Baseball and the Mafia!

The Mafia is one of the most fascinating organizational structures that I have ever studied. Take for instance the fictional Corleone family from “The Godfather” movie. Vito Corleone was the boss and while he was well and calling the shots, the Corleone family thrived. The family could survive arrest or hits to their soldiers all the way up to high-ranking captains, as long as Vito was running the show. If a rival family wanted to disable or cause dysfunction in the Corleone family, getting to Vito was the quickest way to do this. Getting to the boss is pretty tough as you have to go through layers of underboss, captains, and soldiers to get to him OR you have to find the perfect opportunity to catch him when he is vulnerable. Regardless of the tactic to get to the boss, once he is hit, everyone below him is affected and likely to have limited value on their own.

 The human body and the Mafia are somewhat alike. The body has bones which can be considered the boss; tendons, ligaments and fascia which would take on the underboss and captains roles; and muscles that act as the soldiers on the front line. Similar to the Mafia, the primary role of each of these accessory soft tissues are to protect the bones. Each section of the body can be considered as its own family. Certain families, such as the lumbar spine or the pelvic area may be larger and more powerful families.  The smaller families like the forearm and the hand regions are important but don’t necessarily threaten the whole Cosa Nostra if they are injured. Like the boss, bone is usually difficult to get to unless it is hit with enough force to overpower the layers of protection created by ligaments, tendons, fascia, and muscles. In some cases bone is fractured because the body is put in such a vulnerable position that very little force will cause the bone to break.

 J.D. Martinez of the Detroit Tigers almost became the latest example of how a bone fracture can shut down an entire section of the body, but it appears he has dodged the traditional ramifications of a bone fracture. Martinez has a small elbow fracture as a result of excessive force during his collision with a right field wall. Luckily for Martinez, the forearm and elbow family are not one of the bigger families which could shut his whole system down, however for a baseball player, the elbow is like a hitman and therefore essential to the overall operation.

Like an injury to the boss; the worst part about bone fractures is that they typically shut everything else down. After a fracture, the injured area is typically treated with immobilization, which means the bone, the ligaments, the tendons, and the muscles get no action until the bone is healed and ready to get back to business. This period of inactivity will usually cause soft tissue structures to get stiff, weak, and lack coordination. Conversely, injuries to the soft tissues that protect bones will likely result in treatment for that particular soft tissue, and this does not typically cause the bone and other soft tissues to be put on hold. Ligaments and tendons rely on bracing or splinting, while their captain and soldier counterparts may choose to simply rely on more soldiers and protection during periods of weakness. There are some ligaments and muscles that play very significant roles, such as the anterior cruciate ligament or maybe the rotator cuff group. These soft tissues are similar to some of the soldiers and captains who earn large for the family, and can’t be replaced. Apart from a few uniques situations, bones and joints can usually continue to function during a soft tissue injury while the inverse is usually not true.

J.D. Martinez appears to have been lucky as he is reported to have a non displaced fracture which will not need immobilization or casting. It appears that he is being encouraged to continue moving in a limited manner to avoid many of the negative effects that I described above. In essence, this elbow fracture is more like a graze rather than a clean hit. J.D. Martinez has the privilege of letting his elbow family continue doing business on a limited basis while the boss heals from the graze wound. The only worry I have if I am invested in Martinez, is that without a cast or any type of immobilization, you leave the restrictions much to the athletes discretion. Many times, I will explain to patients that they can treat pain like a wall–“go all the way up to the wall, but don’t try to go through the wall.” With athletes, you typically find that they will push things to the limit; which in this case could cause some unwanted inflammation and swelling that could push this recovery to the long end of his four to six-week timetable.

Overall this is not an injury to worry much about as there should not be any long-term ramifications. Martinez may return closer to four weeks if he can follow his Physical Therapy regimen precisely and has the benefit of being a fast healer. His conditioning should be fine as his limitations are minimal. Fantasy owners should keep an ear open for the usual trigger words such as swelling, tightness, inflammation, soreness, etc; as any of these issues in the right elbow region could cause some bio mechanic issues to his swing or throwing motion. With good adherence to his Physical Therapy, these should all be easy issues to manage. If it were me, I would stick with Martinez and expect his productivity to resume shortly after he returns.

Why I Think A Broken Clavicle May Threaten Nick Foles Career!

November 15, 2014

Mark Sanchez is the talk of the league now that injured Philadelphia Eagles Quarterback-Nick Foles is out with a fractured clavicle for 6-8 weeks.  But will Foles be able to return from this injury?

