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Inova Nationals Health Report

Ultrasound now popular sports medicine option

MLB.com

Say "ultrasound," and most people think of pregnant bellies. But ultrasound has a long history of diagnosing all sorts of medical conditions well beyond prenatal testing. As the technology has improved, the ultrasound is becoming an increasingly important tool in sports medicine, said Dr. Peter MacArthur, a primary care sports medicine physician who is part of the Inova Sports Medicine Team, the official hospital network and sports medicine partner of the Washington Nationals.

Ultrasound machines have gotten smaller, with better resolution for peering into the body. Meanwhile, providers who use the devices have gotten even better at interpreting the results, MacArthur said. "We've seen notable improvements even in the last five years."

Say "ultrasound," and most people think of pregnant bellies. But ultrasound has a long history of diagnosing all sorts of medical conditions well beyond prenatal testing. As the technology has improved, the ultrasound is becoming an increasingly important tool in sports medicine, said Dr. Peter MacArthur, a primary care sports medicine physician who is part of the Inova Sports Medicine Team, the official hospital network and sports medicine partner of the Washington Nationals.

Ultrasound machines have gotten smaller, with better resolution for peering into the body. Meanwhile, providers who use the devices have gotten even better at interpreting the results, MacArthur said. "We've seen notable improvements even in the last five years."

Understanding Ultrasound
Ultrasound uses high-frequency sound waves to view structures inside the body. It is particularly useful for diagnosing injuries to soft tissues such as muscles, ligaments, tendons and nerves, MacArthur said.

Unlike X-rays, ultrasound doesn't rely on radiation to create images of the body. And while magnetic resonance imaging (MRI) usually creates sharper images of structures deep within the body, ultrasounds have the following clear advantages:

• Accessibility: People with pacemakers or metal implants can't undergo MRIs. Similarly, people with anxiety or claustrophobia might not be willing to get inside the MRI machine. Ultrasound is suitable for a wider degree of patients.

• Portability: If a player is injured on the field, he or she might not get in to the clinic for an X-ray or MRI until the next day. Ultrasound, on the other hand, is lightweight and portable. "You can bring it to the training room, or to away games, and get the exam done sooner," MacArthur said.

• Cost: Ultrasound is an inexpensive form of imaging. It's so cost-effective and quick to use that medical staff can use it to compare injured body parts to their un-injured counterparts. "If you have an injured elbow, you can also look at the other elbow to see how they differ," MacArthur explained. Those types of comparisons would be time consuming and costly with MRI.

• Dynamic examination: With ultrasound, the patient can move a painful limb or injured joint while you're doing the exam to see what structures are getting pinched or moving incorrectly. "You can place the probe exactly where the patient hurts" to zero in on the problem, MacArthur said.

New Uses for an Old Tool
Thanks to advances in ultrasound imaging, sports medicine doctors are finding new ways to use the old technology, MacArthur said.

For instance, sports medicine doctors can use ultrasound to create baseline images of joints at high risk of injury, such as the elbows of pitchers. By cataloguing existing wear to those joints, medical staff can have images to use for comparison if any pitchers suffer an injury.

Ultrasound is also useful for guiding injections to treat irritated muscles and tendons. Such injections include platelet-rich plasma (a blood product rich in growth factors that can promote healing) or corticosteroids (which can reduce inflammation). With ultrasound, doctors can guide those injections directly to the irritated tissue, MacArthur said.

While ultrasound has been a big advantage in the training room, it's just as vital in the clinic for patients of all ages, MacArthur said. It doesn't replace MRI, but it's a great tool for quick diagnosis, he added. "Ultrasound is great for patient care."

For more information or to make an appointment, call 703-970-6464 or visit Inova Sports Medicine.

 

Washington Nationals

How to recognize and prevent shoulder injuries

MLB.com

Pitchers are no strangers to the risk of shoulder injuries. While pro athletes are usually good at spotting early signs of a shoulder problem, youth players and weekend warriors might be caught off guard by shoulder pain and injury.

Here are some tips for spotting and preventing shoulder injuries, courtesy of Robin West, MD. West serves as lead team physician for the Washington Nationals, head team physician for the Washington Redskins, and chairman of Inova Sports Medicine, the official hospital network and sports medicine partner of the Washington Nationals.

Pitchers are no strangers to the risk of shoulder injuries. While pro athletes are usually good at spotting early signs of a shoulder problem, youth players and weekend warriors might be caught off guard by shoulder pain and injury.

Here are some tips for spotting and preventing shoulder injuries, courtesy of Robin West, MD. West serves as lead team physician for the Washington Nationals, head team physician for the Washington Redskins, and chairman of Inova Sports Medicine, the official hospital network and sports medicine partner of the Washington Nationals.

Located in Fairfax, Va., the Inova Sports Medicine team offers comprehensive, personalized care for athletes of all ages and activity levels. Their focus on injury prevention, recovery and performance makes them a perfect fit for the Nationals' focus on comprehensive care for players.

Shoulder Injuries to Watch For
Unsurprisingly, pitchers are particularly vulnerable to shoulder injuries. Yet any athlete who throws a ball can experience these problems, West said. Common injuries include:

  • Growth plate injuries: Also known as "Little League shoulder," this is an overuse injury caused by repetitive stress. It occurs when inflammation develops around the growth plate in the upper part of the humerus bone. "It's the most common shoulder injury in growing athletes," West said.
  • SLAP tears: Short for superior labrum anterior and posterior tears, this injury occurs when the biceps tendon starts to peel back from the bone inside the shoulder. It's more common in people who are at or nearing skeletal maturity, usually around age 15 or older, West explained.
  • Rotator cuff tears: Throwing athletes can experience partial tears or fraying of the rotator cuff, a group of muscles that attaches the humerus to the shoulder blade.
  • Impingement: This injury occurs when the rotator cuff becomes compressed between bones or other structures in the shoulder. It can happen when the rotator cuff becomes fatigued by overuse.

Diagnosis and Treatment
Shoulder injuries often begin with weakness and a decrease in pitching accuracy and velocity. "When I talk to athletes, they say those symptoms start first. They often just have a sense that something is different," West said. "And then the pain starts."

Athletes with those red flags should be proactive about talking to their athletic trainer, if they have one, West said. "If you're not improving with their care, or you're not improving after a few days of relative rest, I recommend seeing a doctor."

When shoulder problems are caught early, they can usually be corrected with physical therapy before they progress to more serious injuries.

