Yankees’ GM, Brian Cashman, asserted that Jeter did not begin baseball activities until medically cleared to do so. Certainly that seems logical and likely. Jeter’s earlier CT scans reportedly showed a progression of his post-operative fracture from healing to 100 percent healed, at which time he received the go-ahead. Only the newest exam revealed a small “new” crack that explained Jeter’s ongoing symptoms.

Though I don’t have access to his medical records to know definitively, it is worth noting that Jeter’s “new” fracture may not be as new as it appears. The break, as is typical of stress fractures, may simply not have been discerned on x-ray until it began to heal. The less significant a fracture, the more likely this is to be the case. Sometimes an affected area announces itself only as the calcification that signals repair lights up on the x-ray. That is yet another important reason why symptoms should dictate rehab progression, and playing through pain isn’t productive. Doing so only risks exacerbating injuries or resulting in compensatory breakdown. The false starts Jeter experienced in his recovery highlight this point; It appears he’s learned to listen to his 38 year-old-body.

I hereby apologize for ragging Mr. Iwakuma (on the air) last year, with my stopwatch in hand, when he became very deliberate when a runner reached base. You know what? Kuma gets the job done. There’s your bottom line. He really proved that during the second half of last season and has continued to grow and gain confidence since.

Here in ’13, Iwakuma’s started three games and  has a 2-0 record with a 2.18 ERA after Friday night’s 3-1 win over the Rangers — a nice 32nd birthday present to himself. Kuma pitched a strong 6.2 innings, giving up a run on three hits , striking out six and walking one in a win that ended a three game skid. Last week in Chicago, where the Mariners seem to always have trouble, he pitched eight innings and left with the score tied at 3-3. With more of an offensive pop that night, he might have been in position to win that game as well.

Given the slow start at the plate by Smoak, Seager, Ackley and Montero along with the injuries this week to Saunders and Morse, Iwakuma really stands out for the Mariners. Good for him. In 2012 he came to the USA after starring for 11-years in his native Japan. Iwakuma was making the cultural change, and all that entailed. He wasn’t fully healthy, got buried in the bullpen and had not built up trust in the eyes of manager Eric Wedge. But then a few outings coming out of the bullpen worked well for him. A few starts were thrown his way, and next thing you know, Kuma finishes the second half of the season with a 6-2, 1.83 ERA over his last nine starts. In 16 starts, he was 8-4, 2.65 . His ERA was a rookie best in Mariners history, beating out Felix Hernandez’ 2.67 in 2005. Overall his numbers read: 9-5, 3.16 with two saves, 101 strike outs and 43 walks. Hello new 2-year contract with an option for 2015. And hurray, he’s the number-two man in the Mariners rotation behind King Felix.

Big tip of the cap to you Hisashi. Much continued success.

Kobe sustained what was reportedly a “severe” left ankle sprain on March 13^th and returned to the lineup after missing only several games. This script went much like that after a similar injury suffered in 2010 when he missed just five games.  This season, even more than most, Bryant has had to carry the Lakers on his back after a very rough start and a series of significant injuries to his supporting cast.

On Friday night, it wasn’t only Kobe’s left ankle that bothered him. Early in the second half he hyperextended his left knee but stayed on the court to ensure the victory that would keep the Lakers in contention for the last playoff berth in the West. He left the game with 3.06 remaining only after making the foul shots awarded after the play that ended his season. Reports have painted the picture of the warrior fighting through his pain for the good of the team.  As per the hero’s code ,Kobe is to be commended for his commitment and fortitude; however, as an athlete ages, that drive we so admire can become his downfall.  Yesterday it did.

Derek Jeter can relate. It was only after fracturing his ankle and requiring surgery toward the end of last season that he used his 20-20 hindsight to concur that maybe he shouldn’t have played hurt after suffering a severe ankle contusion. Ya think? But, one of the things players and fans have always loved about Jeter is his “get-it-done” attitude. He isn’t a complainer – at least publically – and, with respect to his sport, he is all business. But, as he sits out the start of the 2013 season with lingering issues, perhaps had they spoken, even Jeter would have advised Kobe to take it slower. This season might have been a push already, especially as Bryant was unlikely to lead the team to the championship on an injured ankle, even if they made the playoffs. Maybe being of sound body for next season, with a healthier roster to back him up, should have been the focus. But, too late now, and anyway there are never any guarantees.  If he could have a Mulligan, what would Kobe opt to do?