The Science


The clavicle bone which is very commonly referred to as the collarbone is basically the bridge from your sternum (breast bone) to your scapula (shoulder blade).  Just like an actual bridge, when the clavicle is injured or broken, it leads to a ton of problems.  Many of the bones in our body are simply involved in a short list of actions or responsibilities, but the clavicle is not one of them.  The clavicle serves as one of the attachment sites for muscles of the neck, shoulder, and chest region.  Without a functioning clavicle, in many ways the entire upper extremity on the affected side is shut down.  Try it yourself;  put your opposite hand on your clavicle and move your arm in any direction.  You will subtly feel your clavicle rotating and moving with every arm movement.  After a clavicle injury the only arm movements that will be allowed are from the elbow down.  Even for a non athlete, this is a very limiting injury, especially if it occurs on your dominant side.  Luckily the most common way to fracture this bone is just as Nick Foles did–by falling on it.  I imagine that not many of you are making a living falling on your shoulder, so for that reason this is a less common injury outside of athletics.

nick foles
This is how you break your clavicle and possibly threaten your career as an NFL quarterback.

Similar to any other bone fracture, the clavicle will typically heal in 6-8 weeks. One of the earliest considerations, which we saw in the case of Nick Foles is whether surgery is needed.  Surgery is generally needed if the fracture causes displacement of the bone or if the bone is crushed or shattered.  In Foles case, the fracture was not displaced meaning that although he had fractured the bone it was still in good alignment which will allow it to heal without surgical intervention.  In other cases, a surgeon may have to go in and put the bone fragments back in the proper position to allow healing to occur properly.

In either case, the injured side will generally be put in a sling for support during the healing period and range of motion will be maintained with Physical Therapy.  The important issue is what happens to the muscles during the 6-8 week healing period.  That good old saying: “If you don’t use it you lose it” applies here.  After recovering from this type of fracture you can expect an individual to be weaker in the shoulder area, chest area, neck area, and the upper back area as the clavicle plays a role in the movements of all of these areas.  This will be the case for Nick Foles, but fortunately he injured his non throwing arm.

Upon satisfactory bone healing, Foles will be able to resume using his left arm and build that strength back up.  The entire process is typically a 3 month deal but as I always say, the NFL does everything faster.  Foles could legitimately be back on the field at the 8 week mark with this injury, assuming he gains satisfactory strength.

Fantasy and Real Life Implications

Although I just said that Nick Foles should heal up and be ready to go in 2-3 months, the key word is “should”.  I do not believe Foles will get his job back from Mark Sanchez.  Although Nick Foles had a residual buzz from last years exceptional performance, he was severely under-performing this year.  Additionally, the Chip Kelly system fits a more athletic Quarterback much better than it does the lumbering Foles.  I know Chip will say he does not need a running QB, and I agree, but the offense does need an athlete.  Mark Sanchez is the perfect blend of athlete and Quarterback for that system and I believe he will be the Philadelphia Eagles Quarterback for years to come.  Many will disagree based on the “Sanchize” experiment in New York but I place all of that blame on poor coaching.  I assert that Mark Sanchez has been a better Quarterback than Nick Foles his entire life and on every level–Pee Wee, JV, Varsity, College, Draft, etc.  That is until he met Rex Ryan and Brian Schottenheimer.  I think the people who analyze this type of thing; the Mel Kiper’s of the world would fully agree with me on this point, but either way I think we will soon see that he is still better than Foles.

mark sanchez
There is a reason why Mark Sanchez only had to hear 4 names called before his, while Nick Foles waited through 87 names.

To be clear, I don’t think that Foles is done in the NFL.  He has done enough to make a name for himself and will get another chance somewhere or possibly be a coveted back up.  But he is not getting the Eagles gig back, therefore I say this injury is threatening his career.  Unfortunately Nick Foles has not made it to his second contract yet, and for most NFL players the second contract is what should put you on easy street for the rest of your life (although it usually does not).  I believe by the time it is time to negotiate that second contract that Foles may just be a back-up. It will all have to play out in the next year or two, but for now the message that you need to get is to start Mark Sanchez everywhere.

As I have stated in the past, I play one day fantasy on and the million dollar winner had guess who as his starting quarterback…..Mark Sanchez.  Guess who the second place winner had at QB……you guessed it, Mark Sanchez.  This is not a fluke and this was not just because he played the Panthers.  Sanchez will flourish in this offense, and it is not a coincidence that Chip Kelly chose to get him this offseason.  He may quite possibly be in a perfect situation and you will be too if you start him at Quarterback in your traditional and one day fantasy leagues.