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.