Preventing Damage
Athletes both young and old can also take steps to prevent shoulder injuries. Here are some tips on how:

  • Make sure to warm up: Do some stretching and easy throwing before practice sessions or games.
  • Rotate positions: Youth athletes should rotate positions so they're not just pitching all the time.
  • Take time off to rest your joints: "For children, we recommend they avoid pitching on multiple teams with overlapping seasons," West said.
  • Adhere to Little League pitch count guidelines: These are designed to prevent overuse injuries in young players. "When kids are playing on multiple teams, parents should pay close attention to make sure their child's total pitch count doesn't exceed the limit," West said.
  • Focus on mechanics: In younger players, avoid radar guns to measure pitch velocity. "As they're learning to pitch, kids should focus on good control and mechanics, not speed," West said.
  • Don't ignore the pain: "Playing through pain will alter your mechanics, and either worsen the injury or cause another injury," West said. "Adult players might expect some soreness after a game, but that shouldn't last more than a couple of days," West said. And kids should never experience pain from sports. "Kids play for fun. They should never come home and have to ice their shoulder," she said.

For more information or to make an appointment, call 703-970-6464 or visit Inova Sports Medicine.

 

Washington Nationals

Back in Business: Preventing back injuries

MLB.com

Serious spinal injuries are rare among pro baseball players. "But back pain is an issue for athletes (including baseball players) on a fairly regular basis," said Brian J. McHugh, MD, a neurosurgeon with dual fellowship training in orthopedics and neurosurgery. He is a member of Inova Medical Group, the official hospital network and sports medicine partner of the Washington Nationals.

Pulling a muscle, throwing your back out, myofascial strain -- whatever you call it, it's an uncomfortable injury that can strike anyone from elite athletes to desk jockeys. But the underlying cause of that injury might surprise you.

Serious spinal injuries are rare among pro baseball players. "But back pain is an issue for athletes (including baseball players) on a fairly regular basis," said Brian J. McHugh, MD, a neurosurgeon with dual fellowship training in orthopedics and neurosurgery. He is a member of Inova Medical Group, the official hospital network and sports medicine partner of the Washington Nationals.

Pulling a muscle, throwing your back out, myofascial strain -- whatever you call it, it's an uncomfortable injury that can strike anyone from elite athletes to desk jockeys. But the underlying cause of that injury might surprise you.

Tight Legs

Most people have heard the common refrain to lift with their legs, not with their back. That's good advice, McHugh said -- though sometimes, your legs aren't totally up to the job.

"Most of what predisposes you to throw out your back is actually tightness and inflexibility in the hamstrings and gluteal region," he explained.

Your hamstrings and gluteal muscles are a powerful team. "You can lift hundreds of pounds with those muscle groups," he said. By comparison, the paraspinal muscles, which run up and down your spine, are designed to lift maybe 60 to 80 pounds.

When you bend to pick something up, your leg muscles do a lot of the work. But if those muscles are tight and stiff, they might reach their capacity before you finish bending. The rest of the force is transferred to your back -- a recipe for straining your paraspinal muscles.

Overworked Muscles

Baseball players are often most vulnerable to pulling a back muscle after a workout, McHugh said. After sprinting or lifting weights, their leg muscles can become tight and inflamed. Then they might bend to pick up something unsuspectingly light, like a duffel bag, and throw out their backs in the process.

"If you've just done a big workout, those muscles are all overworked, and you want to be extra careful with lifting mechanics," McHugh said.

Non-athletes with tight hamstrings are susceptible to this type of injury, too. And the older you get, the more prone you are to throwing your back out, he added.

Preventing Back Muscle Injury

The good news: Stretching exercises can help prevent back injury. That includes regular stretching to elongate the hamstrings and gluteal muscles, as well as exercises that stretch the lumbar spine.

While it's pretty easy to feel tightness in your hamstrings, it's a bit trickier to correctly perform exercises that isolate the paraspinal muscles, McHugh added. One helpful stretch, for example, is to kneel on all fours and roll your back like a cat.

Warming up before activity is also important, he added. "Coming in cold sets you up to pull something."

If you do pull a muscle, you'll usually recover with rest, time and anti-inflammatory medicine. But it's worth the effort to stretch your muscles and lift with care to avoid back injuries. "Throwing out your back can be really debilitating in the short-term," McHugh said.

For more information or to make an appointment, call 703-970-6464 or visit Inova Sports Medicine.

 

Washington Nationals

Sun Safety: Don't Get Sidelined by Skin Cancer

MLB.com

Serious athletes try to protect their bodies. They eat right, get proper conditioning and take steps to prevent injuries. But they might not always be so disciplined about protecting their skin from the sun when they head out on the field.

That's a problem, since avoiding sunburn and practicing sun safety is the single most important step you can take to prevent skin cancer, said Suraj Venna, MD, a board-certified dermatologist and director of the Inova Melanoma and Skin Cancer CenterInova is the official hospital network and sports medicine partner of the Washington Nationals, and a leader in bringing personalized care to people throughout the Washington, D.C., metro area and beyond.

Serious athletes try to protect their bodies. They eat right, get proper conditioning and take steps to prevent injuries. But they might not always be so disciplined about protecting their skin from the sun when they head out on the field.

That's a problem, since avoiding sunburn and practicing sun safety is the single most important step you can take to prevent skin cancer, said Suraj Venna, MD, a board-certified dermatologist and director of the Inova Melanoma and Skin Cancer CenterInova is the official hospital network and sports medicine partner of the Washington Nationals, and a leader in bringing personalized care to people throughout the Washington, D.C., metro area and beyond.

Melanoma is the most dangerous form of skin cancer -- and it's becoming a bigger problem. Melanoma rates in the United States doubled from 1982 to 2011, according to the American Academy of Dermatology. While it's still more commonly diagnosed in middle and older age, rates are also rising among young people, Venna said.

Sun Safety: Plan Ahead to Protect Your Skin

When you're out on the field day after day, you can't avoid the sun. Luckily, you can protect your skin from damage:

  • Cover up with right type of clothing: Many people believe that clothing keeps out the sun's damaging rays, according to Venna. In fact, a surprising amount of ultraviolet light can penetrate T-shirts and other clothing. "You can actually get a sunburn through a T-shirt," Venna says. Look for workout gear that has an ultraviolet protection factor (UPF) built in.
  • Apply sunscreen often: Venna recommends sunscreen with a sun protection factor (SPF) of 50 or more. And don't forget lip balm with SPF, he adds. Slather sunscreen on all exposed skin, and reapply every 2 hours, or every 90 minutes if you're sweating a lot. Don't wait until your nose is pink to grab your sunscreen, Venna said. "Redness is a sign of stress response in your skin. If your skin looks red, it's already getting damaged." Still, he adds, it's never too late to apply sunscreen.
  • Know your options: Physical sunscreens, which contain zinc or titanium, form a physical barrier against UV rays. They start working as soon as you apply them, but they can be thick and hard to rub in. Chemical sunscreens are easier to apply, but they have to react with your skin in order to work - a reaction that can take up to 20 minutes, Venna said. If you opt for chemical protection, put it on 20 to 30 minutes before you hit the field.
  • Keep it fresh: Toss the crusty old bottles and make sure your sunscreen hasn't expired.
  • Don't go for tan: It's a common misconception that tanning can protect skin from sunburn and sun damage. Think again, Venna said. "There's no such thing as a safe tan."
  • Keep your appearance in mind: Sun exposure accelerates the aging of your skin. If melanoma risk is not enough to keep you motivated, let your appearance be your guide.  

