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Speaker 1: Welcome back since the three to sixty.

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Speaker 2: We're rolling along in the third and final hour of

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Speaker 2: the Thursday edition here on ESPN fifteen to thirty Cincinnati

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Speaker 2: Sports Station. Let's switch gears and let's talk about what

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Speaker 2: we spent some of today, a lot of yesterday talking

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Speaker 2: about and thinking about, and that is what's going on

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Speaker 2: with Hunter Green and the Cincinnati Reds. To bring you

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Speaker 2: back up to speed quickly, Hunter Green has felt discomfort

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Speaker 2: in his throwing arm, his throwing elbow. This is something

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Speaker 2: he dealt with at the end of last year for

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Speaker 2: the last five or six games. It felt better during

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Speaker 2: the offseason. A week before camp got up and going,

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Speaker 2: he started feeling to discomfort again. So now he has

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Speaker 2: scheduled to come back. He's going to see the team doctor,

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Speaker 2: doctor Timothy Kremchek, and then he's going out early next

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Speaker 2: week to see doctor Neil Elatrosh for a second opinion.

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Speaker 2: There's a lot of thoughts about this that we can

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Speaker 2: dive into. But as Austin and I were talking, who

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Speaker 2: better to talk to about this and any injury re

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Speaker 2: question that we have than our guy Bob man Jean

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Speaker 2: from the University of Cincinnati and novacare who joins us

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Speaker 2: right now?

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Speaker 1: Bob, how are you doing, Tony?

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Speaker 3: Getting ready to leave for Fort Worth, Texas to play

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Speaker 3: our last game of the year against.

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Speaker 4: How much does it mean to you to be in

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Speaker 4: a college campus that Andy Dalton dominated for so long,

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Speaker 4: much like he dominated the Pittsburgh Steelers.

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Speaker 3: Oh well, I don't know if my reasoning word dominate

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Speaker 3: a US. Yeah, he meets the Steelers a couple of times.

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Speaker 1: What was he the redhead or the red rifle? Don't

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Speaker 1: act like you forgot the red rifle?

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Speaker 5: That was it?

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Speaker 1: The red rifle?

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Speaker 3: How soon we forget nicknames of NFL quarterbacks, especially at

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Speaker 3: the Bengal Poor.

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Speaker 2: Bob's getting ready to talk about elbow injuries, and then

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Speaker 2: he gets the red rifle thrown at him to start

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Speaker 2: the segment. We're keeping you on your toes. Bob, Wake up,

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Speaker 2: you gotta be ready to go.

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Speaker 1: I'm awake, Tony?

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Speaker 2: All right, Bob, let's dive through this last year. Hunter Green,

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Speaker 2: over his last five or six starts, claims that he

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Speaker 2: had some discomfort in his elbow, some stiffness in the elbow,

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Speaker 2: and then the off season came and that discomfort went away.

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Speaker 2: I would think because he probably wasn't throwing as much,

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Speaker 2: but I'm I'm not a doctor here, that's just my assumption.

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Speaker 2: And then about a week before spring training amp back

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Speaker 2: up this year, he started feeling the discomfort. Again, let's

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Speaker 2: start at that level alone. If this is something that

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Speaker 2: Hunter Green was dealing with over his last five or

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Speaker 2: six starts last year, is this something that you would

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Speaker 2: be you would take time with in the off season,

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Speaker 2: you would rest it, or would you think, okay, maybe

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Speaker 2: let's just get it looked at at the very minimum

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Speaker 2: to make sure there's not more damage there that can

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Speaker 2: linger into another year.

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Speaker 3: Well, again, I'm sure that you with the red staff

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Speaker 3: and the excellent the support they have down there, that

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Speaker 3: they fully investigated where the potential pain was coming from.

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Speaker 3: And then once you get to the off season, you're

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Speaker 3: trying to figure out is this something that is a

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Speaker 3: surgical correction or is this something that we want to

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Speaker 3: do conservative management? And in most cases these guys get

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Speaker 3: you know, two three opinions as far as the best

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Speaker 3: way to go. So I mean, but again, like all pictures,

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Speaker 3: they have to have some period of recovery at the

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Speaker 3: end of the season to where they do shut down

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Speaker 3: and just take a couple of weeks and let every

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Speaker 3: kind of calm down. But then you want to get

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Speaker 3: into a rehab approach specifically for pictures, which you know

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Speaker 3: is different than obviously other players on the field, but

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Speaker 3: you really want to look at, you know, getting them

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Speaker 3: into a good strength program. And this is you know,

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Speaker 3: if you look at the literature on owner collateral ligament

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Speaker 3: injuries in baseball overhead sports, you're looking at like it's

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Speaker 3: a very high rate, very high rate. One in four

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Speaker 3: high school pictures are going to have on their collateral issues.

