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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

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

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

Strasburg to come off DL, start in key series

Righty will face Phillies on Wednesday; Herrera, Doolittle making progress
MLB.com

WASHINGTON -- With a crucial series against the Phillies beginning next week, the Nationals have aligned their rotation for their three best starting pitchers to be on the mound for that series, including Stephen Strasburg, who will return from the disabled list on Wednesday.

Strasburg's return will be sandwiched around Tanner Roark, who will start Tuesday night, and Max Scherzer, who will take the ball Thursday. It will be Strasburg's first start in the Majors since July 20, after he landed on the DL with a pinched nerve in his neck.

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WASHINGTON -- With a crucial series against the Phillies beginning next week, the Nationals have aligned their rotation for their three best starting pitchers to be on the mound for that series, including Stephen Strasburg, who will return from the disabled list on Wednesday.

Strasburg's return will be sandwiched around Tanner Roark, who will start Tuesday night, and Max Scherzer, who will take the ball Thursday. It will be Strasburg's first start in the Majors since July 20, after he landed on the DL with a pinched nerve in his neck.

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Video: WSH@MIA: Nats' booth on Strasburg going on the DL

"Credit to Stras that he got himself ready to pitch for us, and got the opportunity to go up against a team we're trying to catch," manager Dave Martinez said. "He's been working diligently to get ready and he feels good. It's nice to go into that series with our three best pitchers."

Strasburg threw a simulated game on Wednesday in St. Louis, extending himself to about 70 pitches in a little more than four innings. After passing that test and throwing a bullpen on Saturday, the Nats determined he will not need a Minor League rehab assignment in order to build stamina.

Martinez did not commit to any pitch count restrictions for Strasburg on Wednesday, even though he has only made one start -- on July 20 against the Braves -- since he first landed on the DL on June 10. A shoulder injury and the neck injury have limited Strasburg to just 14 starts this season, in which he has posted a 3.90 ERA.

"We'll see how the game goes," Martinez said. "See where he's at with high leverage situations and stuff like that. If he's up there in pitches we got to be careful, but he feels good and he says he's ready.

Worth noting
• Martinez said he was hopeful Kelvin Herrera would be healthy enough to be activated from the DL during the three-game series with the Phillies starting Tuesday.

Sean Doolittle felt "OK, not great, but OK" after testing his foot during a bullpen session last week. He had been altering his mechanics to be able to throw, but the Nats will want the stress reaction in his left foot to be completely healed before he returns to the mound.

Jamal Collier has covered the Nationals for MLB.com since 2016. Follow him on Twitter at @jamalcollier.

Washington Nationals, Sean Doolittle, Kelvin Herrera, Stephen Strasburg

X-rays on Hellickson's wrist negative after fall

MLB.com

ST. LOUIS -- Jeremy Hellickson feared the worst when he injured his right wrist trying to break his fall in the fifth inning of Wednesday's 4-2 loss to the Cardinals. With Harrison Bader trying to score from third on a wild pitch, Spencer Kieboom's throw to Hellickson covering home plate was high and as Bader slid at the plate, Hellickson attempted to jump over him and tumbled to the ground, using his hand to break the fall.

Although he tried to toss a few warmup pitches, Hellickson had trouble gripping the ball and was removed from the game. X-rays on his wrist were negative, but he was still sore after the game.

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ST. LOUIS -- Jeremy Hellickson feared the worst when he injured his right wrist trying to break his fall in the fifth inning of Wednesday's 4-2 loss to the Cardinals. With Harrison Bader trying to score from third on a wild pitch, Spencer Kieboom's throw to Hellickson covering home plate was high and as Bader slid at the plate, Hellickson attempted to jump over him and tumbled to the ground, using his hand to break the fall.

Although he tried to toss a few warmup pitches, Hellickson had trouble gripping the ball and was removed from the game. X-rays on his wrist were negative, but he was still sore after the game.