ABCDE: Warning Signs of Melanoma

Untreated, melanoma can spread through the body and eventually become life-threatening. The sooner you spot it, the better the odds of a good outcome.

"If [a cancerous mole is] caught early, treatment can be a simple outpatient procedure," Venna said. "But if melanoma is not identified in early stages, the patient is faced with some tough decisions about treatment."

Cancerous moles and skin lesions most commonly appear on the upper back, torso, lower legs, head and neck. Remember these warning signs to spot problems early:

  • (A)symmetry: One half of the mole doesn't match the other half.
  • (B)order: The mole has an irregular border with ragged, notched or blurred edges.
  • (C)olor: Moles that are not uniform in color, with a mottled appearance or different shades of brown, black, red, white or blue.
  • (D)iameter: Moles that are greater than 6 millimeters are more likely to be problematic, though melanomas can be smaller.
  • (E)volving: Moles or skin lesions that look different from the others or change in shape, size and color.

You practice hard and play hard -- but with a bit of planning, reducing your risk of skin cancer can be one of the easiest things you do each day.

For more information or to make an appointment, call 703-970-6430 or visit Inova Melanoma and Skin Cancer Center.

 

Washington Nationals

What UCL injuries can do to a baseball career

MLB.com

For a pitcher, an arm injury can be devastating. That's why it's worrisome that the elbow condition known as ulnar collateral ligament (UCL) injury is on the rise for pitchers of all ages.

"There's been a pretty steady increase in the number of UCL injuries diagnosed and treated over the last 10 years or so. We're seeing this as more and more of a problem, for both younger pitchers and professionals," said Robert Najarian, MD, a Washington Nationals team physician and a member of the Inova Sports Medicine Team.

For a pitcher, an arm injury can be devastating. That's why it's worrisome that the elbow condition known as ulnar collateral ligament (UCL) injury is on the rise for pitchers of all ages.

"There's been a pretty steady increase in the number of UCL injuries diagnosed and treated over the last 10 years or so. We're seeing this as more and more of a problem, for both younger pitchers and professionals," said Robert Najarian, MD, a Washington Nationals team physician and a member of the Inova Sports Medicine Team.

Inova Sports Medicine is responsible for the medical care of all the Nationals players in conjunction with the Nationals medical staff -- a perfect match due to both organizations' comprehensive care and focus on injury prevention.

Bigger and Faster

Why are UCL injuries on the rise? "The nature of the game has changed. Players have gotten bigger and stronger. They're pitching with more velocity, and putting more stress on the elbow," Najarian said.

On top of that, pitchers are starting at younger ages, and are more likely to pitch year-round, he added. "Perhaps we are now seeing the cumulative effects of all this excessive pitching from youth and high school baseball players," he said.

And excessive pitching puts the ulnar collateral ligament at risk. The ligament stretches from bone to bone across the inner part of the elbow joint. The act of throwing strains the ligament, Najarian said.

For pitchers hurling ball after ball, day after day, that strain can be significant. "That side of the elbow never sees excessive force in day-to-day use," he said. "During pitching, there are tremendous forces that this ligament is not used to."

If a player has poor pitching mechanics, or doesn't give the arm adequate rest, the ligament can become stretched or even torn over time. 

Tommy John Surgery

Wear-and-tear to the UCL can improve with time and rest. But many pitchers -- especially at the elite level -- find themselves facing UCL reconstruction, commonly called Tommy John surgery.

Recovery from this surgery can take at least a year or more. The good news is that the majority of players can return to the same level of play after recovering from a first-time Tommy John surgery, Najarian said. "Some studies show that greater than 90 percent can return to throwing at the same level, assuming they take enough time and follow the appropriate rehab protocols."

Preventing UCL Injury

Given the high stakes, preventing UCL injuries is key. Najarian recommends taking these precautions to minimize the risk:

  • Good Conditioning: Pitchers put their whole bodies into a throw, from their legs through their core and into their arm and shoulder - a sequence of muscles known as the "kinetic chain." To stay healthy, it's important to keep that whole chain in good condition, from head to toe, Najarian said.
     
  • Proper Mechanics: Youth players should focus on learning the mechanics of good pitching before worrying about speed. And all players should listen to their bodies to keep the pitching process running smoothly, Najarian said. "Injuries anywhere in the kinetic chain can cause you to overstress your arm. Don't pitch through injury - you can change mechanics and put your elbow at risk."
     
  • Rest and Recover: Pro players have a clear regimen of rest days and offseasons. But youth players often push too hard, putting themselves at risk of an overuse injury. To minimize the risk, younger players should avoid pitching multiple days in a row, and should rotate positions so they're not pitching all the time, Najarian said. And they shouldn't be playing year-round, he said. "When the season is over, you need 3 or 4 months when you're not throwing."

For more information or to make an appointment, call 703-970-6464 or visit Inova Sports Medicine.

 

Washington Nationals

Winning mindset: Sports psych & the athlete

MLB.com

For pro athletes like players on the Washington Nationals, keeping the body in top physical form is undeniably important. But there's also more to baseball than muscles and reflexes. In many ways, baseball is a mind game.

"It's been estimated for baseball that mental factors determine as much as 80 percent of the fluctuations in day-to-day performance," said Melissa Womble, Ph.D., a neuropsychologist with the Inova Sports Medicine group, the official hospital network and sports medicine partner of the Washington Nationals. The Inova Sports Medicine team offers comprehensive, personalized care for athletes at every age and activity level, with a focus on injury prevention, recovery and performance. Athletes can access this care all in one convenient location in Fairfax, Va.

For pro athletes like players on the Washington Nationals, keeping the body in top physical form is undeniably important. But there's also more to baseball than muscles and reflexes. In many ways, baseball is a mind game.

"It's been estimated for baseball that mental factors determine as much as 80 percent of the fluctuations in day-to-day performance," said Melissa Womble, Ph.D., a neuropsychologist with the Inova Sports Medicine group, the official hospital network and sports medicine partner of the Washington Nationals. The Inova Sports Medicine team offers comprehensive, personalized care for athletes at every age and activity level, with a focus on injury prevention, recovery and performance. Athletes can access this care all in one convenient location in Fairfax, Va.

