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Inova Nationals Health Report

Arm overuse a concern for pitchers of all ages

MLB.com

When it comes to baseball and softball, pitchers often carry a team on their shoulders. That's not to say they're more important than any other player on the team. Rather, they literally put their shoulders (and elbows) into every throw, delivering upward of 80 pitches per game -- even at the Little League level.

Such intense pressure on the arm puts throwing athletes at risk of overuse injuries, which occur in response to repetitive strain. Still, arm injuries aren't inevitable, said Seth Blee, PT, a team physical therapist for the Washington Nationals and regional clinical director at the Inova Physical Therapy Center, the official physical therapy partner of the Washington Nationals.

When it comes to baseball and softball, pitchers often carry a team on their shoulders. That's not to say they're more important than any other player on the team. Rather, they literally put their shoulders (and elbows) into every throw, delivering upward of 80 pitches per game -- even at the Little League level.

Such intense pressure on the arm puts throwing athletes at risk of overuse injuries, which occur in response to repetitive strain. Still, arm injuries aren't inevitable, said Seth Blee, PT, a team physical therapist for the Washington Nationals and regional clinical director at the Inova Physical Therapy Center, the official physical therapy partner of the Washington Nationals.

Smart choices can protect players of all ages from shoulder injuries -- and increase the odds that they'll be able to stay in the game for years to come.

Focusing on form
Injury prevention starts with good mechanics, said Blee. To protect your shoulder, you have to think beyond your arm. A great pitch actually starts in your feet. As your leg pushes into the ground, energy is transferred through the hips and the torso and out to the ball at the end of your fingertips.

"The more efficiently your system works, the better the energy is transferred through your body to the ball. Any weak link in that chain loses energy, so pitchers often make up for that loss of energy in the arm," Blee said. "Overuse injuries of the shoulder or elbow can often trace back to something inefficient somewhere else in the system."

Of course, if a player has pain in the shoulder, he or she should have it checked out by a medical professional. "But don't stop there," he said. Especially if the pain persists, players should take a closer look at the mechanics of their pitch.

In youth leagues, coaches are often parents or other volunteers who might not be trained in proper throwing mechanics. It can pay to seek out throwing clinics or private pitching lessons, Blee said. "Find someone who knows mechanics, so you don't develop bad habits."

Rest and recover
Taking breaks is also critical for keeping your throwing arm healthy. In youth leagues, there are pitch count guidelines that spell out how many pitches young players should be throwing daily, and how many days of rest they should be taking after a practice or a game.

While most teams abide by the limits, Blee said, problems can arise when kids play on multiple teams. "They can throw 85 pitches [for one team] on Saturday, then show up to a travel team on Sunday and be asked to throw 50 pitches. And their coaches might not know," he said. "It's on players, parents and coaches to communicate better."

Just as the pros have an offseason, so should younger players. "It's recommended that they take about four months off from throwing each year to allow the arm to rest," Blee said. "Volume of throwing is the number one risk factor for injury."

It can be tough to convince a committed athlete to take that time off, especially when they're playing on multiple teams. Yet resting doesn't have to mean couch surfing. Players can take time off from throwing and work on other skills and abilities, such as balance, running speed and reaction time. Playing other sports can help develop useful skills, prevent overuse injuries and also keep young players from getting burned out.

"The vast majority of pro athletes played multiple sports through high school. They're not just great baseball players; they're great athletes," Blee said.

Expert advice
Whether you're a weekend softball star or the parent of a serious Little Leaguer, the best way to prevent injury is to take precautions. Inova Sports Medicine's physical therapists offer baseball screenings to assess players and recommend appropriate exercise programs. For more information or to schedule an appointment, contact Seth Blee at SportsPT@inova.org or call (703) 970-6423.

Washington Nationals

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

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

Zimmerman (back) out for final 2 games of '18

MLB.com

DENVER -- The Nationals have shut down first baseman Ryan Zimmerman for the final two games of the season, deciding there was no reason for him to play and risk further injury while battling a sore back. Zimmerman said Friday that his back injury is not serious and if playoff implications were on the line this weekend, he would be able to play.

"At this point, I don't want to push the envelop with him," manager Dave Martinez said. "The last thing I want to do is for him to go re-injure himself really bad and have to rehab himself over the winter time."

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DENVER -- The Nationals have shut down first baseman Ryan Zimmerman for the final two games of the season, deciding there was no reason for him to play and risk further injury while battling a sore back. Zimmerman said Friday that his back injury is not serious and if playoff implications were on the line this weekend, he would be able to play.

"At this point, I don't want to push the envelop with him," manager Dave Martinez said. "The last thing I want to do is for him to go re-injure himself really bad and have to rehab himself over the winter time."

