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Monday, March 11, 2013
Blue Jays report: Bautista, Johnson, Santos


Toronto Blue Jays slugger Jose Bautista underwent wrist surgery in September after being shut down last season to repair a torn sheath around his Extensor carpi ulnaris (ECU) tendon. In the 2013 fantasy draft kit injury watch, I discussed the injury and how it typically affects an athlete, in particular, a baseball player who is a power hitter.

Jose Bautista
Jose Bautista is making strides in recovering from wrist surgery last year.

One of the more fascinating aspects of talking with athletes about their injuries is hearing how they describe everything from their symptoms to their rehab. It never ceases to amaze how their unique descriptions of what they experience can convey an image beyond any technical terms. Bautista was impressive with regards to the detail in which he explained his entire medical journey, from the anatomy of his injury through surgery and rehab.

For starters, he did not feel pain during his swing that fateful day in July. He said his swing got way behind him and as he tried to slow it down he felt a "pop." But it was when he tried to bring his bat forward again that he felt a sharp pain, which he now thinks was the tendon moving out of position (and which can happen with a sheath tear) and he grabbed his wrist instinctively. Even after his DL stint, Bautista knew he would need to get his wrist surgically repaired in the postseason but he was hoping to finish out the year. The problem was that he kept feeling his tendon move or, as he described it, "lift away" from the forearm bone, a sensation he said was not painful but yet conveyed something was seriously wrong. Ultimately he did not want to risk major injury to the tendon itself and was shut down in August.

The protective sheath is thin, or as Bautista put it, "like carpaccio" whereas the tendon is much thicker, "like a rope." The tendon is the contractile portion of the tissue; it moves the wrist in the desired direction and, for a hitter, helps control the swing. The sheath encases the tendon to protect it from friction against adjacent surfaces but does not control function of the wrist. Consequently, the ultimate concern is protecting the tendon itself. Bautista explained how his surgeon, Dr. Thomas Graham of the Cleveland Clinic, a renowned hand specialist who performs these procedures routinely, reinforced the sheath to help ensure the tendon would remain protected, even if the sheath were to be damaged again. He will be left with a visible bump on the pinky side of his wrist to go along with the small incision scar.

As for how he's doing now, Bautista is happy with his wrist, even if he is still working on his hitting efficiency. "I don't have my full, full motion yet," he said, although when he held up his wrists in extension, I was hard-pressed to see the difference. He expects to gain the remaining motion eventually but says he has enough now to swing his bat freely. He has no discomfort whatsoever -- none of that "lifting away" sensation -- and says he is seeing the ball well, swinging well and hitting is not a problem. "I'm working on timing, pitch recognition, the normal spring training things," Bautista said.

When I mentioned that the wrist injury recently suffered by New York Yankees first baseman Mark Teixeira appears to be similar in nature (the injury was also to his bottom hand on a hard swing, it also involves the ECU tendon and he is being immobilized initially to treat it), Bautista sighed knowingly. He talked about the known frequency of the injury in hockey and golf as a result of the wrist having to counteract the kickback force which travels through a hockey stick and a golf club upon impact. As for baseball, he said, "The injury may be more frequent than we even know."

Bautista sought out others who had been through the surgical procedure -- including teammate Mark DeRosa and Tampa Bay Rays outfielder Sam Fuld -- and learned as much as he could about the process. If anything was clear, it's that Bautista has certainly become well versed on the topic. Now if he returns to form this season, which it appears he certainly has the potential to do, he might just become the go-to guy around the league for how to return from an ECU sheath injury.

Johnson
Josh Johnson, often beset by injuries during his career, is healthy heading into his first year in Toronto.

Josh Johnson is off to a solid start this spring and punctuated it with 3 2/3 perfect innings in his outing Friday. I caught Johnson on his way out to practice Saturday and he said his shoulder continues to feel good. "I've been doing exactly the same exercises I did heading into last year," Johnson said. Last year, Johnson told me it was the first time in nearly two years he felt normal post-pitching body soreness as opposed to shoulder discomfort. In that regard, he says nothing has changed. A club source said Johnson has been impressive in all phases since joining the Jays, from bullpens to live pitching and even in terms of leadership among the younger pitchers in camp. Given that perspective and his dominant Friday start, one might say things are even looking up.

• Despite a recent episode of triceps soreness that has him taking it easy this week, Sergio Santos is all smiles when talking about the health of his throwing shoulder. After undergoing labral debridement surgery last July, Santos has been working diligently to ensure his readiness for the start of the 2013 season. In fact, his preparation started before surgery.

Santos was actually hoping to avoid surgery altogether. After injuring his shoulder in April (he developed soreness during a closing effort), Santos came in to the training room to rehab six days a week in an effort to strengthen the shoulder and hopefully bypass an operation.

"We all know that the outcome is sort of uncertain after shoulder surgery," Santos said, "so I was trying to do what I could to avoid it. But in the end, I think all the rehab beforehand helped my recovery after surgery."

From a medical standpoint, the rationale for pursuing a strengthening program as an initial course of treatment in most cases is that it will either help resolve the problem completely or delay the need for surgery. In the worst-case scenario, surgery may be inevitable but the athlete still benefits from having trained some of the muscles that will be important in the recovery process. Santos pointed out that he had regained full motion within a few days after surgery and felt as if he continued to progress smoothly over the next six months. He insists the shoulder has felt "great" so far and while Santos says he is sorting out "a couple little kinks as far as command and location," the spring has otherwise been a normal one.

Brett Lawrie
Brett Lawrie was supposed to play for Canada in the WBC but suffered a rib injury, although he should be fine for the start of the regular season.

• Third baseman Brett Lawrie suffered a strained left intercostal muscle (small muscles between the ribs) on Wednesday, forcing him out of the WBC. Lawrie dealt with several injuries last season, including a right-sided oblique strain that kept him out for 30 games. Naturally, there was some initial anxiety around this early spring setback, but Lawrie insisted it was not as severe as last year's ailment. The Jays do not expect it to be more than a two- to three-week absence and are thankful that it appears to be only a mild strain.

• I caught up with shortstop Jose Reyes earlier in the week in Tampa where he was sporting the uniform of his native country, the Dominican Republic, as part of their WBC team. He says the hamstring issues that have been problematic in the past are not bothering him at all this spring. Reyes credits increased hill workouts at home in the Dominican for helping him stay healthier last year (he played 160 games with the Miami Marlins) and he says he stuck with the same routine this year. When I asked him if he was concerned about transitioning to the turf in Toronto, he said he can't worry about that. "You can get hurt anywhere." It sounds like he's speaking from experience. Reyes added that he's excited to help his new team win games and the excitement in the clubhouse about his arrival would suggest the feeling is mutual.

• Finally, the Jays are thrilled to start a fresh new season after being riddled with injuries last year. In addition to the names above, pitcher Brandon Morrow is healthy after missing nearly two months last year due to an oblique injury. Pitcher Kyle Drabek is over at the team's minor league facility and is nearly ready to throw off a mound after undergoing Tommy John surgery -- again -- last June. Drew Hutchison, also post-Tommy John, is on a similar schedule. And Casey Janssen, officially the team's closer, is coming off November surgery to clean up his AC joint. He had a bit of a setback in late February due to discomfort in his shoulder but has since resumed bullpens and is making progress. He still hopes to be ready by Opening Day but he has not yet faced live hitters. Consider that target date fluid.