Despite the importance of mental factors, amateur athletes and their coaches are often much more likely to focus on physical skills. Womble added, "Unfortunately, sport psychology services are underutilized mostly due to lack of knowledge."

Luckily, Womble and other sport psychologists are experts in preparing athletes -- both pros and amateurs -- for competitive success as well as overcoming psychological obstacles that may be detrimental to their performance.

Mental toughness

Picture a player in the last inning of a long, tough game. He or she might be mentally counting statistics, experiencing negative thoughts or watching what the coach is doing. He or she might also be worried about disappointing teammates or fans, or dwelling on a mistake made a few minutes before. On top of that, there's the fatigue, especially after a long, draining baseball season.

"Sport psychologists can teach skills to help players stay in the moment," Womble said. "We commonly work on maintaining concentration, enhancing confidence and maintaining composure -- that mental toughness piece that refers to an athlete's ability to play at or close to their best regardless of internal or external circumstances."

But seeing a sport psychologist doesn't mean the athlete isn't tough enough. Rather, sport psychology is designed to give athletes better skills to perform consistently and ultimately succeed.

"We all know that physical skills need to be regularly practiced and refined. But psychological skills also have to be worked on regularly," Womble said.

Tools for success

Sport psychologists such as Womble teach athletes concrete skills and techniques to improve their games. Those skills cover a range of areas, including:

  • Mental imagery: Sport psychologists often help athletes develop mental "scripts" of their perfect game that they can rehearse in their mind.
     
  • Perspective: Athletes can discuss their ideas of success and failure with a sport psychologist to help them better understand motivating factors and ways to put minor setbacks into perspective.
     
  • Anxiety and negativity: It's not uncommon for athletes to suffer anxiety about their performances or to dwell on mistakes. Womble recalls working with a golfer who would become frustrated by his errors and lose focus during tournaments. "By learning to control his thoughts and anxieties, he went on to be very successful at the pro level," she said.
     
  • Relationships and communication: Tensions with coaches, teammates or even friends and family members can get in the way of playing well. Psychologists can help athletes work through these internal circumstances. For example, Womble recalls working with a runner who was struggling with performance during races because of her coach's comments while running. Womble taught the runner tools to restructure her negative thought processes, and she also helped the coach learn ways to incorporate positive motivation when offering feedback. 
     
  • Injury recovery. Coping with an injury, whether it be a concussion or an orthopedic injury, can be stressful for athletes who are eager to get back in the game. And athletes who have been injured, such as those who have been sidelined with a concussion, can sometimes be nervous to return to play. That hesitancy can put them at risk for more injuries, Womble said. Sport psychologists work to help athletes regain their confidence to play at the top of their game. They can also assist athletes in the process of coping with injury by educating the athlete about the recovery process, teaching specific psychological coping skills, preparing the athlete to appropriately cope with setbacks in rehabilitation and fostering social support during the process.

The healthcare professionals at Inova Sports Medicine are dedicated to helping athletes at any level improve their game.

For more information or to make an appointment, call 703-970-6464 or visit Inova Sports Medicine.

 

Washington Nationals

Fuel your body: Eat right to play your best

Sponsor content produced by Inova Sports Medicine @InovaHealth

Pro athletes know the importance of eating right. But amateur athletes, too, could up their game by improving their diet.

"Nutrition is an important part of performance at any level of play," said Dr. Peter MacArthur, a primary care physician and part of the Inova Sports Medicine Team, the official hospital network and sports medicine partner of the Washington Nationals.

Pro athletes know the importance of eating right. But amateur athletes, too, could up their game by improving their diet.

"Nutrition is an important part of performance at any level of play," said Dr. Peter MacArthur, a primary care physician and part of the Inova Sports Medicine Team, the official hospital network and sports medicine partner of the Washington Nationals.

"Nutrition is your fuel, just like gas in a car," MacArthur said. "If you don't have fuel, you won't have the energy to compete."

Here, MacArthur offers advice on fueling your body for high-octane performance:

Basic and balanced
Athletes benefit from the same basic principles of good nutrition that apply to everyone, MacArthur said -- namely, a balanced diet rich in whole-grain carbohydrates, lean proteins, healthy fats, dairy, fruits and vegetables.

Such time-tested diets aren't flashy (or surprising), but unlike the latest fad diets, they have good evidence to back them up, according to MacArthur. And while products such as sports drinks and protein powders can be beneficial, they're less important overall than a balanced diet.

"Focusing on the basic principles of good nutrition is the best way to go," MacArthur said.

Timing is everything
While a balanced diet is pivotal, some food choices are better than others at different times during an activity. Athletes of any age, skill level or sport can benefit from some strategic snack planning.

"Timing is really important," MacArthur said.

• Pregame: About three to four hours before physical activity, eat something high in carbs and protein to fuel your body for the long haul, MacArthur advised. But avoid foods high in fiber and fat, which can cause stomach upset and make you feel sluggish on the field. If you need a snack less than three hours before game time, choose something light and easy to digest, such as a banana or a sports drink.

• In-game: If you're an endurance athlete or if your game goes on for longer than 90 minutes, you should refuel with easy-to-digest carbohydrates. Grab an orange or a sports drink or gel to keep your energy from fading.

• Postgame: After exerting yourself, replace the calories you burned with a balance of carbohydrates and lean proteins.

"Milk is a great option for postgame refueling," MacArthur said.

Don't forget to drink
Staying hydrated is also critical for athletes, especially when working out in hot weather. Severe dehydration can have serious consequences, including problems regulating body temperature, which can lead to heat stroke and even death.

"But," as MacArthur noted, "even mild dehydration can negatively impact athletic performance," causing problems, such as fatigue, cramps, reduced strength and reduced endurance capacity.

To play at your peak, start drinking water several hours before physical activity and keep it up during exercise and afterward, too.

"Usually, water is adequate -- especially for kids," MacArthur said. "But if you're exercising more than 60 minutes, sports drinks can be beneficial."

Helping you play your best
The Inova Sports Medicine team is dedicated to helping athletes at all levels play their best. Nutrition is one important piece of that puzzle.

 

Washington Nationals

Youth sports prep guide: 7 tips for a stellar season

MLB.com

As the official hospital network and sports medicine partner of the Washington Nationals, the Inova Sports Medicine team is responsible for the medical care of all Nationals players, working in conjunction with the Nationals medical staff. But youth athletes also count on Inova's comprehensive, personalized care.

Sports injuries can be devastating for any athlete, even young players. The best way to avoid those painful disappointments? Good preparation, says Chris Young, Director of Athletic Training Services and Outreach at Inova Sports Medicine.

As the official hospital network and sports medicine partner of the Washington Nationals, the Inova Sports Medicine team is responsible for the medical care of all Nationals players, working in conjunction with the Nationals medical staff. But youth athletes also count on Inova's comprehensive, personalized care.

