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Wednesday, April 16, 2008

Erik Bedard - Windup Worries

Posted by Chris Neault at 4:37am

Over the past week, my email has been flooded with requests to highlight Erik Bedard's recent hip injury. I have been trying to figure out what is wrong with his hip, but the problem is that Seattle is staying pretty much silent on the matter. With only the extremely vague description of "hip inflammation", you can see how I would have some trouble writing up a comprehensive article regarding his condition.

But for every injury, there must be a cause. So I decided to watch some video on Erik Bedard to see what his left hip looks like during his pitching motion. What I saw when I first viewed the video on YouTube was so glaringly evident that I can't believe nobody else saw it first (especially Baltimore and Seattle fans - shame on you)!

To my knowledge, there has been no report as to the severity of the injury or any insight as to what structure(s) may be involved. I also have not heard anything about x-rays or MRI results. With that being said, here is my initial impression of what could be going on after having viewed some video footage.

Just scour the hip

A test that is often used in orthopedic evaluation of the hip is called the scouring test. This is when the examiner pushes into the hip joint through the knee while rotating and "scouring" the hip joint surface in the socket. This is a test that is used to assess the articulating surfaces of the femoral head (ball) with the acetabulum (socket). A positive test is indicated by pain, locking, clicking, or catching in the joint.

Video assessment of Bedard's pitching motion

Now take a look at this video clip (thank you YouTube and user jamessutherland23):



Notice how Bedard plants the left leg, then twists his trunk, pelvis, and right knee towards the left hip—past the left hip—then returns towards home plate. In essence, this is a functional scouring test for the hip. The weight of the body is placed through the left hip, so the joint surfaces are abutting one another. The rotation of the upper body over the left hip then "scours" the joint. This can create a situation that is, for lack of better terms, awful for the cartilage surfaces of the hip.

Clinical implications

If Bedard has been pitching like this for a long time, which I can only figure he has been, the chance that he might have an early onset of degenerative changes of the left hip is likely. The articular cartilage that protects the head of the femur can soften and wear away, exposing bone surfaces and creating pain. The other structures I would be worried about are the acetabular rim (the outer rim of the socket, which is bone), and the acetabular labrum, which is much like the labrum of the shoulder (a softer, meniscus-like cartilage that adds depth and extra stability for the joint).

When I read that anti-inflammatory medication was not working for him, it set off a red flag in my mind. The reason I say this is because usually with a minor muscular injury, or some form of tendonitis, the body will respond quite positively to the rest and medication. The fact that Bedard's hip did not respond to rest and medication can lead us to believe that perhaps something else is going on here.

The next step should be diagnostic imaging (although this likely has already taken place, we just have not heard about it). I would not be surprised in the least if we found that Bedard has a labral tear in the left hip, and/or an arthritic hip. Another symptom that led me to believe that this is an articular problem is that he had pain in the morning.

Why? Because arthritic joints respond negatively to prolonged, static postures, especially sleeping. Just ask an older person how their arthritic low back, knee, or hip feels in the morning - probably terrible. They'll probably say they feel "really stiff." I've heard this from countless patients just today.

If there is a labral tear, rehabilitation alone is rarely successful. Usually, arthroscopic surgery to either debride or repair the labrum and shave down the acetabular rim is performed. If it is arthritis, rehabilitation should provide some relief, though he will likely struggle with bouts of increased pain with periods of relief.

Conclusion

Until we hear otherwise, we have to take their word for it: hip inflammation. The more important question, as always: Where did the inflammation come from? That's what Mariners fans—and fantasy managers—want to know.

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