Lowdown on the Achilles

The Achilles tendon is prone to rupture, particularly in males more than 30 years of age. Incidence of rupture rises along with age in an active population. Predisposition to Achilles rupture is heightened with a history of cortisone injections to the area, weakness/atrophy of the soleus muscle (in the lower calf), or with use of prescription medications known as flouroquinolones, (one of which, the drug Levaquin is often prescribed for conditions such as urinary tract infections). Certain systemic conditions, such as gout can also be a factor. Oftentimes, a rupture of the Achilles is preceded by mild symptoms. Did Kobe have them? Quite possibly, given the overall condition of his ankle… In any case, playing hurt definitively meant he was putting undue stress on other areas to compensate.

Anatomy of the Achilles

The Achilles tendon is a fibrous band that attaches the calf muscles (gastrocnemius and soleus) to the calcaneus (heel bone).  Both of these muscles act to point the foot downward (plantar flexion). The gastroc, the bulkier muscle of the calf, originates above the knee (at the femur) and does its work best when the knee is straight.  The soleus, a much smaller muscle, runs from the tibia (of the lower leg) to the heel, and is the go-to muscle for pointing the foot when the knee is bent.  These calf muscles are powerful and propel us as we push off in walking, running and jumping. They also enable us to walk on tiptoes.

Conditions that affect the Achilles

The Achilles tendon can become inflamed which has traditionally been known as tendinitis. Current thought is that tendinitis is generally really more consistent with damage at the cellular level in the form of microtears that, if chronic, ultimately result in a painful thickening and swelling of the tendon. This is known as tendinosis or tendinopathy.  These conditions may be accompanied by an inflammation of the retrocalcaneal bursa, a fluid filled sac that cushions the Achilles, separating it from the bone above its attachment. This is known as retrocalcaneal, or Achilles bursitis.

As a kid growing up in Philadelphia, Dave Sims knew who the great Jackie Robinson was. He was too young to jump on the train and get to Brooklyn, but his father always reminded him of the importance of an American hero. That reverence for history shapes the thoughts, life and calls of one of the best play- by-play voices in all of baseball.

“I was born shortly after Jackie broke the color barrier and by that time, he was an established star who could fight back some,” the two-time Emmy Award winner remembered. “Baseball was my first love and I remember being 10 or 11 years old and understanding some of what Robinson went through and how brave he was. My Dad used to pitch to me and the guys every now and then. He would groove a few right down the middle and you hit a couple then he would throw some high and inside and we would be like – hey what was that for? He would say – what do you think Jackie Robinson had to put up with! Those times taught you that you had to fight back. You had to be strong.”

Sims is in his seventh season as the play-by-play voice of the Seattle Mariners. The thought of Robinson opening the door for not only baseball players but for executives and broadcasters as well never strays far from his mind.

“Mr. Robinson was sort of a forerunner to Dr. King, Sims said. “His impact is just incredible. I’m aware of it often. I’m one of just a few African-Americans in sports broadcasting and take the responsibility that goes with that very seriously.”

Baseball is a game that is handed down from father to son and family to family. Even though Sims didn’t see the Brooklyn Dodgers great in person – his exploits were willed down like prized possessions.

“Unfortunately I only got to watch Jackie Robinson on film, Sims recollects. “My father and his crew made the trip from Philly to Brooklyn often. Ken Burns said it well when in “Baseball” he said that the Dodgers were black America’s team followed by the Giants with Willie Mays, Monte Irvin and that group. I remember flipping through World Series programs and reading and hearing my Dad and others at the barber shop talking about how great he was”

The black baseball players of Sim’s youth bring a huge smile to his face and his chest swells with pride.

I get chills when I just say the names, Mays, Aaron, Frank Robinson, Joe Morgan and that bunch. Dick Allen was one of my favorites,” Sims said. “I really remember it during All Star games when the National League was primarily made up of African-American super stars and kicked the American Leagues butt!”

Even in 2013, racism still exists and a feeling that you have to constantly prove yourself is something else that stays with Sims every time he opens the mic – whether at Safeco Field or at an NFL stadium working for DialGlobal.