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It ends another injury-riddled year for Zimmerman, who was limited to just 85 games. He batted .264/.337/.486 with 13 home runs and a 113 OPS+, respectable numbers limited by a slow start and a lengthy stint on the disabled list. When he got healthy in the second half, he posted a .911 OPS in 52 games, proving once again that when healthy he can still be a force in the middle of the Nats' lineup.

Video: WSH@PHI: Zimmerman smashes a solo jack in the 4th

"He came back and did really well for us for a couple months," Martinez said. "We need him to really focus on getting healthy this winter and coming to Spring Training ready to go because he's a big part of our lineup."

Zimmerman began the year in unusual fashion, however, by sitting out virtually the entire slate of Grapefruit League games. He and the Nats insisted he did not have an injury during that time; rather, he could get himself ready for the season by playing on the backfields. It is up for debate whether that decision led to his slow start in April, but Zimmerman posted a .623 OPS in his first 28 games and landed on the DL shortly after.

Martinez said Saturday that he was hopeful Zimmerman would play in Spring Training games at the start of next year, but the team would evaluate that decision then. For now, he wants Zimmerman to focus on getting healthy, encouraging him to mix in more agility training during the offseason, and enjoying a full, complete offseason.

"If you have to get healthy before you start doing stuff, it's more of a pain than anything," Zimmerman said Friday. "It's just one of those things, to be able to go into the offseason healthy and do whatever you want to do and not have to worry about dealing with something that you shouldn't have to deal with, it's huge going into Spring Training."

Worth noting
• Players circled in and out of the manager's office prior to Saturday's game as Martinez made an effort to meet one-on-one with each player before season's end to offer some evaluations.

"I like to have communication all the time," Martinez said. "We'll communicate throughout the winter, but I want to make sure they understand what they did and how much some of these guys really improved. And what they need to work on going into the winter, what we think they need to improve on and be ready for 2019."

Victor Robles will play winter ball in the Dominican Republic this offseason. Martinez said he wanted to play after missing so much time this offseason after suffering an elbow injury.

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

Washington Nationals, Ryan Zimmerman

Nationals activate Doolittle from disabled list

Hellickson nearing return after throwing simulated game
MLB.com

WASHINGTON -- The day Sean Doolittle first landed on the disabled list in July, just days before the All-Star break, he jokingly mentioned pitching in the game as his Minor League rehab assignment, a sign of his confidence that he would not be sidelined for long.

He would never have imagined he would have to wait nearly two months to the day of his last outing, to be activated because of a stress reaction in his left foot.

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WASHINGTON -- The day Sean Doolittle first landed on the disabled list in July, just days before the All-Star break, he jokingly mentioned pitching in the game as his Minor League rehab assignment, a sign of his confidence that he would not be sidelined for long.

He would never have imagined he would have to wait nearly two months to the day of his last outing, to be activated because of a stress reaction in his left foot.

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"Every DL stint is tough mentally for different reasons," said Doolittle, who was activated prior to Friday night's game against the Cubs at Nationals Park. "To have to kind of be on the sidelines and watch kind of the way the second half of the season unfolded for us and not be able to contribute, not be out there with the guys, was really tough. I'm really excited to be back."

Before the injury, Doolittle was in the midst of a career year. He posted a 1.45 ERA and 22 saves in 35 appearances with 49 strikeouts and three walks in 37 1/3 innings en route to making the National League All-Star team. He will resume his duties in the closer's role.

The Nationals' bullpen struggled in Doolittle's absence, posting a 4.72 ERA since the start of the second half, the fourth-worst ERA in the NL, after its 3.64 ERA was the fourth best in the NL in the first half. Those bullpen struggles ended up being one of the reasons Washington never got on the hot streak it hoped for in the second half.

"I was feeling really good and pitching better than I have in my career," Doolittle said. "If you would have told me when I came out of that game that night that I was going to have to wait two months to get to do that again, I would have said you were crazy."

Doolittle did not have time to complete a rehab assignment, but he threw three simulated games in the past week to test his foot. He spent some extra time during the past week to make sure his foot was 100 percent, throwing an extra sim game and a bullpen session to ensure he had no lingering discomfort.

And to be sure he was not altering his mechanics in any way, Doolittle compared video footage of himself on the mound and checked the numbers on his release point and various other pitching mechanics, all to be sure he was not jeopardizing his return.

"To prove to myself that I'm healthy, to end the season on a good note, I don't know. I've just been really thinking about getting back out there and competing," Doolittle said.

"I just wanna finish the season healthy."

Hellickson nearing return
Right-hander Jeremy Hellickson threw 50 pitches over three innings during a simulated game on Friday afternoon at Nationals Park, his biggest test since landing on the DL with a wrist injury. His next step will be to throw a bullpen on Sunday, but he appears ready to be activated soon.

