Ryan Braun: Intercostal strain, or something worse?

[TooLiveBrew]

I figured this could get its own thread, since it didn't really fit with Braun's radio appearance with Jim Rome. After a few BF posters stated concern over Ryan Braun's health status, I got curious & emailed The Disabled List Informer's Chris Neault to ask for his take yesterday. He pointed me to the write-up he'd done on Braun on March 25th. Below is Chris's email response to me, and after that is the text of the feature on Braun.

 

 

His injury is not an intercostal strain. I think in all my years of being a PT, I have seen maybe one true intercostal strain. Maybe.

 

This is a back problem, regardless what everyone says. [Read my latest post on his injury here.] [this was a link in his email to me... can't get it to show properly here, so use the 3/25 link I included above]

 

This could be one of those lingering back problems. He eerily reminds me of J.D. Drew in terms of back health...just a hunch though.

 

Chris

 

I don't want to come across as just being an alarmist or sensationalist. This does sound like legit reason for concern imo. Here's the post to which Chris referred --

 

What's Going on with Ryan Braun?

 

If Ryan Braun 's persisting "right side stiffness" is truly due to what is being called an "intercostal strain", it may go down in history as the longest-lasting intercostal strain ever.

 

"Obviously, it's not very exciting or very encouraging that it's come back in the same area", said Braun, drawing comparisons to the similar issue he dealt with during the final 6 weeks of the season in 2008. The difference last year was that the pain and spasm was in both ribcages and lower back.

 

** Last season, I voiced my skepticism about the diagnosis **, and thought it to be more likely to be a spine issue of sorts - particularly because the pain was bilateral (both sides of the spine/back), and because there was no causative factor, i.e. no specific activity that could be attributed to a muscle strain.

 

Said Braun, "I'm not one to dwell on negative things. I recognize it's in the same area. That's not a good thing but I don't see it being a chronic issue." Sure seems chronic to me.

 

Last year, I also felt that an MRI would be warranted to rule out an underlying spine condition: "…the Brewers would be smart to administer an MRI to see if there is a disc bulge/herniation, spinal instability, or underlying arthritic pathology that could be responsible for the spasms."

 

Braun apparently had declined an MRI when it was suggested by the Brewers earlier this spring. Expect the MRI to happen in the coming days if his symptoms persist. They would be wise to do it as a precaution, even if he does feel better.

** -- this sentence is a link to a write-up from Aug. 11 of last season

[DuWayne Steurer]

I'm not exactly thrilled to see Braun's name come up in the same sentence (or article for that matter) with J.D. Drew when concerning injury.

 

To echo TLB, I don't want to be an alarmist, and he's probably fine, but this certainly imposes a little twinge of dread.

[TooLiveBrew]

8/11/08 feature on Braun

 

Ryan Braun: Back Pain Lingers On

 

The Brewers better hope that Ryan Braun 's condition is simply one of innocent muscle spasms. Since when are muscle spasms innocent?

 

Red flag #1 - Braun is dealing with pain in both ribcages, but he does not know why.

 

Prior to Saturday's game, Braun said that he felt some discomfort in his lower back and ribcages, and the pain worsened during his first at-bat. Braun described what he felt in terms of symptoms following the at-bat: "I couldn't breathe. It locked up on me. That's why we think it's spasms. It's not actually the back. It's both ribcages."

 

Red flag #2 - Braun continued to talk about what makes him hurt : "Every time I laugh or sneeze or cough or roll over, it's pretty painful. They said it could be something like if I irritated one of my vertebrae. Everything around it tightens up to compensate."

 

Insidious onset of pain and bilateral spasm in the lower back area, combined with pain with coughing, sneezing, laughing, rolling over (activities that markedly increase intra-abdominal pressure), especially in a younger, active individual, is a red flag for a spine issue.

 

Red flag #3 - Pain is not relieved by rest.

 

Rest makes muscles feel better, even after a few days. It is unlikely that this is a muscle injury because of the bilateral nature of the situation, and lack of precipitating factors. He does not recall a specific injury that occurred that would have left him with discomfort prior to his at-bat that ultimately resulted in his increased pain. Muscle injuries tend to have a direct cause and effect relationship.

 

Muscles in the lower back/rib area can, however, spasm in the presence of another pathology. Our bodies are very good at protecting ourselves when we are unaware of the presence of bodily injury.

 

If he is not feeling appreciably better in the next day or two, the Brewers would be smart to administer an MRI to see if there is a disc bulge/herniation, spinal instability, or underlying arthritic pathology that could be responsible for the spasms. Given what we do know, I would not be surprised at all if Braun ended up on the DL.

EDIT: bold & italicized sentence after 'Red Flag #2' is my emphasis

[TooLiveBrew]

Whoops -- so, sorry I didn't see the 'Did Ryan Braun ever actually recover from his ribcage injury?' thread. Crap... I hate being 'that guy'

 

 

Mods, obviously any help merging these posts into that thread would be greatly appreciated. Sorry for the extra work.

[RU Rah Rah]

Excellent (if ultimately very frightening!) footwork here, TLB.

[sgtcluels]

Has anyone actually tracked that dudes blogs accuracy? I'm thinking of he has spinal damage (Read herniated disc) he wouldn't be able to swing a bat. I could barely twist past center, or touch my knees. Swinging a bat, forget about it.

