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April 8, 2010

Under The Knife

Sneaky Recoveries

by Will Carroll

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Lance Berkman (knee, 5/1)
The Astros are on the verge of rushing Berkman back. He has had multiple drainings of his problematic knee, both before and after his surgery. On the last draining, the doctors also injected it with cortisone, a procedure that one orthopedist called, "a bit desperate." He wasn't indicating that this was unheard of, but that it's a procedure that's usually the last step before surgery. Berkman's situation is rare; it's very unusual to go right back into the knee so close after surgery unless something drastic changes. Then again, surgery normally corrects the problem, which it hasn't done completely yet for Berkman. While there's been some progress, he still hasn't had any real tests like full-speed running, stopping and cutting, or running the bases. We have no idea how it will affect him in the field or, most importantly, at bat. I said earlier this week that I didn't believe Berkman would be playing within ten days. The Astros are saying "next Wednesday sounds good." Given what we know about where Berkman is—he hasn't run, he hasn't hit, and he hasn't played in games for over a month —you tell me which makes more sense.

Andrew Bailey (microfracture surgery, knee)
The A's closer did indeed have microfracture surgery early in the offseason, allowing him to come back. While details aren't clear, it seems that Bailey had previous knee surgeries and was having the type of bone-on-bone grinding that necessitates this type of radical fix. The A's didn't so much hide it as let everyone look past it. It still surprises me that a Rookie of the Year could have this type of surgery and yet no one, including me, caught on. There's no reason a team should disclose things, and while I'm working hard to get the scoop on every injury, some are going to sneak by. Bailey was thought to have had a simple clean-up, something that's not a concern at all. While microfracture repair is getting more routine, it would have changed Bailey's PIPP rating to red in the short term had the full extent been known. As I noted yesterday, Bailey is pitching and that's the key point here. He's months out from surgery and while he's had some setbacks, it appears that the surgery did what it was supposed to do—get him back out on the mound.

Jeff Suppan (neck strain, 4/14)
A reader named "Andy" asked a qood question: "It was reported during today's game that Jeff Suppan's neck hurt because of poor pillows during spring training and so he used a rolled up towel instead. Setting aside whether or not they want Suppan to pitch, is there anything that could reasonably be done to stop this? He has a (very) large contract that should allow him to purchase pillows, even if only briefly. In addition, how does the training staff miss this? Shouldn't they be able to provide pillows, mattresses, La-Z-Boys, basically anything they want to make sure that these highly paid athletes are comfortable all the time and not hurting themselves sleeping? Thanks for any insight you can provide on this." The simple answer is that this is completely on Suppan. Players, especially established big leaguers like Suppan, should be smart enough to head to Bed Bath and Beyond to pick up a better pillow. They're not sleeping in dorms or required to do anything but play ball. The medical staff, I'm sure, would have been happy to have suggested something from the pillow menu. The teams certainly go out of their way to help their players. The facilities at Maryvale are world-class, so this one gets a Kanye shrug. For what it's worth, Suppan's throwing on the side and is expected back next week.

Gil Meche (shoulder strain, 4/13)
The Royals watched Meche take on some minor leaguers in extended spring training and came away impressed enough to pencil him into the rotation. With the issues he's had rehabbing from his shoulder issues, this was a pretty positive step. According to observers, Meche still lacks some stamina, some velocity, and some command, but he's "passable" according to one FOT that saw him. Another said "It's the Royals. It's good enough." The key here isn't so much that Meche will be back in the rotation early next week, but that the process has gone well. Under the watch of a new medical staff, Meche was not only able to avoid surgery—at least for now—he stayed more or less on the projected timeline, with no significant setbacks or problems along the way. Nick Kenney and his staff deserve some credit for that, and it bears watching to see if we can discern if there's more changes going on from a medhead standpoint in Kansas City.

Matt Joyce (elbow strain, 4/20)
There's really not much newsworthy to the reports that Joyce will head to Triple-A Durham to do his rehab assignment. This is just an opportunity to remind people about how rehab assignments work. Without all the boring technicalities, what's important is that a player once assigned has 20 days (30 for a pitcher) to play before forcing a decision. If an injury stops the rehab, it can "re-set the clock" but this is something that's watched closely. Teams do occasionally drag an assignment out, taking it to the absolute last day if it behooves them; hat's something we'll often see with Rule 5 picks. With Desmond Jennings also healing up, the Rays' outfield is getting crowded ... in Triple-A, let alone in St. Pete.

