Dodgers’ medical staff feeling the strain

Zack Greinke returned to the Dodgers’ rotation this week, recovering from surgery on his left shoulder in five weeks, three ahead of schedule. Hanley Ramirez came back last month from a broken thumb two weeks earlier than expected.

But head trainer Sue Falsone has little time to celebrate how cutting-edge procedures and rehabilitation methods accelerated Ramirez’s and Greinke’s recoveries.

The Dodgers are in last place not only in the standings, but also in injury prevention. They have nine players on the disabled list and have already used the DL 14 times, more than any team in baseball.

Falsone has long accepted that injuries are part of sports, but, she said, “It’s obviously disappointing.”

She knows there’s nothing she can do to prevent freak accidents, such as when Ramirez broke his thumb diving for a ball in the World Baseball Classic. Or when Greinke fractured his non-throwing shoulder in a bench-clearing incident. Adrian Gonzalez remains on the active roster, but he has a strained neck muscle he suffered in a collision with an umpire.

Falsone also knows that chronic issues are likely to resurface, such as Ted Lilly’s back problems or Stephen Fife’s shoulder inflammation. And she remains comfortable with the calculated risk the Dodgers took by not surgically repairing Chad Billingsley’s elbow last fall, even though he made only two starts before being shut down for the season.

More troubling are the lower-body muscle strains that have plagued the Dodgers. “Those are always the types of things that you’d like to think you’d be able to prevent,” Falsone said.

Second baseman Mark Ellis is out because of a strained quadriceps muscle. Utility man Jerry Hairston Jr. has a strained left groin. Ramirez is back on the disabled list because of a strained hamstring. Pitcher Chris Capuano missed two weeks because of a strained calf. Josh Beckett was put on the disabled list Wednesday because of a strained left groin.

Ramirez’s season perhaps best illustrates the medical staff’s frustration. He returned far sooner than expected from thumb surgery, only to be injured running the bases in his fourth game.

“We talked about it: ‘He’s not going to come back and have a leg problem,’” Falsone recalled. “He ran. He ran a lot. He took ground balls. He wasn’t sitting around.”

Precautions were taken even before that.

When the Dodgers hired Falsone to be their trainer before last season, they did so in large part because they thought she could help prevent injuries. She had worked with the Dodgers since 2007 as a physical therapist, on a full-time and part-time basis.

Although Falsone attracted media attention because she was baseball’s first female head trainer, medical services chief Stan Conte viewed her hiring as groundbreaking for another reason: her background in orthopedic manual therapy.

Traditional baseball treatment was pretty straightforward. If a player’s knee hurt, he received treatment on his knee. But Falsone’s training made her adept at utilizing modern methods, which consider underlying causes rather than symptoms. So, if a player’s knee was hurting, she might treat the hip problem responsible for the pain in the knee.

Results were mixed last season. In an effort to improve, the Dodgers’ training staff visited players at their off-season homes over the winter.

“It was not an off-season,” Falsone said. “Between the seven of us we visited almost every single player, at least once if not multiple times, to get our eyes on them, our hands on them.”

During spring training, General Manager Ned Colletti remarked that the Dodgers were the most fit team of his eight-year tenure. While maintaining a new-age training program that included shoulder and core strengthening, the training staff reintroduced some old-school drills during camp. Namely, running.

“We left spring not having one lower-body muscle injury,” Falsone said. “Right there, it shows us we were doing the right thing and were on the right track.”

So what happened?

“Spring training doesn’t mimic game intensity,” Falsone said. “Sometimes when you’re trying to kick it up one more gear that maybe you’ve never been to before, physics happens.”

Falsone laughed and shook her head. “That’s my new favorite phrase: Physics happens,” she said.

Across Major League Baseball, the number of days players have spent on the disabled list is up about 5% from last year, according to numbers compiled by the Dodgers’ medical department.

“It makes us nuts,” Falsone said. “We know more than we knew 20 years ago about the body. We know more about training. We know about anatomy. We know more about mechanics. Every field has advanced in the last 20 years. We feel that’s the case in sports medicine and physical training and performance training and rehabilitation. But we’re not seeing the trends of injuries going down. In fact, they’re going up at an astronomical rate. So what is that?”

There are some success stories. Clayton Kershaw has avoided the hip problems that plagued him last season and nearly made him a candidate for surgery. Andre Ethier said this is the healthiest he has felt in several seasons.

“We have to stretch before we even go out on the field or do our cage work,” Ethier said. “I like it. I feel really good. I feel healthy. They do a great job. I know a lot of guys feel the same way.”

Ramirez and Greinke underwent surgical procedures and rehab programs that allowed them to return to the field far sooner than expected.

“We call experts across the country,” Falsone said.

In Ramirez’s case, the Dodgers consulted hand specialist Mo Herman, who created a customized splint that allowed the shortstop to throw a baseball while his thumb regained strength. Greinke had a metal plate inserted into his shoulder that kept his collarbone in place as it healed, which allowed him to resume throwing not long after surgery.

Greinke, who has pitched for three other teams, said, “I’ve liked a lot of the staffs I’ve worked with. But I think the Dodgers do have more workers and they’re definitely knowledgeable.”

Falsone remains confident in the Dodgers’ medical program and is hopeful for better results in the coming months.

“It’s always how you end the season, not how you begin, right?” she said. “So if we go the rest of the season and everybody does well, no one will even remember this crazy April.”

dylan.hernandez@latimes.com