Injury Spin: Long road to recovery for Pedro Martinez

New York Mets ace Pedro Martinez is already out on the disabled list after only one regular-season start. The problem however is not his surgically repaired rotator cuff, it's his left hamstring, the large muscle group on the back of the thigh. He was placed on the 15-day disabled list prior to Wednesday's game.

So how realistic is it to expect Martinez to return to the Mets' rotation in the first two weeks of May? And how effective will he be when he returns from this latest setback? The answer is complicated and there are a number of factors to consider, but the projected timetable for Martinez seems optimistic.

Martinez reportedly heard a "pop" when he felt the hamstring go. Sounds that accompany injuries are never a good thing, and in this type of injury, a pop is suggestive of an injury in the tendinous region (as opposed to within the muscle belly itself). The tendon, which is in fact the tissue that anchors the muscle to the bone, does not have as good of a blood supply as the muscle itself. This makes healing more challenging. Martinez reached back to his upper thigh when he injured himself, further suggesting that his pain was felt up high near the tendinous attachment of the muscle to the base of the pelvis. In fact, as he stood on the mound afterward, Martinez could be seen reaching up high on the inside of his thigh, just past the groin area, as if to show where he was feeling the pain. This further implicates the proximal attachment of the hamstring as the source of the problem.

At 36, Martinez is not in his prime as a baseball player. I doubt this information comes as a surprise to anyone, but it bears repeating. When it comes to rate of healing after injury, youth is a bonus. When dealing with an injury such as this, which can very easily turn into a chronic problem, it becomes more critical that the tissue heals before the athlete returns to sport. A little more down time initially for recovery may mean significantly less down time later for recurrence.

Martinez's delivery places a significant load on the left hamstring (his landing leg) from ball release to follow through. His left leg rotates inward as his hip and knee extend, his trunk flexes forward and his right leg swings out wide to finish it off. In other words, his left hamstring needs to be both flexible and strong to enable him to pitch. Add to that the fact that the motion is repeated time and again over the course of an outing, and endurance becomes a requirement in addition to strength and flexibility.

The recent repair of Martinez's rotator cuff is also an issue here. How does the opposite leg have anything to do with his throwing arm? Pitchers rely on their legs and their trunk to help them deliver the ball effectively. The stronger the core trunk muscles and the legs are, the more they assist with ball delivery and offload the work of the throwing arm. When pitchers undergo major shoulder or elbow surgery, a good portion of their rehab time is spent conditioning their legs and trunk, as they become increasingly important in preserving the life of their arm. Pedro has made an amazing comeback following a challenging surgery, but the continued health of his throwing arm is dependent on the rest of his body doing its part.

For all of the reasons outlined above, it would not surprise me at all if the timetable for Martinez gets extended. Not only will his hamstring have to heal to the point where he has no pain with regular activity, he will have to resume a progressive throwing program and demonstrate that he can perform without pain in his leg and without excessive compensation elsewhere. In order for him to return and be effective, he needs to have the leg healthy. In the meantime, the Mets face an early challenge in trying to fill the void left by Martinez's surprise departure.