“You feel like you have to be twice as good and work twice as hard, Sims commented. “Over prepare, make that extra trip to the clubhouse. Look, even when I’m in a suit I’ll catch people looking at me funny or when I tell them what I do for a living they look at me with an odd look. I guess as a child of the 50′s and 60′s, it’s so engrained that you have to stay at a high level and perform twice as hard.”

While Sims’ father, Robinson and Dr. King were role models – broadcasters to emulate were far and few in between.

“Are you kidding me?,” Sims laughed. “I was so happy when Bill White was pushed head first into the booth. I loved watching him play for the Cardinals and of course for the hometown Phillies. He made himself into a great broadcaster and was a thrill to hear him. Without a doubt, he was THE black role model for me. He was the first noted black sportscaster that I had ever seen.”

Broadcasting role models are more plentiful now for African-Americans who aspire to be in the business.

“Kids now have a lot of guys to look at,” Sims said. “There’s Gus (Johnson), the Gumbels, James Brown and so many ex-players who have made the transition. It certainly beats where it was not so long ago I’ll tell ya.”

Jackie Robinson Day will be celebrated throughout baseball and teams will recognize the Negro Leagues as they do every year – but for Sims, it’s Jackie Robinson day 365-days a year.

“You’ve got to know your American history good, bad and indifferent,” said the versatile broadcaster who you can hear doing MLB, NCAA basketball and the NFL. “I totally revere what those folks did in the Negro Leagues and had the honor of meeting so many of them before they passed away. It’s so important to know where you came from and how you got to where you are.”

As much as the voice of the Mariners takes Robinson’s and others sacrifices to heart – he also knows that he enjoys a unique platform as an African-American broadcaster.

“If I don’t relay the message of who we are and where we come from…who will?” Sims said. “I think about that all of the time. I’m one of a very few lucky people in baseball who get to do what we do and do it as an African-American. It’s a mark that I have to hit every day.”

M’s are in Oakland to begin another journey of 162 regular season games in 180 days.

Terrific matchup: The King, Felix Hernandez, goes against tough lefty Brett Anderson.

Coming off a productive spring training swinging the bats, hitting an astounding 58 homers, there’s reason to believe this Mariners team now has some muscle to compete in A.L. West, baseball’s best division.

Speaking with scouts and other observers, word is the Mariners might actually contend. Let’s hope they’re correct.

The pitching after Felix seems to be the big question mark folks are holding over the M’s heads.

Back in Seattle a big crowd is expected tonight at Safeco Field where the club will show off some new charms like baseball’s biggest video board, Edgar’s Cantina and the moved in fences.

Buckle up everybody. Enjoy the ride. Baseball’s Back!

Hey now!

Though everyone’s heart is with him and he is wished a complete recovery, what is less than certain is Ware’s prognosis. Injuries such as this, though rare in basketball, are less so in football or from traumatic events such as auto accidents. Outcomes vary remarkably. Joe Theisman’s 1985 compound tibia fracture (he also fractured the fibula) ended his football career, though he had already played professionally for 14 years, 12 in the NFL.

Complications from a compound fracture, where the bone punctures the skin and is exposed to the elements, are more common than following closed fractures. The most common complication is infection as a result of this exposure. Early administration of antibiotics are crucial, though offer no guarantee that Ware will be free of infection during the healing process.

Because the bone that sustains an open fracture results in significant displacement of the fragments, stabilization with a rod to correct the malalignment is required. The degree of displacement, or gap in the fracture, is another factor affecting the amount of healing time required for the bone to mend. Complications in bone healing include delayed or non-union, when the mending of the bone is slow or incomplete. The bone healing alone for a fracture such as Ware’s could take up to six months. That is why it has been estimated that his recovery could take as long as a full year.

Fractures can be traumatic, as from a fall, a motor vehicle accident or contact injury, or they can be due to pathology in the bone that creates a predisposition. Ware’s fracture occurred without contact, as he landed from a leap while attempting to block an open three point shot. In the absence of trauma, some have wondered whether there were underlying bony issues such as undiagnosed stress fractures that had weakened Ware’s
tibia. It is unlikely that he had stress fractures without also experiencing pain, and pre-existing complaints have not been reported.

Other complicating factors that must be guarded against and assessed during the healing process are neurologic in nature. Any damage to the nerves of the leg could result in diminished strength, sensation and function of the area below the level of the injury.