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"When I went down, I thought it was going to be a lot worse," Hellickson said. "Really sore on the pinky ring side of my hand. Little tingly. Tough to squeeze and grip. I think I got kind of lucky, wasn't as bad as I initially thought."

After Hellickson left the game, Wander Suero came on in relief and allowed his first inherited runner to score all season when he gave up a single to Yadier Molina. Hellickson was charged with three runs in 4 1/3 innings with two strikeouts and two walks.

Injuries have been an issue all season for the Nationals, who fell to a game under .500 and a season-high nine games out of first place with Wednesday's loss. Although they were relieved Hellickson avoided the worst, manager Dave Martinez said they will make a decision on a potential DL stint Thursday.

"It was one of those freak plays," Martinez said. "When I saw him land, I actually thought it looked a lot worse than the outcome. I thought he broke his wrist, but hopefully he's OK."

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

Washington Nationals, Jeremy Hellickson

Rendon should return to lineup in St. Louis

MLB.com

CHICAGO -- Anthony Rendon was out of the Nationals' starting lineup for Sunday's series finale against the Cubs, missing his second straight start after being hit on the wrist with a pitch during Friday's game. The Nats diagnosed Rendon with a left wrist contusion. X-rays were negative, but he still feels some discomfort when swinging a bat.

Fielding grounders at third base is not an issue for Rendon, but taking four plate appearances might put too much pressure on his wrist, said manager Dave Martinez. Rendon will be available off the bench with the hope he can return to the starting lineup on Monday against the Cardinals in St. Louis.

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CHICAGO -- Anthony Rendon was out of the Nationals' starting lineup for Sunday's series finale against the Cubs, missing his second straight start after being hit on the wrist with a pitch during Friday's game. The Nats diagnosed Rendon with a left wrist contusion. X-rays were negative, but he still feels some discomfort when swinging a bat.

Fielding grounders at third base is not an issue for Rendon, but taking four plate appearances might put too much pressure on his wrist, said manager Dave Martinez. Rendon will be available off the bench with the hope he can return to the starting lineup on Monday against the Cardinals in St. Louis.

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"He swung yesterday, but it's just sore," Martinez said. "We'll see if we need him. He's definitely available to play defense, but throughout the day, he's going to take his swings."

Rendon was plunked in the first inning on Friday, but he played the remainder of the game. Each time he swung and missed, he felt some pain in the wrist, and Martinez thought it was best not to risk further injury.

Rendon has been one of the Nats' most consistent hitters this season. He's played in 91 games and posted an .851 OPS with 16 home runs. Mark Reynolds started at third base in his place.

Doolittle could throw off mound soon
Sean Doolittle felt encouraged after simulating his throwing motion on Sunday afternoon off a mound, testing to see how the stress reaction in his left foot would feel. He could throw off a mound as soon as Monday, which would be his first time doing so since landing on the disabled list last month.

"I know it's baby steps, but it's progress," Doolittle said. "You string enough good days along, string enough good mornings along, and you start to make some progress. The last two or three days have been really really good, so I'm starting to feel really optimistic."

Jamal Collier has covered the Nationals for MLB.com since 2016. Follow him on Twitter at @jamalcollier.

Washington Nationals, Anthony Rendon

Herrera exits game with shoulder tightness

MLB.com

WASHINGTON -- The Nationals already have one closer on the disabled list, and they received an injury scare from another during the ninth inning of Tuesday's 3-1 loss to the Braves, when Kelvin Herrera exited the game with tightness in his right shoulder.

Herrera, who gave up the game-winning two-run triple to Ender Inciarte, will undergo an MRI on Wednesday morning.

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WASHINGTON -- The Nationals already have one closer on the disabled list, and they received an injury scare from another during the ninth inning of Tuesday's 3-1 loss to the Braves, when Kelvin Herrera exited the game with tightness in his right shoulder.

