AL CHAMPIONSHIP SERIES: RED SOX v YANKEES

October 13, 2004

Theo Epstein

Dr. William Morgan

DR. WILLIAM MORGAN: Yeah, Curt during the Anaheim game had a subluxation or a tear on one of the tendons in his ankle, but the sheath that houses the tendons themselves, so now the tendon is snapping over the bone. We've been working on ways of making modifications for that so that he'll be able to continue to pitch. During a bullpen the other day we were able to get him to the point he was comfortable, and we're very confident that he was going to be able to pitch yesterday, as was Curt. Once he did get out there, he did experience some problems as you know. At the present time, we're working on other techniques and making some modifications and we're hopeful that he will be starting Game 5.

DR. WILLIAM MORGAN: Well, he was having some difficulties just preceding the Anaheim series. And as everybody saw at the beginning of the game in Anaheim where he grabbed his ankle that at that point in time it became apparent that he had more than just a tendinitis in his peroneal sheath and it became apparent to us that he had dislocated a tendon, and when I say "dislocated" it was a snapping over the side of the bone itself and it snaps in and out and it becomes an unstable situation. At that point in time it became apparent and we immediately started working on ways of bracing and keeping it in position. As I mentioned in the bullpen on Sunday, he looked very good and he felt very confident. Going into the game yesterday, again we felt very confident. But once he began pitching, it started subluxing, or snapping, again, out of position.

DR. WILLIAM MORGAN: The condition didn't really deteriorate; it recurred. In other words, there's two tendons behind the outside bone in the ankle and one of them became free from a sheath, it's a very thin sheath that we all have that keeps it behind the bone, so it snapped in front of the bone. So at this point in time it continues to snap from the front and the back and we are using a bracing technique to hold it back where it belongs. We thought we were successful in doing so but it reoccurred yesterday during the game and that's why he was having difficulties with his control.

DR. WILLIAM MORGAN: The conventional way, if this was your problem, we would put you in a cast. You would be immobilized in a cast. So we had to come up with a custom type of system to hold it in position. It's a molded plastic system to try to hold it against the outside bone in the ankle which is called the fibular. It's totally custom. You can't buy something like that at the store because he would not be able to pitch whatsoever. Once we get that into position, it's still painful to him so we did augment it with Marcaine. It's not a Novocaine; it's an anesthetic. It was augmented with the Marcaine and the hope was that it would stay in the sheath where it belongs. As he began yesterday, despite this custom splinting it began to, we call it sublux, but slip out again, and just that slipping out itself, even though it wasn't painful because you had Marcaine, it was causing some instability and interfering with his ability to pitch.

DR. WILLIAM MORGAN: Well, the first question is there's two motions. One, as he sets up he raises his left leg so he's planted only on his right ankle and more importantly when he thrusts, and to extend, the full extension, that's when the snapping occurs and that's the challenge. He's a big guy with a lot of stresses on that tendon and the challenge is to try to keep it in position. Now the answer to your second question, is if this was mid-season, and we had a few months to play with, he would have been placed in a cast, and potentially undergone surgery. Irregardless at this point in time he is going to require surgery. If we were not where we are right now, he would have the surgery done. The surgery is to reconstruct that sheath where those tendons usually anatomically lie. Now the next question; are we causing injury to this player, allowing him to play, and the answer is no. These injuries, a lot of people will sublux frequently for many, many months and they can be repaired. So we are trying to get him through this series.

THEO EPSTEIN: As far as further injury, if we can get Curt's ankle stabilized to the point where he can, the tendon stays in one place and he's able to have balance and drive and effective delivery, then he'll go out there and start Game 5. If we can't get him to the point where the ankle is stabilized, then he won't pitch. Because then we would risk further injury in his shoulder and he would be ineffective. So we are going to spend the next couple of days continuing to try to stabilize the ankle and keep the tendon -- the tendon is perfectly intact, it's just not in the groove where it's supposed to be. If we had this brace that kept it in place, it worked on the side and worked right up until the game. Under a game situation, essentially after the first inning, the brace didn't work. The tendon kept going back and forth. If we can get that tendon to be stabilized he can pitch with his normal delivery, he'll be out there and then have surgery when we are done playing. If we can't, he's done.

