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June 7, 2010

Under The Knife

Monday Update

by Will Carroll

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Grady Sizemore (microfracture knee surgery, ERD 10/4)
On Friday, Sizemore had microfracture surgery. As simple as that, Sizemore is done for the 2010 season and his future as an elite player is in doubt. Yes, most think that Sizemore can come back, but in baseball, there are no good comparable players who have had the procedure and returned, unless you're an Indians fan that really enjoyed the latter years of Sandy Alomar Jr. While you can look at advances in the procedure and a success rate in other sports, it's more difficult to make direct comparisons for Sizemore. First, let's be clear—we don't know where or how many holes were created during the microfracture part of the surgery. The Associated Press stated that Sizemore had holes drilled into his patella (knee cap), which is not a weight-bearing part of the joint. It's common to have problems with the "glide" of the patella and the groove of it, and the patellar tendon is in it. If this is the only part where microfracture took place, this is very significant. To say this very simply, this is not a Carlos Beltran situation, which is a weight-bearing problem. This is closer to, but not identical to, the problem that Magglio Ordonez had at the start of his Tigers tenure. Ordonez didn't have microfracture, but a different type of surgery using shock waves rather than a drill or awl. Sizemore will have the rest of 2010 to recover and rehab. The question is less about will he come back—that's almost assured—but can he adjust to the limitations and remain a star-level player in 2011 and beyond.

Oliver Perez (patellar tendonitis, ERD TBD)
"Placed on the DL" is a pretty simple phrase. We all see it and know what it means. We'll even snicker at times that there are some roster shenanigans going on. Fact is, it's not just a push-button process. Behind the scenes, a doctor has to essentially send in a note. The "Standard Form of Disability" has to be submitted, giving the diagnosis and some more information. The form used to include how the injury occurred and an expected length of disability, but I'm not sure that those processes made it over to the new electronic system MLB has in place. The diagnosis that the Mets released for Perez was patellar tendonitis, an injury that ended his season early last season and required surgery. Yesterday, I was told by multiple sources that a team had asked the commissioner's office to look into this move. Teams have the right to ask for this, but seldom do so, knowing that they'll likely need to make one of these moves themselves someday. Triangulating my sources, at least three teams made the request, a real surprise. I don't know which teams, but there's so many questions about this that many seem to question why it wasn't more rather than the number reported. I'd be surprised if this was overturned. Assistant general manager, John Ricco, worked in the commissioner's office before moving to the Mets and understands the rules and technicalities as well as anyone. Perez's stay on the DL could end up much like his exile during his last days as a Pirate. Perez wasn't motivated to improve then, and with a much bigger contract in his back pocket, I'd be surprised if he was motivated now. As for the tendonitis, it's hard to say how long this will affect him since it's as much about his performance as his injury.

Alex Rodriguez (strained groin)
Jorge Posada (fractured foot)
Rodriguez left Sunday's game with a sore groin, but with a day off today, he's not expected to miss any time. This might be the first time we see an effect of Posada's limitations. Locked in to DH, the team can't shift Rodriguez to the spot to keep his bat in the lineup while resting his leg. The team is used to this. Under Joe Girardi, there hasn't been much in the way of flexibility. Girardi has been locked into lineups due to limitations (Hideki Matsui and now Posada), a lack of positional flexibility, and a Joe Torre-like tendency to want roles filled more than players available. Rodriguez's groin won't be a big concern, but it could have been if it were a longer-term issue. As for Posada, he's going to progress to some catching drills this week after being cleared by doctors. It sounds as if he'll be worked slowly back into the catching rotation over the next few weeks, but Girardi is open to him staying at DH full-time.

Josh Hamilton (inflamed knee, ERD 6/7)
Hamilton is never going to be "normal." That's not a slight on him; he's just got no comparables when it comes to talent or challenges. The biggest challenges he's faced have always been internal and now it's his body, not his willpower, that is hurting his ability to put that talent on the field. Oddly, most of Hamilton's injuries since his comeback have been to soft tissue, usually cartilage. It's hard to say if this is coincidence or pattern, but it's worth noting. Hamilton had a cortisone injection in his knee over the weekend, designed to reduce some pain and inflammation that he's been dealing with off and on all season. This isn't a Sizemore situation by any stretch of the imagination, but it does remind us of the unique challenges that the Rangers face with Hamilton. He'll likely never play much more than 100 games in a season, 120 at the high end, but he can be valuable if they're productive appearances rather than ones he grits his teeth through.

