ROTISSERIE: A primer on injury grades

"An ounce of prevention is worth a pound of cure."  —Benjamin Franklin

When it comes to player injuries, we are pretty limited in our ability to prevent the injuries themselves. But as fantasy players we do have the ability to prevent their potentially devastating effects to both our rosters and our chances of winning.

That all starts with a little better understanding of the injuries themselves and the associated treatments and healing processes.

My goal is to take some of the common injury terms that you probably read/hear on almost a daily basis and to attempt to better explain them in few paragraphs that you can actually use to evaluate player injuries yourself—especially with regard to severity and expected healing time—without the inconvenience of having to earn a medical degree first. (See also our first article that reviewed common diagnoses and what they really mean.)

Now, with some injuries, even a small or partial tear will almost invariably require a long recovery time or surgical repair, and an associated long absence (think multiple months minimum) when they occur in the player's throwing arm.  

Examples would include:

  •   The ulnar collateral ligament (UCL or "Tommy John" ligament) in the elbow
  •   The labrum (the cartilage ring in the shoulder joint)    
  •   The rotator cuff tendons in the shoulder  

As soon as you find out that a player on your roster is dealing with one of these injury scenarioes, any additional news is likely going to be bad for all parties involved (for fantasy baseball purposes anyway).  It's probably time to move on to Plan B.

However, there are many other common injury scenarios where I feel that with a little better understanding of the injuries themselves and how they are reported, you can gain a significant fantasy advantage.  Specifically (and with the exception of a few special cases) I mean injuries to the bones, muscles, tendons and ligaments.

First, before we start defining and describing all of these injury terms, I'm going to condense about six months of medical school anatomy into a few sentences and give you a really quick description of the major players of the human musculoskeletal system. These are the categories:

Bones:  The hard, mineralized things in the body that hold us up and act as a foundation for the other moving parts.

Cartilage: A type of soft tissue that acts as a cushion and prevents wear—usually in areas where bones are close to each other (like the joints).

Muscles: Bundles of fibers that bend and stretch to perform work.

Tendons: Bundles of (less bendy/stretchy) fibers that attach muscles to bones.

Ligaments: Bundles of (even less bendy/stretchy) fibers that attach bones to other bones.

And that's pretty much it.  Ok yeah, there are other parts of the anatomy we could talk about, but are you performing surgery tomorrow or are you trying to win a fantasy title?  Exactly...

So now that we know the major components of the musculoskeletal system and their functions, let's look at what happens when they get injured or damaged.

 

Fracture

It's quite simply a break in a bone, which means that aside from it being a really, really painful injury (which anyone who has ever broken a bone will attest to), a broken bone isn't able to act a stabilizer or absorb or distribute forces. And if a bone can't do that, than none of the other parts of the system around that bone can do their jobs very well either. This is especially inconvenient and detrimental if said job includes catching a baseball, throwing a baseball really hard and/or swinging a heavy bat in an attempt to hit a baseball thrown at you. 

How do you fix it? Line up the broken pieces the best you can and keep the area still while new bone is made to fill in the break(s). Sometimes a cast is enough to accomplish this. Sometimes surgery is needed to add plates, pins, rods, screws or other hardware to get the job done.

Any long term effects after healing? Not really. Once the new bone has matured, you are pretty much as good as new.

How long does it take to heal? Usually 4-6 weeks (sometimes longer if surgery is needed).

 

Strains and Sprains

These are injuries involving the fibers of muscles and tendons (strains) and ligaments (sprains).  An easier way to think about them is just to consider them all "tears of the soft tissue fibers"—because that's really what they are. 

Now if you are thinking, "Why don't they call them all 'tears' instead of messing around with these different terms which seemingly mean the same thing and just save us the confusion and hassle?"  I have three responses:

  1. Great question, I like where your head is at.
  2. Medicine likes to complicate things—I mean, they have to fill that 4 years of school with something, right? 
  3. This is where knowing what these terms actually mean is going to help you gain an advantage on your competition.  

In order to differentiate and categorize these injuries ("tears") most doctors use a grading system, which if you have played fantasy baseball for more than a few minutes, I'm sure you have come across the most common one: Grades 1, 2 and 3. We see, hear, and read about these all the time. "Grade 1 ankle sprain," "grade 2 calf injury," etc.  So what exactly are they saying, and more importantly for fantasy purposes, what can we expect in terms of expected recovery time?

Grade 1 Strain/Sprain—"Microtear": This is an injury to the soft tissue fibers of the muscle, tendon or ligament without a visible tear.  An MRI will show abnormal appearance/signal at the site of injury and surrounding fluid (but no visible tear, so "no structural damage").  So there is an injury present but it's a "tear" on the microscopic level.  This is usually painful, but if it occurs in a big muscle, it's probably not as bad.  There are plenty of other intact fibers to pick up the slack for the injured component.  If it's a small ligament or tendon, like in the knee, ankle, wrist, shoulder or finger/toe, well, they're pretty much working solo so that's probably going to hurt.  A lot.   