Sports injuries can be devastating for any athlete, even young players. The best way to avoid those painful disappointments? Good preparation, says Chris Young, Director of Athletic Training Services and Outreach at Inova Sports Medicine.

In fact, Young offers these seven tips if you want to help your sports-loving child prepare for a healthy, injury-free season:

1. Get set. Part of being prepared is using the right equipment and making sure it's in good condition, Young says. Don't rely on gear that's falling apart or that has been collecting dust in the garage for longer than you can remember.

2. Warm up. It's not unusual for kids to show up five minutes before a game ready to jump right in, says Young. "Skipping a warm-up can affect an athlete's performance," he says. Worse, it can put them at risk of injury. Have your young athlete warm up for 15 to 20 minutes before an event, he suggests.

3. Use the offseason wisely. When working with pro baseball players at the start of the season, "they'll be the first to tell you how important their offseason conditioning program is to their in-season performance," Young says. It's equally important for youth athletes to stay in shape year-round to reduce the risk of injuries when their season starts up. "Some of those who get hurt often didn't take care of their bodies in the offseason," he says.

4. Try cross-training. Playing a single sport all year long can put kids at risk of developing overuse injuries, caused by using the same sets of muscles all the time. A better bet is to cross-train, playing complementary sports that utilize similar skills and movements. A baseball player, for example, could benefit from playing lacrosse or soccer, or by swimming in the offseason. "Cross-training is a big part of injury prevention," Young says.

5. Don't specialize too soon. There's a lot of pressure on many young athletes to specialize early, focusing all their energy into a single sport and even a single position. But it pays to wait, Young says. Such a single-minded focus puts kids at risk of overuse injuries and also makes them more likely to burn out on the sport long before they reach the Big Leagues. "Nolan Ryan didn't start pitching until he was well into his teenage years," Young points out.

6. Eat right. Good nutrition is an important part of keeping an athlete's body in top form. When kids are traveling for games or tournaments, though, it can be all too easy to resort to junk food while on the road. "Fueling bodies properly is so important," Young says. "Parents should try to instill good habits early."

7. Listen carefully. In his work with youth, Young stresses the importance of being honest when something is wrong. But it's equally important for coaches and parents to listen to what their players are telling them. If your child complains that something hurts, pay attention. Instead of worrying about the outcome of a single game, focus on the long-term, he says. "Think big-picture. Disregarding injuries can be detrimental to the athlete's overall success."

For more information or to make an appointment, call 703-970-6464 or visit Inova Sports Medicine.

 

Washington Nationals

Preventing injuries: From pros to youth leagues

MLB.com

Baseball is a very safe sport. Still, like all sports, it carries some risk of injury. Fortunately, there's a lot that players, parents, trainers and coaches can do to minimize the risk. Whether you're a professional player or a young person still dreaming of breaking into the big leagues, knowledge is key for preventing injuries.

Injuries from overuse
Sudden injuries -- getting hit with a fastball, twisting a knee on a slide into home -- can strike at any time. "But the majority of baseball injuries are what we call overuse injuries, which are injuries resulting from repetitive but typical athletic movements that occur over time," says Robert Najarian, MD, a Washington Nationals Team Physician and part of the Inova Sports Medicine Team. In fact, Inova Sports Medicine is responsible for the medical care of all the Nationals players in conjunction with the Nationals medical staff. This has been a perfect match due to both organizations' comprehensive care and focus on injury prevention.

Baseball is a very safe sport. Still, like all sports, it carries some risk of injury. Fortunately, there's a lot that players, parents, trainers and coaches can do to minimize the risk. Whether you're a professional player or a young person still dreaming of breaking into the big leagues, knowledge is key for preventing injuries.

Injuries from overuse
Sudden injuries -- getting hit with a fastball, twisting a knee on a slide into home -- can strike at any time. "But the majority of baseball injuries are what we call overuse injuries, which are injuries resulting from repetitive but typical athletic movements that occur over time," says Robert Najarian, MD, a Washington Nationals Team Physician and part of the Inova Sports Medicine Team. In fact, Inova Sports Medicine is responsible for the medical care of all the Nationals players in conjunction with the Nationals medical staff. This has been a perfect match due to both organizations' comprehensive care and focus on injury prevention.

The Inova Sports Medicine team's approach to care extends well beyond the professional athletes they treat to their other patients, too, from the weekend warrior to the youth league player. Naturally, Dr. Najarian has seen the full spectrum of overuse injuries. And while they can affect any player, he says pitchers are especially susceptible to overuse injuries of the shoulder, elbow and wrist. "Pitchers sustain the majority of overuse injuries, both among amateurs and professionals," Dr. Najarian says.

The first signs of these injuries might be subtle: A pitcher might notice his speed or accuracy is a little bit off. He or she might start to have mild pain. Those are signs that shouldn't be ignored.

Dr. Najarian and the Inova team treat overuse injuries with rest, physical therapy and applicable medications. With the right treatment, a player can often get back in the game in a short period of time. But ignoring the warning signs and playing through the pain can lead to problems that are even worse down the road, such as torn ligaments. What's more, players sometimes compensate for mild pain by slightly changing the mechanics of their pitch. That shift in form can also put them at greater risk for a sudden injury. "If you push through, sudden injuries are more likely," Dr. Najarian adds.

Preventing injuries: What the pros know
The good news is that players can take steps to reduce the risk of painful injuries that will put them on the sidelines.

Good nutrition is important for keeping the body in top form. Strength training and conditioning are also critical. Players should warm up before and stretch after a workout or game, Dr. Najarian says. And all players can take a tip from the pros, who follow stringent conditioning programs and schedules -- and for good reason. Keeping muscles and joints strong (and resting them sufficiently between workouts) is essential for preventing injuries.

It's also important to be candid about potential injuries, Dr. Najarian says. Coaches and training staff usually have a good read on their players and can often tell when something is off. By being open and honest about any concerns, players, coaches and team physicians can spot potential problems early and treat small problems before they become major issues.

Players also have to be honest with themselves if something doesn't feel right. After all, a few days of rest and physical therapy are always better than surgery and/or a season on the sidelines.

Kids and baseball: Preventing injuries in youth sports
Unfortunately, pro athletes aren't the only players susceptible to sports injuries. In fact, overuse injuries are becoming an increasing problem among younger athletes.

"There's increased pressure for kids to excel by practicing a single sport year-round," Dr. Najarian says. That's worrisome, since rest periods between seasons are so important for preventing overuse injuries. Kids should also rotate through positions, he adds, rather than focusing on perfecting their pitch year-round.

The USA Baseball Medical & Safety Advisory Committee has issued guidelines for the number and types of pitches young players should pitch per game, week, season and year. These pitch count limits help parents and coaches ensure that youth players are minimizing the odds of injury.