Herrera, who gave up the game-winning two-run triple to Ender Inciarte, will undergo an MRI on Wednesday morning.

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"[Herrera] didn't quite have the life that he had the last outing," catcher Matt Wieters said. "So, he called me up there and just said he wasn't feeling right. So, no reason to push it, and make sure we get it right before we get him back out there."

Pitching in the ninth inning of a tied game, Herrera yielded a pair of singles to Freddie Freeman and Nick Markakis to put himself into a jam to start the inning. Kurt Suzuki connected with a line drive, but third baseman Anthony Rendon snagged it for the first out. Then, Inciarte snuck his triple down the right-field line.

Video: ATL@WSH: Rendon saves a run with diving catch in 9th

Manager Dave Martinez saw Herrera shake his right arm after the triple, prompting him to emerge from the dugout with head athletic trainer Paul Lessard. After a brief conversation, Herrera came out of the game.

"I couldn't finish my pitches," Herrera said through an interpreter, and he added it's the first time he has ever experienced this issue. "I felt like I was aiming them instead of throwing them."

Since joining the Nationals, Herrera has had his struggles. In 19 games, he has posted a 4.76 ERA -- way up from the 1.05 ERA he posted in Kansas City to start the season -- and has given up 23 hits and walked eight in 17 innings. But Martinez said this is the first time he has complained of shoulder soreness.

The Nats cannot afford to lose Herrera for an extended period of time. Sean Doolittle is still recovering from the stress reaction in his left foot and has not been cleared to throw off a mound. The club just traded two valuable relievers in Shawn Kelley and Brandon Kintzler. Although the Nats signed Greg Holland on Tuesday, he has been far from reliable this season.

So, the Nats will await the results of Herrera's MRI, and hope they will not be without yet another arm in the bullpen.

"We'll see," Herrera said. "We've got to see the results tomorrow."

Jamal Collier has covered the Nationals for MLB.com since 2016. Follow him on Twitter at @jamalcollier.

Washington Nationals, Kelvin Herrera

Stras receives shot, could resume throwing soon

Robles, Kieboom, Garcia land on MLB Pipeline's Top 100 Prospects re-ranking
MLB.com

MIAMI -- The Nationals had good news to share about the status of Stephen Strasburg one day after the right-hander was placed on the disabled list with a pinched nerve in his neck. After traveling to Los Angeles to be examined by a neurologist, Strasburg received a shot in his neck, according to manager Dave Martinez, who was not sure exactly what kind of shot he received.

The team will now wait 72 hours for the shot to take effect, and if it alleviates the pain, Strasburg could resume a throwing program shortly thereafter.

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MIAMI -- The Nationals had good news to share about the status of Stephen Strasburg one day after the right-hander was placed on the disabled list with a pinched nerve in his neck. After traveling to Los Angeles to be examined by a neurologist, Strasburg received a shot in his neck, according to manager Dave Martinez, who was not sure exactly what kind of shot he received.

The team will now wait 72 hours for the shot to take effect, and if it alleviates the pain, Strasburg could resume a throwing program shortly thereafter.

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"I can't wait to really hone in, get him healthy and get him back," Martinez said. "We miss him. I'm not going to sit here and say that we don't need him, cause we really do. When he's back and healthy, he's going to help us win a lot of games."

Strasburg is expected to rejoin the team Saturday in Miami to continue his rehab. His return to the DL, retroactive to Sunday, came as a surprise after he complained of neck issues Wednesday. He had just missed more than a month with a shoulder inflammation, but Martinez reiterated they have found no issues with his shoulder.

That news is encouraging for the Nationals, who are still hopeful Strasburg can return from the DL quickly and help stabilize their rotation.

"I actually think it's good news," Martinez said. "We know it's not his shoulder. We know exactly what it is. Now it's just getting him better and getting him right. He's one of the best in baseball. We miss him and we need him. But I want him totally healthy and ready to go."

