In 2018, the Minnesota Twins star centerfielder Byron Buxton has played just 28 games at the major league level. Among hitters with at least 90 plate appearances, he checks in third from the bottom (above just Trayce Thompson and Magneuris Sierra). With a potential to play a maximum of 162 games in 2018, Byron has gotten in just 61 across all levels of pro baseball. If there's anything to take away from a lost season, it's that the most important trait going forward has to be availability.
Injuries are always going to be a part of athletics, and at times, you're going to deal with relative flukes. From migraines to a foul ball breaking your foot, Buxton has tested that theory in earnest during 2018. What's unfortunate however is that this isn't the first instance in which the uber-talented outfielder has dealt with this type of setback. Byron has missed time in each of the past few seasons, and most of that time on the shelf seems at least somewhat preventable.
By playing the game with reckless abandon, Buxton has thrown himself into outfield walls more often than he'd probably like to admit. The catches and highlights from those moments play on loop for years, but it's worth wondering what the opportunity cost is. Slamming into the wall in order to make a single out while trading a few games of availability seems like quite the ask. It's a difficult line to decipher when you're questioning if 110% effort is truly the best plan for long term success.
From my vantage point, the most integral thing for the Twins to get Byron Buxton on track is a level of consistency. Allowing him to thrive at the major league level likely comes through a repetition of quality at bats and positive results. That blueprint requires him to be on the field, and in a position to compete on a daily basis. There's so much talent to be put on display, and he's significantly beyond the highest minor league level (as we've seen since his latest activation from the disabled list). Distancing him from the nicks and bumps that have taken Buxton off the field has to be the next step in this journey.
Not all of Buxton's injuries are related to his centerfield exploits. He's hurt his wrist on the basepaths and at the dish, obviously migraines are a bodily issue, and things like an errant foul ball are simply bad luck. No matter what the malady though, having the Twins training staff best position Byron for success is imperative to his future development. Maybe the answer is to add muscle mass, or maybe it's having a more distinct understanding of outfield dimensions. At any rate, a new design taken with a focus on consistent health seems of the utmost importance.
There's no reason to panic on the player at this point. Buxton is lightyears ahead of where his predecessor Aaron Hicks was at this point. Hicks is now the best centerfielder in baseball not named Mike Trout. Byron is also on par with the likes of Torii Hunter and Kirby Puckett at the same age. The talent and tools are all there for him to succeed, but he also needs to be physically capable of putting them on display in a more routine fashion.
Telling a player to take their foot off the gas pedal is never an optimal plan of action. I don't know that it's the right one to suggest for a guy that's coming off being the best defender in all of baseball either. If there was something I found myself hoping Torii could impart on Byron during spring action down in Fort Myers, it was how to play all out while still protecting yourself for the long run. The Twins Hall of Famer only missed significant time once in his ten full seasons with the club. It's worth speculating that Buxton could end up being better than Spiderman if he can consistently stay on the field.
Lost seasons from some of Minnesota's most important young players was always going to spell doom for the 2018 campaign. Going forward, the amount of time that Byron Buxton can limit away from the field of play only benefits the overall success of the organization. There's still a star in the making here, and worrying about the on field exploits does nothing for me. Keeping the young man healthy and in the action remains the biggest piece of the puzzle.
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The Twins community recently received some concerning news about highly-regarded prospect Royce Lewis. Lewis left the Cedar Rapids Kernels Saturday game with what is being reported as ‘patellar tendinitis’, which has been causing him trouble off-and-on for about a month. But what is ‘patellar tendinitis’ exactly? And what might it mean for Royce going forward? Let’s discuss:
Question 1: Where is the ‘patella tendon’? The patella tendon is the tendon that goes from your kneecap (also called the patella) down to the upper part of your shin bone (tibia). It is the attachment of your quadriceps muscle group to your lower leg, and it is what allows people to extend the knee.
Question 2: What is ‘patellar tendinitis’? Patella tendinitis is a term commonly used to refer to activity-related pain that occurs near the attachment of the patella tendon to the patella. The suffix ‘-itis’ is used to indicate inflammation. While the term is commonly used, in actuality a more appropriate term is ‘patella tendinopathy’, which refers to degenerative changes within the tendon in the absence of inflammation (which is more accurately the case in this diagnosis). This difference is important when considering treatment options.
Question 3: Royce is clearly a high-level athlete. Why did he get this problem? Patellar tendinopathy is also commonly called ‘jumper’s knee’ since it occurs most frequently in athletes that do a lot of jumping. In some studies of professional volleyball and basketball players, the incidence of jumper’s knee has been shown to be more than 30%. It is much less common in non-jumping athletes, but still occurs in around 2-3% of soccer players. I was not able to find any information specifically discussing the incidence in baseball players. It is unclear exactly why this problem occurs. It is most likely a combination of factors including BMI, flat feet, muscle imbalance in the quad/hamstrings, low flexibility, and intrinsic properties of the patellar tendon. There are likely other factors as well, including overuse. The area involved is usually located directly at the bottom end of the patella/top part of the tendon. Symptoms usually come on gradually over time. Initially, the knee typically hurts only with activity. Over time, if the condition worsens, pain may begin to be present even at rest.
Question 4: How is patella tendinopathy diagnosed? The diagnosis is usually fairly clear from the history and physical exam of the athlete. Xrays are usually normal, though in some cases calcifications of the tendon may be visible. An MRI is the standard test to identify the extent of the problem and also to rule out other problems inside the knee. The area of the tendon involved in the problem is typically fairly small- around the size of a couple tic-tacs.
Question 5: How is patella tendinopathy treated? The most commonly prescribed treatment for patellar tendinopathy is rest from vigorous activity and specific physical therapy exercises (called eccentric exercises). These exercises are designed to strengthen the quad muscles, stretch the hamstrings and ultimately cause favorable adaptation of the knee. The time needed for symptoms to resolve can be highly variable, but often takes at least a few weeks. When therapy isn’t effective, other treatments can be tried including various injections and ultrasound. At this time, there is no significant evidence that PRP (platelet rich plasma) injections are helpful for this condition, though I suspect it is being considered. There is, to my knowledge, no significant data on stem cell injections for this problem.
Question 6: Is surgery ever needed for patellar tendinopathy? Rarely, yes. In most studies, around 10% of patients will fail to respond to appropriate conservative treatment. In these cases, surgery may be needed. There are two main options: open surgery and arthroscopic surgery. In either case, the procedure is similar- the area of affected tendon is excised and a small (a few millimeters) part of the patella bone is removed to stimulate healing. Therapy is begun soon after surgery. The success rate for return to sports is around 80% for both surgeries, with return after the arthroscopic version being quicker on average. Usually, 4-6 months is needed for full return to sports after surgery.
Question 7: Is Royce at increased risk of rupturing the patella tendon because of this problem? No. Having patella tendinopathy does not appear to place anyone at increased risk of having a patella tendon rupture when compared to those without the problem.
Overall, I believe the most likely scenario to be that Lewis’ body is adjusting to playing professional baseball every day and he is having some minor issues as a result. I don’t expect this to be a substantial problem going forward, though the possibility that this requires surgery in the future does exist. Hopefully he will get through rehab quickly and be back on the field soon.
