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In the aftermath of significant, life-threatening head injuries suffered by pitchers, MLB has informed its 30 clubs that padded caps have been approved to provide some head protection against line drives flying back at the mound.

According to ESPN’s Outside the Lines, a product, with help from the Players Association, has been launched with the purpose of protecting pitchers. 

Now, a new task emerges for the sport: Convincing pitchers to wear the product on a daily basis.

The announcement, although exciting and important, is just the first step. 

Dan Halem, MLB executive vice president for labor relations, was ecstatic about the potential for safety and future growth of the technology.

“We’re excited to have a product that meets our safety criteria,” Halem told Outside the Lines, adding that baseball will continue its efforts to come up with more options. “MLB is committed to working with manufacturers to develop products that offer maximum protection to our players, and we’re not stopping at all.”

Per the OTL piece, five pitchers—Oakland’s Brandon McCarthy, Houston’s Mickey Storey, Detroit’s Doug Fister, Toronto’s J.A. Happ and Tampa Bay’s Alex Cobb—were hit in the head with batted balls between Sept. 5, 2012 and June 15, 2013.  

In the span of less than one year, five pitchers, including Fister on the World Series stage, had their lives hang in the balance when a baseball came careening at them, affording even top-tier athletes little time to move out of the way.

While the rash of pitcher injuries grew in a quick span, the issue for Major League Baseball has been around for years. From San Diego’s Chris Young to Houston’s Billy Wagner to Boston’s Bryce Florie, the sight of a bloodied, dazed pitcher walking off the mound is all too familiar to baseball fans.

Unfortunately, the names listed above and video evidence of unsightly and grotesque injuries won’t change the mindset of some pitchers.

Amazingly, despite falling victim to one of the most famous incidents in the history of batted-ball injuries, Brandon McCarthy didn’t react positively to the new technology. As he told Jayson Stark of ESPN, the new cap is “too big” and doesn’t “pass the eye test.” 

In sports, comfort trumps safety. For an athlete to perform best, mental and physical comfort is a necessity. In the NFL, it’s routine to see skill players (wide receivers, running backs, defensive backs) eschew standard padding for more comfort and the perceived ability to move more fluidly.

The new caps, per OTL, will have seven ounces of weight more than the prior, non-padded cap. That may seem like a small amount for peace of mind, but could be looked at as another obstacle or distraction in a craft that desperately attempts to simplify things. 

While some pitchers will adopt and adapt early in the name of safety, not everyone will be willing to go the extra mile for peace of mind.

Alex Cobb, one of the recent line-drive victims, spoke about his incident as a “pink elephant” (video below, per MLB.com) and references the need to put worry and fear out of sight and out of mind. If that mindset is prevalent among pitchers with a past injury, they may not want to be reminded of it every time they put on their cap. 

Comfort issues can be overcome, but knowing that protective head gear is in the cap could lead pitchers to thinking about the possibility of being struck. If that thought process begins, it’s unlikely many pitchers would jump at the chance to wear the new technology.

When asked by OTL if he would wear the cap, J.A. Happ, despite his recent injury, wasn’t sure due to the feel and comfort.

“I’d have to see what the differences in feel would be. Does it feel close enough to a regular cap? You don’t want to be out there thinking about it and have it take away from your focus on what you’re doing.”

Furthermore, if the cap looks different or fits atop a pitchers head strangely, jokes will ensue. In 2009, on the path back from a concussion, New York Mets third baseman David Wright wore a new helmet designed to keep him safe in the event of another erratic pitch striking him in the head. 

When he took the field looking like a bobble-head, the commentary and comedic banter commenced among the media and fans.

Although the new, padded cap will be bigger in weight, it won’t be a gigantic version of the old caps, thus a David Wright situation is unlikely to occur. Still, some players won’t be receptive for reasons of comfort or the inability to block out why a padded cap is necessary.  

In time, the sport could consider making the new equipment mandatory, but until then it’s impossible to predict how many pitchers will actually wear the new gear. Hopefully, protected or not, baseball doesn’t go through another year of scary moments on the mound.

Yet, as morbid as it may sound, one of the only ways for the message to get across is more instances of injury to pitchers during game action.

This announcement is a major step for the long-term safety of pitchers, but it’s only one step. The key will be in convincing pitchers of how important the new technology may be in saving careers and lives.  

Comment, follow me on Twitter or “like” my Facebook page to talk all things baseball. 

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The New York Yankees‘ Alex Rodriguez returned to baseball Tuesday night, making his first rehab start since undergoing hip surgery in January. Most of the fans here in Charleston showed up mainly for the novelty of one of baseball’s great players coming to town. As an orthopaedic surgeon, I was much more interested in watching how well his hip rotated with each swing of the bat or when chasing ground balls.