Martinez also announced left-hander Tommy Milone will remain in the rotation in Strasburg's absence. In his first Major League start this season, Milone tossed five innings of three-run ball with six strikeouts and no walks.

MLB Pipeline unveils new rankings
MLB Pipeline unveiled its annual midseason re-ranking of the top prospects in baseball, featuring some new positioning among Washington's top farm hands. The Nats now boast three players on the Top 100 Prospects list in Victor Robles (No. 5), Carter Kieboom (No.35) and Luis Garcia (No. 95), all of whom are 21 years old or younger.

Robles moved up a spot from the sixth-ranked prospect in baseball to the fifth. Robles was activated from the Minor League disabled list on Friday and added to the roster of Triple-A Syracuse, completing his rehab assignment from the left elbow injury he sustained earlier this season. Robles has played in 16 games in the Minors this season, posting a slash line of .298/.441/.319 with seven stolen bases.

Video: NYM@WSH: Robles laces an RBI single up the middle

Kieboom has continued to mash at the plate. In 90 games between Class A Advanced Potomac and Double-A Harrisburg, he has posted a slash line of .292/.369/.464 with 13 home runs that earned him a spot in the 2018 SirusXM Futures Game.

And the Nats own a new top Minor League arm after this year's first-round selection, Mason Denaburg, surpassed Erick Fedde as the team's top pitching prospect (No. 4 in Washington's system).

Worth noting
Anthony Rendon and his wife, Amanda, welcomed a new baby girl -- Emma Kate Rendon -- on Thursday night, the couple's first child.

Jamal Collier has covered the Nationals for MLB.com since 2016. Follow him on Twitter at @jamalcollier.

Washington Nationals, Stephen Strasburg

Doolittle dealing with strained left big toe

MLB.com

WASHINGTON -- Nationals closer Sean Doolittle has a strained left big toe, but the left-hander told Washington manager Dave Martinez he feels fine.

Doolittle injured his toe avoiding a liner back the mound during the Nationals' 3-2 win over the Marlins on Friday night at Nationals Park. The 31-year-old underwent an MRI on Saturday and took the day off. Doolittle, who hasn't dealt with foot issues before, threw before the Nationals' series finale against Miami on Sunday.

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WASHINGTON -- Nationals closer Sean Doolittle has a strained left big toe, but the left-hander told Washington manager Dave Martinez he feels fine.

Doolittle injured his toe avoiding a liner back the mound during the Nationals' 3-2 win over the Marlins on Friday night at Nationals Park. The 31-year-old underwent an MRI on Saturday and took the day off. Doolittle, who hasn't dealt with foot issues before, threw before the Nationals' series finale against Miami on Sunday.

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A significant injury to Doolittle would come at a poor time, as the Nationals have pulled within five games of the Phillies and Braves in the National League East. Martinez didn't use Doolittle in the Nats' 10-2 loss to the Marlins on Sunday.

"He gets in with the trainers, and he's got an unbelievable routine before each game," Martinez said of Doolittle. "And then he goes out and throws. He tells me when he's available and when he's not. Like I said, I have an open dialogue with those guys and I know his history. I want to keep him healthy, and when he says he needs a day, I honestly believe he needs a day."

Doolittle is the midst of perhaps his most impressive season, with a 1.45 ERA, 49 strikeouts and three walks over 37 1/3 innings while recording 22 saves in 23 opportunities. Opponents have hit just .134 off him and he owns a 0.54 WHIP.

Worth noting
Matt Wieters told Martinez he felt good during his first rehab game with Double-A Harrisburg on Saturday. Wieters went 1-for-4 with an RBI and a strikeout and caught again Sunday, going 0-for-2 with a walk. Wieters, Washington's starting catcher before his injury, has been on the disabled list since May 11 with a left hamstring strain.

Kyle Melnick is a reporter for MLB.com based in Washington.

