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April 30, 2010

Under The Knife

In A Bad Spot

by Will Carroll

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It seems like it was just yesterday that I was standing on the field in Cincinnati, talking to C. Trent Rosecrans and a couple of other beat writers. It was Opening Day and the grass on Great AmericanBall Park's field was freshly cut and slightly wet. No team starts off fully healthy, but that's supposed to be the day where Bud Selig's "hope and faith" is the strongest. A couple home runs from Albert Pujols can shake the hope of any National League team, but while Pujols has been mostly healthy, the same can't be said of many others across the game. It's always at about this point in the season where people say injuries are up, or down, but in truth, it's just the first month of the season. Any random grouping of 25 days could come up with a similar number, more, or less. It's not a random process, but it is a random result. Don't read too much, if anything, into it. With that out of the way, let's get to the injuries:

Carlos Beltran (multiple knee problems, ERD 7/1)
Yesterday, I talked about Beltran and his knee brace, but I struggled with how to explain why the brace might be of any real use to his recovery. Gene Patterson, an athletic training consultant I often consult with who has experience with similar braces in his practice, had a better take in comments. I thought it deserved a full airing, so here it is: "Continued bruising of the tibial plateau is likely being caused by the large end of the femur "banging" into it as he extends his knee. Sense the cartilage left in his knee is minimal, the front (anterior) portion of the tibial plateau is getting beat up. The custom brace is likely fitted to block his knee from going into complete extension (as well as any hyperextending). This will limit the femur from 'slamming' into the plateau. The brace won't solve the problem but the idea is to limit the continued irritation. Look for even more decrease in his speed than has already occurred with this kind of bracing though." Without seeing the brace we can't be sure of its intent, but it's insight like this that I love to hear. It doesn't make me more positive on Beltran's short or long-term prospects, but the thought process of his medical team is fascinating.

Jorge Posada (knee contusion, ERD 5/2)
Ben Wolf, a smart guy you'll be hearing from in the near future in this space, points out something about Posada getting hit by a pitch Wednesday that hadn't occurred to me: "Was reading your latest column and saw that Posada was hit in the fibular head (I had just read knee in the general news).  Even if there isn't a fracture, there's a risk of the injury being more of a long-term problem if he ends up with any restriction in the superior tibiofibular joint, especially considering the demands of a catcher squatting on the knee (including that joint specifically I think), not to mention any mechanistic problems he could have running.  I suppose we will see." Wolf is right here and brings up a more important point about the functional demands of each position. It's clear that catching has some additional biomechanical demands over other positions. We see the catcher squatting, uncoiling throws, and taking hits, so it's apparent, but don't forget that each position has the some sorts of issues. Posada says he could catch if it was an emergency, but it's clear that it's the squatting that's the problem. We'll see how the Yankees deal with this over the weekend, but expect Posada to miss time. At best, he could DH, but I think they'll hold on to the retro DL move until they're more sure.

Justin Duchscherer (left hip strain, TBD)
One of the things that goes into the perception that injuries are up is where you are located and what you're watching. I'll guarantee that Athletics fans think the numbers are up right now. The team has 10 people on the DL and there might be more coming with Duchscherer's latest injury. Duchscherer left Thursday night's start with a left hip problem that doesn't sound good at all. It's the description of the injury as identical to the problem he had with his right hip that has me most concerned. That situation, which required two surgeries to correct, could be something that is structural/genetic in nature. In other words, having one hip this way makes it more likely that both hips were identically susceptible. The two hips have different functions in the delivery, so I'm curious to find out how the loading would work on that. Duchscherer is headed for tests to determine the root cause of the problem, but it's unlikely he'll be able to avoid the DL. The team is just hoping the stay will be minimal at this stage.

Cliff Lee (abdominal strain, ERD 4/30)
Lee returns ... or rather debuts for the Mariners tonight after a long rehab process. Lee's abdominal strain was similar to, but not identical, to the one he had in 2007. Still, the history made his new team a bit cautious, something the Mariners already are with pitching injuries, in large part because of their previous history as what I once referred to as an "arm-shredding machine." That was a while back and the injury situation has gotten a lot better over the past five years, actually putting the Mariners in the upper third of teams by most of the standard day and dollar stats. Lee has had no issues with pain or soreness that have been noted after his simulated games, a great sign. There's some concern about how close those games get to "full-go" and situations like Brandon Webb's have shown us that even small differences are significant. Lee will be on a 100-pitch limit, since his stamina is still a concern and you should also look see how his command is early.

