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cortisone shots

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A shot in the dark

Brad Lidge Sometimes it feels like we write the same thing over andover again. It’s not quite a Groundhog’s Day thing, but often with sports some of the themes repeat themselves.

Actually, those themes can repeat themselves with the same guy, too. For instance, last April I wrote this:

Lidge, it was revealed after Monday’s game, has inflammation in his right knee and was unavailable to pitch. Though Lidge is listed as day-to-day, the inflammation was severe enough for the closer to undergo an MRI last Monday and then have a cortisone shot last Wednesday. For now the closer and manager Charlie Manuel are hopeful that a trip to the disabled list is not needed.

“We don’t think so yet,” said Manuel striking an ominous tone when asked if Lidge could land on the DL.

Lidge also is optimistic despite the fact that the swelling and soreness is on the same knee that he had operated on twice in 2008. However, Lidge pointed out that his knee hurts when he pushes off the rubber from the stretch.

The good news is that the MRI revealed no structural damage to the knee, but there was excess fluid and swelling, the pitcher said.

“Based on the MRI I’m not overly concerned,” Lidge said, standing in front of his locker with a large ice pack wrapped around his right knee. “It’s something that I’m just dealing with the fluid and inflammation. I’m concerned on a small level because it’s not feeling great and I want to get back there as soon as possible. But I think if we nip it in the bud right now, hopefully it will be something I won’t have to worry about for the rest of the year.”

Sound familiar? Lidge something just like that when he got a cortisone shot the other day, only this time is was for his right arm. So if you’re scoring at home, Lidge has had three cortisone shots in the past 12 months, as well as surgery to remove chips out of his throwing arm. Going back to when he first signed on with the Phillies, Lidge has had three surgeries—two on his knee—and a bunch of MRIs.

Oh yes, Lidge has a pretty good health care plan from playing for the Phillies.

And you know what? It’s a good thing, too. If history is any indication, he’s going to need it. After all, even in his best season Lidge was hurt. Remember that? He started the 2008 season on the disabled list after having two different surgeries on his knee before the season began and went out to close out 48 straight games. Considering that he had been removed from the closer’s role in his last season in Houston, Lidge’s perfect season came out of nowhere.

The oddest part is that even though Lidge was banged up, disabled and pitching with chips in his arm, he still appeared in more games in 2009 (67) than he did in 2007 (66).

Now here’s where it’s all connected… Lidge and the Phillies have said pretty much the same thing throughout. That quote in italics above sounds a lot like what Lidge said when he got the cortisone shot the other day.

“This puts you a couple days behind where you want to be,” Lidge said. “That being said, if it works, like we're hoping it's going to, it's going to speed up things a lot on the other side of that.”

The one word common to both quotes is “hope.” Last season manager Charlie Manuel and general manager Ruben Amaro Jr. hoped Lidge would bounce back from the breaks and the shots and find his lost form—you know for as much as a guy pitching with fragments in his elbow could rebound.

This year Lidge and the Phils hope his fastball can top 90-mph and he can get back to saving games a little more efficiently than last year where he set a record for the highest ERA (7.21) by a pitcher with more than 20 saves. But that’s just it—it’s just hope. The only guarantee is that Lidge will get paid the remainder of his $37.5 million deal through the 2011 season (with $1.5 buyout of the option for 2012).

Look, Lidge very well might regain his lost form after another stint on the disabled list. After all, the team physician and the front office say the latest cortisone shot was no big deal. That very well could be the case since Lidge says he feels strong.

“My arm strength is good and my slider was coming around and everything else was going the way it should, but velocity was not going,” Lidge said. “Rather than projecting on when it will, we decided to take action into our own hands, get a cortisone shot and speed the process up.”

Said Amaro: “I think you guys are making a little too much of the cortisone shot. If this helps accelerate him in getting his velocity back, that's more the nature of it.”

However, Lidge very well might be the recipient of the very first cortisone shot that was not a big deal. After all, there’s a reason why cortisone injections are banned in nearly every other professional and amateur sports around the world. According to Brian J. Cole, MD, MBA and H. Ralph Schumacher, Jr, MD in the Journal of American Academy of Orthopaedic Surgeons, the Lidge and the Phillies could be teetering on the edge of some long-term effects.

Physicians do not want to give more than three, but there is not really a specific limit to the number of shots. However, there are some practical limitations. If a cortisone injection wears off quickly or does not help the problem, then repeating it may not be worthwhile. Also, animal studies have shown effects of weakening of tendons and softening of cartilage with cortisone injections. Repeated cortisone injections multiply these effects and increase the risk of potential problems. This is the reason many physicians limit the number of injections they offer to a patient.

So there’s that and we haven’t even discussed the future of the Phillies’ bullpen. Smartly, though, Manuel cut to the chase about Lidge’s return from this injury.

“We’re just speculating,” Manuel said, “and that’s not good.”

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