[Fatter than Joey]

http://www.millionaireplayboy.com/mpb/wp-content/gallery/mpb_batphone/finishedphone.jpg

[Ennder]

Has anyone actually tracked that dudes blogs accuracy? I'm thinking of he has spinal damage (Read herniated disc) he wouldn't be able to swing a bat. I could barely twist past center, or touch my knees. Swinging a bat, forget about it.

It has been extremely accurate overall considering he talks about players he doesn't actually get to see himself. I use his advice all the time for fantasy baseball though and it is generally correct.

[RU Rah Rah]

Yeah, it's reliable -- to the extent that it can be, given that he doesn't actually examine guys, etc. He typically does an excellent job of cutting through the team- and player-generated spin related to injuries.

[Invader3K]

Braun says "I feel great." http://www.jsonline.com/blogs/sports/43061622.html

 

Really interesting blog piece from Haudricourt, where Braun says he just hasn't gotten his time and swing down yet.

 

I hope we can just get patient instead of panicking about what phantom injury he may or may not have. Guys have gotten off to much worse starts than the .200 BA and .350 OBP he has to start this season. It's only been 8 games, after all.

[Ennder]

The fact that he admits he is still get treatment for the injury would seem to somewhat validate the worries people are having. Obviously the injury is something they will have to manage long term and while he may say it feels fine it doesn't mean it isn't affecting his swing in some way. I still am more worried about him than say Fielder or Hardy as an example.

[DougJones43]

I hope we can just get patient instead of panicking about what phantom injury he may or may not have.

 

Phantom injury? Are you suggesting there was never actually anything wrong with him? He missed time last season, and this spring for the problem. Classifying it as "phantom" isn't exactly fair, or accurate...

[Ennder]

He had a couple of really hard hit balls tonight even if they weren't HR type balls. Good to see.

 

I still wish he had better music before his ABs though!

[Invader3K]

I hope we can just get patient instead of panicking about what phantom injury he may or may not have.

 

Phantom injury? Are you suggesting there was never actually anything wrong with him? He missed time last season, and this spring for the problem. Classifying it as "phantom" isn't exactly fair, or accurate...

No, obviously he was injured before. I'm saying that people need to quit grasping at straws.

[DHonks]

I still contend he's hurting since he's swung through at least a half dozen pitches that he normally would have hit for homers. Fat heaters and hanging sliders, and he's not even fouling them off....just swinging through them. So I think he's hurt

[Dragonbait]

I'm on the fence on this one...

 

I mean... have we seen Braun ever slump significantly when healty. Even the best guys have some down weeks.

 

Personally, I just think he's being tentative so he doesn't 're-aggrevate' that injury.

[TooLiveBrew]

No, obviously he was injured before. I'm saying that people need to quit grasping at straws.

 

No one is grasping at straws here. This is (imo) a very serious situation, and given the confidence with which Neault spoke about Braun's woes, I'm concerned that there is something very seriously wrong with Ryan's back.

 

As others have mentioned, Neault has been a stellar injury analyst, and the opinion of him should only (rightfully) inflate once the fact that he doesn't get to examine any MLB players first-hand is weighted. Chris is an awesome resource, and I encourage any & all to email him and/or comment on his blog. The DL Informer is hands-down my favorite MLB blog.

 

I'd like to hear why you think that I/'people' am/are "grasping at straws", Invader. I can't see how that would be the case. I would hope I have at least a decent track record around these forums as being level-headed & rational.

 

 

EDIT: And FtJ cracks me up... yet again http://forum.brewerfan.net/images/smilies/laugh.gif

[Invader3K]

He doesn't look injured to me.

 

(Had to bump this in light of his performance tonight).

[stoutdude04]

Helps that moyer only throws 80 mph. Its seemed like hes struggled with high fastballs thus far. Just from what I have seen. No stats or evidence to back it up though. I am excited though. Dont get me wrong.

[PlayerHader]

Well he sent that second HR about 450 feet the other way tonight. That doesn't happen without good bat speed.

[Ennder]

The injury is the type you have to 'manage', not the type that you can fix with surgery. While it is absolutely great to see him hit 2 HR this is the kind of thing that could bother him all year and just have good days and bad days. Or it could be something that isn't bothering him at all too, it is really hard to say at this point.

[SoCal Brew Crew Fan]

"All these injuries are related," Braun said. "They're all similar, everything I've gone through. Rib cage, back. They are all in the same general area and have the same general feeling."

 

Unfortunately this pretty much validates TLB's initial post. I'm about to break into FtJ's phone.

 

Since this thread we've seen Braun bust out and look like a world beater. A few games ago he seemed to slip back into that Sept. 08 version where he struggled. Not sure how this plays out, but it could be an up and down year for our hero. Anyone know what the long term impacts of this are? Sounds like it's something that warrants an MRI to find out.

[JohnBriggs12]

I'm less worried about the long term implications than the fact that the choices to replace him came down to Chris Duffy and Brad Nelson. I've said this before, but they need a veteran LH corner OF bat to back up Braun and Hart.

[Invader3K]

Maybe it wouldn't be such a bad idea to contact Geoff Jenkins at this point?

[strawbossisevil]

Jim Edmonds > Geoff Jenkins