HOT SEAT FANTASY PLAYER: COREY DICKERSON

Rising MLB star, Corey Dickerson was recently traded from the Rockies to the Rays. Fantasy players had high hopes for Corey's 2015 season but chronic plantar fasciitis and rib fractures limited him to 224 AB. He still managed to bat .303 with 10 HR in limited duty.

Manager Walt Weiss has been quoted as saying, "this kid could hit underwater." His talent is not being questioned. We're going to look at the long term implications of his 2015 injuries and see if he is worth the gamble in 2016.

Plantar fasciitis is inflammation of a thick band of connective tissue that connects the heel bone to the toes. The plantar fascia supports the arch and absorbs shock to the foot.

Due to the chronic nature of this injury, I suspect Corey may have faulty foot mechanics which along with prolonged standing and walking (needed for his job) have caused repetitive trauma to the fascia.

This is an injury that may need constant maintenance given his job description. Treatment likely includes anti-inflammatory injections, orthotics to support his foot mechanics and unload the plantar fascia along with an aggressive strength/stabilization and stretching program. Given his work ethic, I think this problem will be manageable for him going forward.

Corey also missed considerable time due to fractured ribs he suffered while diving for a fly ball on July 30. This injury should be fully healed now and based on his recent batting cage sessions I don't forsee this injury being an issue in the future.

The challenge to Corey's value will be TB's crowded OF situation. Given every player's learning curve when transitioning to a new league; the question becomes will Corey get enough ABs to merit his selection on your Fantasy team. If he can get off to a hot start he should be a nice pickup.

Labral Tears: THROWING ATHLETES MOST FEARED INJURY (A simplified guide)

Now that the smoke has cleared on the news that Greg Bird has a right labral tear requiring surgery, let's talk about this Boogeyman (known as a labral tear) and what this really means.

The labrum is a ring of soft fibrous tissue located in the shoulder socket. It's job is to help stabilize the shoulder joint. This collagen material cannot be strengthened and there are no reliable techniques to prevent labrum injuries. Oh, and did I mention they are tough to diagnose too!

A type I tear is when a portion of this tissue frays but remains intact. Usually PT can help regain motion, strength and function. In some circumstances arthroscopic surgery is recommended. Most procedures involve removing torn sections of this tissue.

A type II tear is when the labrum actually becomes detached from the bone. To correct this, the labrum is sutured back to the bone through anchors arthroscopically. As you can imagine this is a more involved rehab process than recovery from a type I tear.

These procedures are far more complicated and pose more of a threat to a throwing athlete's career than Tommy John surgery. In two separate studies it was reported that 3% and 14% of pitchers suffering from labrum tears were able to return to their previous level of success. This is far from the nearly 90% reported following Tommy John surgery.

Recovery really depends on a lot of factors such as the location and severity of the tear, how well the repair went, how well the patient heals, if they follow their physician's protocol and is compliant with physical therapy. Return to full essential function is usually between 6 and 8 months however the stress of throwing a baseball requires much more time. (12-14 months)

The good news is Greg Bird is not a pitcher and he plays a position in the field that requires the least arm strength. What makes Bird special is his bat not his arm. Expect him to be ready to compete at 2017 spring training. Ok... now everyone take a deep breath.

Hunter Pence PILATES WORKOUT

http://youtu.be/HdeV-GNDtk0

Check out Hunter Pence as he rehabilitates an abdominal injury from last season. This is the type of injury prevention and performance enhancement program I like to see when recommending players for your fantasy teams. Pilates is an excellent core strength and stability program many Yankees would benefit from; particularly Chase Headley and Dustin Ackley, who have had their share of lower back issues. Let's hope they're friends with Hunter.

CONCUSSION: MLB Policy and Youth Sports Screening.

Since the release of the movie Concussion starring Will Smith, some of the most frequent questions I am asked in my physical therapy practice are related to concussions.

As many of you saw in the movie, a concussion occurs as a result of the brain being physically jostled within the skull. This can cause swelling, bruising and trauma to brain tissue. Symptoms may include headache, problems with balance/coordination, concentration and memory.

MLB has made great strides to protect it's players and umpires from brain injury by implementing rules changes to reduce hits on a defense-less catcher, mandatory baseline neurological testing, new protocols for evaluating and clearing players for return to play and creation of a seven day disabled list.

It is very important that someone that has been concussed not be allowed to return to contact sport participation until these symptoms have resolved. If one returns to sport too soon they run a greater risk for a second concussion and additional damage to the brain. This can lead to permanent brain damage, long term disability or even death. Yes, this is scary stuff.

If concussion is suspected one should see a physician immediately to determine the severity and implement the proper treatment. Treatment for a mild to moderate concussion includes rest to allow swelling or contusion to reduce. This means rest from cognitive tasks, concentration and physical exertion. Aspirin free medication may also be prescribed as ibuprofen, Motrin and Advil may increase risk for further bleeding. Yes, physical therapy including vestibular rehab may be appropriate once a physician has deemed it safe to resume light/ moderate activity.

80-90% of concussions heal spontaneously within 7-10 days, however developing brains of children and adolescents may take longer. This is why Major League Baseball adopted the 7 day disabled list for players with concussion to prevent them from returning too early. This also takes the onus off the player feeling the pressure to return. He must fulfill the criteria in a series of neurological exams in order to be cleared for return to play.

The problem in youth sports is many coaches, parents and trainers don't have the experience or training to determine if in fact their athlete has been concussed and are allowed to resume participation risking further injury as I described above.