A-Rod underwent arthroscopic surgery on his left hip in January. Performed by Dr. Bryan Kelly at the Hospital for Special Surgery in New York, the surgery aimed to correct a hip labral tear and femoroacetabular impingement (FAI) found at the end of last season.

The labrum is a cartilage bumper in the acetabulum (socket). A player with a tear in his labrum might feel pain in the groin and a catching sensation with twisting motions.

FAI is a condition in which extra bone develops on either side of the ball-and-socket hip joint. In A-Rod’s case, it appears to have been a bony prominence on the femoral head. The extra bone can catch against the socket with flexion or rotation of the hip. An affected baseball player would likely feel pain in the groin with twisting to swing the bat.

Bryan Hoch of MLB.com reported that A-Rod complained of a lack of explosiveness at the plate. Impingement in his left hip when turning his body during the swing could explain those struggles.

Dr. Kelly held a conference call with reporters prior to performing Rodriguez’s surgery. According to Andrew Marchand and Wallace Matthews of ESPN New York, Dr. Kelly anticipated the need to reattach the torn labrum, remove the extra bone and repair any cartilage damage. According to a Yankees news release soon after the surgery, the procedure “went as planned and without complication.”

Tuesday night, Yankees fans got their first glance into A-Rod’s recovery from that surgery. If the surgery went as expected and the third baseman rehabilitated well, Rodriguez should expect less pain and better hip motion as he returns to the field.

Unlike most of the fans here, I wasn’t interested in A-Rod’s hits or home runs. I wanted to see how well he moved side-to-side and rotated with his swing. The time line below gives my account of Rodriguez’s fielding efforts and plate appearances.

6:54 p.m. (ET): Starting lineups. There is a lukewarm ovation from the sellout crowd here at The Joe. Charleston might be the friendliest city in America, but some fans just don’t like him. 

7:07 p.m.: On the first pitch of the game, the batter for the Rome Braves bunts a short chopper toward third base. A-Rod runs forward quickly to track down the ball, lunges to pick it up and fires to first. He doesn’t get the runner, but he showed no difficulty with hip flexion or rotation on that play.

7:13 p.m.: A-Rod bounds into a 5-4-3 double play on his first real swing. I wasn’t impressed with his body rotation, but it might have been the pitch.

7:35 p.m.: Batter hits a cheap bloop single about 10 feet past the plate up the third base line. A-Rod, probably knowing there was no chance to get the runner, halfheartedly goes after it. It’s hard to blame that one on his hip.

7:48 p.m.: In his second and final at bat, Rodriguez badly misses one pitch and later strikes out. Maybe it was the pitch, but his groin might be affecting his batting more than his fielding. 

7:50 p.m.: With A-Rod out of the game, I am headed to the press conference. I’ll update the story if he has any important information to share about how his hip felt. It will be interesting to see if he has any hip or groin discomfort later tonight or tomorrow.

From an orthopaedic sports medicine surgeon’s perspective, A-Rod looked good. Honestly, he moved better than I expected in the field. I expect his swings will look better and stronger with more at-bats. If he didn’t suffer any major setback Tuesday night, I would expect Dr. Kelly to clear him for more innings and games and the Yankees to advance him back to the majors in the coming weeks.

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On Jan. 12, pitcher Carl Pavano—currently a free agent—slipped while shoveling snow and suffered a ruptured spleen. According to Joe Christensen of the Minneapolis Star-Tribune, the seemingly minor tumble almost proved fatal.

As Christensen states, Pavano didn’t think much of the fall at the time.

‘It knocked the wind out of me,’ (Pavano) said. ‘I didn’t think anything of it that weekend. We were out on snowmobiles and sleds with the kids. We were building snowmen.’

Two days later, (he) went through a full workout.

However, Pavano’s condition took a drastic turn for the worse four days after the fall. Christensen continued:

On Jan. 16, Pavano went for another workout in Westchester. Riding to the facility, he felt a sudden wave of abdominal pain and nausea.

‘My body just went into shock,’ (Pavano) said. ‘I turned white. It was one of the worst feelings I’ve probably ever had.’

Three days, three hospitals, a collapsed lung and one emergent surgery later, Pavano narrowly survived what anyone in the medical field would deem a close call—he nearly died.

Thankfully, it appears he is now out of the woods and focused on recovery—the best possible outcome of the frightening sequence of events.

Wait a second, what? He slipped while shoveling snow and nearly died as a result? How can that be possible?

Believe it or not, upon examination of the reported mechanism of injury, it actually makes sense. That said, it should be emphasized that the following merely represents educated speculation, as exact medical details are—as always—unavailable.

With that in mind, let the anatomy lesson begin.

