Cub’s Pitcher on the Disabled List

Just when some excitement started to brew with Yu Darvish’s return for the 2018 playoffs, Yu has been placed on the Cub’s disabled list yet again this year. All it took was one inning and 19 pitches in his “rehab start” in the minor leagues for him to realize that something was just not right with his pitching elbow. Darvish has been on the disabled list twice this season, first with the flu and then due to triceps tendinitis, resulting in sub-par performance with just 8 starts and one win. He had not pitched since May 20th and has taken some heat from fans and critics due to “no structural damage” shown by MRI for his original triceps tendinitis injury.

However, after pitching on August 21st, MRI confirmed Darvish to have a new injury; a stress reaction in his right elbow in addition to a triceps strain. He will be out for the rest of the season with a predicted 6-week recovery time.

Stress Reaction vs. Stress Fracture

What is a stress reaction and how is it different than a stress fracture? A stress reaction is a pre-curser to a fracture, which often results from repetitive movements and overuse of a joint. Repetitive submaximal loading of a bone overtime in movements such as pitching can cause weakening and breakdown of bone structure. If rehabilitative measures are not taken, a stress reaction can eventually lead to a stress fracture which involves a small crack in the bone.

Throwing is one of the fastest known motions to occur in the body. If the arm was able to rotate 360 degrees at the shoulder, it would be able to rotate fully around up to 27 times in one second (1). That’s a lot of force and torque that occurs through both the shoulder and elbow! The faster and harder someone throws, the more it can take a toll on the body, especially if proper training and warm-up techniques are not taken.

Is Darvish’s previous triceps tendonitis related to this new injury? In short, most likely.

Triceps Tendinitis

Triceps tendinitis is inflammation of the triceps muscle tendon, usually at the point it attaches to the head of the elbow (olecranon process of the ulna) resulting from repetitive overloading of the tendon, in this case from repetitive pitching. Symptoms include swelling, tenderness to touch, brittleness of the tendon, and tightness. When the triceps does not function properly or activate like it should, it is unable to absorb shock during the pitching motion, making the elbow more susceptible to injury. This results in more pressure on the bone, causing it to weaken (stress reaction) and eventually crack (stress fracture). It is also entirely possible that this stress reaction is actually what has been bothering Darvish since the end of May, and has only just been diagnosed now.

Injury Recovery

Darvish’s injury recovery will likely address muscle imbalances, mobility, strength, and stability at the elbow joint to promote healing. Physical therapy for stress reactions at the elbow will commonly consist of the following:

  1. Rest: Yu will most likely stop throwing for a while to reduce load on the elbow joint. However, this will be “active rest”, meaning he will be performing light exercises that will stimulate the recovery process without imposing unneeded stress on the injured body part.
  2. Addressing muscle imbalances: any restrictions in strength, mobility, or stability in the core, spine, shoulder blade, or shoulder joint can cause inefficient transfer of energy through the elbow and increased load on the elbow joint. For Darvish, this may include hands-on manual therapy to the triceps, biceps, shoulder blade and forearm musculature to address soft tissue restrictions and muscle insufficiencies.
  3. Stabilization of the shoulder and scapula: this involves strengthening the muscles surrounding the shoulder blade including the rotator cuff, rhomboids, mid and low trapezius musculature.
  4. Strengthening forearm musculature, biceps, and triceps to help support the elbow joint.
  5. Return to throwing program: slow gradual throwing progression addressing speed, velocity, distance, and volume of throwing.

In the end, Darvish’s health is important to the team long-term, as he signed a 6 year, $126 million dollar contract this year with the Cubs. Although it is disappointing that he will not be pitching again this season, addressing his injury now prevents it from getting any worse and affecting his whole pitching career. We predict that Darvish will be back to 100% and ready to go in the spring next year!

For more information on elbow, shoulder, or common throwing injuries contact us at The Fit Institute, or schedule a complimentary injury screen. Our physical therapists and movement experts would love to answer any questions you may have!

Katie Budz – Doctor of Physical Therapy. Graduate of Rosalind Franklin University of Medicine and Science. Former collegiate athlete playing 4 years of Division III basketball at Dominican University in Chicago.

The FIT Institute is a physical therapy and sports performance facility in North Center. We increase the of an athlete’s career by teaching proper movement patterns that often lead to overuse injuries, we do this by bridging the gap between physical therapy and sports performance.

References:

Mike Reinold. How to Prepare Before You Throw – Part 1: Prepare Your Body. Mike Reinold. https://mikereinold.com/how-to-prepare-your-body-before-you-throw/. Published October 20, 2015.