Syndergaard Seeks Second Opinion

May 3, 2017 · by · in Baseball Health · Leave a comment

To the dismay of Met’s fans ace pitcher, Noah Syndergaard, is out indefinitely due to a muscle injury. Latest estimates are predicting the powerful pitcher’s return in 3 months. However, it has been reported Syndergaard is seeking a second opinion.1 While here at Slapstick Baseball we aren’t privy to Syndergaard’s medical records, I can over some insight on muscle tears in a more general sense.

Syndergaard missed Thursday’s game against the Atlanta Braves due to a sore bicep and forewent an MRI. After a solid practice on Friday and some discussion by team management he was allowed to compete against the Washington Nationals, only to leave in the second inning holding his shoulder in pain. On Monday Syndergaard got his long overdue MRI. This revealed a partial tear in his latissimus dorsi.2 Some experts are claiming this was predictable given his immense pitching power and the fact he added 17 pounds of muscle this past offseason. It has also been reported that Syndergaard did not practice throwing in the offseason. According to Tom House, a famous pitching coach, it’s essential for pitchers to practice throwing everyday, especially when adding new muscle mass. This goes against the league’s current train of thought.3

The latissimus dorsi is a large muscle that flanks both sides of the back. It attaches to various points on the spine and upper arm bone, the humerus. The latissimus dorsi allows a person to bring their shoulder down, extend their arm, rotate their arm in, and bring their arm across their body.  In regards to a pitcher this muscle plays a large role in allowing them to wind up, put some speed on the ball, and direct the pitch. 4

Muscle injuries can be broken down into 3 categories.  A grade 1, 2, or 3. Grade 1 injuries consist of mild damage to a muscle resulting in a minimal loss of strength and motion. Healing time is typically 2 to 3 weeks. Grade 2 injuries are partial tears and have a greater impact on strength and motion. These types of injuries come with a 2 to 3 month recovery timeline. Grade 3 injuries are complete tears in the muscle and may require surgery. Syndergaard has a grade 2 injury or partial muscle tear. Standard treatment for this is rest, ice, compression, elevation, anti-inflammatories like ibuprofen, physical therapy, and ultimately time.5 A Systematic review of major league baseball players with isolated latissimus dorsi injuries found the average return to play time was 99.8 days.6 Teammate Steven Matz suffered the same injury in 2015 and was out for 2 months.2

As I said before I have no clue about the specifics surrounding Syndergaard’s current injury. However, I am willing to speculate that due to him wanting a second opinion and his pedal to them metal mentality his first doctor offered him this more conservative treatment plan. There are alternative treatments out there that are believed to speed up the healing process. These include losartan and platelet-rich plasma injections.5

Losartan is a medication used to control hypertension. Experimental models on mice have demonstrated that it may also be able to speedup the healing time for acute muscle injuries by decreasing scar tissue formation and improving muscle regeneration.7 Unfortunately, I was unable to find any clinical trials demonstrating these same effects of humans. Platelet-rich plasma (prp) is another treatment that uses a patient’s own blood. Essentially they concentrate the blood with platelets by removing other unnecessary blood components. This platelet-rich blood is then injected back into the body over the injury site. Platelets release growth factors that may promote muscle regeneration and decrease scar formation.5 Several clinical trials have been conducted testing this method out, only to come up with conflicting results.8,9 Despite this prominent athletes such as Hines ward, Maria Sharapova, and several others credit prp treatment with allowing them to return back to play quicker than they otherwise would have.10 For the time being though Mets fans will be waiting anxiously to see what this second opinion yields for their star pitcher.

Citations:

  1. Axisa @mikeaxisa 6h ago • 2 min read, M. (2017, May 03). Noah Syndergaard goes for second opinion and could reportedly miss three months. Retrieved May 03, 2017, from http://www.cbssports.com/mlb/news/noah-syndergaard-goes-for-second-opinion-and-could-reportedly-miss-three-months/
  2. Roscher, L. (2017, May 01). Noah Syndergaard has a partially torn lat muscle with no timetable for return. Retrieved May 03, 2017, from https://sports.yahoo.com/news/noah-syndergaard-partially-torn-lat-muscle-no-timetable-return-164047034.html
  3. Davis, S. (2017, May 03). One of baseball’s most famous pitching coaches said the injury that may keep Noah Syndergaard out for 3 months was ‘waiting to happen’ Retrieved May 03, 2017, from http://www.businessinsider.com/noah-syndergaard-injury-likely-says-tom-house-2017-5
  4. Lin, H., Su, F., & Koo, T. (n.d.). BIOMECHANICAL FUNCTIONS OF LATISSIMUS DORSI MUSCLE IN BASEBALL PITCHING. Retrieved May 3, 2016, from http://www.tulane.edu/~sbc2003/pdfdocs/0865.PDF
  5. Gullotta, L., MD. (2009, October 27). Muscle Injuries: An Overview. Retrieved May 03, 2017, from https://www.hss.edu/conditions_muscle-injuries-overview.asp
  6. Mehdi, S., Frangiamore, S., MD, & Schickendantz, M., MD. (2016, March). Latissimus Dorsi and Teres Major Injuries in Major League Baseball Pitchers: A Systematic Review. Retrieved May 3, 2017, from http://www.mdedge.com/amjorthopedics/article/106554/sports-medicine/latissimus-dorsi-and-teres-major-injuries-major-league
  7. Angiotensin II Receptor Blockade Administered after Injury Improves Muscle Regeneration and Decreases Fibrosis in Normal Skeletal Muscle. (2008, August 1). Retrieved May 3, 2017, from http://journals.sagepub.com/doi/abs/10.1177/0363546508315470?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub%3dpubmed
  8. Rossi, L., Romoli, A., & Bertona, A. (2016, April). Does platelet-rich plasma decrease time to return to sports in acute muscle tear? A randomized control trial . Retrieved May 3, 2017, from https://www.researchgate.net/profile/Luciano_Rossi4/publication/301344115_Does_platelet-rich_plasma_decrease_time_to_return_to_sports_in_acute_muscle_tear_A_randomized_controlled_trial/links/5745b19708ae9ace8424096f/Does-platelet-rich-plasma-decrease-time-to-return-to-sports-in-acute-muscle-tear-A-randomized-controlled-trial.pdf
  9. Reurink, G., MD, Goudswaard, G., MD, & Moen, M., MD. (2014, June 26). Platelet-Rich Plasma Injections in Acute Muscle Injury — NEJM. Retrieved May 03, 2017, from http://www.nejm.org/doi/full/10.1056/NEJMc1402340
  10. Aschwanden, C. (2014, July 14). E Platelet-rich plasma treatment is popular for sports injuries, whether it works or not. Retrieved May 3, 2017, from 1. https://www.washingtonpost.com/national/health-science/platelet-rich-plasma-treatment-is-popular-for-sports-injuries-whether-it-works-or-not/2014/07/14/b6293b10-0607-11e4-a0dd-f2b22a257353_story.html?utm_term=.c853ee7e788e

 

 

 

 

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