Grade 2 Strain/Sprain—"Partial tear": An injury to some of the soft tissue fibers that is visible on MRI ("macrotear") but some of the fibers remain intact.  These injuries can also be further broken down in severity as low, moderate or high grade depending on the size of the actual tear (with a low grade partial tear only involving a few fibers to a high grade partial tear where almost all of the fibers are torn).

Grade 3 Strain/Sprain—"Complete tear": It's exactly what it sounds like—all of the fibers are torn. If this sounds bad, that's because it is.  Now, "grade 3 sprain/strain" sounds way more benign than "complete tear," doesn't it?  Well, they both mean the same thing.  In fact, I don't even use the term "grade 3 sprain or strain" because I think it's that misleading.  I say "complete tear of X."  So now, when you hear or read "grade 3 injury," you know it means "complete tear" (and it's a really, really bad injury).

How do you fix them? For lower grade injuries, rest, rest and more rest. Higher grade injuries usually will require surgical repair (and then rest). 

Any long term effects after healing? Unfortunately, yes. Whether the injury heals/repairs itself or requires the assistance of your friendly neighborhood orthopedic surgeon, the repaired areas contain fibrous ("scar") tissue. Scar tissue is both not as strong nor as flexible as the original tissue. So the injured area losses some functional strength and is more prone to reinjury/retearing after healing.  The bigger the tear the more scar tissue there is.  With higher grade injuries, surgery decreases the amount of scar tissue formation, but some still occurs.

How long does it take to heal? With sprains and strains, it can be tough to pin down an exact recovery timetable due to the many variables involved (including player age, mechanism of injury, new versus recurrent injury, and about a couple dozen other things). However, a rough estimate for healing times is as follows:

  • Grade 1 injury ("microtear"): 2-4 weeks.
  • Grade 2 injury ("partial tear"): 4-8 weeks (with the higher grade partial tears requiring the longer recovery times).
  • Grade 3 injury ("complete tear"): At least 8 weeks (with a very high likelihood of being out for most or all of the year).

Sure, this is a broad range, however, the main takeaway from this table isn't for you to try to nail down the exact time when a player is likely going to return weeks down the line, but rather to keep an eye/ear out for when a reported injury timeline significantly deviates from the above. For example, if your player has a grade 1 ankle sprain and his manager says he's probably only going to miss "a couple days," or has a grade 2 groin injury, but it is being reported that he "should be back in 2-3 weeks", be skeptical (and plan accordingly).  And the more the reported recovery time deviates from the above, the more skeptical you should be that the player is actually going to healed and back on the field in that time.

 

Inflammation

This is irritation of the soft tissues.  In the setting of baseball, it is most often an overuse/repetitive motion injury which occurs over time. The player repeats the same activity (throwing, hitting, etc) and the structures involved get "angry."  (As opposed to a sprain or strain which usually happens suddenly). Anyone who has ever had hand or wrist pain from typing or playing video games too long knows exactly what this is.

Here are a few things you might not know.  

Inflammation looks almost identical to a grade 1 injury on MRI (abnormal signal/fluid in and around the injured tissues but no visible tear)—so much so that when I see it in real life (and I don't know history or the mechanism of injury) I often call it "Inflammation/Grade 1 injury" because I can't tell the difference. Now "inflammation" can sound not that bad, (at least not as bad as a "grade 1 strain/sprain" or "microtear") but when you see those terms, you should remember a few things:

  • Even though they may occur for different reasons "inflammation" and "grade 1 strain/sprain" can behave very similarly (both in appearance and recovery time).
  • They can both keep your player out for weeks (because despite the MRI showing "no structural damage" they can be extremely painful. Ask our favorite "Guitar Hero," Joel Zumaya if you don't believe me).
  • The injury/pain can recur or can even progress to partial or full tears if not given enough time to heal (so, maybe your player coming back a few days or a week early isn't such good news after all). In fact, maybe you don't want to cut that player who's been filling in so admirably for you until you see your injured player demonstrate that he really is all the way back - Yes, Gary Sanchez (C, NYY), we're looking at you.

The Takeaway: When you hear or read someone dismissing your player's injury as "just a little inflammation" and thus, "no big deal," don't believe the hype. Your player could still be looking at an extended absence (for any number of reasons).  Maybe consider lining up that potential replacement just in case, because when it comes to plugging holes in your fantasy lineup...

An ounce of prevention really can be worth a pound of cure.

 

Conclusion

Hopefully this gives you an overview of some of the common baseball injuries that might befall your players and a better understanding of the terms associated with them. But remember, if and when your player goes down with an injury, this is only meant to be a rough guide. Every injury (and the associated recovery process) is unique, and that's where the other BaseballHQ.com content like "The Big Hurt" column is extremely useful.  There you will get specific injury details, updates and estimates as well as information about your player's progress, setbacks and risk of reinjury, until he is back on the field and in your lineup.

With player injuries, the devil might be in the details, but hopefully now you are better equipped to manage your injured players and your roster, and make it hell on your competition in the process. I hope you agree.

Wishing you good luck into the dog days and down the home stretch!  Hit me up with any questions, comments or suggestions in the comments section below.  

 


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  For more information about the terms used in this article, see our Glossary Primer.