Ellsbury back on DL; playing made ribs worse

BOSTON -- When Red Sox outfielder Jacoby Ellsbury came off the disabled list last Saturday after missing five weeks, he said he was told by the team's medical staff that playing would not aggravate his condition, even though it was understood by all parties he was not fully recovered.

On Friday, Ellsbury returned to the 15-day disabled list after seeing a thoracic specialist who informed him that while his four fractured ribs appeared to be healing "faster than normal," playing had worsened his condition.

"[He] basically advised me that I needed to be at a further state of healing before I resume play," Ellsbury said. "To this point, right now I really don't have a timeline for when I'm coming back. Just talking with the medical staff, I'm going to do everything I can to get back on the field as soon as possible."

Ellsbury said he is experiencing many of the same symptoms that have occurred since his collision April 11 with Red Sox third baseman Adrian Beltre in Kansas City, including pain when he attempts to take a deep breath.

"Basically I tried playing with a level of discomfort," Ellsbury said, "knowing that I was not 100 percent. And doing so worsened my condition."

Ellsbury played three games after being activated and went 1 for 14. He also made a diving catch in Philadelphia. Red Sox manager Terry Francona had given Ellsbury a day off Tuesday against the Rays as a matter of course for a player coming off the DL, but before Tuesday night's game, after a hitting session off a tee with coach Dave Magadan, Ellsbury complained of pain.

X-rays and a CT scan were taken at the time and Ellsbury was evaluated by the Rays' orthopedic doctor, Koco Eaton. Ellsbury subsequently missed the three games before Friday's meeting with the specialist. Francona announced before Friday's game that Ellsbury had been returned to the DL, with reliever Scott Atchison recalled from Pawtucket.

Ellsbury, who was in the clubhouse before the game, was asked if it had been presented to him, before he came off the DL, that his condition could worsen if he played.

"When I came back we were pretty much on the understanding that if I came back … it wouldn't regress," Ellsbury said. "It wouldn't worsen. Unfortunately that was the case this time."

Asked if he had come back too soon, Ellsbury said, "Well, I guess the way it looks now I came back too soon. But with everything, the way I felt, the way the medical staff felt, we felt it was time to go. But we knew I wasn't fully healed."

Ellsbury said he will proceed more cautiously before he returns. "When I talked to the specialist, he said you need to be at a further state of healing," Ellsbury said. "When I come back, I'll definitely be farther along in the process."

Fractured ribs -- and calling them hairline doesn't diminish their seriousness, a fracture is a fracture -- can sustain microfractures even after they have scarred over and healed, causing inflammation and further pain. Given that Ellsbury had four fractured ribs, and the way the ribs come into play every time he swings a bat, it is not unexpected that he is experiencing such symptoms.

It's conceivable that the injury could linger for considerable time.

"We hope it's quick," Francona said, "but we don't know."

After the game in which he was hurt, Ellsbury underwent X-rays while still in Kansas City, which came back negative, and the injury was diagnosed as bruised ribs. It's not unusual for rib fractures to go undetected initially; often it isn't until a second round of tests shows the inflammation indicating fractures, which appears to be what happened with Ellsbury.

On Wednesday, Ellsbury had asserted that the original injury was misdiagnosed.

"I think they downplay it because they misdiagnosed it," he said. "They said you treat it all the same way. Remember that comment? How do you treat a bruise the same as a break?"

Red Sox medical director Thomas Gill maintained at the time that you do, indeed, follow the same protocol for bruised ribs, treating them as if they were fractures, until you can make a fuller determination. He also stated that Ellsbury's progress would be measured by the symptoms he was exhibiting.

Now, after saying he was told that he couldn't aggravate the injury by coming off the DL, then learning otherwise Friday, suggests that there may still be issues between the player and the medical staff. If so, Ellsbury did not acknowledge as much on Friday.

"I think we've all been on the same page," he said when asked about the misdiagnosis comment. "We all put our heads together. We're at a good state right now. I'm happy at the [medical] attention I've gotten. With that being said, I have to do all I can do to get back on the field."

Was it a mistake for the Sox to tell him to come back when he did?

"I think we're all on the same page," he said. "I have my information, they're going to give me their medical side and we put our heads together, we have a plan of attack. Unfortunately we all knew I wasn't going to be fully healed. We thought that it wouldn't regress. It wouldn't worsen. That's kind of where we're at."