How exactly the Nats utilize Hellickson once he returns remains to be seen. Their rotation is currently full with Joe Ross and Erick Fedde inserted in this month after coming off the DL. The organization wants to see those young starters get innings to prove they are healthy and can perform next season.

Manager Dave Martinez said he will not utilize a six-man rotation, so it is possible Hellickson, who is slated to be a free agent at season's send, might have to pitch out of the bullpen when he returns.

"It would just be nice to get back out there and face hitters again before the year is over," Hellickson said.

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

Washington Nationals, Sean Doolittle, Jeremy Hellickson

Doolittle to throw sim game on Friday

MLB.com

PHILADELPHIA -- A few times over the past few weeks, Nationals closer Sean Doolittle has attempted to throw off the mound in the bullpen, but each time the stress reaction in his left foot bothered him too much to make significant progress.

But Doolittle's foot has improved during the past few days, and on Tuesday he finally lasted through an entire bullpen session without much discomfort -- the best he has felt since landing on the disabled list just before the All-Star break. The next step for Doolittle is to throw a simulated game Friday at Nationals Park.

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PHILADELPHIA -- A few times over the past few weeks, Nationals closer Sean Doolittle has attempted to throw off the mound in the bullpen, but each time the stress reaction in his left foot bothered him too much to make significant progress.

But Doolittle's foot has improved during the past few days, and on Tuesday he finally lasted through an entire bullpen session without much discomfort -- the best he has felt since landing on the disabled list just before the All-Star break. The next step for Doolittle is to throw a simulated game Friday at Nationals Park.

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"He's progressively getting better," manager Dave Martinez said. "He feels better. The ball's coming out pretty good now. So, just get him to face some hitters and we'll go from there."

The Nationals have been without Doolittle since July 10 (retroactive to July 7), just days before he was named to the National League All-Star team. In 35 appearances, he posted a 1.45 ERA and 0.536 WHIP with 49 strikeouts and three walks in 37 1/3 innings while converting 22 of his 23 save opportunities. Initially, he and the team believed he would not be sidelined for long, but the injury lingered and he has not pitched in the second half.

In Doolittle's absence -- which has coincided with other ill-timed injuries and a pair of reliever trades -- the Nats' bullpen has faltered, dropping from the fourth best relievers' ERA in the National League through the first half of the season to the fourth worst in the NL since the break.

"He's one of the best," Martinez said. "So knowing that you have him to close in the ninth inning is awesome. He's definitely missed."

Because he does not have an arm injury, Doolittle has been able to keep his arm active since landing on the DL, throwing off flat ground and testing himself on the mound a few times. Martinez believed Doolittle was likely to experience some discomfort in his foot for the rest of the year, but it had become manageable in the past few days and the team was confident he had not altered his mechanics in any way.

"He says he feels a lot better and it looked like it in the past few days," Martinez said.

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

Washington Nationals, Sean Doolittle

Herrera's season likely over; Madson reinstated

Midseason acquisition tore Lisfranc ligament in left foot
MLB.com

PHILADELPHIA -- Kelvin Herrera limped out the door from the Nationals' clubhouse on Monday afternoon, wearing a walking boot on his left foot and using crutches to meet the Uber driver waiting for him. The Nats placed him on the DL with a torn Lisfranc ligament in that left foot, and although Herrera will seek a second opinion, the injury seems almost certain to end his season.

"It's awful," manager Dave Martinez said. "I feel terrible, because he's a big part of our success here and what we do."

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PHILADELPHIA -- Kelvin Herrera limped out the door from the Nationals' clubhouse on Monday afternoon, wearing a walking boot on his left foot and using crutches to meet the Uber driver waiting for him. The Nats placed him on the DL with a torn Lisfranc ligament in that left foot, and although Herrera will seek a second opinion, the injury seems almost certain to end his season.

"It's awful," manager Dave Martinez said. "I feel terrible, because he's a big part of our success here and what we do."

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If Herrera, who will be a free agent at season's end, does indeed miss the rest of the season, the injury ends what has been a rocky tenure in D.C. since the Nats acquired him from Kansas City in June. The Nationals jumped the trade market to acquire Herrera early, with the intent of creating perhaps the most formidable bullpen in team history. Their plans quickly went awry as Herrera battled injuries and ineffectiveness.

In 21 games with the Nats, Herrera posted a 4.34 ERA and a 1.714 WHIP, a dip in his performance from this strong start to the year with the Royals (1.05 ERA and 0.818 WHIP). He had just returned from a two-week stay on the DL with a right rotator cuff impingement and was pitching the ninth inning of Sunday's blowout 15-0 win to stay fresh after not pitching in five days. The injury occurred while Herrera was making a play at first base.

"I still got the out," Herrera said with a chuckle. "High price for it."