Jair Jurrjens (strained hamstring, TBD)
Yunel Escobar (strained groin, ERD 5/1)
The Braves have gotten off to a bit of a slow start, but if you look at the standings, it's not like the season has gotten away from them. Instead, it's an easily explained situation, caused by a combination of slight underperformance and injuries. The underperformance is of the "small sample" type, such as with Jason Heyward. That's the kind that is purely meaningless, despite what anyone will try to twist into a column. The injures are a bigger concern. Jurrjens, a guy coming off an innings increase—yes, yes, I know what the numbers have said about the Verducci Effect, but until I see a bigger more complete study, I'm going to keep it as a red flag, OK?—is now dealing with a hamstring strain. He left Thursday's start in the second inning holding the top of his leg. Right now, the Braves are saying he'll make his next start, but they know that his response to the injury is going to be key. Fatigue, which is really what we're trying to get to with proxies like the Verducci Effect and even Pitcher Abuse Points, manifests itself in odd ways and I remain convinced that things like this have their roots in workload. The Braves are also missing Escobar, whose head shot reminds me of John Rocker, as he deals with a mild groin strain. The team will keep him out a couple days, perhaps through Saturday, in hopes that he won't need a stint on the DL. The Braves are being very up front on this one, so don't expect it to be much more than this.

Wandy Rodriguez (back spasms, ERD 5/1)
It's never good when a pitcher is scratched from his start, but the Astros think this one could be as minor as theycome. Rodriguez was scratched on Thursday from his scheduled start tonight, but the team thinks he should be good to go on Saturday. Follow all that? Back spasms on Thursday. Won't start on Friday. Might start on Saturday. This isn't something that just popped up. Rodriguez stiffened up during or just after last Saturday's start and the team has been working on this to try and get him ready for his scheduled start. Part of the issue is that the team was flying into Atlanta, but I have a hard time buying that flights these days are really that hard on players. It's not like Rodriguez is getting stuck in a middle seat on a red-eye. The medical staff will continue to work on him, hoping the anti-inflammatories have him ready for Saturday. Having already moved Brett Myers up a day, it's likely the Astros would adjust by doing the same for the other two weekend games if Rodriguez is unable to go.

Everth Cabrera (strained hamstring, ERD 5/18)
The Padres tried to keep Cabrera off the DL. However, three games, his hamstring wasn't healing fast enough to be back without a DL stint. Cabrera is the definition of "speed player," one of the few Rule 5 guys that can take an incomplete skill set and play off that one thing they do well enough to keep a job. For a speed guy, any leg injury is a concern, but he's been healthy throughout his career. His four-for-six stealing ratio this season wasn't affected by this injury; once he was injured, he stopped running and actually playing. It will be a big concern once he gets back, though it appears that the team is going to take the cautious route here. Jerry Hairston Jr. will keep filling in at shortstop, with Lance Zawadzki taking the roster slot. When a guy doesn't have a PECOTA card, which is the case with Zawadski, it's pretty telling.

Quick Cuts: There's not much info on this, but Carlos Quentin is day-to-day with a "very mild" hamstring strain. The White Sox know they have to be very careful with anything that could re-stress Quentin's foot. ... Justin Verlander is on a "strict pitch count" according to Jim Leyland. It's not clear where the limit is, though there's some indication that it's a rolling total, rather than a per-game limit. ... Kurt Suzuki's injury is an intercostal strain, not an oblique. The timeframe and treatment is the same, though it's fun to see what an iPhone does to "intercostal strain" when people type it into Twitter quickly. ... The Rockies' Jorge De La Rosa's finger injury is very much the same as the one that cost Adam Wainwright two months a couple seasons ago. The upside?Wainwright was fine once he had healed. ... The Royals will be cautious with Rick Ankiel and his quad strain. He'll likely be held out through the weekend and the DL remains a possibility. ... In an ironic twist, J.J. Hardy has turf toe. Of course, that can happen on grass, and may actually be blamed more on modern shoes than turf. ... Chris Dickerson is headed back for an MRI after spraining his wrist. There seems to be concern that this could be more serious than a simple sprain. ... Joe Blanton will be activated on Monday, according to the Phillies. He's not expected to have any issues with his oblique. ... The Padres' Chris Young will make his rehab start on Sunday after missing an earlier date. ... Desmond Jennings is dealing with a sore shoulder, a definite worry for a guy with a history like his. The Rays insist he'll be back in the lineup quickly at Triple-A Durham, but the one skill Jennings hasn't demonstrated is health. ... In February, I made a comment about David Wright intended to comment on how his off-season regimen would be perceived. It was clumsily written and 140 characters doesn't leave much room for subtlety. I wish I'd said what I said in a better way, or actually not at all. ... With the iPad 3G hitting stores and hands today, I figured a quick update was reasonable. Having the iPad handy on the couch has changed how I watch games. While many were expecting TV and the net to integrate, instead, I think everyone will have something like an iPad which functions as both a second screen and a smart extension. I love mine and highly recommend it. Touch is the future. ... While others are just now getting to telling you about Jacoby Ellsbury's ribs, I do this almost every day. See you Monday.

Related Content:  Hamstring,  The Process,  Quad-a

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