Studies done on non-athletes with shaft fractures of the tibia demonstrated that a significant number (nearly half) experienced some functional limitations due to the injury even 12 months after surgery. This was in spite of a low complication rate. With youth on his side let’s hope that Kevin Wade falls on the right side of that equation and has a long and rewarding basketball career ahead of him.

Rodriguez’ right hip surgery (in 2009) revealed

that a labral tear was accompanied by a cyst within the joint as well as significant degenerative changes to the surface of the bone. These degenerative changes are likely to be the cause of his recent complaints.

Is Rodriguez’ condition unusual?

Certain elite athletes may be at a higher risk of intraarticular hip disorders (those within the joint) because of the unusual forces that their hips sustain. The injuries are most commonly related to hip impingement and generally include labral tears and/or chondral defects.

What is the labrum? See detailed image

Similar to the anatomy of the shoulder, the hip is a ball and socket joint with the ball at the end of the femur attaching via ligaments to the socket at the pelvis. The labrum is a fibrous cartilaginous structure that is situated along the inside rim of the socket, serving to deepen it and provide some suction for the ball thereby adding to the stability of the joint. It can be torn traumatically or by a degenerative process due to repetitive motion that is common in many sports (particularly hockey) or even in certain occupations, such as for carpet layers. Like the menisci in the knees, the labrum is poorly vascularized (has poor circulation), which is a primary reason it does not readily heal once injured.

What is a chondral defect?

The smooth glassy chondral surfacing that lines the ends of adjacent bones where they form joints is also known as articular (joint) cartilage, or hyaline cartilage. Degenerative changes or wear and tear to this region of a bone/joint is a hallmark of osteoarthritis.

What is hip impingement?

A combination of signs, symptoms and pathology that involves the end of the femur coming into contact with the rim of the acetabulum (socket), particularly during extreme ranges of motion (hip flexion, adduction and internal rotation). FAI (femoroacetabular impingement) is thought to be a factor in the development of degenerative arthritis at the hip, which entails abnormal changes in the bony contours. Those with congenital bony abnormalities may also be more prone to developing FAI. There are two types of hip impingement (known as Cam and Pincer), each of which entails different anatomical variations, though both generally result in labral pathology.

What does a labral tear feel like?

Those with labral tears generally complain of joint stiffness and on examination there is typically a loss of range of motion and pain at the end ranges of hip flexion/adduction/inward rotation (particularly with compression during a physical exam). Labral complaints might also include a catching or locking of the hip, and some people may also complain of a sense that the hip is unstable. MRI findings are generally used to support the diagnosis.

Can a labral tear be treated without surgery?

Rehab for a tear focuses on reducing inflammation and restoring range of motion while also addressing muscle strength and flexibility. For those players with sufficient relief, working back into play with a specificity of training is also important to determine if they will be able to tolerate the demands of sport. Those with persistent pain go on to have the labrum reattached to the socket or in some cases, a small portion of the labrum may be removed. These procedures are now performed arthroscopically.

Post-operative recovery

The goals of post-operative therapy are much like those for the non-operative patient except that the rehab period may last up to about six months. The exact timeframe would depend on the severity of the injury or injuries, the specific nature of the surgery and whether there were any other complicating factors.

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The SC Joint

The SC joint, where the collarbone meets the sternum (breastbone) (see diagram), provides the connection between the shoulder girdle and the trunk.  Though it permits only limited movement, the SC joint is involved in most movements that occur at the shoulder.

If you place your fingers at your SC joint and then elevate or depress your shoulder, you will feel the movement that takes place there and understand the importance of stability in this region. This is also the case if you move your shoulder backward or forward, or move your arm in a circular motion.

What is an SC Joint Separation?

A separation of the SC joint implies that the ligaments connecting the two bones have been badly sprained. This is why you may have seen some reports referring to Roethlisberger’s injury as a sprain and others as a separation. Sprains are graded between 1 and 3, with a Grade 3 being complete tears of the involved ligaments. The SC joint may be partially out of alignment after a sprain (referred to as a subluxation), or the clavicle may dislocate completely. In the case of trauma, dislocation is more likely, while subluxations are known to occur spontaneously, generally in a younger population, particularly in the presence of ligamentous laxity (looseness of the ligaments).

SC joint dislocations occur anteriorly (forward) far more often than posteriorly (backward), and in some instances requires surgery in order to reposition the clavicle. The integrity of the ligament connecting the clavicle  (collarbone) to the first rib is paramount to preserving the stability of the region.

