Injury Outlook for Blue Jays’ Marcus Stroman

Why is Marcus Stroman out for the season and Michael Saunders might even be back by opening day? They’re both knee injuries right? Well, the unfortunate reality for Stroman is that the ACL (anterior cruciate ligament) is a much more vital structure for the proper function of the knee. I do think though, that these two knee injuries could be related in a way. I’ll talk about that further down.

In an article about Michael Saunders’ injury, I talked about how the menisci of the knee are primarily involved with shock absorption and that athletes can compete without them. Menisci injuries have fairly far-in-the-future type implications. The difference with the ACL is that it is absolutely crucial to the function of the knee, they don’t heal up on their own, injuries to them often occur in conjunction with injuries to other structures, they have right-now and in-the-future type implications. In short, they are quite devastating injuries.

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The ACL is usually injured under similar circumstances to Stroman’s injury. Quick stops, rapid changes of direction, cutting back and forth or jumping are common causes. 70% of ACL tears are a result of these types of non-contact forces. The key is the speed of the motion. With slow motions, the muscles surrounding the knee have the time to recognize the force on the ligaments and to contract to alleviate those forces.

We don’t know the extent of Stroman’s tear. There are three grades of ACL sprain (I, II and III). Given Stroman’s description of instability and an audible snap, it sounds like a grade III. A grade three is a full tear into two parts. It might be a near complete tear though, given that he spoke of a large degree of pain. Grade III’s are actually not usually associated with a ton of pain.

Either way, with anything more than a mild grade I sprain, professional athletics are almost always directed to have surgery to repair the damage. This is because of the ACL’s essential role in knee stability, the risk and increased likelihood of further tearing with high demand activity and because of the ACL’s inability to heal itself.

For Stroman’s surgery, they will either take a tendon graft from Stroman himself or from a cadaver. I would guess they would use a graft from Stroman since cadaver grafts due have a higher failure rate. The physical therapy involved with recovery of ACL injuries is very demanding. Right away after the surgery, Stroman can begin strengthening the knee again. In the first two weeks post-surgery, he’ll face the seemingly simple task of straightening his leg again. Sometimes crutches are used in this stage. Stroman would also be wise to keep his upper body (and especially arm) in shape by doing exercises that don’t place stress on the lower half.

From then the focus is on managing swelling and pain, strengthening the surrounding muscles and reclaiming range of motion. When Stroman’s neuromuscular control of the knee fully returns, when full ROM is back, and when pain and swelling are completely gone, he can start to think about returning to full physical activity. This normally means 4-6 months. The Blue Jays’ prognosis seems a bit long, which may be a testament to the severity of Stroman’s sprain or it could be a sign that other structures were damaged. “After the first ACL injury, there is a risk of repeated injury. It is estimated to be between 5 and 15%”

It is concerning to me the rate of “freak” injuries with the Blue Jays. Saunders and Stroman this year and Maicer Izturis last year for example. All three of those were knee injuries. This makes me suspicious that proprioceptive exercises are not being used or adequately used by the training staff. These exercises are huge in preventing ligament injuries like these—especially in the knee. They work by increasing sensory and movement response time, balance and autonomic awareness of joint position. This helps muscles fire faster to alleviate strain on ligaments—making it less likely the ligament will sprain. Suppose a baseball player stepped into a sprinkler divot in the outfield, strain is detected on the knee, the brain directs the surrounding muscles to contract and save the knee from overextending or twisting. Hurrah! Injury averted. Proprioceptive exercises are newer and less known exercises that the players are likely not aware of. If the trainers aren’t pushing proprioception, they need to be. We might have had a healthy Izturis last year and a healthy Saunders and Stroman this year.

(Rivera had the same injury in 2012. A good angle on what happened at 1:10)

A few things to be thankful for: it’s not an arm injury and Stroman is not a position player, soccer player or football player (these athletes usually don’t perform at quite the same level following surgery). His injury would affect his pitching without surgery though. Stroman is a righty and plants with his left foot. You can’t do that on a wonky knee. It’s going to be a difficult 6 months for Stroman both physically and psychologically.

We dodged a bullet with Michael Saunders but Stroman we took the slug right between the eyes. Nothing to do but press on.

(aaos.org was my main source. It and others are linked throughout the article)

Next: Stroman Injury Podcast