I’m just going to rip off the Band-Aid. Or rather, the surgical tape.

Devin Mesoraco is done catching for the Cincinnati Reds this year.

At least the odds are stacked against it. He’s got a painful condition that’s aggravated when he catches. It usually requires surgery to remedy, season-ending surgery.

Mesoraco has been diagnosed with a left hip impingement. And if the doctors have that part right, it’s not going to get better with rest. Bone spurs and cartilage don’t have blood vessels like muscle, so they can’t heal themselves.

That’s the best guess based on what we know about his condition. It could be wrong. I’m no medical expert. In more innocent times, hip impingement meant as much to me (nothing) as patella tendonosis and flexor mass strains.

The Catcher in the FAI

The hip is a joint. A long bone (femur) with a ball at the end joins with a second bone (pelvis or acetabulum) that is shaped like a socket. Simply put, two bones, ball in socket.

hipxrayThe socket has a fibrous lining or ring called the labrum. Think of it as an inner tube on a bike wheel. Its role is to keep the two bones apart and act as a shock absorber and stabilizer. If the joint operates properly, the ball moves smoothly inside the socket, sheathed by the labrum.

Impingement means the ball and socket fit together too tightly. This happens when a bone spur, an overgrowth or bump, develops on either the femur or pelvis. Repetitive motions with weight bearing loads, like squatting to catch a baseball, cause the spurs. The spurs tear the labrum, undercutting its prophylactic function. When the ball and socket rub together, it’s called femoroacetabular impingement (FAI), and  it’s painful.

Spurs on the femur are called cam impingements. Spurs on the pelvis are called pincer impingement. An individual can have cam, pincer or both kinds of impingement. Cam impingement is more common in men.

The Cause

FAI is a curse of athleticism. It occurs in only a tiny number of non-athletes. But it is surprisingly common among elite male athletes, the ones who put tremendous pounding on their hip joints.

FAI is found with increasing frequency among professional athletes, including major league baseball players. According to the Baseball Prospectus database of injuries, in the 5-year period of 2002-06, about 1.5 players had hip surgery each year. From 2007-11, that number rose to 6.5 per season.

The reason for more cases is open to debate. The condition typically presents as groin pain, so in the past it was frequently misdiagnosed as a strain or sports hernia. Will Carroll, a sports injury expert, in a radio interview with Cincinnati’s Mo Egger yesterday said that only in the last eight years has MRI technology been advanced enough to see inside the hip joint.

Another theory is that sports specialization at young ages (11-15) promotes year-round repetitive pounding on the hip. Dr. John Christoforetti of the Allegheny Health Network points out that “regular sports participation by young males may change their hip bone shape for the rest of their lives.”

Chances are that Devin Mesoraco’s condition began back when he was playing for Punxsutawney Area High School or even before that. He joins Chase Utley, Alex Rodriguez and Troy Tulowitzski as notable major league FAI sufferers.

Treatment

The initial course of treatment is rest and avoidance of the activities that cause the symptoms. In Mesoraco’s case, that means stop catching for now. Non-steroidal anti-inflammatory drugs might be tried to reduce pain and inflammation. I spoke with a sports physical therapist who has worked on these cases, and he said specific exercises could improve hip motion and strengthen surrounding muscles in a way that can relieve stress on the injured labrum.

Those steps are all well and good. But the problem is most of the time they’re not enough. FAI is structural. Rest doesn’t reverse bone spur growth or cartilage tear. It’s not like a muscle strain. In the Reds catcher’s own words, “It’s not a pulled muscle or something you can easily do rehab to fix.” Non-surgical treatments are long shots. Once an athlete like Devin Mesoraco develops FAI, odds are he’s headed to surgery.

Surgery

Until recently, surgery meant intrusive scalpel cutting, laying the hip area open. Recovery times were 12-18 months. Fortunately, huge improvements in surgical technique have ahs2-320x238occurred in the past 15 years. Most of the time repair of the labrum and shaving down the cam or pincer spurs can be done with an arthroscope, on an outpatient basis.

More good news is the surgery works. Research conducted ten years ago by Dr. Marc Philippon, who is credited with developing the arthroscope technique, found that 93 percent of professional athletes returned to their sport after hip arthroscopy. With greater experience, recovery rates are even better today. Yesterday, Will Carroll described the surgery as having a “great record” of success.

Rehab and Prognosis

Devin Mesoraco’s exact diagnosis hasn’t been released yet and there is a range of possible conditions that could fall under the category of hip impingement. I spoke with a Yale-trained orthopedic surgeon who used to work for the Baltimore Orioles and is now a Reds fan. She said it makes a difference if the injury is just to the soft tissue (labrum) or if it involves the bone(s) with a cam or pincer lesion. The former involves a shorter recovery time.

Experience with treating the condition has also led to improvements in rehabilitation techniques. Recovery from hip arthroscopy generally takes 3-4 months, plus a few more weeks to get back into playing form. However, there are significant variances among doctors in rehab protocols. Many are increasingly aggressive, with some as short as eight weeks. A study of hockey players shows the average time from surgery to return to hockey drills was 3.4 months.

Short-term prospects for baseball players are positive as well. Major league players generally return to form in 4-6 months. Troy Tulowitzski (August 2014) said he felt good as new four months after surgery. He was ready to participate when spring training began six months later. Tulowitzski is hitting .321/.328/.551 as of today.

Equally important, surgery can provide long-term relief. Chase Ultey (2008) and Alex Rodriguez (2009) have avoided recurrence. Both are playing in their late 30s. When I asked the orthopedic surgeon about the incidence of recurrence, she pointed out that “hip scopes” were a relatively new approach. Because of that, she explained, there isn’t enough data yet to know about recurrence, especially for the narrow sub-category of baseball catchers.