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Speaker 3: Ten percent of all you literal league kids and some

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Speaker 3: predict as high as fifty percent of little league kids

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Speaker 3: who pitch overpitch get pain just like the pros do

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Speaker 3: so and they have to have like the pros, they

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Speaker 3: have to have an off season. But no matter when

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Speaker 3: you go into your off season rest period, you have

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Speaker 3: to get into a good rehab program, and you have

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Speaker 3: to get into a good strength program because with you

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Speaker 3: going into a rest period and not over or not

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Speaker 3: training those muscle systems that require you to throw, then

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Speaker 3: you know you're you're not going to be in good

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Speaker 3: shape to come back and start throwing if you're not

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Speaker 3: reconditioned so you want to get reconditioned before you start

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Speaker 3: throwing again. But again, until you actually start doing the

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Speaker 3: function that you know cause the pain in the first place.

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Speaker 3: So let's say somebody doesn't throw the whole off season

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Speaker 3: and all they do is lift, then you know you're

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Speaker 3: not going to know if you're going to have pain

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Speaker 3: again into you actually do the function that resulted in

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Speaker 3: the pain or cause the pain. So the bottom line is,

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Speaker 3: even when you know, I've had a couple of major

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Speaker 3: league pictures in the last couple of years I work

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Speaker 3: with in the off season, and yeah, we went into

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Speaker 3: a two to three week rest period, but then we

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Speaker 3: have light, long toss throwing, progressive throwing.

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Speaker 1: You know, throw a day off.

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Speaker 5: A day light toss a day.

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Speaker 1: A little heavier toss two days later. But all the

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Speaker 1: while you're doing this, you are lifting.

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Speaker 3: You're working specifically for torqueing your body, because throwing his torque,

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Speaker 3: if you did not have great dynamic support around the

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Speaker 3: elbow from those intrinsic muscles in the arm, shoulder, back,

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Speaker 3: you would tear your.

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Speaker 1: Owner collateral ligament.

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Speaker 3: Every time you throw a ball, you generate ten thousand newton.

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Speaker 1: Torque around a force that elbow.

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Speaker 3: You would literally obliterate your honor collateral every time you threw.

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Speaker 3: If you didn't have strong enough must mature in the forearm,

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Speaker 3: the shoulder, the back, the hips, and so you know that's.

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Speaker 1: An each level Tony.

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Speaker 3: In each level, like you see these little kids in

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Speaker 3: the Little league there shoulder throwers. They don't have enough

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Speaker 3: strength in their hips, they don't have enough strength in

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Speaker 3: their back, to all of a sudden they developed shoulder

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Speaker 3: and elbow problems because they need to get stronger, and

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Speaker 3: in the off season that's the time to get stronger.

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Speaker 2: I want to take a quote from Hunter Green yesterday,

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Speaker 2: and again we don't know the ins and outs of this,

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Speaker 2: but his words were, he had to discomfort last year.

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Speaker 2: They were in a playoff push, so he pushed through it.

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Speaker 2: After the season, he felt fine, and he got an injection.

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Speaker 2: Now we don't know what that injection would be specifically

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Speaker 2: in the off season, but the extent of what he

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Speaker 2: did in the off season was get an injection. And

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Speaker 2: then he goes on to say a week before spring

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Speaker 2: training the discomfort came back. So whatever the consensus was

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Speaker 2: that they came to, an injection was on the list.

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Speaker 2: If the injection doesn't work. What's the next step then

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Speaker 2: for a player or a pitcher in the in Major

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Speaker 2: League Baseball.

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Speaker 3: Well, it depends on what you see on your objective

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Speaker 3: testing that your MRI or or your X rays, and

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Speaker 3: what you feel.

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Speaker 5: In your physical exam.

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Speaker 3: So, but if they're continuing to complain of pain and

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Speaker 3: they can't function, and you've gone through a six week

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Speaker 3: conservative course of reham, you know, some of these people

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Speaker 3: face surgical intervention at the elbow to either remove bonees furs,

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Speaker 3: to repair the ligament itself, to correct There's a muscle

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Speaker 3: complex there called the flexer pernator mass, and I've seen guys.

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Speaker 1: I had one guy I.

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Speaker 3: Won't say what teams from, but he had chronic overload

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Speaker 3: to the flexer pernator mass. They went in to bring

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Speaker 3: into flexer fernator mass. We attached it, and you know,

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Speaker 3: we rested him for four weeks and still they brought

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Speaker 3: him back.

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Speaker 5: There's all kind of.

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Speaker 3: Options in that medio elbow that these guys run into.

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Speaker 3: You know, one of the common things are bone spurs. Yeah,

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Speaker 3: and so you have to if that's what they think

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Speaker 3: is the cause, regardless of the age. You know, one

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Speaker 3: of our athletes here at you see at the end

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Speaker 3: of the season had to have a scope to remove

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Speaker 3: some bone spurs and hopefully he'll be able to get

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Speaker 3: back to throwing without issues after that.

