Royce Lewis, Injuries, and Stupid Luck

[Lucas Seehafer PT]

The Minnesota Twins lost Royce Lewis to yet another muscle injury on Wednesday afternoon, this time a Grade 2 right adductor strain. It is the fourth significant injury to his right leg in the last three seasons.

Image courtesy of © Matt Blewett-USA TODAY Sports

Luckily, the Twins are hopeful that it isn’t as severe as the right quadriceps injury which caused Royce Lewis to miss the first two months of the season.

The adductor muscles provide breaking forces through eccentric muscle contractions (i.e. the muscle is contracting while lengthening) to help control athletic movements. So, it should come as no surprise that groin and adductor strains are among the most common muscular injuries in elite athletes.

The Grade 2 categorization essentially indicates that it is a moderate injury. From an advanced imaging standpoint, this means at least 10% but no more than 50% of Lewis’s muscle fibers were damaged. Because of the wide range of damage, outcomes for Grade 2 strains vary considerably, though most generally heal within six to eight weeks. That would be a rough estimate for Lewis’s return sometime between Aug. 14 and the end of that month. 

Now, the question facing Lewis and the Twins, one that is undoubtedly on everybody’s mind: What can be done to prevent this from occurring again?

As I mentioned previously, this is the fourth significant injury Lewis has suffered to his right leg—ACL twice, quadriceps, adductor—since reaching MLB, and the sixth issue (those four, plus strains of his left oblique and left hamstring) that has landed him on the IL. Unfortunately, there aren’t any easy, straightforward answers here.

It’s often said that the best predictor of future injury is past injury, though that saying is only true as it pertains to the same muscle or location. For example, the best predictor of suffering a right ankle sprain is if you previously sprained that right ankle. All of Lewis’s injuries thus far—save for the ACL—are to unique muscles.

Muscle weakness is a common characteristic following ACL reconstruction, yet there is a surprising lack of research looking into the presence and persistence of weakness in muscle groups other than the quadriceps. However, there is evidence that muscle activation patterns (specifically the co-activation of the gluteal and adductor muscles) are impaired for up to two years following surgery. Unfortunately, research going the next step—determining if these impaired activation patterns are associated with greater injury risk—is largely absent.

It’s also important to consider that, as a professional athlete, Lewis has access to elite rehabilitation and strength and conditioning programs. The Twins have been cautious with his rehab and training, and assess his force production (strength, power, etc.) via scientific means such as force plates and dynamometry regularly. 

Athletes aren’t cleared to return to play following a major injury until all of their measures have reached or exceeded their pre-injury values. (As far as imbalances go (i.e. one side is stronger than the other), there isn’t much strong evidence to suggest it is an important factor in injury risk mitigation or performance.)

Finally, the most powerful but least satisfying factor needs to be considered: Dumb luck. We don’t like to think that nothing could have been done; that Lewis’s injury was an accident, the simple flap of the butterfly’s wing throwing into motion a chain of events that were unpredictable and uncontrollable.

Suggesting so nullifies the ability to ascribe blame, leaving our frustrations and sympathies simply afloat in the ether. We can’t blame Lewis’s legs or work ethic, nor can we question Nick Paparesta’s treatment philosophy and practices. But often that is done anyway, by the talking heads and individuals with no avenue for venting their frustrations. They label the athlete as “injury-prone”—despite not fully appreciating the complexities of the human neuromusculoskeletal system and injury risk mitigation—and place blame via jumps in logic and correlation-equals-causation thinking.

Losing Royce Lewis sucks--for him, for the team, and for us. We all want to see Lewis batting in the middle of the order and playing a stout third base. But right now, he’s headed for another IL stint. It’s not his fault. It may not even be his body’s fault. It may just be Lady Luck striking yet again.

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[Eris]

 

 

Based on performance, it may have taken Larnach 2 years to recover from his groin injury.  Although there are other factors such as skills and pitch selection that make drawing a conclusion difficult  

 

I think it is generally understood that people who tear their ACL are at greater risk for additional injuries.  This is an interesting article that uses fantasy points to assess performance. Seems that there should be more than 15 mlb players. 
 

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10078163/

 

[Original_JB]

And........ it could just be genetics.

[JD-TWINS]

Definitely a bummer!

Until reading this I was thinking 2 weeks, maybe 3 weeks. Wow - middle of August at best?!?!

Offense isn’t the same but it’s not a disaster……..defense replacement seems seamless.

[D.C Twins]

The pattern over the past 1+ year would argue against dumb luck....

It could be just the way he is built, but that should be the conclusion only AFTER a full review of his stretch and strength regiment. 

[DuluthRoots]

Yoga?