Washington Nationals, Sean Doolittle

Stras, Zim progressing toward return to Nats

MLB.com

PHILADELPHIA -- The Nationals have battled injuries to key players all season, but two of their longest-tenured players are making progress in their return from the disabled list.

Stephen Strasburg (right shoulder) played catch and threw from flat ground in the outfield on Thursday at Citizens Bank Park, and he could throw a bullpen session this weekend. And Ryan Zimmerman (back) could begin a Minor League rehab assignment as soon as Monday.

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PHILADELPHIA -- The Nationals have battled injuries to key players all season, but two of their longest-tenured players are making progress in their return from the disabled list.

Stephen Strasburg (right shoulder) played catch and threw from flat ground in the outfield on Thursday at Citizens Bank Park, and he could throw a bullpen session this weekend. And Ryan Zimmerman (back) could begin a Minor League rehab assignment as soon as Monday.

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Strasburg has resumed throwing for a little more than a week after the shoulder inflammation that forced him to the DL also caused him to be shut down from baseball activities. The team wanted to make sure the inflammation in his shoulder subsided before he began the steps toward a comeback.

Meanwhile, Zimmerman has been out of action since May 12 with back and oblique injuries. He had been fielding grounders and taking batting practice, but the Nats said he has made some significant progress lately toward a return.

"We talked a little bit about it," manager Dave Martinez said. "I want to make sure that he's doing everything full activity ... but I'm going to get together with him this weekend to see where he's at."

Both players are on track to provide a significant upgrade for the Nats at some point next month.

Daniel Murphy has been the primary first baseman of late while Zimmerman and Matt Adams (broken finger) have been sidelined. But once Zimmerman returns, the team will shift Murphy back to second base and perhaps utilize a platoon between its two first basemen once they are both healthy.

Strasburg has been replaced in the rotation by right-hander Erick Fedde, the club's top pitching prospect and ranked as its No. 3 prospect overall by MLB Pipeline. At times, Fedde has shown signs why the team carries such high aspirations for his future. But while the Nats' rotation is struggling, the team could benefit from getting one of its aces back to pair alongside Max Scherzer.

Jamal Collier has covered the Nationals for MLB.com since 2016. Follow him on Twitter at @jamalcollier.

Washington Nationals, Stephen Strasburg, Ryan Zimmerman

Kintzler, Hellickson ready to come off DL

MLB.com

WASHINGTON -- A pair of Nationals completed rehab assignments at Class A Advanced Potomac on Sunday. Right-hander Jeremy Hellickson started and threw 83 pitches in 4 2/3 innings, while Brandon Kintzler tossed a scoreless sixth with a strikeout.

Both players were expected to join the Nationals at Nationals Park for evaluation before the team departs for St. Petersburg after Sunday night's series finale against the Phillies.

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WASHINGTON -- A pair of Nationals completed rehab assignments at Class A Advanced Potomac on Sunday. Right-hander Jeremy Hellickson started and threw 83 pitches in 4 2/3 innings, while Brandon Kintzler tossed a scoreless sixth with a strikeout.

Both players were expected to join the Nationals at Nationals Park for evaluation before the team departs for St. Petersburg after Sunday night's series finale against the Phillies.

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Hellickson gave up 11 earned runs on nine hits with three walks, but his rough line did not leave manager Dave Martinez concerned.

"I'm more concerned about the way he feels," Martinez said. "And we'll go from there."

Both players were expected to only need one rehab outing before they were ready to return. Kintzler, who has been on the disabled list since June 10 with a right forearm flexor strain, could be activated as soon as Monday against the Rays to put the Nationals' bullpen at full strength for the first time since the club acquired Kelvin Herrera from the Royals.

And Hellickson -- sidelined since June 5 with a right hamstring strain -- should be on track to rejoin the Nationals' rotation through the next turn. Sunday's starter, right-hander Jefry Rodriguez, has been Hellickson's replacement.

