WASHINGTON _ Two pitchers went to Dodger Stadium last Saturday to throw in a simulated game. Clayton Kershaw was assigned four innings in his final tuneup before rejoining the Los Angeles Dodgers. Alex Wood intended to throw two innings as he rebuilt arm strength in his recovery from an elbow injury in late May.
Neither emerged from the outing unscathed. Kershaw suffered a recurrence of soreness stemming from a herniated disk. Wood required a cleanout of loose bodies in his left elbow, a procedure called a debridement that will require an eight-week layoff.
Minutes after discussing Wood's predicament Wednesday, manager Dave Roberts acknowledged the increased possibility that Kershaw could require surgery to repair his back.
"With the way it flared up, it's more of an indication that surgery is more of a possibility, with the way his back responded," Roberts said before a game against the Washington Nationals. "But we're still hopeful that he's going to be back."
The Dodgers view the possibility as remote. The medical staff deemed his disk herniation as "mild" when Kershaw received an epidural injection in late June.
His symptoms have not changed since then, Roberts said. Kershaw is feeling soreness in his back, but has not felt shooting pains, numbness or weakness in his legs.
The most common procedure to fix a herniated disk is called a micro-diskectomy, explained Andrew Hecht, the chief of spinal surgery for Mount Sinai Health System and Mount Sinai Hospital in New York. It is necessary when the bulging disk compresses the nerves in the spine.
"In the absence of having a lot of buttock pain or leg pain, we typically counsel athletes not to have surgery for that problem," Hecht said. "Because micro-diskectomy is most effective for people who have buttock and leg pain, not just back pain. We don't usually do micro-diskectomy surgeries on people with back pain, only."
For a patient dealing only with back discomfort, Hecht continued, the typical treatment involves administration of anti-inflammatories, physical therapy and general rest.
Robert Watkins, the Dodgers' back specialist, recommended an epidural for Kershaw on June 29. The team placed him on the disabled list. From there, the organization has declined to offer specific information about his recovery, out of respect for Kershaw's request for privacy.
In general, members of the front office have deferred comment about Kershaw's injury to Roberts, in order to allow the information to flow from one source.
Even so, when Kershaw started playing catch July 6, Roberts indicated he was "pleasantly surprised" to see his pitcher was ahead of schedule.
Kershaw threw a bullpen session July 10. After spending the All-Star break representing his team in San Diego, Kershaw completed another bullpen July 13. The Dodgers hoped Kershaw could rejoin the club after his simulated game over the weekend.
That hope was dashed Sunday. Kershaw reported his soreness to Watkins, who recommended the left-hander be shut down. Kershaw has not picked up a baseball since.
"Right now, it's just doing the rehab progression, as far as exercises," Roberts said. "It's less on the aggressive side, obviously. There's no baseball activity right now. It's just more of trying to calm this back down."
The medical staff did not tell Roberts there was an increased chance of surgery for Kershaw. But, Roberts said, "for me, that's just logic," after the setback.
Speaking without having examined Kershaw, Hecht expressed confidence in the Dodgers' ability to rehabilitate the player.
"The Dodgers have excellent team physicians, and excellent consultants," Hecht said. "They're managing him, it sounds like, expertly. The odds are, regardless of which way they go, he'll return to play."
