ESPN injury expert with some thoughts on Dylan Bundy and PRP injections

Dylan Bundy has started his prescribed six weeks of rest after getting a platelet-rich plasma (PRP) injection last Monday in his right forearm/elbow area from orthopedic specialist Dr. James Andrews in Gulf Breeze, Fla.

An MRI on Bundy's right elbow came back clean. PRP is blood plasma that has been enriched with platelets and stimulates the healing of bone and soft tissue.

Zach Britton received a PRP injection last spring because of chronic soreness and weakness in his left shoulder.

To get more informed about all this, I checked in with Stephania Bell, injury expert and senior writer for ESPN.com. She said the first time she had heard of the PRP injection being used for an athlete was when the Steelers' Hines Ward had an injection in his knee that allowed him to recover quickly from an injury to play in the 2009 Super Bowl.

She said right now there is no way to accurately project when Bundy can pitch in a game this year.

"The six weeks is really six weeks of no throwing, being shut down and that is pretty standard," Bell said. "If you look at Bundy's case, they shut him down in late March, did an MRI and that didn't find anything substantial and then he had some rest and started to resume his throwing program with some light tossing.

"You could be looking at another month of a throwing program after that or a couple of months. The longer the down time, in addition to working your way back through a throwing program, you have to build up the endurance of the arm. It makes it hard to put a date on it and you likely won't see the team do it. Too many variables there."

Can we read anything into the severity of this issue by the decision to have the PRP injection and not some other form of treatment at this point?

"What I look at more is these symptoms haven't gone away so they are just taking it to the next level if you will in terms of treatment," Bell said. "Now they are adding something that hasn't been tried to see if that makes a difference. Whenever you see a drop in velocity, you get worried. Is there an injury?

"They also evaluate when did a pitcher feel that? Where at the point of throwing is it? In the acceleration phase or at ball release? Those can hint at different origins of the problem. There are things happening that we are not privy to that may be informing them of what is the more likely culprit even if they are not seeing something significant on the MRI."

For now, based on the information we've been given, she said, there is no reason to jump to any conclusions.

"I would not be panicking as someone looking at a distance watching this," Bell said. "I'd say they escalated it to the next level. If he doesn't respond well to this next episode, there are certainly more reasons to be concerned."

At this point, there is just a lot of uncertainty here and a big range of final outcomes with not much ruled out.

"Yes and that is the frustrating part," Bell said. "People read the highlights and speculate players are heading for Tommy John (surgery). More often than not there is this road of something in between for a while.

"You take the good news where you can find it and they didn't see anything dramatic on the MRI that made them say he needed surgery right away. But until we see how he responds we really don't know.

"Most of these injuries in the elbow area are the result of overuse. Not the result of a sudden snap or event and they have pain. It starts with things like discomfort, tightness, stiffness, losing control and velocity. That is why when we hear about it happening, you get nervous with a young pitcher like Bundy.

"But there are also times when pitchers go through phases of experiencing a little of that and then it settles down. They go on to pitch again and they are fine for another period of time. Pitchers are always at risk and we can never say they are completely out of the woods. Right now we just know they are in the process of taking this next step to try and help the problem."

She added that the biomechanical testing the Orioles have used for some of their pitchers could be important for Bundy's case as well as the testing analysts could compare readings and measurements from his windup and delivery from last year to this season to see if there have been any changes that may have contributed to the current issue. They could be changes that any pitcher was not directed to make but a subtle difference from year to year can sometimes create an issue.


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