while throwing a baseball, the UCL is usually one of the first structures to be injured. The UCL can be injured acutely - failure after one subjection to a high force — or chronically — a build up of “wear and tear” over the course of many throws. Just like any other ligament in the body, the degree of injury of the UCL can vary. A grade 1 sprain of the ligament is analogous to a simple “over stretch”; these injuries aren’t usually severe and heal on their own over the course of a few weeks. The main treatment for grade 1 injuries is rest and ice. Grade 2 and 3 sprains of the UCL involve tearing of the ligament, with grade 3 sprains being full ruptures. Grade 2 injuries may be able to heal on their own due to the UCL’s relatively good blood supply, so the first line of treatment usually involves targeted strengthening of the wrist flexors, a gradual return to throwing, and perhaps a platelet-rich plasma (PRP) injection or two. PRP injections involve removing some of the athlete’s blood, spinning the collected blood very rapidly to separate the red blood cells from the plasma, then injecting the plasma back into the elbow; the thought is that the plasma will boost the healing of the UCL, though the true efficacy of PRP injections is up for debate. If conservative treatment for grade 2 and 3 tears fails, Tommy John surgery is ultimately required. Tommy John surgery — also known as ulnar collateral ligament reconstruction — involves creating a new UCL by grafting a piece of tendon - often from the hamstring or palmaris longus of the forearm - into the elbow. The physiological process of the body turning the tendon into a new ligament is, appropriately, known as ligamentization, and this combined with the amount of rehabilitation that is required for the athlete to return to game action can take some time. It isn’t uncommon for a major league pitcher to miss 9-18 months after undergoing Tommy John surgery. However, this is where Hill’s latest injury needs to be discussed. Hill underwent a largely experimental though highly encouraging procedure this past October to repair a partial tear of the UCL in his left elbow, known as a primary repair with internal bracing and was conducted by renowned orthopedic surgeon Dr. Jeffrey Dugas(Dr. Dugas studied under and now works with Dr. James Andrews in Alabama and, interestingly enough, is the Associate Medical Director for the WWE!). To my knowledge, pitchers Seth Maness and Jesse Hahn as well as outfielder Brandon Guyer are the only other professional baseball players to undergo this procedure as of this writing. involves using biotape — a relatively thick-stranded surgical “thread” dipped in collagen (the substance that comprises all connective tissue) — to increase the strength of the repaired UCL. In essence, the torn portion of the UCL is reattached to the bone and the biotape is woven within the UCL, which, in turn, increases its strength. (Quick surgical terminology aside: “Repair” means that the existing structure has been reattached during surgery; “reconstruction” means that the existing structure has been removed and a “new” structure has been put in its place.) Not all UCL injuries are eligible to undergo Dr. Dugas’ procedure, however; the tear has to be relatively clean with defined edges. The biggest difference — besides the surgical differences outlined above — between traditional Tommy John surgery and the procedure Dr. Dugas performed on Hill is the typical recovery timeline. Athletes who undergo the primary repair with internal bracing procedure , whereas they have to wait until at least week 16 with traditional Tommy John surgery. When asked recently about his recovery timeline, Twins’ President of Baseball Operations Derek Falvey relayed that Hill will soon resume throwing. Said Falvey, “Rich will begin a throwing program or process here going into spring training ... Our hope is that he’s pitching in some rehabilitation games in June.” This would place Hill’s return to play at about 8-9 months, at least a full month, or likely much more, sooner than he would have had he undergone traditional Tommy John surgery. However, as Falvey stated, Hill’s return and rehabilitation process isn’t set it stone. “[Hill’s return] is all going to be somewhat dependent on how he responds at each juncture. Could [his return-to-play timeline] speed up? Sure. Could it slow down a little bit? Absolutely it could. We just need to see how he is once he gets to a more aggressive part of his throwing program.” That last clause is the most important aspect of Hill’s recovery; it would be wise for the Twins to bring Hill along slowly, making sure that his surgically repaired elbow responds positively (i.e. doesn’t hurt and is producing sufficient amounts of force) prior to progressing him in his throwing program; Hill’s starts in September, and hopefully beyond, are much more important to the Twins than his potential starts in June. According to Baseball Savant, Hill has primarily utilized a two-pitch mix over the past four seasons; Hill’s four seam fastball and curveball usage percentage ranged between 44.9-55.4% and 36.0-49.2% respectively from 2016-2019. This is important as higher pitch velocities place greater amounts of stress on the inner elbow. It is important that Hill have adequately strong rotator cuff and wrist flexor muscle strength and endurance to help attenuate the forces placed on the inner elbow with repeated throws greater than 90 miles per hour. If Hill is able to rehab without any hiccups it wouldn’t be out of the realm of possibility for him to return to his Los Angeles Dodger-levels. Perhaps the biggest obstacle to returning to prominence, however, would be Hill’s relatively advanced age — he’ll turn 40-years-old in March. All baseball players experience a decline in performance at some point and few have been able to carry high amounts of success into their 40s. However, with Hill’s contract being heavily performance-based, his signing was a low-risk, high-reward move for the Twins. If he returns healthy, Hill could be an extremely viable Game 3 starter behind Jose Berrios and Jake Odorizzi; if he doesn’t, the Twins still have Michael Pineda. MORE FROM TWINS DAILY — Latest Twins coverage from our writers — Recent Twins discussion in our forums — Follow Twins Daily via Twitter, Facebook or email Click here to view the article