Brandon Webb (strained shoulder, ERD 7/20)
Webb is working on keeping his arm in the right slot, not raising it as he was doing. Of course, he was doing this to reduce the irritation and pain he was feeling inside his shoulder, so there's some danger here. He's nowhere close to throwing at 100 percent, the spot where he had issues last season. Webb is scheduled to get up on a mound sometime in the next 10 days and at that point, he'll need to build up to a "normal" activity schedule. That puts him on pace, at best, for a rehab assignment to start somewhere toward the end of June. Since he hasn't pitched for over a year, it's likely he would need something close to the full 30 days of rehab time to get not only his stamina, but his "touch and feel" back on his pitches. Webb has a bit of an advantage here in that he relies so much on one pitch, the sinker. Once he gets that working, the rest is mostly just for show. I have some grave concerns about Webb, but the returns of Jeff Francis and Fausto Carmona are encouraging, as is the big thumbs-up he got from Birmingham.

Jeremy Hermida (ribs/forearm soreness, ERD 6/8)
Let's just call him "Beltre the Destroyer." Beltre had his second collision with an outfielder this season and again, the outfielder came away the worse for it. Hermida had a CT scan on his arm and ribcage to make sure that he didn't have any lasting issues after a run-in... or run-into... with Beltre. Hermida described the pain in his ribs as "like a bone bruise," but there are no fractures. Hermida was out of the lineup Sunday and could miss a couple more games depending on how his body responds. Watching the play, I can't tell if there's any way to determine who, if anyone, is at fault. Was anyone calling for the ball? Given this is the second occurrence and in very similar circumstances, I have to believe that whichever coach is focused on defense might be making sure that the outfielders know "yo la tengo"! or at the very least "proteger a sus costillas."

Chipper Jones (inflamed finger, ERD 6/8)
It's always tough to read an athlete's mind, but we can get some clues from media reports and the actions a medical staff takes. Jones told the media that he wasn't seeing improvement with his finger on Saturday, but that he was going to wait a couple days before making a decision on having a cortisone injection. Yesterday, he had the injection. The cortisone is expected to reduce the inflammation in his right ring finger, allowing him to grip both the bat and ball without significant problems. It will take a couple days before the Braves know if the injection did what it's supposed to, so there's no chance of him playing before Tuesday. At that point, if there's not significant relief, the Braves will have to push Jones to the DL and hope that rest and more aggressive treatment can clear up the problem. Jones tends to heal well, so I'm optimistic about him at least trying to play through it.

Stephen Strasburg
It was a year ago when Strasburg was drafted and tomorrow, he'll make his major-league debut. Since he first burst onto the national stage featuring a 100-plus mph fastball and secondary pitches that alone would have made him the first overall pick, we've had armchair biomechanists predicting breakdowns using every letter in the alphabet. The simple fact is that I don't know, you don't know, and the Nationals don't know either, but neither do these experts. While Strasburg could be the next Joel Zumaya or Mark Prior—and would that be so bad?—he could just as easily be the next Nolan Ryan or Jamie Moyer. I asked Dr. Glenn Fleisig if velocity could predict the forces on an arm and he answered with the following:

"Faster ball velocity is not always associated with more force on the shoulder and elbow. From Isaac Newton, force = mass * acceleration (not velocity). The first part of the equation is "mass" which, in this case, is the mass of the ball and throwing arm. The second part is acceleration—and this is a function of mechanics. Pitchers with better mechanics can produce ball velocity with less acceleration and force produced at their shoulder and elbow (by producing more energy and better coordination throughout their body)."

The Nats, like most teams, have never had a motion analysis done on their pitchers. Strasburg is as much a mystery to biomechanists as he is to hitters. Saying that he'll break down is pretty simple. More than half of pitchers in any given three-year period will hit the DL. Dr. Mike Marshall famously predicted that Prior would blow out his elbow after seeing his first few starts. As far as I know, Prior's elbow is still pristine. The shoulder? Not so much. Let's hope that the Nats and Strasburg have better luck and a bit more science behind them. (The most amazing fact to me about Strasburg is, after all the drama about his demands last year, is that even with his signing bonus added in, he's making less money over four years than Jason Marquis will over two.)

