"First, let me give you the data," said Dr. Gill. "I think there are a few misconceptions about the timeline here. Obviously we don't make an announcement every time we do a test medically or what's going on. From a medical perspective, strictly, there's really nothing to avoid. He's been given the absolute standard of care and the best possible treatment from the time this injury occurred. Rib injuries and contusions -- whether you have a rib contusion, a stress response, a stress fracture, etc. -- they're all treated 100 percent the same way.
"With Jacoby, people say the word 'fracture' and I think they get a little concerned. But these are 'fractures' you can't see on an X-ray. They're very stable injuries. They happen all the time in football and all the time in hockey and we have a huge wealth of knowledge and experience treating these types of injuries. I can tell you, having taken care of a lot of these types of athletes, we've been extraordinarily conservative with Jacoby and our progression with him.
"Just to reiterate a couple of points that might clarify it. He first had this injury in April when he collided with Adrian Beltre. Following that injury, we got the X-rays, showed no fracture, so as is the policy of our staff, we take the worst-case scenario. We assume there's a mild non-displaced injury, and it's treated the exact same way as a bad contusion.
"They're both stable injuries. You never operate on these injuries. We check the lungs to make sure there's no injury. We check the abdomen to make sure there's no injury. We look for any associated problems and then we move forward. We remove the player from any kind of contact, and the return is based on any kind of symptoms. Then, more because Jacoby had some questions, said 'I understand it's treated the same way,' but sometimes people like to know 'Is there or isn't there?'"
"We got an MRI/CT scan. To be frank, two or three of them. Even upon knowing something is there, you can't see them very well. And there's one where they're more obvious. We got those. Confirmed little non-displaced injury in front of chest. We kept him out of competition, but the treatment went on exactly the same way. We got about six weeks into his recovery, which again is an extraordinarily conservative approach for the stable injury, but we wanted to make sure he was absolutely fine and comfortable with everything before returning him.
"The criteria for his return to play was having no pain, no tenderness, to be able to take fully batting practice -- which as you know has a lot of torsional motions stresses -- let him run, catch and do everything he needs to do with no symptoms.
"What he said to us was 'I feel fine now, I have no other problems.' Six weeks is about the right amount of time for any kind of bone to get strong. So we started him on a rehab assignment. Now it was actually Jacoby that said to us, 'I feel great, no problems, I don't need to spend a full week on a rehab assignment, I'm ready to come back to play.' We've been very conservative and slow in our approach to him. So at his own saying, with our medical opinion, it was safe to have him come back."
But in Ellsbury's second game back, he appeared to aggravate the injury all over again, making a diving catch in a game played on a Sunday afternoon at Philadelphia.
"Then he went to Philadelphia and had the dive and initially didn't have any problems or concerns with it," Gill said. "Then I believe it was [Tuesday] kind of late afternoon before batting practice in [St. Petersburg], he came to our training staff and said, 'I have this pain.' Now it was in a different area. It was no longer in the front where his initial trauma had been, but in what we call the posterior-axillary line, which is just behind the armpit area.
"Literally within two hours of him telling the training staff on an away trip in a visiting city that he had these symptoms, we had already obtained a new MRI and CT because of these new complaints in a new area. If you've ever tried to get an MRI/CT yourself, you know within two hours is a rapid response there.
"These were read by the radiologist down in Tampa as negative to any kind of new fracture. We had these studies Fed-Exed up to both myself and our radiology consultant, Dr. Palmer at Mass. General, who's a bone and muscular-skeletal radiology expert. To both of our views, they were also negative. You had three or four eyes looking at it and there were no fractures there."
Ellsbury was shut down again at that time and placed on the DL three days later.
"We again took him out of competition and began his normal rehab and recovery process," Gill said. "Earlier this week, maybe Sunday or Monday, he came in to our training staff and said his pain had moved again. Now it was kind of closer to his spine, right where the ribs come close to the spine, and he was having acute onset, more pain.
"This is when the team was on the road. I got this phone call from the team that he had new pain. So I said to the training staff, 'Why don't we have him come back to Boston and we'll reimage the new area again?' Now he's already had the initial MRI/CT scan from the initial injury. He had another MRI and CT scan from the dive, and now because he had new symptoms we again were going to have him come back to Boston for another MRI and CT scan.
"At the time I asked to bring him back, that's when I found out the player's agent [Scott Boras] had requested an appointment with Dr. Lew Yocum, who is an outstanding physician and a close colleague of mine. I said 'Well, if he's already on the road, that's great.' So I called Dr. Yocum and gave him a little background on the injury and said, 'Can you do me a favor -- I wanted to get these tests in Boston, but because he's coming to see you, do you mind getting those studies out there?' He said, 'Sure no problem, I think that's a good idea.'
"So then Jacoby goes out and sees him, gets the exam and the X-rays, and finds just a very small non-displaced injury on the sixth rib, and that's where we are right now. That's a long-winded way of saying I guess I understand the question, but I guess -- I won't say it's not relevant -- but I don't know what else there is to do differently.
"He's had three MRIs, three CTs. He's seen two opinions from his agents, and three orthopedists and a thoracic surgeon at Mass. General. That's probably more sub-specialty care than you can imagine, and every detail checked not once, but four times. I think we're on the right path, and I think he'll get back and be very productive for the rest of the season."
When will Ellsbury -- who is currently working out at the Performance Athletes Institute in Tempe, Ariz. -- return to action?
"I hate to put an estimate on it," said Gill. "Obviously we want to do what's better for Jacoby both mentally and physically. We want to make sure he's fully comfortable and confident like he was when he came back the first time. He will really dictate a lot of it by the history of his symptoms.
"It won't be less than two weeks, because we just want to give him a good two weeks away, let him do some rehab and really just get some rest more than rehab right now. I'll reevaluate him at the two-week point, and if he looks good at that point we'll start progressing him back in. So I would say -- if I had to guess -- I don't want to put any timelines on Jacoby, but I would put anywhere from the two-week point to the All-Star break, somewhere in there, and I just don't know. We'll support whatever pace he needs to recover at."