[Doctor Gast]

Muscle weakness is a common characteristic following ACL reconstruction, yet there is a surprising lack of research looking into the presence and persistence of weakness in muscle groups other than the quadriceps. However, there is evidence that muscle activation patterns (specifically the co-activation of the gluteal and adductor muscles) are impaired for up to two years following surgery.

Thank you Lucas for this very interesting article. That confirms my assumptions. I somewhat expected some soft tissue problems with Lewis as I did with Buxton, Polanco, & Kiriloff after a prolonged stint on the IL due to knee, wrist & shoulder problems. My approach is to be very proactive, Because competitive players like Lewis & Kiriloff aren't going to tell you that they are hurting, especially Kiriloff because his job is on the line. Pure hitters like Kiriloff & Mr. I don't do slumps Lewis, in most cases when they slump it's because they are hurting & it affects their swing. In Lewis & Kiriloff's cases it should set off red flags, where Lewis & Kiriloff should have been set aside & told, "You are sitting, where does it hurt? Let's resolve this".

IMO Paparesta is doing a great job. Now management needs to step up & do a better job. IMO Baldelli is better than most but I'm suggesting to go further out of the box thinking of playing hurt until you drop.

[FargoFanMan]

1 hour ago, Original_JB said:

And........ it could just be genetics.

Ah genetics. The scapegoat we can use for everything. Wipe our hands, shrug our shoulders and walk away. Maybe. But as Lucas has outlined and in great detail by the way a much more plausible explanation. His body is simply compensating for not one major injury but 2. Those being major knee surgery. That combined with the massive bulk that Royce has put on I think combine to lay it out in front of us. The body doesn’t simply recover when the IL time is up but rather it takes years to gradually build up and transfer the compensation back to the injury point. Genetics may be a small part of it but I think we fail to realize how the body works in a top of the line athlete. What we should ask is how many abdominal muscle area pulls he had before is 2 major knee injuries. Again thanks to Lucas Seehafar for this great in depth article!

[LambchoP]

Unfortunately I think it's looking more and more like Lewis is a "Buxton 2.0". Immensely talented, capable of carrying the whole team for weeks at a time, but injured WAY too often. Hoping for a quick and successful recovery, we'll need him for the playoffs if we get there. On a positive note, at least we got Brooks Lee to fill in. Nice to see him get two hits and an RBI in his debut:)

[Lucas Seehafer PT]

16 minutes ago, DuluthRoots said:

Yoga?

If we want to dive into the weeds:

-Muscle strains generally occur at one of two points: the point where stress (i.e. force) is too great for its ability to strain (ability for the muscle to deform) or when the muscle is transitioning from a concentric (shortening) to eccentric (lengthening) contraction.

-Based on option one, you'd think stretching would be protective against injury but there is so much research on the topic I can confidently say that stretching doesn't reduce injury risk.

-Yoga improves overall body mobility which seems to be protective, but only to a point. In my opinion, mobility has become over-hyped by the fitness and performance legion.. it's helpful but not a panacea.

-There is a ton of research that suggests strengthening the groin and hamstring muscles eccentricly reduces injury and re-injury rates. Without a doubt this was/will be part of his rehab process. Does he need to do more in the offseason? Maybe, but who knows.

-As I stated in the article, we know muscle activation and strength issues persist for up to two years following ACL surgery. But beyond that we're just taking logical leaps and inferring that those issue lead to greater injury risk. Logically, that makes sense but I'm not comfortable saying so definitively. Sports med just isn't that simple vary often.

[Patzky]

27 minutes ago, DuluthRoots said:

Yoga?

Couldn't hurt.. or does it?

[Whitey333]

Nice article.  Injury prone is better determination than dumb luck.  Your comment about people not understanding the muscle skeletal system is probably quite true as most of us are not doctors.  So why then do most players on most teams play most of the year without the major injuries.  Yes there has been a plethora of injuries throughout MLB.  But most still play most of the time.  We have put up with all the nonsense and mostly non playing career of Buxton.  Lewis appears tge same.  We should be used to it.

 

 

[Lucas Seehafer PT]

1 minute ago, Whitey333 said:

So why then do most players on most teams play most of the year without the major injuries.  Yes there has been a plethora of injuries throughout MLB.  But most still play most of the time.

If we had an answer to this question, we'd have much, much fewer injuries. 

Again, the extremely unsatisfying answer is that random chance plays a significant role. There are so many factors associated with injury occurrence that it's nearly impossible to account for them all. Strength training, sleep, diet, traveling from east to west, weekly load, yearly load, lifetime load, intrinsic characteristics about the individuals body, modifiable risk factors, non-modifiable risk factors, I could go on. There aren't enough hours in the day, especially during an MLB regular season. 

When conducting research, we often look at a variable's p-value when determining if it's a risk factor. This values attempts to determine if the outcome in question is due to chance or the variable being assessed. The cutoff is often set at 5%. So if a p-value comes in at 4%, we determine the result is "significant" but what it is really saying is that there is a 4% chance that the outcome occured due to luck. Luck is *always* an option. (And that's not even getting in to how 5% is probably not sensitive enough to find true significance and that most studies have too small of a sample size.)

