Injury updates from Cactus League

Stephania Bell has been visiting spring training camps, following up on some of the key injury storylines of the spring. The following is an update to some of the players covered in the preseason "10 key injuries to watch," and also highlights other injury situations from the Los Angeles Dodgers, Chicago Cubs and Arizona Diamondbacks camps.

Brandon Webb, SP, Diamondbacks: Webb was certainly not taking part in any competition during my spring training visits, as he is just trying to recover from his latest setback with his right (throwing) shoulder.

Webb or the Diamondbacks might argue with the term "setback," preferring to use the word "plateau," but given Webb's projected goal of a steady progression to return to play, anything less has to be viewed as a step in reverse. Although the team's and Webb's latest comments project optimism, there has to be concern about how the story will continue to unfold.

After all, nothing of any major significance was discovered during surgery, so there is nothing to point to specifically as the source of Webb's ills. There are certainly instances where a thrower's shoulder does not exhibit remarkable damage beyond some normal wear and tear, yet can still be problematic enough to limit throwing. Conversely, another thrower's shoulder could look as if surgery should be imminent, yet he continues to be able to function. The pictures definitely do not tell the whole story.

The concern with Webb, however, is that he seems to have recently experienced the same symptoms he complained of a year ago when the whole saga began, only now he has had several rehab episodes and a surgery in between. Most recently, Webb complained of his arm feeling "stagnant" and that he could not advance his throwing program. While it is not unusual to have minor setbacks during the course of a return to the mound, the difference here is that Webb's specific complaints are very similar to what we heard last year, not just fatigue from an arm unaccustomed to the work of throwing. And the troubles last year always came when he was throwing hard right around the point of transitioning to throwing from a mound. Sound familiar?

After a few days off recently to rest his arm, Webb threw with his surgeon, Dr. Keith Meister, in attendance to check things out. According to The Arizona Republic, as Webb put it, his surgeon told him, "Dude, you look fine, I don't know what you're talking about."

So what is it then? Perhaps Webb just needed that vote of confidence, because since that time he seems to feel like he has been able to cut loose on his throwing. After a throwing session with teammate Dan Haren in mid-March, Webb told The Arizona Republic, "I was letting it go almost all the way. I felt like I had more left in the tank, even. It was good, really good."

The Diamondbacks have to hope it is just that simple. For now, they are taking a cautious approach, limiting Webb to primarily long toss for at least the next several days.

In the meantime, Webb has not thrown from a mound since early March, and Opening Day is drawing ever closer. While it is no secret now that he will likely begin the 2010 season on the disabled list, the bigger concern is just how long it will take for Webb to make his return. After all, a pitcher typically has about five or six mound sessions before game innings and then requires about 25 innings to get ready for major league play. Accounting for days of rest between outings, Webb appears to be facing at least a month before he could consider rejoining the rotation.

Fantasy owners should be concerned as well. Without any evidence thus far to confirm that Webb's shoulder has recovered, there is no way to gauge how soon he will return ... or how effectively.

Alfonso Soriano, OF, Cubs: With Soriano coming off knee surgery, my main curiosity was to see how he would look running. While he wasn't limping by any means, he certainly didn't run convincingly in the outing I witnessed (Cubs at Dodgers, Thursday, March 18). Soriano struck out in his first at-bat but managed a single in the fourth inning. He never really ran hard, either to get to first or on the basepath afterward. The third out occurred before he was able to score and he was never in a particularly demanding situation as far as speed. Suffice it to say I left with the same impression I had before seeing him. It seems as if Soriano is holding back to some degree, as if he still lacks confidence in his legs. Perhaps it will all come together by the season opener, but it doesn't appear to have happened just yet.

Aramis Ramirez, 3B, Chicago Cubs: Ramirez was scratched from the game I attended Friday because of lingering soreness in his right triceps muscle (on the back side of the arm). Ramirez first experienced soreness in his arm the previous Sunday (March 14) when making a throw toward first base. Originally he expected to be back throwing within a couple of days so it was a bit of a surprise that he was not in the game five days later.

It's worth noting that Ramirez missed nearly two months last season after dislocating his intermittently problematic right shoulder. Ramirez did not have any offseason surgery, opting for a conservative strengthening program. One key to protecting his shoulder is proper function of all the muscles on both sides of the joint, which includes the triceps. Ramirez did manage to suit up Saturday for some minor league play as a designated hitter and got one hit in five at-bats. Perhaps more importantly, he gave no indication of increased soreness after swings and misses, an activity that bothered his shoulder last year. Ramirez is expected to see some major league play later this week so he is one to keep an eye on.

