Of Hamilton, Adductors & The Future

Ever seen a guy with a fake leg?A couple of weeks ago, Josh Hamilton disclosed that what had originally been reported as a groin pull and / or a sports hernia as he sucked it up and fought through the 2011 post-season in excruciating pain was actually neither a groin pull nor a sports hernia.  Not exactly.  It was far more serious.  

Hamilton disclosed that the adductor muscle group in his inner left thigh had almost completely detached.  Hamilton explained that three of the muscles in this group had completely detached and that the fourth one "was about to pop." [Note: the medical research I have found on this matter indicates that there are five muscles in this group -- adductor longus, adductor brevis, adductor magnus, gracilis and pectineus -- not four.]

The reaction of media and fans seemed to be mostly a matter of "wow, it was so gutsy of Hammy to suck it up and play through that. What a guy." And yes,  I agree: You have to respect Hamilton for what he suffered through for the good of the ballclub.

But ever since that news broke, I've been bothered by the nature of this injury and hoping that someone would investigate it further. It hasn't happened yet, so I decided to start to look into it myself.

With Hamilton's contract status beyond the 2012 season in limbo and the public debate on his future with the Rangers beginning to heat up, I think it is worth considering how this injury occurred, how often it occurs with athletes and how successfully athletes who have suffered this injury have returned to action.

Millions in Rangers nation have fallen head-over-heels in love with Hamilton for a wide array of reasons. The story of what Hamilton went through last fall will only create more intense feelings for Hamilton in many quarters.  Fans of Hamilton will understandably want their ballclub to pay the player to stay based in large part, if not exclusively, on what he has done over the past four years.

But smart, successfully run front offices in any sport hand out long-term contracts to players based not on what the player did the last four years, but what the organization believes the player will do over the next four (or five, or six). In Hamilton's case, of course, figuring out what the next four or five years will hold is perhaps harder to figure out than with nearly any other top-shelf position player in my lifetime.

I am not in a position to draw any conclusions about this situation. My aim here is merely to begin a discussion or draw attention to an issue that the Rangers are certain to be considering as they contemplate what sort of offer they will make to keep Hamilton in Arlington or whether they will make any offer at all.

While groin pain or "sports hernia" (clinical term: athletic pubalgia) is certainly not uncommon among professional athletes (but it's not common either, it accounts for 2% - 5% of all sports injuries), it is most commonly seen among soccer players, hockey players, skaters and equestrians.  And completely detached adductors -- the most extreme form of athletic pubalgia --  are extremely rare.  I can find no other examples of a professional baseball player undergoing surgery to repair completely detached adductors. This is not to say that it hasn't happened, but searches for athletes and any combination of the terms detached and adductors come up with three names:  Josh Hamilton, Ladanian Tomlinson and Kevin Youkilis.  It appears that LT never actually had this problem and Youkilis suffered a detached adductor in his thumb, not his groin.

Obviously, this is purely anecdotal "evidence" but it seems logical that if there were more examples of this type of injury occurring with baseball players, it would have been written about somewhere.  Even the medical articles dealing with athletic pubalgia that are available online exhibit a uniform paucity of references to baseball.

By all accounts, one cannot pass this injury off as yet another example of Hamilton's style of play (e.g. the hairline fracture that occurred when diving head first into a bag).  This is a worn out part. It is a repetitive injury, but there seems to be substantial research that indicates that it is not an isolated thing.  There is quite a lot of conjecture in the medical community that athletic pubalgia can be related to degeneration in the lumbar spine which makes the athlete susceptible to this type of injury.

You may recall that the event that sent Josh Hamilton into his descent into the dark side was an automobile accident in which he suffered a lower back injury and ultimately ended his 2001 Double-A season after 23 games.  He has since missed time due to what was described as a lower back pinched nerve (probably a foraminal encroachment in his lumbar spine).

Moreover, it seems clear from the medical research I was able to browse that the abdominal tear that Hamilton also suffered this year is also connected to the athletic pubalgia. It seems not at all uncommon that severe cases of athletic pubalgia indicate a strong possibility of other issues in the core and lower half.  

Hamilton may not be merely unlucky and it may not be as simple as passing his increasing litany of injuries off as a matter of his "style of play."  This severe injury might quite likely be yet another sign of a body that is literally beginning to deteriorate rather significantly. 

I am not a physician and I am not pretending that the sparse amount of research I have done on this issue so far is in any way conclusive. I am merely suggesting that there is quite likely a lot  more to this injury than yet another allegedly isolated and easily explainable incident. Or bad luck. 

You can be sure that the Rangers front office has committed significant time and energy into understanding what Hamilton's body is likely to be like in two, three and four years down the line.  The decision will not be -- cannot be -- made based upon something as simple as some nebulous speculation about whether or not his past drug abuse has aged him beyond his years or whether his extensive injury history can be passed off as his "style of play."  

As I have written before, what has fueled the Rangers' ascent to the top of the sport has been, more than anything, their extraordinary ability to evaluate professional talent.  They seem to evaluate players in every deal better than the other guys do and never has that been more critical than it will be in evaluating Hamilton's value over the next four or five years.  Letting Hamilton walk will be a PR nightmare for the club, but I would suggest that if they do, the decision will probably be based upon a determination that Hamilton's injury history is not merely a series of unfortunate coincidences.