"Most of these injuries are preventable," Dr. Najarian says. "It's so important that parents and coaches are informed about the risks of playing too much."

For kids who dream of making it to the pros, it can sometimes be hard to put a limit on their practice schedule. But by taking care of their bodies and doing all they can to prevent injuries, players will maximize the chance of long-term success. Dr. Najarian and the rest of the Inova Sports Medicine Team are committed to helping all athletes feel and play their best. "As I often remind my young players, they won't make it to the big leagues if they burn out before the end of high school," he says. And he would know.

If you think you or your child may need an injury evaluation, make an appointment to see one of Inova's doctors or athletic trainers by calling 703-970-6464 or visiting Inova Sports Medicine.

 

Washington Nationals

Meet the Nationals' Lead Team Physician: Dr. Robin West

MLB.com

The Washington Nationals revamped their approach to treating and rehabilitating injured athletes following the 2015 season, opening the door for a new, progressive team of sports medicine experts to join the club as its official medical team.

The Nationals' overhaul of their medical staff led the club to Dr. Robin West, Chairman of Sports Medicine at Inova, who now serves as the team's Lead Team Physician. Dr. West and the Inova Sports Medicine Team are a natural fit for the Nationals as the organization focuses on comprehensive care for its players -- which is consistent with the approach Inova takes.

The Washington Nationals revamped their approach to treating and rehabilitating injured athletes following the 2015 season, opening the door for a new, progressive team of sports medicine experts to join the club as its official medical team.

The Nationals' overhaul of their medical staff led the club to Dr. Robin West, Chairman of Sports Medicine at Inova, who now serves as the team's Lead Team Physician. Dr. West and the Inova Sports Medicine Team are a natural fit for the Nationals as the organization focuses on comprehensive care for its players -- which is consistent with the approach Inova takes.

What are your day-to-day responsibilities with the Nationals organization?
As Lead Team Physician, there are three key elements that define my day-to-day responsibilities with the Nationals. The first is accessibility, 24 hours a day, 7 days a week and 365 days of the year. If the team needs me, I am available to evaluate injuries, order tests, organize specialists and activate the appropriate plan to get the athlete treated, healthy and back in the game. The second quality is affability. It's very important that I get along well and work collaboratively with every member of the medical team. This ensures we're all on the same page regarding each of our responsibilities and what the injured athlete needs to return to play as quickly and safely as possible. The last quality is ability. As the Lead Team Physician for any professional sports organization, you must have a high level of skill and expertise to ensure you're treating any professional athlete with the absolute best care available.

Can you tell us about your experience and the career path you followed to get here?
It's a long road to become a team physician. You have to go through high school, four years of college, four years of medical school, and then on to training. I'm an orthopedic surgeon so I did five years of orthopedic surgery residency, and one additional year of sports medicine specialty training at the University of Pittsburgh. To be a team physician for a professional team, you must be board-certified in orthopedic surgery as well as board-certified in sports medicine. After my training, I worked at UPMC for 12 years, where I served as a team physician for the University of Pittsburgh, Carnegie Mellon University and the Pittsburgh Steelers.

Point of Interest: Dr. West is one of only a few female lead team physicians in the sports medicine industry. Among her long list of accolades and experiences, Dr. West has two Super Bowl rings she keeps locked away safely at home, mementos of her time taking care of the Steelers organization.

Can you tell us more about Inova Sports Medicine and why your organization was the right fit for partnership with the Nationals?
Because of our focus on comprehensive care and injury prevention, Inova Sports Medicine has been a natural fit for the needs of the Nationals. Inova Sports Medicine is a comprehensive program that includes a one-stop shop for athletes of all ages and abilities. We have, under one roof, the specialists that any athlete needs to rehabilitate quickly and safely and get back to play as soon as possible. At Inova Sports Medicine, our team includes athletic trainers, physical therapists, neuropsychologists, primary care physicians, orthopedic surgeons and sports performance specialists. We are all fellowship trained in sports medicine, giving us the necessary education and experience any athlete of any ability should expect of their team of doctors for injury care and rehabilitation.

Do you treat the Nationals' professional players any differently than you treat the everyday athlete?
That is a great question and one that I'm asked often. No, I do not treat any one athlete different than another, regardless of ability. If you're a Washington Nationals professional player or an average everyday athlete visiting Inova Sports Medicine, the time you spend with me and our staff will be very similar. We will offer the same customized care options, specific to the needs of the individual we are treating. The main difference between the care of a professional athlete and the care of an everyday athlete is the urgency surrounding an injury and the length of time to get that professional athlete back to play, quickly and safely. We have the same goal at Inova Sports Medicine for every athlete that we treat. However, professional athletes are paid to play, which means they have resources available to them, 24 hours a day and 7 days a week that most amateur athletes do not. Nationals players have a team of specialists employed by the organization solely focused on treating an injured player and rehabbing them as quickly as they possibly can to get that player back on the field and working.

Can you talk about baseball injuries that are common to the sport, regardless of the level of play?
The Washington Nationals organization puts a lot of emphasis on injury prevention. It's a core strategy in the care of our athletes but regardless of the preparation, injuries are still going to happen. Baseball injuries are typically overuse injuries. We don't see a lot of traumatic injuries such as those that occur on a football field, as an example. From throwing and squatting, we see a lot of overuse injuries in the elbows, the shoulders and the knees. These are the most common injuries that occur in baseball players and depending on the player and the severity of the injury, the treatment methods vary. Injuries don't always mean surgery, necessarily. We are able to evaluate injuries through MRIs, ultrasound technology and various types of testing to determine the best course of action. Yes, that could mean surgery but it also could mean non-surgical treatment such as injections under dynamic ultrasound guidance, targeted physical therapy or any other number of different treatment options depending on the athlete, the injury and the severity.

What is your favorite part of the job?
My favorite part of my job with the Nationals is the privilege of working with a fantastic medical team and providing a superior multi-disciplinary approach to injury prevention and treatment. I am so proud to have helped in building the great team at Inova Sports Medicine from the ground up. Our work with the Nationals is the favorite part of the responsibilities I share with my sports medicine team at Inova.

Are you an athlete?
Yes, I was a competitive swimmer growing up in Southern California (Santa Monica), and I still compete regularly in triathlons, marathons and all sorts of road races. I could fit into the category of "weekend warrior" but honestly, most of my weekends are spent with the Nationals! My competitive nature and focus on healthy living allows me to keep my own training and athletic capabilities a priority, regardless of how busy the other areas of my life become.

Point of Interest: Dr. West isn't your average athlete. Her competitive nature is apparent by the most recent races she competed in, including the Alcatraz Triathlon (for those who don't know, this challenge includes a 1.5 mile swim across San Francisco Bay), the Ironman 70.3 Eagleman and the DC Rock 'N Roll Half Marathon.

