I am sure that Washington National’s fans and Stephen Strasburg fantasy owners are holding their breath with the latest mishap of a career full of injuries. The information reported on this injury is somewhat vague, but Strasburg appears to be suffering from an upper back strain after dislocating “a couple of ribs” during a workout incident. Considering this information, I assume this to be a posterior (toward his back rather than toward his chest) dislocation of his ribs, with the subsequent upper back issue being due to the trauma of the ribs coming out-of-place and then being put back into place, which caused irritation to the tissues in that area. I think for this particular player that any injury needs to be taken seriously, but even if this was not Stephen Strasburg I would have a moderate level of concern with this type of injury.
When most people hear the term dislocation they think of a bone moving to a place where it should not be. When I hear the term dislocation, I think of the structures and tissues that need to be overpowered and damaged to allow the dislocation to occur. Additionally, I think of El Chapo and how he escaped from prison. A bone dislocation can be very similar to a prison break as there needs to be force and there needs to be an overpowering of many layers of protection for either to be successful. Furthermore getting the bone back in place can be just as traumatic depending on the methods used to achieve this. El Chapo was captured with a finesse method which would be similar to a Physical Therapist or other healthcare professional carefully pushing the rib back into place with the help of other muscles and positioning. On the other hand, his capture could have gone another way with the inclusion of firearms and brute force; which represents the dislocation that is popped back in by a friend at the pickup football game. In most cases this method causes more damage getting the bone back in, as compared to the damage caused on the way out.
Similarly, with Stephen Strasburg, I am worried about the trauma during the dislocation, and I also worry about the trauma suffered when the bones were reduced (put back into their proper place). The tissues that suffer during this trauma are the ones we need to focus on, in order for the joint and the surrounding area to return to normal. In this case, the costal cartilage on the chest side which connect the ribs to the sternum; the various ligaments that connect the ribs to the thoracic vertebrae on the back side; and whatever other muscles and soft tissues that are positioned near the site of the dislocation; are all at risk for trauma and injury. Considering Strasburg is primarily complaining of discomfort in his upper back, we can assume that the structures that received the most trauma were the tissues in that area. Each rib has a group of ligaments to secure it to the thoracic spine, and as the rib moves to the surface there are layers of muscles that would be irritated or even injured by a rib pushing into them. Without knowing the severity of tissue strain, it is difficult to give an exact timetable for Stephen Strasburg’s injury. In a general sense, I would give the irritated soft tissues in his back at least 3 weeks to heal.
With soft tissue healing, much of the assessment relies on time, as we know how long most tissues take to heal; but we also use performance followed by assessment of how the tissues react to the performance. The issue with this approach with a player who has an extensive injury history and has not shown himself to be an exceptionally fast healer is that assessing that performance too early may cause a setback rather than just allowing you to gather the information you want. If this were another position or another sport, I think this would be considered a minor injury that I would pencil in for a quick return. However, when you consider the length of the baseball season and the time this provides you to make sure you get this right, I would take my time with a 3 week minimum. If Stephen Strasburg attempts to come back too early, this could turn into a lingering issue for the rest of the season. The anatomy of this injury gives Strasburg no options as to avoiding the use of this area as the upper back area is directly connected to his scapular movement, and his scapular movement is one of the two most important pieces to his throwing motion. If Strasburg would have tried to be a tough guy and push through on this past Sunday, the discomfort that he felt when trying to warm up for his start against the Brewers would have progressed with every pitch to the point of pain and dysfunction. The risk of repeated dislocation is always in play when you don’t allow the structures that allowed the first dislocation to regroup and heal. The thought of him going out there and trying to pitch right after the ribs were reduced would be like putting El Chapo right back in the same cell he escaped from, before you can close the hole and change the prison guards.
The Washington Nationals and fantasy owners should embrace the thought of Stephen Strasburg taking at least 3 weeks off to heal as anything sooner than this would seem to be risking the chance for a chronic situation that could put his season in jeopardy, after such a good start. If managed properly with the appropriate rest, physical therapy, and gradual return to throwing; there is no reason Strasburg will not return at near 100 percent in about 3 weeks.