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Speaker 2: So that would be my follow up question because Hunter

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Speaker 2: goes on to say that as of now, there's no

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Speaker 2: UCL damage, but he did openly say that he knows

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Speaker 2: he has bone spurs in the elbow. So my question

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Speaker 2: would be, if he knows there are bone spurs, should

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Speaker 2: those already have been addressed or if they now choose

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Speaker 2: to go and address the bone spurs, how long are

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Speaker 2: you thinking before a guy can get back up to

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Speaker 2: pitching in Major League Baseball?

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Speaker 3: And that's completely individually based, And so can you get

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Speaker 3: in there and remove those bone spurs?

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Speaker 1: Yes?

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Speaker 3: Can he successfully or any athlete successfully come back and

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Speaker 3: throw after bone spur removal of the answers, Yes, But

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Speaker 3: everybody's an individual because you've got to consider their total body,

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Speaker 3: where they are strength wise and range emotion wise. And

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Speaker 3: the other thing is if you look at a thrower,

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Speaker 3: and this is a Japanese study about ten years ago,

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Speaker 3: and the reason that they have such interesting data is

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Speaker 3: that the problem becomes the rising incident of these honor collaterals.

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Speaker 3: Some of it is bony change and bone spur changes.

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Speaker 3: And they looked at little leaguers in Japan and by

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Speaker 3: the time they were fourteen, the kids that were pitching

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Speaker 3: because they have year around baseball. The worst thing ever

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Speaker 3: happened in America is indoor facilities and you're around throwing

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Speaker 3: and you're around baseball. The orthopedic surgeons love it because

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Speaker 3: it's creating so many patients in these little kids. You know,

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Speaker 3: this specialization by the time they're eight, nine, ten years

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Speaker 3: old is an absolute travesty. Let the kid play other

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Speaker 3: sports and see, you know, give their elbow arrest.

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Speaker 5: Let them go play frigging basketball or something.

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Speaker 3: But the problem became that sixty nine, sixty eight or

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Speaker 3: sixty nine percent of the kids by the time they

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Speaker 3: were twelve showed bony changes from the.

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Speaker 1: Year around throwing.

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Speaker 3: And so there's no doubt when you get to the

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Speaker 3: MLB level, you know you are going to see bony changes.

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Speaker 3: And the question is how you address them. And one

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Speaker 3: way you can address them, my guests, is through injection.

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Speaker 1: I don't know.

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Speaker 3: Another way is through conservative management. I'm sure people are

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Speaker 3: trying PRPs. I'm sure people are trying all kinds of things,

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Speaker 3: but if it's not working, then it's some point you

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Speaker 3: potentially have to go in there and clean them out

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Speaker 3: and then put them back on a progressive return to

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Speaker 3: play at pathway.

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Speaker 4: The other thing I was wondering about this Bob is

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Speaker 4: Hunter Green did have Tommy John surgery in twenty nineteen.

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Speaker 4: What's the shelf life of a surgery like that.

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Speaker 1: At that level?

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Speaker 3: What was it two years ago at the Andrews Institute

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Speaker 3: Baseball meeting somewhere in the neighborhood of about seven years?

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Speaker 3: I think they reported sven or eight years. So you know,

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Speaker 3: you start looking at the fact that if you have

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Speaker 3: the surgery, the surgery leads the star tissue you've got,

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Speaker 3: You're you're putting soft tissue anchors in there to keep

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Speaker 3: the ligament stable. Nowadays they do, you know, they use

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Speaker 3: another tissue and they're with it to on minute and

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Speaker 3: it gets you.

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Speaker 5: Back faster, but you're still overloading.

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Speaker 3: Sure, and it's basically you know, the number one cause

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Speaker 3: it in all sports right now is the fact that

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Speaker 3: you're getting a lack of rest, constant loading.

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Speaker 5: And you know, these these younger kids especially.

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Speaker 3: But again, when you're I don't know how old he is,

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Speaker 3: but you know, when you get into a certain age group,

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Speaker 3: you know you're you're throwing ability. He starts to deteriorate

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Speaker 3: people like Ryan or Nolan Ryan. He's a freak. Okay,

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Speaker 3: Bob Gibson, they're freaks.

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Speaker 1: You know. I was very, very fortunate back.

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Speaker 5: I can't remember what year it was where I got to.

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Speaker 1: To conservatively treat a guy named Tom.

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Speaker 5: Seaver and you know, he's it was.

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Speaker 1: Incredible what his shoulder looked like at his.

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Speaker 5: Age by the time I got to treat him when

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Speaker 5: he was with the reds. Uh.