DR. WILLIAM MORGAN: No, I don't think it aggravated it. But certainly before putting him into a game situation, we had to test it and that was our only opportunity to test it. Certainly as Theo just pointed out, if he fails the next pull bullpen session before the next start, it's unlikely that he'll go, because he has to be able to pitch effectively.

DR. WILLIAM MORGAN: After the reconstruction of that sheath, we have to protect it for about four to six weeks, and then he'll undergo another, about, six weeks of rehabilitation, in terms of regaining his motion, his strength, so we are looking at about a three-month period of time.

THEO EPSTEIN: No, we had an expert come in and we tried. As Dr. Morgan said, this is an injury where if any other person besides a right-handed pitcher would have it, they would be immobilized in a cast or go into surgery right away. The challenge here was to create a brace to allow him to have a normal pitching motion but at the same time we keep the tendon stabilized. It was a state-of-art brace. Dr. Morgan can go into more detail about it, and it worked very well in the bullpen session and it worked well right up until about the first inning or so. Under game conditions, when you're giving 100%, the tendon began to sublux and Curt's delivery was altered and that's why he was ineffective and that's why we got him out of the game. We're going to take another shot at it and continue to use every medical technique under the sun to try to get this tendon stabilized so he can go out there again. And if we can't stabilize the tendon we are not going to send him out there and we'll have the surgery.

DR. WILLIAM MORGAN: We are relatively optimistic in the fact that this tendon that we are now trying to keep in the groove, we are going to allow it to stay out of the groove. We are going to try to modify the splint so that it won't -- the problem is that it's snapping back and forth from the groove. We have already failed in keeping it where it is so we are going to attempt to keep it out where it will be fine with a different type of bracing system to hopefully keep it from snapping back in.

DR. WILLIAM MORGAN: The biggest thing is the physical limitation. He first of all has a very high pain threshold and he does very well with that and we are able to control some of the pain with the medication we just mentioned. But it's the physical snapping of his tendon that interferes with his ability to balance and his ability to focus, really.

THEO EPSTEIN: No, we considered it but everyone was in agreement, all of the doctors, that this was not an injury that would benefit from one, two, even three, four, five days' rest. It's not a matter of rest. It's a matter the tendon itself is located and subluxed. We either will find a way to stabilize it so he can have his normal delivery or we won't. We found something that worked on the side and we were all very hopeful that it would work at Yankee Stadium in a playoff game, and it turns out that it didn't. We're going to continue to try to find something so they can pitch in Game 5. But one, two, three, four five days' rest would not have made any difference in this case.

DR. WILLIAM MORGAN: It's a combination of both. With this continuously snapping in and out, it causes a considerable amount of inflammation of the tendon so he has a baseline of tenderness. Now when he's not in the game situation, he's been in a boot that's much like a cast to protect this and limit the amount of time that that occurs, so it's a matter of the inflammation that occurs from the snapping and the physical snapping. This is only a week old. The first few days it was very, very uncomfortable. It's more comfortable, but it's still a relatively acute injury.

THEO EPSTEIN: No. Again, we won't send Curt out unless the tendon is stable, unless it's in one place and he can have his normal delivery. As you saw last night in the game, any pitcher would has to pitch without his legs underneath him who can't properly balance, who cannot properly stay aligned on the way to home plate can't be effective and may eventually put unnecessary strain on his shoulder or another part of his body. If we can get Curt to the point where we can have normal mechanics -- and that's our goal, we either can find that or he can't; then he'll be out there. But we won't compromise the team by sending out Curt Schilling who won't be effective, and we won't sacrifice Curt's long-term health, either.

DR. WILLIAM MORGAN: I'll answer the second question first. We have no guarantees, because you cannot duplicate a game situation in the bullpen. But that's our best shot. Again, we are going to modify what we already have and we're going to take a different approach and we're going to push him as far as we can but certainly in a game situation, the intensity is much higher, his drive is much higher and his focus has to be much more clear. That's the difference between the bullpen and the game.