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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

13 comments have been left for this article. (Click to hide comments)

BP Comment Quick Links

BP staff member Will Carroll
BP staff

Late word that Jarrod Salatalamacchia has been placed on the DL. "Upper back stiffness" that's very near the area where the thoracic outlet syndrome surgery occurred. More details tomorrow.

Apr 08, 2010 09:12 AM
 
j11forbes

Will - how many teams regularly conduct the sort joint load analysis you mention regarding Scherzer? Is this a regular practice for most MLB teams or are only a few doing it? Is it something that's normally only done when people feel there might be a problem with someone's throwing motion?

Apr 08, 2010 10:45 AM
rating: 0
 
BP staff member Will Carroll
BP staff

Two teams have their own equipment.
Ten have done it at some point, but never nearly all pitchers.
I think four, maybe five doing it right now in any capacity.

Apr 08, 2010 10:59 AM
 
nugget247

Care to name the 4 or 5?

Apr 08, 2010 13:13 PM
rating: -1
 
j11forbes

Is there anything to indicate that teams who are using it are getting better at preventing/predicting pitcher injuries or is everything still too new?

Apr 08, 2010 15:03 PM
rating: 0
 
BP staff member Will Carroll
BP staff

Too new. Teams that have done it ib the past - it was discussed in moneyball - but never comprehensively. With the two teams now i know how one is using it but not the other. With the one i know, they have some good but proprietary results. Im not going to out either, but one has spoken of it a bit publicly. Im hoping to get them on record soon.

Apr 08, 2010 19:52 PM
 
Edwincnelson

If Berkman's problem is the damage to his knee, with the fluid being the symptom of the underlying damage, is there any good chance he avoids either a long rest period, or surgery? Is his knee just going to fix itself in 10 days?

Can Carlos Beltran play 130 games in the outfield without any cartilage in his knees? Can surgery really correct that?

Apr 08, 2010 10:54 AM
rating: 0
 
BP staff member Will Carroll
BP staff

The question on both is comfort and consequence. Can they play without being in so much pain it affects what they can and cant do, and can they play without the type of swelling and pain Berkman has right now. The answer is yes, but requires a lot of maintenance, a lot of pain tolerance, and a lot of luck.

And yes, it's possible. We don't have any good long term microfracture guys in baseball, but there have been several Synvisc guys.

Apr 08, 2010 11:01 AM
 
quietgoesthedon

It's going to be a long season in Houston, even if Berkman returns. They're still talking about a return for the St. Louis series. That sounds a bit rushed, from the above.

Apr 09, 2010 09:46 AM
rating: 0
 
BrewersTT

If the Brewers can have a pitcher hurt himself using the salad tongs at a buffet (Matt Wise, 2006), I see no reason to be surprised that one can hurt himself sleeping. Wise was so fragile that he also hurt his shoulder losing his grip on a dugout railing.

Apr 08, 2010 14:44 PM
rating: 1
 
smallflowers

Will, I've seen Meche listed quite a bit as a 4/10 activation, 4/11 start. Is 4/13 more accurate?

Apr 08, 2010 17:04 PM
rating: -1
 
BP staff member Will Carroll
BP staff

Erds are always best guesses.

Apr 08, 2010 19:52 PM
 
cyborg

Is it more likely that Suppan has the "phantom" neck injury? The Brewers don't need a 5th starter for the first few weeks of the season and want the roster spot.

Apr 08, 2010 20:25 PM
rating: 0
 
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