Jamal Collier has covered the Nationals for MLB.com since 2016. Follow him on Twitter at @jamalcollier.

Washington Nationals, Jeremy Hellickson, Brandon Kintzler

Adams out vs. Blue Jays due to finger injury

First baseman likely will be re-evaluated Monday in Washington
MLB.com

TORONTO -- Matt Adams was out of the Nationals' lineup for Saturday afternoon's game against the Blue Jays, a day after he took a ball off his left index finger during a bunt attempt.

He received an X-ray on his finger, but it "didn't really show much," according to manager Dave Martinez, as the team waits for the swelling to subside. Once it does, Adams is likely to be re-evaluated Monday in Washington.

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TORONTO -- Matt Adams was out of the Nationals' lineup for Saturday afternoon's game against the Blue Jays, a day after he took a ball off his left index finger during a bunt attempt.

He received an X-ray on his finger, but it "didn't really show much," according to manager Dave Martinez, as the team waits for the swelling to subside. Once it does, Adams is likely to be re-evaluated Monday in Washington.

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"He's still a bit sore," Martinez said. "He's got a little bruising on the tip of his finger, so we'll see if they can work it out."

Adams had his finger in a splint as he arrived at the ballpark Saturday, but he was able to bend his finger this morning, which signified some progress.

Daniel Murphy started for Adams at first base Saturday, the first time he has played the field since being activated from the disabled list Tuesday. Initially, Martinez said he planned on keeping Murphy as the designated hitter through the weekend, but Adams' injury altered that plan.

Murphy came to Martinez before the start of the series and told him he felt healthy enough to play second base this weekend, and although he had his reservations of playing him in the field, he decided first base would be less strenuous.

"I think it's a lot easier than the middle of the field," Martinez said.

Jamal Collier has covered the Nationals for MLB.com since 2016. Follow him on Twitter at @jamalcollier.

Washington Nationals, Matt Adams

Harper 'good to go' after 2 HBPs vs. Yankees

MLB.com

NEW YORK -- The Nationals received a momentary scare when Bryce Harper left after being hit on the left foot in the eighth inning of a 3-0 loss to the Yankees on Tuesday. After getting drilled by an errant pitch from right-hander Dellin Betances, Harper took a few hobbled steps down the first-base line before he turned around and headed toward the dugout.

Harper said his toe briefly went numb and decided to be cautious. He felt much better after the game, however, and after postgame X-rays came back negative, he expected to be back in the lineup Wednesday.

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NEW YORK -- The Nationals received a momentary scare when Bryce Harper left after being hit on the left foot in the eighth inning of a 3-0 loss to the Yankees on Tuesday. After getting drilled by an errant pitch from right-hander Dellin Betances, Harper took a few hobbled steps down the first-base line before he turned around and headed toward the dugout.

Harper said his toe briefly went numb and decided to be cautious. He felt much better after the game, however, and after postgame X-rays came back negative, he expected to be back in the lineup Wednesday.

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"It just hurt," Harper said. "Trying to walk down the first-base line, there was no point."

Video: WSH@NYY: Harper on getting hit twice, Roark on start

Harper reached base four times on Tuesday night despite not getting a hit, as he walked twice and was hit by two pitches. The first incident came in the fifth inning, when he was drilled on the right elbow by a pitch from left-hander CC Sabathia. Harper was in considerable pain afterward, but remained in the game after consulting with a trainer at first base.

Tuesday marked the fifth time in Harper's career that he reached base at least four times without recording a hit, and the second time he has been hit by pitches twice.

Video: WSH@NYY: Martinez provides update on Harper, loss

"He's a tough kid," Nationals manager Dave Martinez said. "That's what kind of worried me, when he started walking off the field. But he's good to go."

Jamal Collier has covered the Nationals for MLB.com since 2016. Follow him on Twitter at @jamalcollier.

Washington Nationals, Bryce Harper