4/4/25: Dr. Adam Metzler From OrthoCincy, on Austin Hays, Tyler Stephenson, and More.

Dr. Adam Metzler from OrthoCincy joined us to talk about the calf issues that Reds outfielder Austin Hays is dealing with, the oblique injury suffered by Tyler Stephenson, and more.  

Learn more about OrthoCincy by going here.

Listen to the show live weekday afternoons 3:00 - 6:00 on ESPN1530.

Listen Live: ESPN1530.com/listen

Get more: https://linktr.ee/MoEgger

Episode Transcript

Speaker 1 (00:00):
We do this typically on Wednesdays. My schedule this week
was a little bit different because I was off on Wednesday.
So we're doing it now. It's our weekly look at
injuries with one of the experts from Orthos since Orthopedics
and sports Medicine. By the way, they have fixed my neck.
My neck bothered me all throughout the fall and for
most of the winter. And in February I went and

(00:21):
saw my guy, doctor Angel Velaskaz at Ortho Sincy and
they took care of me. And my friend Courtney recently
had her acl fixed at Ortho Sincy. Ortho since he
does it all. They've got specialist locations and services all
over the tri State, including walk in orthopedic urgent care
at five locations, and extended evening and weekend hours in

(00:42):
Edgewood and Anderson. Learn more at Orthosincy dot com. That's
orthos ci Ncy dot com. Doctor Adam Exler from Orthosincia
is with us. I want to ask you about Austin Hayes,
the Red's outfielder who is a start of the season
on the injured list. He is dealing with a left
cast strain and I guess for me what stands out

(01:04):
about this is this is similar to the injury that
he suffered last year, a calf strained same leg kept
him out of action in April. And may so let
me start with that, is the fact that he has
dealt with this before. Is that something that we should
should be a little bit more concerned about than usual?

Speaker 2 (01:22):
Yeah? I think yes, a little bit for sure. Anytime
you've had one injury to one area of a muscle,
it does predispose to increase risk of re injury. Hopefully
these these are more precautionary measures, just trying to keep
it from becoming worse. But yeah, you should always kind
of consider that if you've had an injury once to
a muscler, it's going to increase your risk of the

(01:43):
future injury to that muscle.

Speaker 1 (01:44):
I also think often about muscles. This time of year,
it's cold out right, and so the Reds are playing
maybe not this week because they're indoors, but they're playing
a lot of cool weather games. Does that have any
impact on something like this?

Speaker 2 (01:55):
Yeah, absolutely, there's some reasonable evidence that without appropriate warm
up that you can increase risk of muscle strain hamstring,
quad muscle, calf, muscle like this there's an increased risk
of these strain injuries and partial tearing.

Speaker 1 (02:11):
What are some of the determining factors that they'll weigh
when deciding whether or not he can come back.

Speaker 2 (02:18):
Yeah, I mean, ideally we want to be pretty much
pain free as we return to play. For a calf strain,
they're going to make sure range of motion of that
ankle is good, making sure that you're able to pass
functional testing, so sports specific testing. Can he run, cut, plant,
change direction, push off, and throw bat without having pain?
And you know, if they determine that he's a high

(02:38):
percentage of normal function, they'll let him return back to
play as long as he passes those functional testing protocols
they have in place.

Speaker 1 (02:45):
And then when it comes to an injury like this,
can you remind us of the different grades that are used.

Speaker 2 (02:51):
Yeah, so we use a generic term for these sprain
strained tear. We all they're interchangeable, and a grade three
is a complete tear. Any of those muscles were tendons,
and so grade three is the worst. Grade two is
a partial poll partial strain sprain tear, and a grade
and one is a more mild partial strain or sprain

(03:11):
to that muscle or tendon, and so Grade three is
the worst and a longer recovery, particularly for a calf
muscle itself. We're not talking about achilles here, an achilles
tear like a Deshaun Watson injury, that's a complete tear.
Those are season ending injuries and require surgery. These calf
muscle strains, Grade three can take months sometimes to recover.

(03:31):
Grade one can take just a few weeks.

Speaker 1 (03:33):
The other major injury we've been talking a lot about
is the one that Tyler Stevenson is dealing with, and
April seventh is going to be a big day for him.
That's Monday. He is going to undergo another MRI and
hopefully get closer to returning to the field. He has
obviously started the season on the injury list with an
oblique injury. So that MRI give me an idea what
they're looking for.

Speaker 2 (03:55):
Yeah, so on the iron we're looking for, obviously the muscles,
these the bleak muscles, are the muscles on the side
of our abominal muscles to the side of our body.
And what we're going to be looking for specifically on
that MRI is to actually see less inflammation, less what
we call signal or white, So healing is going to
be noted in the lack of white or inflammation on

(04:15):
the amrin. That's what we're looking for on these scans,
and so once we see healing will be determined based
in the fact we're not going to be seeing that
white signal or a little bit or fluid within the muscle.
That'll suggest that at least based on an MRI, that
we have evidence that there's less swelling inflammation associated with
that oblique strains. That's at least on an MRI. How

(04:36):
we look at it clinically, he needs to be able
to do batting, hitting, throwing, catching, in movements behind the
plate in order for us to clear him for a
return to the professional.

Speaker 1 (04:49):
Yeah, you kind of went where I was going to
go next. How much does it complicated the nature of
Tyler's position?