[twinfan]

Some players are just injury prone and we have had more than our share. let's hope Lee can hit major league pitching and Miranda and Castro keep going. I guess we'll see where we are in late August to determine if we should shut Lewis down for the year.

[Beast]

At this point, I don’t think we call it luck.  Could be, but it seems really unlikely to me.

Some people may be phenomenal athletes, but their bodies can’t handle it for whatever reason.

Maybe they started strength training too early and things didn’t develop properly.

Maybe too much strength training.  Some people’s bodies can’t handle the additional load/force.

Maybe they weren’t well rounded enough in their activities and things didn’t develop properly.  My son plays hockey and you hear it from a lot of high level coaches now that focusing all year on hockey isn’t great for their development as an athlete.  Sports all rely on different muscle groups in varying ways.  High end guys now do one thing rigorously all year as children in the hopes of scholarships, going pro, etc.  It can come with consequences.

Genetics was mentioned above, and it’s valid (some responses would lead you to believe it’s not).  Some bodies can’t handle it no matter what you do to your body.

I grew up with a guy who was one of the best baseball players I’ve seen.  Great athlete, naturally.  Very minimal strength training, not a muscle-bound guy by any stretch.  Very gifted runner, extremely fast.  4 sport athlete that excelled at everything.  He seemed to do everything right developmentally, incredibly fit, his body just couldn’t handle it.  He had hamstring problems that started in high school and got progressively worse until he was basically forced off his college baseball team.  Later on in his 20s, he couldn’t even play slow pitch softball anymore, despite being one of the best players in the state (when he could play).  The guy could not run without incurring a soft-tissue injury.

Who knows the root cause.  But, it’s definitely looking like Royce’s body is just breaking down.  If so, there’s nothing that can be done.  If you’re to the point where you have to devise ways to keep guys healthy via telling them not to do routine athletic activities (don’t run bases more than half speed, etc.), it’s probably already over.

It certainly could be luck.  But, to me, that sounds like much more of a coping mechanism than “genetics.”  Getting hit by a pitch, running into another player, stepping on a base wrong, running into a wall, etc. all seem like a “luck” write-off.  There’s something you could’ve done differently.  Repeated non-contact soft-body and ligament injuries to your legs while running or fielding a ball….there’s an underlying problem.

[GNess]

Interesting and well-written article. Royce Lewis is a potential mega-star, but with all athletes in almost all sports a huge variable is consistent good health to reach their maximum potential. 

[Doctor Gast]

2 hours ago, Original_JB said:

And........ it could just be genetics.

In some cases, this could be the case but in Lewis's case I doubt it. This all started with a freak accident of a Southern California kid unfamiliar with ice in Texas. Playing 3B IMO helps to slim the chances of another ALC but he remains susceptible to soft-tissue injuries independent of heredity. 

IMO this will limit what Lewis can do. But if properly managed he can still be very successful in this 2 yr. span.

[tarheeltwinsfan]

Lucas, I sincerely appreciate your sharing your knowledge with us at TD.  Thank you.

[wabene]

I would think some people are just more prone to injury than others. I look to boxing where some clearly have a stronger "chin" than others. There are boxers who can stand so much punishment it can be hard to watch. Mohammed Ali is known for great skill, but it was his chin and stamina that were the separators. There really isn't a way to study this I would guess. 

You can have two boxers go through the exact same training camp and in the end why is it one is more durable and or clearly has better stamina? They are two different organisms.

I watch Willi Castro fly around the field and the bases. He plays anywhere you stick him without any problems. When Willi is flying around I enjoy watching. When Buxton or Lewis are flying around I brace myself. 

 

[Guest]

One word:  yoga.

[bean5302]

I don't believe it's at all luck related for Royce at this point. It might be something modifiable, but the sheer glut of injuries he accumulates would require some astronomical odds.

[Kummel]

When I see Lewis running the bases, I have thought more than once that he is moving in a way that is not to the point of "reckless" but is not really contained either.  Not "smooth."   I have worried that he might get injured, but of course we all are because of his injury history. 

 

[Doctor Gast]

8 hours ago, Doctor Gast said:

Muscle weakness is a common characteristic following ACL reconstruction, yet there is a surprising lack of research looking into the presence and persistence of weakness in muscle groups other than the quadriceps. However, there is evidence that muscle activation patterns (specifically the co-activation of the gluteal and adductor muscles) are impaired for up to two years following surgery.