Who is Robin West? Can you tell us more about the person behind the doctor?
Let's see … what can I tell you? I like hard rock music and love outdoor summer concerts -- Kid Rock and Zac Brown are probably my favorites! I make great homemade pizza and would consider studying to be a chef in my next life. My favorite place to be is anywhere outdoors, especially when I'm with my family. I love spending time with my two daughters, my husband and our two dogs. And really, that's what motivates me. I work hard every day to be a strong role model for my daughters. I want them to believe they can do and be anything they set their minds to.

 

Washington Nationals

Eaton: Knee responding 'extremely well'

Outfielder talks rehab, Spring Training prep on MLB Network
MLB.com

It has been a little more than eight months since Nationals outfielder Adam Eaton tore the anterior cruciate ligament in his left knee. There are a little more than 11 weeks before Opening Day.

"I'm feeling pretty good, actually," Eaton said Tuesday morning on MLB Network. "I haven't had very favorable weather for a knee injury, I would say. It's been about negative-15 to negative-30 here in Michigan. It's been a tough go. But I think with this last two to three weeks, we're starting to run and starting to cut, and [I'm] doing what I need to do. The knee has actually responded extremely well.

It has been a little more than eight months since Nationals outfielder Adam Eaton tore the anterior cruciate ligament in his left knee. There are a little more than 11 weeks before Opening Day.

"I'm feeling pretty good, actually," Eaton said Tuesday morning on MLB Network. "I haven't had very favorable weather for a knee injury, I would say. It's been about negative-15 to negative-30 here in Michigan. It's been a tough go. But I think with this last two to three weeks, we're starting to run and starting to cut, and [I'm] doing what I need to do. The knee has actually responded extremely well.

"We've still got another three months until Opening Day. I know Spring Training is right around the corner, but once you get five-plus years, you kind of understand what it takes to get ready. That's the way we're taking it and looking at it. [I'll play] as many games as I need in Spring Training to try to get ready, but once the lights come on, there's no holding back and you've got to be ready to play."

Eaton, 29, was hitting .297 with an .854 OPS in 107 plate appearances before the injury. He is expected to open the season as the Nats' starter in left field.

"I think we're on a great schedule," Eaton said.

Todd Zolecki is a reporter for MLB.com. Follow him on Twitter.

 

Washington Nationals, Adam Eaton

Rizzo: Murphy on track for Opening Day

MLB.com

LAKE BUENA VISTA, Fla. -- It's been nearly two months since the Nationals announced second baseman Daniel Murphy underwent debridement and microfracture surgery on his right knee, and the club's optimism about his status has continued to increase.

On Wednesday, general manager Mike Rizzo said Murphy is on track to be ready for Opening Day, his strongest statement yet about Murphy's status.

LAKE BUENA VISTA, Fla. -- It's been nearly two months since the Nationals announced second baseman Daniel Murphy underwent debridement and microfracture surgery on his right knee, and the club's optimism about his status has continued to increase.

On Wednesday, general manager Mike Rizzo said Murphy is on track to be ready for Opening Day, his strongest statement yet about Murphy's status.

"I think that his rehab is coming along very well," Rizzo said. "He's doing well. He's progressing at a good rate. We still feel that our target date of Opening Day, he'll be ready to play."

Murphy never landed on the disabled list for the knee injury, but the Nats have acknowledged that he played through it for part of the second half of the season. His overall numbers were solid, but at times it appeared he did not have the same power as he did earlier in the year. Murphy will be at the Nationals' WinterFest this weekend.

There has been some uncertainty about Murphy's status because that sort of knee surgery is a bit unusual for a baseball player. Justin Turner had a similar operation after the 2013 campaign and went on to play more than 100 games and bat .340 for the Dodgers the following season. There aren't many other comparisons to gauge a true timeline for Murphy.

However, Rizzo's optimism is an encouraging sign for the Nationals, who have maintained that Murphy's status would not affect their offseason plans. They were comfortable with Wilmer Difo as a capable backup, but also maintained they were not concerned about Murphy missing an extended period of time. Despite the unusual nature of the injury, Rizzo said it did not complicate the Nats' estimates for Murphy's rehab timetable.

"I don't think so," Rizzo said. "I think that you have the [comparisons] and past surgeries of athletes, and I think we're kind of using that as our gauge."

Jamal Collier covers the Nationals for MLB.com. Follow him on Twitter at @jamalcollier.

 

Washington Nationals, Daniel Murphy

Nats optimistic about Murphy, but have options

Club sees Difo as possible fill-in if second baseman isn't ready for Opening Day
MLB.com

WASHINGTON -- The Nationals remain optimistic about second baseman Daniel Murphy's status for Opening Day after he underwent debridement and microfracture knee surgery on his right knee on Oct. 20, even though it is still a bit early on to tell.

The uncertainty around Murphy, however, will not impact the Nationals' offseason plans. Even if they do not think Murphy will be ready for Opening Day or rehabbing his right knee takes longer than predicted, the club is not expected to chase after another second baseman or middle infielder to serve as his backup.

WASHINGTON -- The Nationals remain optimistic about second baseman Daniel Murphy's status for Opening Day after he underwent debridement and microfracture knee surgery on his right knee on Oct. 20, even though it is still a bit early on to tell.

The uncertainty around Murphy, however, will not impact the Nationals' offseason plans. Even if they do not think Murphy will be ready for Opening Day or rehabbing his right knee takes longer than predicted, the club is not expected to chase after another second baseman or middle infielder to serve as his backup.

A major reason for that is the team's comfort level in Wilmer Difo, who they believe took huge strides in showing that he is Major League ready in 2017. His overall numbers look a bit unspectacular, outside of a .271 batting average, but Difo demonstrated what he is capable of during a two-month stretch in July and August when he had the chance to play every day. After Trea Turner fractured his right wrist, Difo emerged as the Nats' replacement at shortstop.

Difo played in 50 games for those two months combined and made 44 starts, compiling a slash line of .343/.389/.483 with four home runs and seven stolen bases. He was spectacular all season at defense, accumulating 14 defensive runs saved at shortstop in 2017. All are reasons the Nationals believe Difo can handle filling in for Murphy if necessary. Some members of the Nats were also impressed with what they saw from infielder Adrian Sanchez in his first Major League stint and believe he could play a role as a reserve in Washington next season.

That does not mean the Nationals should be completely ruled out from making a push to re-sign a player such as Howie Kendrick, but perhaps Kendrick could get more guaranteed playing time elsewhere.

From his conversations with Murphy in the weeks after his surgery, general manager Mike Rizzo remains hopeful that Murphy will be able to make a full recovery and be ready to start the season on time or shortly thereafter. And the Nationals feel they already have some solid insurance on the roster just in case.