Russell Martin, C, Dodgers: Martin is recovering faster than expected from his groin injury according to Stan Conte, Los Angeles Dodgers director of medical services. Martin has made very good progress in his activity (drills, swinging the bat and running on the field). In fact, Martin is expected to start catching bullpens Friday.

Conte cautions however that although the "first 80 percent" of the rehab is going better than expected, "the last 20 percent -- the part that includes sprints, explosive movements and change of direction -- is the tricky part." He stresses that there is no return date targeted for Martin since the goal is not to speed his return but rather to get the injury resolved. "We don't want to go back to square one."

One of the tools that has assisted in Martin's rehabilitation so far is the use of the Alter-G treadmill, a treadmill that allows an athlete to perform his normal walking and running motion at a fraction of his body weight, therefore minimizing impact. Conte indicated that Martin began training at approximately 40 percent of his body weight, progressed to 70-80 percent and now is at full body weight running on the field. By decreasing the percent of body weight in motion, a player can simulate striding without the normal pounding of running. Instead of being limited to conditioning on a bike or elliptical machine, the athlete can actually perform the desired activity, such as running, with less risk of injury. This helps make the transition to running on land a much more natural progression, which is also an important element of sport-specific training.

Martin also received a PRP (platelet-rich plasma) injection into the damaged area shortly after the injury occurred, which may also be assisting in his recovery as well as the long-term health of the muscle tissue itself.

The biggest challenge remaining is to hold Martin back from overdoing it since he is feeling so much better. No one in the Dodgers camp is celebrating his speedy progress just yet; they know the true measure of success will be avoiding a midseason reinjury that results in more extended time on the disabled list. Fantasy owners should be encouraged however not only by Martin's rapid gains, but by the fact that everyone overseeing his care is being extremely cautious.

Chad Qualls, RP, Diamondbacks: Following Qualls' season-ending left knee surgery, I was eager to see how he would look on the mound. The type of injury Qualls suffered (dislocated kneecap) was not expected to be limiting once he achieved full recovery; the question was whether he had indeed returned to form.

The answer appears to be yes.

Qualls had his first outing on March 7 and was able to complete a scoreless outing. He struggled when facing the Kansas City Royals on March 19, but that seemed to be a function of getting back his form as opposed to issues with his knee.

As a right-handed pitcher, Qualls uses his surgically repaired left leg as his lead leg. That leg is subject to a fair amount of torque during ball release and follow-through as it stabilizes the trunk, so any apprehension would likely show up during those phases. I saw him in his subsequent spring relief appearance on March 21 when the Diamondbacks hosted the San Francisco Giants in Tucson. Qualls entered in the seventh inning and it was three up, three down, no problem. The reliever's knee seems to be performing well, so there should be no worries as far as Qualls' physical health heading into the regular season.

Conor Jackson, OF, Diamondbacks: Jackson's 2009 season ended early when he contracted Valley Fever, more formally known as Coccidioidomycosis, a fungal infection that results in symptoms including fatigue, muscle aches and, naturally, fever. The disease gets its name because the spores that cause it are located in the soil of semiarid regions ... like Arizona. The spores become airborne when the soil gets stirred up (such as on a dry, windy, dusty day) and are then inhaled. Some people never develop symptoms; others, like Jackson, can experience debilitating effects.

Given that some cases can take many months, even years to recover from, there was certainly concern as to just how long Jackson would be sidelined. Jackson started to turn a corner in the fall, however, and really looked improved while playing in the Dominican Winter League. He has seemed to turn it up yet another notch in Cactus League play this spring. When I saw him on March 21 as the Diamondbacks played host to the Giants, Jackson was on the field for five innings and certainly made his presence felt. Batting leadoff for the first time, Jackson not only singled to get on base in the first inning, he promptly stole a base to reach second. In fact, he looked as if he'd never missed a game. Jackson's overall performance signaled a nice comeback for a player with plenty of playing years left.

Ted Lilly, P, Cubs: The Chicago Sun-Times is reporting that the Cubs are hoping Lilly can make his regular-season major league debut in late April. (Lilly underwent a "cleanup" procedure on his throwing shoulder in early November.) While Lilly had just returned to Cubs camp Thursday following the birth of his child (translation: I did not see him throw), there seemed to be general encouragement about his status. Lilly is expected to throw a simulated game later this week followed several days later by pitching in a real game. Bear in mind that Lilly's timetable presumes no setbacks, but so far he has been able to meet his targets.

Stephania Bell is a physical therapist who is a Board Certified Orthopedic Clinical Specialist and a Certified Strength and Conditioning Specialist. She is a clinician, author and teacher with extensive experience in the area of orthopedic manual therapy and sports medicine.