One quick and easy test for determination of concussion is the King-Devick test. There are over 50 peer reviewed studies supporting this objective visual screen as an excellent tool that can be administered by a lay person right on the field to assess whether an athlete has sub-optimal brain function and needs to be taken out of the game and sent to a physician immediately or allowed to return to play. Here is a link about the test from the Today Show. There's even a smart device app for it.

youtu.be/URjMCuRJrrE

Starlin Castro WORKOUT

www.pikore.com/starlincastro1324

Here is Starlin's latest post of himself getting ready for the season. Not sure I love his choice of bicep curls. I'd have him hold an isometric curl at 90 deg of elbow bend on one arm while the other arm curls through full range at the same time single leg bearfoot balancing on foam but tomato, to-mah-to. In any event keep it up and thanks for sharing Starlin!

CC Sabathia's Knee Degeneration And The Road To 300

Just a few years ago many believed CC Sabathia had the best chance of any active pitcher to reach 300 wins. With 2,775 and 1/3 innings entering the 2015 season CC had pitched more innings by age 32 than any hurler of the last 40 years except Greg Maddux. Over the past two seasons CC’s R knee has shown signs of all this mileage. He was diagnosed with degenerative joint disease and suffers from chronic pain, inflammation and swelling. As a physical therapist and sports rehab junkie I thought it might be fun to chronicle and break down the many procedures and treatments that he has gone through and have been recommended to him along his journey.

CC has been pitching through intermittent knee pain since the 2010 season. He tried reducing stress on the knee by losing weight during multiple off season’s only to put the weight back on over the course of the season. These efforts came to a halt during mid July of the 2014 season when he simply could not pitch through the pain any longer. At this time CC underwent arthroscopic surgery to the knee for debridement and removal of a bone spur. CC was told he would not require microfracture surgery.

For those of you that are not interested in the procedures I'm about to explain, skip ahead otherwise let's dig in!

Microfracture Surgery-

This is an invasive surgical procedure where tiny holes or “microfractures” are made in the bone near the damaged cartilage. These holes are said to release cells in the bone which build new cartilage and repair damaged tissue. The goal is to slow or prevent further cartilage damage. This treatment is usually followed by an intensive bout of physical rehabilitation.

His plan was to rehabilitate the knee and once again reduce weight during the off season. A knee brace was recommended but CC simply wasn’t comfortable pitching with it. CC made it to August of the 2015 season when the pain and swelling became unbearable once again. Over the course of a year and a half CC went through multiple rounds of platelet rich plasma and stem cell injections.

PRP (Platelet Rich Plasma) injections-

Platelets and liquid plasma are portions of our blood that contain many factors which promote healing in soft tissue and bone. Blood is drawn from the patient and spun in a centrifuge separating the platelet rich plasma from the blood’s other components. The PRP is then injected into the knee, in this case with the intention of intensifying the body’s healing capacity.

Stem Cell Injections-

Stem cell injections are an alternative to joint replacement and steroids injections. A physician injects amniotic stem cells into the body which act as a natural anti-inflammatory and joint lubricant.

The combination of these treatments, rest, physical therapy and his willingness to use his prescribed knee brace resulted in a fairly effective return to the mound to close the 2015 season. Little did we know he was in need of a different kind of rehab. On October 5th he went to the team requesting help with alcohol addiction.

Due to the degenerative nature of his condition, his size and the position he plays, in my professional opinion I believe it to be unlikely CC's knee will be able to endure the stress of 200 innings any longer and will either have to be nursed through the season or relegated to the bullpen. His dream of achieving 300 wins is over.

Please let me know if you agree or have topics for future discussion in the comment section below.

Dustin Ackley- DAMAGED GOODS?

Dustin Ackley was placed on the DL with back pain after appearing in just 2 games and 3 AB for the Yankees following his acquisition from the Mariners at the 2015 trade deadline.

The former #2 overall draft pick had experienced intermittent lower back issues over the years but was not experiencing issues or seeking treatment at the time of the trade therefore his back problem is now the Yankees problem.

The team initially called his injury a right lower back strain but later admitted Dustin was dealing with a lumbar disc herniation. The prescribed treatment was an epidural injection along with physical therapy.

An epidural injection is a common treatment for this condition which entails the delivery of steroid medication directly around spinal nerve roots to reduce inflammation. Physical therapy would have consisted of repeated spinal movements, joint mobilizations and soft tissue techniques designed to centralize then abolish his symptoms. Once these symptoms were centralized or abolished typical rehab programs for this injury would focus on a progressive core stabilization program to prevent re-injury.

Apparently this treatment plan was effective as Dustin was able to return to play and contribute without exacerbation during the stretch run for the Yankees.

The Yankees have access to the best medical care in the world therefore it is safe to assume Dustin's off season program includes dynamic core stabilization and an overall flexibility program to reduce the risk for re-injury.

With Starlin Castro now the full time 2nd baseman and a crowded OF, it looks like Dustin is going to have a bench role for the Yankees.

It might be a bit more difficult for Dustin to get loose in a pinch if Girardi calls on him however with the new amenities like underground batting cages and vast locker rooms in most stadiums, I don't think this will be too much of a problem. As long as Girardi can keep his bat from becoming stale I don't anticipate Ackley's back from limiting his 2016 performance.

Please let us know what you think Dustin Ackley's contribution will be to the 2016 team in the comment section below.