Jamal Collier covers the Nationals for MLB.com. Follow him on Twitter at @jamalcollier.

 

Washington Nationals

Nats, Murphy optimistic he'll be ready for 2018

MLB.com

WASHINGTON -- Nationals general manager and president of baseball operations Mike Rizzo said the team is optimistic that Daniel Murphy will be ready for Opening Day after the second baseman underwent successful surgery last month to repair the articular cartilage in his right knee.

"That's me telling you that on Nov. 2," Rizzo said. "I've been in contact with him on several subjects. He's feeling good. He's moving around. And he feels optimistic that he'll be ready, so that makes me feel optimistic."

WASHINGTON -- Nationals general manager and president of baseball operations Mike Rizzo said the team is optimistic that Daniel Murphy will be ready for Opening Day after the second baseman underwent successful surgery last month to repair the articular cartilage in his right knee.

"That's me telling you that on Nov. 2," Rizzo said. "I've been in contact with him on several subjects. He's feeling good. He's moving around. And he feels optimistic that he'll be ready, so that makes me feel optimistic."

Murphy had debridement and microfracture surgery performed by Dr. Timothy Kremchek, an orthopedic surgeon in Ohio, following the 2017 season, in which he posted a slash line of .322/.384/.543 with 23 home runs in his second straight All-Star campaign since joining the Nationals.

However, near the end of the year, it appeared that Murphy looked a little bit off, and although the injury never forced him to the disabled list, Rizzo acknowledged it was hampering Murphy down the stretch.

"It wasn't to the point where it was debilitating, but he wasn't himself," Rizzo said. "I don't want to put a kind of percentage on it, but this game is hard enough to play when you're feeling good and your body is reacting well. Suffice to say, he grinded through it. We needed him in the lineup and he played."

For reference, Dodgers third baseman Justin Turner had a similar surgery after the 2013 season and then went on to play more than 100 games and hit .340 in '14.

Jamal Collier covers the Nationals for MLB.com. Follow him on Twitter @jamalcollier.

 

Washington Nationals, Daniel Murphy

Scherzer's slot in NLDS rotation TBD

MLB.com

WASHINGTON -- The Nationals are still trying to determine the remaining order for their rotation in the National League Division Series presented by T-Mobile after officially naming Stephen Strasburg the starter for tonight's Game 1 against the Cubs.

• NLDS Game 1: Tonight, 7:30 p.m. ET on TBS

WASHINGTON -- The Nationals are still trying to determine the remaining order for their rotation in the National League Division Series presented by T-Mobile after officially naming Stephen Strasburg the starter for tonight's Game 1 against the Cubs.

• NLDS Game 1: Tonight, 7:30 p.m. ET on TBS

The health of Max Scherzer, who is dealing with a right hamstring injury, will be the deciding factor in how he and Gio Gonzalez line up for Games 2 and 3. Scherzer did not throw a bullpen session on Thursday afternoon, but Gonzalez did throw off the mound, which would almost certainly line Gonzalez up to start Saturday's Game 2 and Scherzer to be pushed back to Monday's Game 3.

:: NLDS schedule and coverage ::

The Nationals have said Scherzer was scheduled to test his hamstring injury off a mound for each of the past two days; however, both times he has played catch in the outfield on flat ground. Scherzer has been puzzled by his hamstring issue, which he says does not bother him running or doing any other activity other than pushing off a mound. But he has not thrown a bullpen session the past few days.

"When you have a nagging injury, every day is important for our trainers to evaluate it, put hands on him, and see if he's still sore or if he's feeling great," Nationals manager Dusty Baker said.

Although the Nationals have Strasburg to fill in the gap for Game 1, losing the ability to pitch Scherzer twice in the series is a blow. Scherzer is a leading candidate for the NL Cy Young Award after going 16-6 with a 2.51 ERA and an NL-leading 268 strikeouts. He has been one of the best pitchers in the Majors over the past few seasons.

Ideally, Washington would have Scherzer throw one of the first two games to ensure he could pitch in a potential Game 5, but Baker said his health will still be the No. 1 priority.

"We realize that if [Scherzer] pitched Game 2, he could probably pitch Game 5 if necessary," Baker said. "We realize that, but is that worth taking a chance? And if you get past the first round, then are you jeopardizing the second round? So you have to kind of weigh both. But you know, the health of Max -- I think -- is number one."

Robles makes postseason roster; Goodwin says he's healthy

Victor Robles, the Nationals' top prospect, has made the team's postseason roster, a source told MLB.com Thursday, bringing his exciting speed to the team's bench. Robles, the No. 2 prospect in MLB as rated by MLBPipeline.com, played in 13 games for Washington as a September callup, which was enough to impress.

His two triples this season were two of the three fastest triples by a Nationals player ever recorded by Statcast™. His inclusion on the roster is unlikely to affect outfielder Brian Goodwin (groin strain), who says he feels healthy after playing instructional league games for a week at the team's complex in West Palm Beach, Fla.

Video: WSH@NYM: Statcast™ tracks Robles' two-run triple

Goodwin participated in baserunning and fielding drills and got controlled at-bats against Minor League pitching.

"I think I'm in a good place," Goodwin said. "I got a chance to get a ton of at-bats [against] a lot of pitchers down there working on stuff trying to get better. I got the opportunity to go down there and see a lot of it and work with a lot of it, so I think my timing is where I want it to be, where I would expect it to be."

Now the Nationals must determine if Goodwin, who has not played a game in the Majors since Aug. 13, has shown enough to make their postseason bench. He hit .251 with 13 homers and 30 RBIs in 251 at-bats.

"He's been great for us this season," Nationals general manager Mike Rizzo said. "He's a guy that if he's healthy and ready, we'd like to see him on the roster."

Video: MIA@WSH: Goodwin smashes a go-ahead homer to right

Flexibility out of the bullpen

As Nationals right-hander Brandon Kintzler prepares for his first career postseason series, he has taken note of the different ways relievers have been used in October, particularly in the past few years. He brought up how David Robertson threw 50 pitches in his longest career outing in the Yankees' victory over the Twins in the American League Wild Card Game.

Video: WSH@NYM: Kintzler locks the Nats' win on 29th save

Kintzler said he plans to have a conversation with Baker or pitching coach Mike Maddux about when they plan to use him in games, so he can prepare. Washington has used Kintzler along with Ryan Madson and Sean Doolittle to close out the end of games over the final three innings; however, Kintzler said he would be open to coming into the game earlier if the situation called for it.

"I mean, why not? I'm here to win," Kintzler said. "I think we got traded for these situations."

Jamal Collier covers the Nationals for MLB.com. Follow him on Twitter at @jamalcollier.

 

Washington Nationals, Max Scherzer