Speaker 2 (04:57):
Yeah, I mean I think you're constantly reaching round and
forwarded back for playing catcher. I think it probably makes
it a little bit more challenging. I think that's why they're,
in my opinion, being a little bit more cautious as
they allow him to progress back behind the plate, and
certainly errant pitches and things like that can put you
in odd positions and really pull on those oblique muscles,

(05:17):
and probably more so than others other field positions than
behind the petchers. So that's probably the reasons are being
more cautious than other positions.

Speaker 1 (05:25):
All right, there's one more that I want to ask
you about. This is not a Cincinnati read. I want
to ask you about show Hey O Tommy because I
was listening to a discussion on the MLB Network and
they were talking about his return to the mound because
he had Tommy John surgery late in twenty twenty three. Now,
he played last year and was awesome as a DH,
winning the nl MVP Award. He was the best player

(05:46):
on the team that won the World Series. Yet he
didn't pitch, and the question was asked, and there were
no medical experts at the desk, the question was asked
or they were talking about the fact that he was
so good with the bat despite the fact that he
was coming off of Tommy John surgery which kept him
from pitchingviously, when he's healthy a two way player, and
so it made me wonder, how can you have a
procedure like that, not be able to pitch but still hit.

(06:09):
And I guess to a degree hit as effectively as
he did.

Speaker 2 (06:13):
Yeah, I mean, I think one thing that we forget
in these these are elite athletes with unique skill sets
that most of us average people don't have. And so
I think part of it is just being genetically gifted
and having the ability to be the size and strength

(06:34):
and you know muscles that he has is just so
unique that they can accommodate or count for that. Yeah,
I think the reason why you can bat is you
can figure out ways to unload the auto clutter ligament
to Tommy John surgery, if you're bracing or if it's
the non depending on what side your right handed, you
know pitcher, but you're batting left handed, different ways that

(06:55):
you can accommodate or through bracing protocols to protect that
arm during hitting. And the load isn't anything near when
you hit compared to when you throw. The amount of
force and torque on the elbow joint that high velocity
is just it's just insane with that elbow has to
has to hold as you're pitching, from what we call
the late cocking to early acceleration phase when you're in

(07:17):
that full backswing to coming into your initials follow through
to pitch the ball amount of torque on that all
clatter Ligam and that Tommy John Ligan and if you will,
it's just so insane that the bat batting doesn't even
come close to approaching that amount of torque. And so
I think with exceptions and appropriate player understanding, you can
make some exceptions for patients like that. Certainly in the
youth level, we're going to be very cautious and not

(07:40):
you know, put our youth at risk compared to that.
But we're also talking about someone who's worth hundreds of
millions of dollars and obviously very effective when he's out
there on the field and hitting, but holding back from
the pitching opportunities that he has to protect his Tommy
John surgery as UCL surgery, and the facts are get
two of those.

Speaker 1 (08:00):
There's no procedure in baseball we talk about more than
Tommy John. He's had it twice. You know, I think
of tj Antone with the Reds, who has had the
procedure twice. There are a lot of pitchers, a lot
of players who have at once come back and they're
good to go and never have to deal with anything
like that again. And then you have instances like this
where either the surgery happens again, or in TJ's case,

(08:21):
the surgery happens again and he still deals with elbow issues.
Why with some athletes does that particular procedure not take
as well as it does to others?

Speaker 2 (08:30):
I mean, I think it's unfortunately, like any of there's
lots of variables to go into that question, and there's
different ways. There's been some evolution the certical technique that
we think has kind of helped our patients return back safely.
But when you look at the overall return to professional
pitching and you look at the data behind that after
a primary Honor Platter ligament Tommy John surgery, you're looking

(08:53):
at eighty ninety percent of professional pitchers able to return
back to the mound. After you do a revision or
redo of that, that number's going to drop again, maybe
in like the sixties and seventies, because you're redoing something else.
The question is why do some people, why are they
able to make it successfully back and others aren't. I
think it's it's just a matter of, you know, a
well done technical surgery with great rehab, even that can

(09:17):
still not be enough for vide overall stability for an elbow,
and sometimes, unfortunately, things can reinjury, become reinjured, or you
can get reinjured. And I always core it with my patients,
you know, I say, look, you know, you injure yourself
to say it's an ACL injury or UCLA to the elbow.
You tore what you were born with. Even a perfect surgery,
you can care what we do. Unfortunately, and I think

(09:38):
sometimes pitts don't want to hear that, but that's really
the truth. I mean, if you tear your native ACL
by playing a sport, even at perfect surgery, you can
recare what we do. And so there are inherent risks
with surgeries, and there's inherent failure rates. And basfully, with data,
we can at least give our pictures and our athletes
a reasonable number to know what they're kind of getting
involved with. But unfortunately, the more surgery you have to

(10:00):
any joint, including the elbow, and more Tommy John surgeries,
the less likely you are to make it back to
the mound, and the more likely you are to have
problems with that elbow. Just term, more surgery to that area.

Speaker 1 (10:10):
That's as good of an answer as I ever could
have expected. Awesome stuff, I appreciate the time as always.
Have a great weekend. Man, Thanks so.

Speaker 2 (10:17):
Much, thanks for having me on. I appreciate it.

Speaker 1 (10:19):
You got a doctor, Adam Metzler from Orthos since I
say it every single week because it's true. The great
thing about Orthosincy is they've got specialists and locations across
the tri State. This includes walk in orthopedic urgent care
weekdays nine am to nine pm and on Saturdays nine
am to one pm at both Edgewood and Anderson. It's
easy because you don't need an appointment, and it's definitely

(10:41):
cheaper than going to an er. Whenever you have an
urgent orthopedic injury, go to Orthosinc. Dot com. That's Ortho
ci Ncy dot com