What Max Scherzer's injury means for rest of the World Series

Just hours before the first pitch in Game 5 of theWorld Series in Washington, news broke that the highly anticipated duel between Astros ace Gerrit Cole and Nationals top starter Max Scherzer was not to be. The Nats' No. 1 was scratched from the assignment because of neck spasms, putting swingman Joe Ross on the spot as the man Washington has to entrust with the start in a series that's tied at two games apiece.

In the wake of this surprising development with series-altering implications, we asked our experts about the impact of Scherzer's late scratch.

1. Could this actually work out in the Nationals' favor?

Jeff Passan:Ross could be the Nationals' answer to Jose Urquidy. And even if he isn't and the Nationals lose Game 5 but Strasburg wins Game 6, Scherzer could join a grab bag of starters in Game 7 alongside Anibal Sanchez and Patrick Corbin. Chris Sale closed out the World Series last year. Could it be Scherzer this year? Possibly, but if we're being truthful, the ideal situation would've been that a healthy Scherzer starts Game 5 and comes back in Game 7 for an inning. If it works out in the Nationals' favor, it will be pure happenstance and luck.

Bradford Doolittle:If Scherzer can pitch again in the series -- and pitch like Max Scherzer -- then it very well could. That doesn't mean that you would game-theory it so that you concede Sunday's game to Cole and instead line up Stephen Strasburg and Scherzer for the last two games -- with Game 7 suddenly becoming a favorable matchup for Washington, with a very Mad Max going against Zack Greinke. Every win has an enormous impact on your probability of winning a seven-game series, and there is no scenario in which it is better for the Nationals to lose Game 5 than to win it. But if the Nats steal it ... then Scherzer's injury becomes a blessing in disguise. If, of course, he can go. And if you don't win, and Scherzer recovers in time to pitch Game 7, then at least that's about as good a backup plan as you could want.

David Schoenfield:I say no. I mean, sure, you could get to Game 7 and hopefully have Scherzer ready against Zack Greinke, but you are now less likely to get to Game 7. Put it this way: If we throw Cole, Scherzer, Strasburg and Justin Verlander into a bucket and say they are all essentially equal, and factor in that Houston has the better lineup and bullpen, the Astros would be slight favorites the next two games even with Scherzer. Now those odds go down. It's not rocket science: Having to start Joe Ross in place of Max Scherzer is not a good thing.

2. So how severe is Scherzer's injury?

We turned to ESPN injury expert Stephania Bell to answer this question.

Bell: When Nationals manager Davey Martinez announced that Max Scherzer was being scratched from his scheduled start Sunday night, it came as a shock, particularly when the culprit was revealed to be neck spasms.

Sure, neck spasms sound uncomfortable. But to those accustomed to Scherzer's signature toughness and willingness to pitch through discomfort -- who else pitches with a broken nose? -- this hardly seemed worthy of keeping the team's ace from pitching in a pivotal World Series matchup. It wasn't until Scherzer came to the podium to address the media that it became clear just how complex his neck issue is.

First and foremost, spasms are involuntary muscle contractions that are often painful. They can occur as the body's protective response of an injured area so as not to result in further injury. The intensity of the spasm can be enough to completely restrict movement of the affected area. In Scherzer's case, he described his neck as "locked up" when he woke up Sunday morning, the pain severe enough to force him to "fall out of bed" and catch himself with his left arm. Scherzer said he was in so much pain and his motion so limited ("I couldn't really move my arm") that his wife had to help him get dressed.

Instinctively the goal is to reduce the spasm, but to do so successfully requires getting to the root of the problem. Scherzer revealed the root cause of his injury was nerve irritation at the C5/C6 vertebral level in his spine. There are seven cervical (or neck) vertebrae. They are numbered accordingly from top to bottom beginning with C1 (the first cervical vertebra sitting immediately below the skull) and ending at C7. The C5/C6 area Scherzer referred to as the source of his discomfort is located in the lower part of the neck.

Each vertebral level has a specific spinal nerve associated with it, which then feeds into a network of nerves that provide sensation and power to various muscle groups. When those nerves become irritated, the result can be pain, weakness and in some instances numbness or tingling. Movement in a given direction can exacerbate these symptoms, so one of the body's preferred responses is to trigger muscular spasms -- which then inhibits movement. Pretty clever, right?

The problem with this response, however, is that it does not allow for normal range of motion, which then limits function such as the ability to, say, repeatedly throw a baseball at 90 mph. And in some instances, treatments aimed at decreasing spasms -- manual mobilization, hot/cold therapy, laser therapy and acupuncture, just to name a few -- can actually have the opposite effect. Scherzer alluded to this when he said he received treatment on Saturday that is normally helpful for him, yet he woke up Sunday feeling worse.

Scherzer's downward turn ultimately led to him receiving a steroid injection in the C5/C6 area to deliver an anti-inflammatory (such as cortisone) to the affected area and, hopefully, quiet the nerve, which should in turn decrease the spasm.

Unfortunately, these problems can be tricky, and the response to such injections is variable. It's normal to have the athlete lay low for at least 48 hours afterward and not perform any vigorous activity in order to obtain the best result, hence the reason Scherzer would not be available to pitch before a potential Game 7 on Wednesday. If at that point his symptoms have improved and he has normal range of motion and strength, he should be able to proceed. From a risk standpoint, there is no precautionary reason to hold him out if he has returned to his baseline self.

At this point, there is little else for the Nationals to do other than wait and see how Scherzer responds.