According to Christensen, Pavano did not slip and fall down. Rather, he partially lost his balance and fell onto the upright handle of the shovel he was using. As he is certainly much taller than the shovel, he likely jammed the shovel upward into the left side of his abdomen and under his left rib cage.

That’s the spleen’s territory.

One of the spleen’s primary functions is to help the body fight infections. It is especially important in fighting certain bacterial infections. That said, it is not necessarily for survival, and countless people live entirely normal lives after having it surgically removed for one of any number of reasons.

Usually, the lowest three left ribs protect the spleen from direct hits. Nevertheless, an upward-angled blow to the left side of the abdomen can sidestep that protection by going under those ribs. In other words, nothing but soft tissue sat between Pavano’s spleen and the shovel handle, resulting in direct trauma to the organ.

However, that is only the beginning of the story.

Via the splenic artery—one of the largest arteries in the human body—the spleen receives approximately 10-15 percent of the body’s blood supply all by itself. If any of the blood vessels within the spleen are broken for any reason, that massive blood supply turns into internal bleeding.

Bleeding from splenic injury can range from slow and smoldering due to a small laceration—like the case of the NFL’s Jason Witten—to immediately life-threatening following frank organ rupture. As Pavano now knows, one can turn into the other, as well.

Due to the important—though not vital—immune function of the spleen, doctors usually try to allow it to heal on its own following less-serious injuries. As Christensen reports, that was the case with Pavano—even after things first started to look concerning:

‘I was in good shape, so my vitals were strong,’ Pavano said. ‘They didn’t feel the bleeding was proficient enough where we needed to rush into surgery. I got into the hospital on a Wednesday, and I was just deteriorating every day, little by little.’

Unfortunately, the spleen—an already fragile organ—is even more vulnerable when it is injured, and the progression of a smaller injury to a life-threatening one is very possible.

A ruptured spleen represents as big of a medical emergency as they come. Though it can sometimes be repaired, the injury usually requires either a splenic artery embolization—surgically blocking the blood vessel—or a total splenectomy.

It also requires it now.

Policy differs from hospital to hospital, but usually an on-call general surgery or trauma surgery team is assembled, and the operating room is prepared as the patient is being transported to it.

Luckily, doctors identified the gravity of Pavano’s situation in time—a difficult task in and of itself. CT scans and ultrasounds are only so good at identifying severe internal bleeding, and the abdominal compartment can silently hold an amazingly large volume of blood.

In Pavano’s case, the blood may have gone somewhere else, as well. He may have also had a partially ruptured diaphragm.

The left half of the diaphragm—a thin, flat muscle that somewhat resembles a horizontal piece of paper lying on top of the abdomen—sits immediately above the spleen.

If the shovel handle forced itself far enough into the abdomen to rupture Pavano’s spleen, it is reasonable to guess that it also tore part of the left half of his diaphragm, creating a connection between the normally separate abdominal and chest cavities. As the diaphragm is essential for breathing, an injured diaphragm also explains Pavano’s feeling of getting “the wind knocked out of (him).”

If his diaphragm did, indeed, rupture, Pavano’s spleen could bleed not only into the abdominal cavity, but through the tear and into the chest cavity, as well. As blood accumulates within the chest, it can force a lung to collapse—called a “hemothorax”—as it did with Pavano. Christensen mentions that doctors needed to remove over six liters of blood from the chest cavity before performing a splenic artery embolization to stop the bleeding.

In short, it appears likely that the shovel handle not only caused a medium-sized cut in Pavano’s spleen, but also partially tore his diaphragm. His body then compensated for the bleeding—slow at first—as the blood accumulated in his abdomen and chest over the next few days. Then, when the amount of blood lost became large enough to cause a hemothorax and shock, his condition began to spiral downhill—fast.

According to Christensen, at one point doctors warned Pavano how bad it had gotten. “I was hours away from going into cardiac arrest and probably wouldn’t even be here,” Pavano told Christensen.

Fortunately, it appears doctors intervened just in time. By evacuating the blood from Pavano’s chest, doctors allowed his collapsed lung to re-expand, and by performing a splenic artery embolization, they stopped the source of the bleeding. After then removing the spleen entirely, his medical team ensured this would never happen again.

They also saved his life.

Consequences of hemorrhagic shock range from the minor and reversible to the permanent and debilitating, and details regarding his recovery will likely continue to surface over the coming weeks and months.

Though Christensen reports that he wants to pitch again, Pavano is going to defer figuring that out until a later date.

“Right now, that’s the last thing I’m worried about,” he said. “It’s been a crazy few weeks.”

Follow @DaveMSiebert

Dave Siebert is a medical/injury Featured Columnist for Bleacher Report who will graduate from medical school in June. He plans to specialize in both Family Medicine and Primary Care (non-operative) Sports Medicine. Injury and anatomical information discussed above is based on his own knowledge.

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