***

You’ve got questions, good ones. Here’s the part of the post where we move from fact to opinion, from science to art, from research to Kremlinology.

So where are we?

There’s a small chance that a few weeks of rest will alleviate or, in Devin’s words, “calm down” the pain. It’s possible this was a temporary inflammation of the labrum. Mesoraco said this was the first time he’d felt the pain. If his condition can be managed, surgery could be delayed until the offseason.

Mesoraco might try to catch a game or two, maybe a simulated game, to see if the pain has subsided. But odds are we’ve seen the last of him catching for the Reds this year, at least on a regular basis. So much for the debate over whether he should catch 130 games or 140.

The most likely scenario is that Mesoraco will have surgery at some point this year and be ready to catch next year.

To point out how much of a body blow this is for the Reds chances to contend in 2015 is to state the obvious. That glorious vision of Joey Votto and Devin Mesoraco spending a season together crushing baseballs will have to wait a little bit longer.

Why haven’t the Reds put Mesoraco on the DL yet?

The Reds’ working theory seems to be that batting and running won’t aggravate the problem. It’s been reported that Mesoraco’s hip only hurts when he catches. Presumably, if his role stays limited to pinch hitting, Mesoraco can still accomplish the vast majority of the rest he’d have on the DL.

Further, it’s not like there’s a bat in AAA who would make an impact for the Reds. If the call-up’s main job would be to pinch hit, Devin Mesoraco is better at that. If the Reds had a solid bat to promote, Mesoraco would probably be on the DL right now.

The rehab process for hip arthroscopy is well known and well defined. With the end goal being Mesoraco being 100 percent for spring training next February, the Reds can wait for several months. As long as Mesoraco isn’t aggravating his condition by his limited role, this makes sense. Walt Jocketty will have landed his right-handed power bat off the bench.

Here’s the intriguing part. Through a scheduling quirk, the Reds play all their inter-league away games in the months of May (8) and June (2). The first of those takes place in Chicago two weeks from tomorrow. If the Reds delay Mesoraco’s surgery until the end of June, he would give them a legitimate designated hitter for those ten games. As you know, the Reds haven’t always had that.

Trying to guess what the Reds are going to do with Mesoraco is like figuring out Soviet leaders during the Cold War. But given the embarrassing lack of plausible pinch-hitting options at AAA and or other designated hitters (we’ve got Skip for that?), it makes sense to keep Mesoraco in the dugout for those roles the next two months. After that, use the knife endoscope and get him ready for 2016.

When I ran that theory by the orthopedic surgeon (again, she’s a Reds fan, one who had noticed Mesoraco grimacing), she seemed receptive, saying they could “definitely do it that way.”

And I think that’s what they’re up to. That’s why they let him pinch hit and blow the 10 days of DL backdating. Because they knew he isn’t going on the DL any time in the near future. Mesoraco hasn’t tried to catch again and the Reds already know he won’t go on the DL. They’ve got that pinch-hitting, DH role in mind.

So the Reds haven’t mismanaged the roster, seriously?

Their moves to this point have been defensible, even if their statements haven’t been fully candid. The notion that Mesoraco might get better by sitting out a couple days is fantasy. But I suspect they never believed that. Not after the doctors said hip impingement.

The case for a DL stint would have been this: Mesoraco wasn’t going to pinch hit for a week or so (the sitting out fantasy), they could have disabled him so Bryan Price wouldn’t have been short-handed. Put him on the DL right away and bring him back to pinch hit and DH in May and June.

About that contract extension? 

The orthopedic surgeon raised this point. Did the Reds make Mesoraco submit to an MRI prior to signing the his $28 million contract extension three months ago? She said that bony lesions would likely have been apparent even on a simple X-ray, although damage to the soft tissue would not. An MRI is necessary to catch labrum issues. She noted, before the Miami Marlins signed Giancarlo Stanton to his long-term deal, they made him undergo an extensive “hours long” regimen of MRIs “top-to-bottom.” She said the Bengals do the same thing for players who show up for the combine. The MRIs are cheap compared to the guaranteed contracts.

Should the Reds plan on Mesoraco catching in 2016 and beyond?

The surgery should provide Mesoraco full relief. Bone spurs start when players are young and develop over a long period of time. Mesoraco can do exercises that help prevent recurrences. Utley and ARod, yada, yada, yada.

On the other hand, while FAI does occur in players at every position, catchers do have unique vulnerability. Catchers are subjected to extra weight on their hip joint due to squatting for extended periods of time. The physical therapist I spoke with (he’s also a big Reds fan) pointed out that Mesoraco often puts his full weight on his left hip, jamming his knee up tight. That’s a lot of pressure on the hip and an obvious risk of impingement. Examples of catchers (non-MLB) who have experienced FAI are easy to find.

Experts have highlighted catchers, along with dancers, hockey players and hurdlers as athletes who put more stress on their hips. Here’s an example: “A catcher has the most extreme and distinguishable lower body mechanics compared to other position players. The catcher’s stance requires the hips to assume an extreme of flexion combined with external rotation and abduction.” Dr. James Andrews, Sports Medicine of Baseball (2012).

A decision to move Mesoraco to LF is multifaceted. Who would catch? The Reds would almost certainly be a better team overall with Mesoraco catching and someone else, like Jesse Winker, playing LF. But that assumes Mes can stay healthy while catching. The orthopedic surgeon would like to see Mesoraco move to the outfield.

The Reds decision will be based on what they are told by their medical experts. If the doctors say the risk of recurrence is minimal, which is my overall impression from what I’ve read, then Mesoraco should and will return behind the plate. But it’s a risk and remember, the long-term data is scarce.

Hmm … Bryan Price’s profane explosion?

Now I get it.