The Nationals did not provide a timetable for Herrera's recovery, so it is unclear if the injury will affect his status as a free agent this offseason. Herrera, who will be 29 in December, has been an elite reliever and was a two-time All-Star for the Royals through his eight-year career. But his strikeout rates dipped this season and walk rates climbed after being traded to Washington, a concerning trend for a reliever who battled injuries all year.

Martinez did attempt to console Herrera by pointing out that at least he did not suffer an arm injury.

"He's a free agent, so I know he's concerned about that," Martinez said. "I told him, 'Look at it this way: it's not your arm, it's your foot. As soon as you get it taken care of you'll be pitching again and you'll be strong and good to go.'"

Madson activated from DL
The Nats did benefit from some good timing with right-hander Ryan Madson ready to be activated from the DL on Monday to fill Herrera's spot on the roster. Madson had been on the DL on Aug. 14 (retroactive to Aug. 13) with a lumbar nerve root irritation.

That injury to Madson's back led to an ugly outing on Aug. 12 at Wrigley Field when Madson surrendered a pinch-hit, walk-off, grand slam to David Bote in a 4-3 loss. He was placed on the DL shortly after and spent some time last week in Arizona working out with his personal trainer to help fix his back issues.

Madson was encouraged prior to Monday's game the issue was behind him. The Nats have a hole at closer with Sean Doolittle still on the DL and Herrera's injury, but Martinez hinted he could use Madson in lower leverage situations before he resumes closing duties.

"If the matchups are right, I can see Madson throwing the ninth inning, but we'll see," Martinez said. "I kind of want to ease his way back into this whole deal instead of throwing him back into the fire. But we'll see how the game goes."

Worth noting
Joe Ross has made four Minor League rehab starts as he works his way back from Tommy John surgery and he is on track for a return in early September. Ross owns a 1.84 ERA in 14 2/3 innings in the Minors and has increased his pitch count to approximately 65-70 pitches. Whether he returns as a starter or reliever will depend on the Nats' needs at the time, Martinez said.

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

Washington Nationals, Kelvin Herrera, Ryan Madson

Velo issue won't force Strasburg to miss a start

Righty showed diminished endurance in return from DL this week; Doolittle, Madson making progress
Special to MLB.com

NEW YORK -- The endurance concerns that affected Stephen Strasburg (Stras) in his return from the disabled list Wednesday won't keep him from making another start next week in Philadelphia.

Strasburg threw a between-starts bullpen session Friday at Citi Field, and Nationals manager Dave Martinez said everything went as planned. While Martinez didn't yet list a date for Strasburg to pitch, his spot in the rotation would come up Monday.

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NEW YORK -- The endurance concerns that affected Stephen Strasburg (Stras) in his return from the disabled list Wednesday won't keep him from making another start next week in Philadelphia.

Strasburg threw a between-starts bullpen session Friday at Citi Field, and Nationals manager Dave Martinez said everything went as planned. While Martinez didn't yet list a date for Strasburg to pitch, his spot in the rotation would come up Monday.

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"He said [the bullpen session] went well," Martinez said.

Strasburg's start Wednesday was his first since July 20 and just his second since June 8. He gave up five runs in four innings against the Phillies at Nationals Park, tiring by the end of his 84-pitch outing. While Strasburg was able to throw his fastball 94-96 mph in the first inning, by the fourth inning most of his fastballs were clocked at 91-92 mph.

Video: PHI@WSH: Strasburg on first start back from DL

"I think he just has to build up to that [endurance level]," Martinez said.

Martinez said the Nationals will need to watch Strasburg closely, looking at the velocity, pitch count and also whether he is able to maintain his mechanics. He said he also expects Strasburg to communicate with pitching coach Derek Lilliquist.

"As he comes in after 75 or 80 pitches, we have to ask him," Martinez said. "He'll tell you [if he's tiring]."

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Doolittle, Madson progressing
Closer Sean Doolittle (Doc), on the disabled list since July 10 with left toe inflammation, is with the Nationals at Citi Field and threw off flat ground Friday. Martinez wouldn't say when Doolittle will be able to throw off a bullpen mound or when the team might expect him back.

Reliever Ryan Madson (Blest), on the DL since Aug. 14 with lumbar nerve root irritation, was also expected to join the team in New York but isn't ready to return.

Campaigning for Max
Cy Young candidates Max Scherzer (Blue Eye) of the Nationals and Jacob deGrom of the Mets both pitched Thursday, so neither will pitch in this weekend's series. But the race for the National League Cy Young Award, which also includes Phillies right-hander Aaron Nola, was still a topic for pregame conversation Friday.

"I'm a big Max Scherzer fan, now that I see him every day," Martinez said. "He has six more starts, and I expect Max to be Max."

Video: PHI@WSH: Scherzer K's 10 over 7 two-run innings

Danny Knobler is a contributor to MLB.com based in New York.

Washington Nationals, Sean Doolittle, Ryan Madson, Max Scherzer, Stephen Strasburg