According to KSTP's Darren Wolfson, Minnesota Twins shortstop Jorge Polanco will likely resume "baseball activties" - often hitting off a tee, fielding drills, etc. - as early as this week after undergoing an arthroscopic procedure in November to address impingement in his right ankle. This good news follows the report last week by the Minneapolis Star Tribune's Phil Miller that centerfielder Byron Buxton was on track in his recovery from a left shoulder labrum repair. Ankle impingement is a broad term that refers to structures in the ankle being "pinched" due to soft tissue injury, boney deformity, and/or excessive/restricted joint motion; there are multiple joints in the ankle: the talocrural joint allows for dorsiflexion and plantarflexion (pointing the foot up and down) and the subtalar joint allows for inversion and eversion (rolling the ankle in and out). There are various locations within the ankle in which tissues can become impinged upon, though the most common locations are at the anterior (front) and posterior (back) ankle, with anterior impingement being the most common. Anterior impingement - also known as anterior impingement syndrome - often arises due to repetitive microtrauma (many instances of small trauma built up over time) and occasionally after lateral ankle sprains - also known as inversion or "rolling" ankle sprains. Anterior impingement syndrome isn't a very serious diagnosis, though it is often painful and can hinder an athlete's ability to perform at peak levels. Anterior impingement syndrome is often exacerbated by end range and/or repeated bouts of dorsiflexion. This condition is often treated conservatively (i.e. rehabilitation) at first with emphasis placed on restoring pain-free range of motion, with arthroscopic surgery conducted if conservative rehabilitation fails. The arthroscopic procedure is often termed "debridement" as the structures causing the impingement are resected to open up more space. Outcomes following arthroscopic debridement of anterior impingement syndrome are good. Posterior impingement syndrome is similar in concept, though it is often exacerbated with end range and/or repeated plantarflexion and may involve the Achilles tendon. In all, Polanco appears to be recovering in line with the typical timeline following arthroscopic debridement procedures. This isn't a condition that is likely to be a long-term concern for Polanco and he should be return to game action in plenty of time for the beginning of the regular season.

Once an anatomical structure is injury, it will always have an increased risk for re-injury. That said, each injury is unique; the risk increase can be wildly variable. Being that the injury was in Buxton's non-throwing shoulder I'd say the risk is less than if it was in his throwing shoulder.

Hello all. My name, as you could see from the byline, is Lucas Seehafer and I am a Doctor of Physical Therapy and strength and conditioning specialist working in the greater Minneapolis-St. Paul area. I've been a fan of the Twins since the early 2000's and figured the Twins Daily community may enjoy some insight into the field of sports rehabilitation and performance. If this is the type of content you enjoy, I can be found on Twitter at @sportkinematics and many other sites, including A Wolf Among Wolves, The Step Back, and (soon) Forbes, where I cover athlete health and performance. In what can only be seen as encouraging news, Minnesota Twins centerfielder has been cleared to begin swinging again, according to The Minneapolis Star Tribunes' Phil Miller. Miller reports, "[buxton] will be limited to hitting off a tee or doing other basic drills while his shoulder gains strength, but the Twins expect Buxton to progress to hitting off a pitching machine by early next month. He could be ready to hit live pitching when the Twins hold their first full-squad workout on Feb. 17." Buxton has not been able to swing since undergoing surgery in early September to repair a torn labrum in his left shoulder, which he originally injured after crashing into the centerfield wall. The labrum is a ring of cartilage found in the shoulder - also known as the glenohumeral joint - that serves to deepen the socket; the labrum improves the stability of the shoulder by increasing the surface contact area between the bones of the shoulder - the humerus and the scapula - as well as by creating a vacuum that keeps the head of the humerus in contact with the socket of the scapula. The labrum is often torn in one of two areas: the superior - or top - aspect or the anteroinferior - or bottom front - aspect. The first kind of tear is known as a SLAP lesion; SLAP is an acronym for superior labrum anterior to posterior. This type of labrum tear is commonly seen in the dominant shoulder of overhead athletes as the primary mechanism of injury is repeated, forceful throwing. The second kind of labral tear is known as a Bankart lesion and these are most frequently seen after an anteroinferior dislocation of the shoulder, the most common type of shoulder dislocation. It is likely that Buxton suffered a Bankart tear as his injury was originally - and erroneously - reported to be a partial separation; a separation of the shoulder involves the acromioclavicular joint, whereas a dislocation involves the glenohumeral joint. Overhead athletes are usually cleared to return to higher-level, sport-specific activities by about four months post-Bankart repair, regardless of which shoulder, their dominant or non-dominant, was operated on; Buxton is almost exactly four months post-op. The reason for this is pretty simple: the repaired labrum needs to be protected as much as possible while it is healing and the strength of the rotator cuff - the group of four muscles near the shoulder that assist the labrum in stabilizing the shoulder, amongst other things - needs to be sufficiently built up. Throwing a baseball places a great amount of stress on the labrum of the dominant arm and, depending on the players handedness while batting, so does swinging (see the main image of this article). All of this is to say that Buxton is right on track in his recovery process, which is good news for the Twins and Twins fans alike. Buxton will be brought along further in his recover program as his rotator cuff strengthens further and the Twins along with Buxton are able to determine how increasing the intensity of his workouts impacts his shoulder. As Miller states, barring any setbacks, Buxton should be able to progress to swinging at full-speed by mid-February and partake in game action during Spring Training or, at the very least, the beginning of the regular season.