Should we be concerned about Salvador Perez’s head injuries?

On Tuesday night in Minnesota, Salvador Perez was plunked in the wrist on a pitch from Ervin Santana. The immediate diagnosis was a right wrist contusion, causing Salvador Perez to leave the game. Hopefully he will miss just a few games, but the worst case scenario is the wrist bone has broken and Salvador Perez will be out for the year. Eventually, the bone will heal, and he will return for the 2017 season, same as he ever was.

What concerns me more is an injury from last week. In the ninth inning of Friday’s game against Detroit, Wade Davis delivered a 95 mph fastball that was fouled straight back by Jose Iglesias, right into the mask of Salvador Perez. The force of the ball striking his head caused him to stumble backwards with a stunned look on his face as the Royals training staff ran to his aid.

Salvy stayed in the game, making the final out of the 7-6 loss. He started the next game, and even started the Sunday afternoon game to conclude the series, and has not been out of the starting lineup since.

This incident came just a week after he was struck in the face in a game against the Marlins.

Baseball is a non-contact sport, but Salvy has been taking shots to the head, and has been doing so for years.

On August 4, 2013, Salvador Perez took a foul ball straight into the catcher’s mask in a game against the Mets. The ball jarred his head so severely, it left his jaws sore and gave him headaches that night. Nonetheless, he finished the game before checking into a New York hospital that night. The Royals placed him on the seven-day disabled list for concussions. Ned Yost expressed his concern.

"Always after the game, he'll come over and give me a hug, right? But he didn't yesterday. So I said, 'What's wrong with you?' And he said, 'Uh-uh-uh,' and then he gave me a hug. He goes, 'I've got a headache, my head's hurting.' So I knew something was wrong there.

A month later, Salvy was struck again by a foul ball in the head in a game against the Mariners. With his recent concussion fresh in their minds, the Royals removed him from the game and had him run through concussion tests.

"He's fine," manager Ned Yost said. "He came in and had a little nausea and a little dizziness, but it dissipated really quickly. They gave him the SCAT test and he was an 84 out of 85. If he comes in feeling good tomorrow, he'll be ready to go."

In October of 2014, the Royals were in the middle of a magical post-season run. They squared off in the American League Divisional Series against the top team in the league that year, the Los Angeles Angels of Anaheim. In Game 2, Angels slugger Josh Hamilton swung and missed at a pitch from Yordano Ventura and inadvertently nailed Salvador Perez in the head with his bat on the follow-through.

Trainer Nick Kenney came out to attend to Salvy, but the catcher stayed in the game. Afterwards, Salvy talked about his symptoms.

''A little headache. After I get hit, I just feel like ... dizzy, a little foggy a little bit,'' Perez said. ''I talked to Ned about that and after 30 seconds, I think everything is gone. But now I feel good, no more headache and ready to go.''

Salvador Perez played in Game 3 two nights later in Kansas City, and caught every single inning of the post-season after that game.

In this interview with Esquire Magazine, Salvy claimed that he had actually suffered three concussions during the 2014 season.

I had three concussions last year. They were from foul balls, not collisions, but these are dangerous situations.

If Salvy did suffer concussions, he did not miss any time from it. The only instances in which he missed back-to-back games in the 2014 season was in late May due to a thumb injury, when he missed three straight games, and in late July, when he missed two games due to a groin injury. While the Royals were in their pennant push, Salvador Perez started 32 of the final 33 games.

In 2015, the head injuries continued. Salvy left a game in June against the Indians as a precautionary measure after a foul ball struck him in the mask and he reported dizziness. He passed concussion tests and was back behind the plate two days later.

In the American League Divisional Series that fall against the Astros, Salvy was again struck in the face by a foul ball, leaving him jarred. He passed concussion tests and stayed in the game until he was struck in the arm by a pitch and had to leave the game. After an off day, Perez was back in the lineup for the pivotal Game Five.

"Of course, of course," Perez said. "If I had to play today, I'd catch today, too. They told me to hit [during Tuesday's workout], and I feel great. I'm OK."

In Game Four of the Royals 14-2 rout of the Blue Jays in the American League Championship Series, Salvy again took a foul ball to the mask, leaving him “a little dizzy”. He would eventually leave the game.

“I put my head a little down, because if the ball is going to hit me, I’d rather to hit me in here,” Perez said, pointing to his forehead, “rather than down in my face.”

The concerns about concussions in sports have centered mostly around football, due to the violent nature of the sport and the high prevalence of concussions. But concussions are a part of other sports such as baseball and soccer as well, although at much lower rates. According to a study by the National Academy of Sciences, high school football has a rate of 11.2 concussions per “athletic exposures”, the highest rate of any sport, while high school baseball has a rate of 1.2 concussions, among the lowest rates of any sport.

However concussions do happen, particularly at the professional level where pitchers throw harder and batters swing harder. Major League Baseball instituted a concussion protocol back in 2011. For in-game trauma, a player must be checked out by the trainer and removed from the game if there are any signs of concussion. Serial examinations must be done throughout the game, whether or not there are signs of a concussion or not. If a player is determined to be out for several days, he can be placed on a seven-day disabled list for concussions.

The health effects of concussions have been well-documented. Aaron Reese at KC Kingdom does a great job summarizing how concussions cause long-term brain damage.

Repeated blows to the head can cause chronic ailments due, in part, to a protein called S100B. Under ordinary circumstances, this particular protein is only found in the brain. A study of college football players found that the higher the number of hits to the head, the higher level of S100B that leaks into the bloodstream, indicating damage to the blood-brain barrier. Because the S100B protein is a foreign substance in the bloodstream, it is attacked by the body’s autoimmune system. The antibodies seep back through the damaged blood-brain barrier and start attacking brain tissue....

The effects of S100B seeping into the bloodstream can cause “long-term brain damage.” The more blows to the head, the higher concentration of S100B in the bloodstream, increasing the efficiency of autoimmune antibodies tasked with attacking it, thus compounding the brain damage. Perhaps this auto-immune response is what causes (at the very least correlates with) the now well-known “Chronic Traumatic Encephalopathy,” a degenerative neurological condition found only in people who have suffered repetitive brain trauma. It is the same disease that most likely prompted the suicide of former Kansas City utility player Ryan Freel.

I am not suggesting that Nick Kenney is not doing his job or that Ned Yost is wantonly ignoring medical advice in an attempt to win games. But it is clear, there is an enormous incentive to get these players on the field. By my count, Salvador Perez has suffered over ten blows to the head in a four-year period. Salvador Perez is just 26 years old, presumably with many years of catching ahead of him. Perhaps the system needs to be more rigid with a more independent source clearing players to protect their long-term health. Perhaps Salvador Perez should even consider no longer catching. At the very least, there should be more questions raised about whether his head can continue taking this kind of beating.

Later today, the Royals will likely get some diagnosis of Salvador Perez’s wrist, and the concerns will be over his playing time. But we should also be concerned about his long-term health and his ability to remember the name of his expected child someday.