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Speaker 3: He came over when I was with Cincinnati Sports Medicine

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Speaker 3: and you know, get him stretched out and strengthen some

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Speaker 3: and what he could do with his shoulder was humble it,

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Speaker 3: which is why he was still, you know, in his

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Speaker 3: thirties throat.

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Speaker 1: So these when when I see.

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Speaker 3: A little league kid and the parents look at me

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Speaker 3: and say, you know, I want my kid to be

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Speaker 3: the next Nolan Ryan or whoever, it's like, well, you know, hopefully,

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Speaker 3: you know he's got something that's DNA and them, because

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Speaker 3: Dolan Ryan was a friggin freak and and you know

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Speaker 3: how many forty two year olds can throw a ninety

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Speaker 3: eight mile an arm fastball.

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Speaker 1: Yeah, they's an end of one that I know of.

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Speaker 1: The last I would ask for page.

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Speaker 2: The last I would ask upon this is is Hunter

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Speaker 2: Green multiple time set? As of right now? The UCL

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Speaker 2: is intact. As of right now, the UCLs in good shape.

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Speaker 2: Do you run the risk even though the UCL is

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Speaker 2: clean right now if you don't take care of this,

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Speaker 2: of that becoming more of an issue? Is that something

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Speaker 2: where these things are connected.

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Speaker 3: Well, especially if you change your mechanics at all, especially

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Speaker 3: if you know, the worst nightmare for a picture is

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Speaker 3: I have pain or I am discomfort in one aspect

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Speaker 3: of my elbow. So I'm going to kind of change

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Speaker 3: a mechanic a little bit, and the next thing, you know,

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Speaker 3: you do put an extra overload either on the flexi

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Speaker 3: pronator mass or a little extra overload on the ulter

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Speaker 3: collateral ligament. And now it is starting to be a problem.

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Speaker 3: So you know again, Ligaments change over time. Okay, It's

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Speaker 3: there's a thing called Wolf's law. A tissue underload, any

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Speaker 3: tissue vast or underload can change over time. Ligaments can

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Speaker 3: get thicker, Ligaments can stretch bony tissue for example, we

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Speaker 3: ever see the picture that can't straighten all the way out.

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Speaker 3: That has nothing to do with the ligaments. And I

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Speaker 3: remember you when you throw in football, you know you

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Speaker 3: had difficulty getting extension in your arm because you develop

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Speaker 3: little bony spurs that prevent you from getting it all

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Speaker 3: the way straight because you're isn't comfortable all the way

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Speaker 3: in extension whenever you're throwing right. And that adaptation occurs

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Speaker 3: somewhere between sixteen seventeen, eighteen years of age. It doesn't

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Speaker 3: occur when you're twenty five or thirty. It's already there.

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Speaker 3: So you know, An again, those are little bony changes

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Speaker 3: because of Wolf what we call Wolf's law. And now

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Speaker 3: that puts extra strains somewhere else because you're you don't

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Speaker 3: have full range of motion.

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Speaker 1: Yeah, does that make sense?

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Speaker 5: Yes?

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Speaker 2: Yes, that is Bob Mangean sifting through the latest with

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Speaker 2: Hunter Green and the Cincinnati Reds. Bob, you're getting ready

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Speaker 2: to head uh to TCU. It is it's a testament

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Speaker 2: to what this team has done because they've played themselves

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Speaker 2: into a conversation. So best of luck on the road

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Speaker 2: and go get one more. Let's make this thing interesting

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Speaker 2: next week.

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Speaker 4: Thanks Bob and We're going.

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Speaker 1: To sure try Tony.

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Speaker 3: So you guys have a good weekend and try to

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Speaker 3: stay dry because it's you know, all the roads are

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Speaker 3: flying baby. Never it's the great Slot of twenty six.

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Speaker 2: Never a doll moment. That is Bob Manjean from the

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Speaker 2: University of Cincinnati and Novacare. Bob, thanks so much for

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Speaker 2: your time. We'll talk again next week.

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Speaker 5: You're welcome.

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Speaker 1: Guys, have a good day.

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Speaker 2: From traveling to the game, walking to your seats, and

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Speaker 2: partaking in postgame celebration. Your body can take a beating

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Speaker 2: from all the activity on game day. At Novacare Rehabilitation,

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Speaker 2: they understand how important it is for fans to be

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Speaker 2: there to root for their team. Through the power of

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Speaker 2: physical therapy, you don't need to let eggs, pains, or

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Speaker 2: injury keep you from the game. Find a center near

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Speaker 2: you today at Novacare dot com. Our three rolls on

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Speaker 2: next on ESPN fifteen thirty, Cincinnati Sports Station.

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Speaker 6: WCKY Cincinnati and iHeartRadio Station Guaranteed Human ESPN fifteen thirty iHeartRadio.

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Speaker 5: This winter, comfort starts with your windows and door