Justin Duchscherer (back)
It wasn't a great outing for Duchscherer, but it was an outing. He completed a comeback by going into the sixth inning in his first start, showing no real signs of the back or hip problems that have plagued him. Of course, Duchscherer also battled depression last season, and that's much tougher to get a handle on from this vantage point; we can only hope things are going well there. While Duchscherer showed no physical problems on the mound, he also didn't appear to have his best stuff. While rehab professionals will often nod and say "baby steps", that's not good enough for a game that counts every day. Duchscherer's made one step, but the A's need him to make the next one pretty quickly. They have a lot of pitching options at their disposal, but most of them are young. Having Duchscherer eating up some innings to protect those young arms would be valuable.

Ervin Santana (elbow inflammation)
There's control and then there's command. With elbow injuries, one of the first signs is a loss of control. But what is control and how is it different than command? While the definition changes slightly depending on who you're speaking with, control is the ability to get the pitch in the strike zone, while command is the ability to move the ball in and around the strike zone. Without control, there's no command. With no command, control isn't that valuable, though you will occasionally get a guy who has such great stuff that he can succeed without it. Santana showed trouble keeping the ball down in his first start, giving up hits and homers. While it's often control that is attacked by an elbow injury, often itself a problem of proprioception, it might be that command is also problematic and perhaps a bit more subtle. I don't mean to read too much into one start—anyone can have a bad day—but Santana's chronic elbow issues make this one worth monitoring closely.

Edinson Volquez (Tommy John surgery, 8/15)
While some are questioning when Volquez will be back, Reds sources were adamant that he's not "ahead of schedule." Nine to twelve months is the timeframe it takes most to be ready to return, and that's precisely where Volquez is at. Well, physically he's in Arizona, but you know what I mean. Don't be confused by the problem of the offseason. A player can often be ready in December or January, making his recovery look longer. Volquez will be back and the Reds are expecting him by August. Given his current state and leaving a little room for a setback, mid-August—precisely at the one-year point—seems very reasonable. As with Santana (above), there's going to be some question about his control and command, something that wasn't exactly a strong suit for Volquez before the UCL sprain.

Max Scherzer
No, he's not hurt, but a lot of people wonder about Scherzer's odd-looking motion. In the past, I was as guilty as anyone of thinking I could look at a motion and see something. Lots of people did, but years and injuries later, we're realizing just how much we didn't know. Watching a pitcher pitch gives us some information, but not enough. There's keys, things you can look for, but like a car making a sound, even a trained mechanic is going to need to open the hood. And just like that mechanic, we need advanced tools and training. While people like @sstretch98 are asking whether or not Cory Schwartz and I like Scherzer to go for a strikeout title or a long stay on the DL, the simple answer is: We don't know. Not just me, but the Tigers don't either. What we need to know are joint loads, the types of calculations that need motion capture analysis and biomechanics experts to decipher. We can guess about Scherzer and almost every other pitcher in the big leagues, but we just don't know. What I do know is you should join the conversation over on Twitter. Lots of good conversation over there, even with big TV stars like Cory.

Quick Cuts: While there's still at least a month before Carlos Beltran is back, there have been positive signs. He starts running in earnest this weekend, a major test. ... Ian Kinsler took batting practice on Wednesday. He'll test the ankle with some running this weekend. ... Joe Blanton is playing catch. That's a long way from getting in a game, but he's a day ahead of schedule and that's something. ... Brad Lidge is "very close" to throwing a rehab game. His return is still late April-ish. ... Sam Gervacio heads to the DL with a rotator cuff strain. I was looking forward to seeing what were described as "Fidrych-style antics" on the mound and the reaction of hitters. The Astros aren't sure when he'll be back. Expect more tests. ... Alfonso Soriano ran well during Wednesday's game. Two sources called to tell me how good Soriano looked compared to his early spring form. ... Michael Wuertz is about a "week away" according to John Shea, but that week is how far he is from starting a rehab assignment, not returning to the A's pen.

Related Content:  Back,  Surgery,  What You Need To Know,  Control

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