Oftentimes the SC joint remains prominent after healing and, though this is not significant of outcome, some do report long-term pain or loss of function after SC dislocation.

Mike Baxter of the NY Mets suffered a SC separation, displacement of his clavicle and torn rib cartilage when he hit the outfield wall to save Johan Santana’s no-hitter in early June. You may recall that it was two months before he re-joined the team. That recovery time is fairly typical.

As I’ve written before, predictions for return to competition after injuries in the pro ranks are generally unrealistically optimistic. Roethlisberger has somehow often been an exception to that rule. He has seemed to rebound more quickly than expected, in part because he appears to play (though sometimes less effectively), while still in the throes of injury. Perhaps he is also a fast healer.

Reports that say Roethlisberger is likely to start in week 12 are being generous. This is a pretty serious injury to his throwing shoulder and if his rib injury is anything but very mild, it too is likely to get in his way. Both injuries require rest to heal and the shoulder should be rehabbed to restore the strength, mobility and power that may have been lost during the early post-injury recovery. But, then again, we’re talking about Big Ben…

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38 year-old center/forward Marcus Camby hadn’t practiced for nearly four weeks until the start of this week; the remnants of a calf strain suffered at the start of training camp still getting in his way. With Thursday night’s game against the Nets postponed, will Camby be out there tonight? Not likely.  If so, will he log significant minutes? Did one extra day of healing make that much difference? Despite any hype, don’t count on it. Keep in mind too that muscle strains can be nagging, particularly for older athletes and that unfortunately, recurrences are common. That is especially so if an athlete returns to competition before being fully healed. The calf muscles are power muscles, important for the push-off necessary for running and jumping. Camby should warm the bench until he can play at full speed.

Tyson Chandler, 30 year-old Knicks center and 2012 Defensive Player of the Year, made an early but not hasty exit due to a knee injury just after the start of a pre-season game on October 24^th. He left the arena that night on crutches to minimize further stress to his left knee. Though expected to play tonight, one week is an accelerated healing time for the bone contusion he reportedly suffered. It must have been a very mild bruise or he would be losing more significant time. Regardless, it won’t be a surprise if Mike Woodson does a lot of subbing tonight. With Camby and Stoudemire hurting, power forwards Kurt Thomas and Rasheed Wallace will likely get some time at center.

Forward/center Amar’e Stoudemire, who will be thirty years old in just two short weeks (Happy Birthday, Amar’e), underwent arthroscopic debridement on his left knee after receiving a second opinion shortly after suffering a burst popliteal cyst. Surgery on his already vulnerable knee will keep Stoudemire on the sidelines for at least two months. Though he may be one of the hardest working players in and out of season, Stoudemire’s vulnerable knee may keep him from contributing enough to have the impact he has worked toward. He isn’t getting younger and a knee that has already undergone microfracture surgery isn’t a great long-term investment.

33 year-old guard, Baron Davis, sustained a partial tear of his patellar tendon, (which connects the kneecap to the tibia below) and complete tears of his anterior cruciate ligament (ACL) and medial collateral ligament (MCL) during the 2011 playoffs.  Tough to rebound from at any age, and with an expected rehab period of one year, if Davis is able to come back, it isn’t likely to be during the 2012-2013 campaign. Going beyond rehabbing the reconstructed primary stabilizer of his knee (the ACL) and healing the ligament that stabilizes the inner compartment of the knee (the MCL), recovery after a patellar tendon repair is no small matter.

27 year-old shooting guard J. R. Smith has continued to receive treatment for a sore left Achilles Tendon that has plagued him through the pre-season and is listed as questionable for tonight’s contest. If he plays it will likely be intermittently. This earlier column provides more detailed information on the Achilles.

22 year-old guard Iman Shumpert, the Knick’s youngster on the injured list, was another Knick casualty of the 2011 season, having torn his ACL and lateral meniscus in the first playoff game (in April).  His return is reportedly anticipated for mid January. Hopefully he will be able return to form.

Ronnie Brewer. 27 year-old guard/forward who signed with the Knicks this off-season, is listed as probable for tonight. Brewer had meniscal surgery on his left knee in early September and, though he scored 12 points in 20 minutes in his late pre-season debut as a starter, it came on four for 14 shooting. A defensive specialist, a lot will be expected of him, particularly with the age of his colleagues.

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