The Nationals outfielder took a scary fall over the weekend and suffered what appeared to be a gruesome injury. Harper injured his left knee when his foot slipped on first base. The base itself was unmistakably wet, the result of ongoing rain that was preceded by a three-hour rain delay. The violent motion forced Harper’s knee into hyperextension and sent the outfielder tumbling to the ground in pain. Fortunately, further testing revealed no tendon or ligament damage. Instead Harper has been diagnosed with a bone bruise on the inner aspect of his knee. The diagnosis is a clear win for Harper and his long-term health, but the severity of a bone bruise should not be minimized.
The bones of the body are made up of multiple layers of tissue. The thickness and consistency of these layers vary from bone to bone, often due to the various stresses applied to each bone.
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The periosteum is the thin, outer layer. It is the first layer of protection and surrounds nearby nerves and blood vessels. The most prominent layer of bone, compact bone tissue, sits below the periosteum. This dense and harder layer comprises most of the human skeleton. Below the compact bone is cancellous bone. Because of its porous makeup cancellous bone is often referred to as spongy bone. Spongy bone is more prevalent at the end of long bones like the femur. The various layers work together to protect the innermost aspect of the bone, the bone marrow, which is vital in the production of red blood cells.
Unfortunately, these layers can be damaged when overloaded or stressed. A broken bone or fracture understandably involves damage to all layers. However, not all mechanisms of injury result in a complete fracture. If the damage is isolated to a single layer, it is classified as a bone bruise or contusion. Bone contusions can occur in a variety of locations.
A periosteal bruise develops when blood builds up underneath the thin periosteum. An interosseous bone contusion, the most common type of bone bruises among professional athletes, involves the medulla of the bone. A subchondral bruise develops between an area of cartilage and the nearby bone tissue.
A more complex process of healing is what differentiates bone contusions from simpler soft tissue bruises. When the bone begins to mend a bone bruise, it takes the same approach as it would with a complete fracture, recruiting specialized cells known as osteoblasts. The osteoblasts produce and incorporate new bony tissue at the injury site. The process can be painstakingly slow but it will ultimately return the bone to its pre-injury strength.
Unfortunately for Harper owners, bone contusions of the knee, especially the patella, often require even more time to adequately heal. The reasons for the prolonged recovery is linked to the movement of the kneecap during joint motion. Due to its location within the quadriceps tendon, the kneecap makes direct contact with multiple areas of the knee, particularly the femur. This repetitive bone-on-bone impact often slows healing and increases the individual’s time away from the sport.
The injury is by no means a season-ending injury, though it drastically alters Harper’s fantasy value. He’s officially been ruled out indefinitely, and the Nationals will handle his recovery with extreme caution. Their sizeable lead in the National League East will allow them to focus on a postseason return, and it wouldn’t be shocking if Harper’s regular season is over. His value in keeper leagues remains unaffected barring an unforeseen setback.
The Yankees right-hander has been placed on the 10-day DL with inflammation in his throwing shoulder. Manager Joe Girardi downplayed the severity of the injury and framed the decision as an opportunity for a tired Tanaka to get a much-needed break. Team doctors evaluated the area and failed to discover any structural damage. However, it would be hasty to ignore Tanaka’s history of elbow and forearm problems and dismiss the idea that this injury is linked to his prior ailments. Pitchers can suffer a slow cascade of problems that start at the elbow and work their way up the kinetic chain, if the reason for the initial problem remains untreated or ignored. Even if Tanaka does return after 10 days, his level of risk will increase moving forward, limiting his overall value. Owners in keeper leagues should pay particularly close attention to Tanaka’s health entering the offseason.
James Paxton: The Mariners emerging ace is back on the DL after straining his pectoral muscle. The “pecs” sit near the upper portion of the chest and are generally associated with pushing exercises like bench press. However, the pectoralis major anchors to the upper arm bone, the humerus. As a result, the pec plays a role in multiple shoulder motions. The fan-shaped muscle helps flex, extend and rotate the upper arm. It also pulls the arm toward the midline of the body in a motion known as adduction. The initial timeline for Paxton’s recovery is a minimum of three weeks, though look for Seattle to slow play his return with this being his second upper-extremity injury of the season. He missed time earlier in the season with a strained forearm.
Andrew McCutchen and Gregory Polanco: The Pittsburgh outfield took a beating in Toronto with both McCutchen and Polanco coming up lame. McCutchen made an early departure from Friday’s contest due to left patellofemoral discomfort. Patellofemoral pain syndrome is a bit of a catchall term for pain surrounding the kneecap. The root of the problem ultimately can be an assortment of things ranging from overuse to a cartilage injury. Luckily, the Pirates hinted it was more of a soft tissue injury that could be resolved with treatment and routine maintenance. The work done by the medical staff appeared to work as McCutchen was back in action by Sunday, though in a designated hitter role. With the Pirates headed to Milwaukee, the team will no longer have the DH at their disposal, though Monday’s day of rest should allow McCutchen to be ready for a complete return.
The same can’t be said for Polanco who aggravated his left hamstring strain. Polanco has already served two separate stints on the DL for similar injuries and it appears a third is likely. Fantasy owners can no longer rely on Polanco’s availability and should move on for the remainder of the season.
Jeff Stotts works as a Certified Athletic Trainer (MAT, ATC, PES, CES). He won the 2011 Best Fantasy Football Article in Print from the Fantasy Sports Trade Association. Follow Jeff on Twitter: @InStreetClothes.
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