Thank you Lucas for this very interesting article. That confirms my assumptions. I somewhat expected some soft tissue problems with Lewis as I did with Buxton, Polanco, & Kiriloff after a prolonged stint on the IL due to knee, wrist & shoulder problems. My approach is to be very proactive, Because competitive players like Lewis & Kiriloff aren't going to tell you that they are hurting, especially Kiriloff because his job is on the line. Pure hitters like Kiriloff & Mr. I don't do slumps Lewis, in most cases when they slump it's because they are hurting & it affects their swing. In Lewis & Kiriloff's cases it should set off red flags, where Lewis & Kiriloff should have been set aside & told, "You are sitting, where does it hurt? Let's resolve this".

IMO Paparesta is doing a great job. Now management needs to step up & do a better job. IMO Baldelli is better than most but I'm suggesting to go further out of the box thinking of playing hurt until you drop.

On June 20th Lewis said "Hey, I don't do this slump thing"

Lewis said "he began feeling a tightness in that area during the Twins’ series at Oakland from June 21-23. And when he tried to run out a double on Tuesday, the pain intensified to the point he didn’t think it was safe to continue."

As I thought Lewis's slump began when he started to feel tightness in that area. Shortly after his slump started he should have been approached.

[RpR]

10 minutes ago, Doctor Gast said:

On June 20th Lewis said "Hey, I don't do this slump thing"

Lewis said "he began feeling a tightness in that area during the Twins’ series at Oakland from June 21-23. And when he tried to run out a double on Tuesday, the pain intensified to the point he didn’t think it was safe to continue."

As I thought Lewis's slump began when he started to feel tightness in that area. Shortly after his slump started he should have been approached.

Maybe he should retire then.

[Doctor Gast]

44 minutes ago, RpR said:

Maybe he should retire then.

How did you come to that conclusion on what I said? What has shortening slumps & injury time has to do with retiring?

[RpR]

22 minutes ago, Doctor Gast said:

How did you come to that conclusion on what I said? What has shortening slumps & injury time has to do with retiring?

You are playing doctor to make excuses for his first failure, IF he is tha fragile, he career will be short.

He had a slump probably becauxe pitchers now  know his weak spots, not some medical glitch.

His health, he will deal with it as he sees fit, and I do not think holding back is part of his equation.

22 minutes ago, Doctor Gast said:

 

 

[OBX 3 6 28 29 34]

Adrenaline can sometimes push these incredible athletes past their bodies' capabilities resulting in injury. It is a learning process that will hopefully protect them and preserve the talent we love to watch before their short time ends. Good luck Royce and we'll look forward to watching your breathtaking talent again. 

[RaoulDuke]

Sometimes I wonder if guys like Royce and Buxton are reaching a point where mechanics/ refined training have made it so the cream of the crop athletes are becoming too explosive to prevent injury. 

Top end pitchers have been going through this for years with the increased velocity and spin.  The human body can only handle so much repeated stress focused on a couple points of failure.

Sports cars like Buxton and Royce can out preform but are under very high stress, making them prone to blow out at critical points in the process of generating that power/ speed.

 

[RpR]

12 hours ago, RaoulDuke said:

Sometimes I wonder if guys like Royce and Buxton are reaching a point where mechanics/ refined training have made it so the cream of the crop athletes are becoming too explosive to prevent injury. 

Top end pitchers have been going through this for years with the increased velocity and spin.  The human body can only handle so much repeated stress focused on a couple points of failure.

Sports cars like Buxton and Royce can out preform but are under very high stress, making them prone to blow out at critical points in the process of generating that power/ speed.

 

They are reaching the point where they are finding their physical short comings , nothing more.

Between two gents with similar macho man physiques, one may be able to take he beating so called pro wrestlers take and say I've had worse and mean it, while the other may end up with life long cripplings.

Twenty years ago when he big boomer six gun shooting was the big deal, I would shoot the .475 Linebaugh type  revolvers and recoil meant nothing to me; a gent similar in physique would be shooting next to me and say I am done for the day, my writst is telling me to quit.

At the same time I was shooting with some gals, barely 5 ft tall, and they had no problems.

Some people are cursed with amazing looking but fragile bodies; others that would sadly be called wimps, could take a beating and keep on ticking.

[Riverbrian]

On 7/4/2024 at 12:15 PM, bean5302 said:

I don't believe it's at all luck related for Royce at this point. It might be something modifiable, but the sheer glut of injuries he accumulates would require some astronomical odds.

The strange thing with his injuries are they lack any kind of trauma. He wasn't struck by a fastball, he didn't collide with the wall or a player, he didn't strike the ground sliding for a base or diving for a ball. 

The two injuries this season have come from simply running.

Even his knee injury making that catch out in CF May, 2022 lacked direct contact to his right knee that was injured. It was the left side of his body that absorbed the contact with the wall. His right leg appeared to be in the air when he made contact with his left side. 

https://www.mlb.com/video/sonny-gray-in-play-out-s-to-emmanuel-rivera