David Ortiz (strained wrist)
I was speaking to a physical therapist over the weekend and she mentioned something interesting about Ortiz. She wondered if Ortiz's problem with his wrist could be chalked up to some form of arthritis. As many of us with the condition can vouch for, weather has a major effect on how joints feel. Cold weather, changes in temperature and atmospheric pressure, and the whims of the world can mean a lot in terms of both feel and function. It would take a pretty in-depth analysis of factors to tell if there was any sort of pattern here. Things like barometric pressure aren't on Retrosheet, but when I asked a Boston team source about this Sunday, that source locked up hard. Knowing how these things go, I get the sense that the Red Sox have done precisely this kind of analysis and know the answer. It's something that can't be done from the outside—we simply don't know how Ortiz feels or the treatment he gets both pre- and post-game—but it's one reason why anyone that thinks they have better information than teams do is wrong.

John Wooden
A couple years ago, I had the incomparable opportunity to meet Wooden. The Wooden Classic was being played in Indianapolis and he was doing a quick meet-and-greet. At 95, he was still as sharp as any and more clear than most. There were touches of both a coaching style and an educator's mischievous need for inquiry. I asked a question that meant almost nothing in the scheme of things, wanting to know about the possibly apocryphal tale that he started each year's practice with a lesson on how to properly tie shoes. I wondered if it was about injury prevention or a lesson in fundamentals. His answer was that it was both and an easy way to know who was listening and following through. "I could walk into practice in February and see who not only listened, but understood, just by looking at their shoes." He looked at my well-worn slip-on Chucks and laughed, "I don't know what to do about those!" Wooden was all those things I wish I could be—graceful, intelligent, humble, likeable—and we're all richer for his having been in sports.

 Quick Cuts: I think John Fay nails it with regards to Mike Leake. The answer is another pitcher, not Dusty Baker using him less. My worry is that a division race throws out common sense. ... The Reds haven't made a final decision on Homer Bailey after seeing his side session yesterday. Signs are pointing to him making a start Tuesday for the Reds. ... Brad Penny is making progress, but it appears the Cardinals are moving pretty conservatively toward getting him back in the rotation. It wouldn't surprise me if he makes a rehab start. ... Jair Jurrjens is making good progress, running and throwing in the pen. His hamstring shouldn't be an issue when he starts a rehab assignment next week. Don't be surprised to see him back early. ... Justin Morneau has the flu, but he's expected back before long and with no real long-term issues. ... Orlando Hudson will go to the DL, according to several sources. He'll be replaced on the roster and at second base by Michael Cuddyer, who is returning from bereavement leave. ... Mark DeRosa is going to get until mid-week to prove he can play through his wrist injury, but he wasn't on the field yesterday. So far, he's got an 0-fer going on the rehab assignment and observers say his bat "looks like it's underwater. He's grimacing on every swing." ... Miguel Montero made it through back-to-back games in extended spring training, so he shouldn't have much challenge with a rehab assignment. That starts today with the expectation that he'll be back in the Diamondbacks lineup the following week. ... Eric Chavez is going to give it another try. He'll go on a rehab assignment in a couple weeks, but no one seems to have much hope that he can contribute again. ... This is a little outside my normal purview, but I'm very curious. With the draft today and all the talk about Bryce Harper and makeup, why does no one look back at someone who has a very similar issue? A.J. Pierzynski has been one of the most disliked players in the big leagues for years, but also a successful, long-term major leaguer. What did the scouting reports say about Pierzynski when he was drafted in the third round by the Twins in 1994, considered the ultimate scouting organization? Did he slide on the makeup issues, if there were any, and why did the Twins think he'd succeed? What other high draft picks had makeup issues? Scouting is done so much in the dark that there's seemingly no institutional memory. ... And a final thought on the draft—you'd be stunned at how many teams haven't yet made a final determination on players. Despite the chance to examine players at workouts, most players refuse to share medical records. For several players expected to go in the first round, it might be doctors as much as scouts that determine their futures.   

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