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June 28, 2010

Under The Knife

The Red Sox Report

by Will Carroll

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Dustin Pedroia (fractured foot, ERD 8/15)
Welcome to the Red Sox Report... err, Under The Knife. Same thing, today. Pedroia has an unusual injury. It’s a non-displaced fracture of the navicular bone. It’s a common injury in horses, not so much in humans. Even then, it's usually a stress fracture rather than a traumatic injury like Pedroia's. The simple answer here is that it should take about six weeks for it to heal. The rehab goes in two-week “thirds” — first two weeks involves limited activity, second two weeks brings light activity, third two weeks ramp up to full activity, to tolerance. It’s not that Pedroia will be "normal." Remember, rehab protocols are made for people like you or me, or Grandpa, not a professional athlete with a full support and medical staff, nothing to do but rehab, and a high base for fitness. Add in the possibility of advanced therapies like pulsed electromagnetic therapy, cold lasers, or drugs that improve bone healing. It's possible, if not probable, that we could see Pedroia back sooner than six weeks. There's also the possibility that he'll have surgery, a simple procedure that would pin the bone to make sure it heals. Doctors I spoke with said that the surgery is seldom done unless there's a significant displacement. Otherwise, it doesn't do much in terms of results or timing. A final determination will be made today when Pedroia meets with Sox doctors. Looking ahead, we'll have some keys to his return. About the point he starts hitting, you’ll know he’s getting close. I doubt Mr. Low-and-Inside will need much of a rehab assignment, if any, to get his swing back. For now, he goes from putting on a laser show to maybe getting a laser shoe. Too bad; he really was crushing the ball lately.

Victor Martinez (fractured left thumb, ERD TBD)
After taking two foul tips off it in Sunday's game, Martinez's thumb swelled up to the point that it was noticeable from several steps away. The medical staff certainly noticed, pulled him aside, and eventually sent him for imaging. There's a fracture, but it's at the midpoint of the bone, so it should have minimal effect on his grip. It's going to end up a pain tolerance issue once they have the swelling out, and Martinez could avoid the DL. Given the rest of the team's injury struggles, the decision may end up being as much about the roster as the injury. We'll know more today after Martinez makes it through the iPhone-like line to see the Sox team doctor.

Clay Buchholz (hyperextended knee, ERD TBD)
Josh Beckett (strained back, ERD 7/10)
There is some good news in Beantown, as two pitchers from the Sox rotation are on the mend. Things looked pretty bleak just after Buchholz was injured on the basepaths—thanks, interleague play! Buchholz reported hearing something pop behind the knee, but a day later, things don't look so bleak. The hyperextension doesn't appear to have caused any structural damage and the swelling was minimal. Buchholz won't be needed until July 6, due to off days, but it will need to be noted if he makes his throw day. With the All-Star break, the Sox could DL him and only lose the one start. The team will wait before making any decision and despite Buchholz limping through the clubhouse yesterday, things look positive. The news was also good for Beckett, who made it through a 75-pitch simulated game on Saturday. The team is now shifting him towards a five-day schedule, but it doesn't seem that he'll go on a rehab assignment this week, if at all. His ability to recover and the stamina he shows in Thursday's scheduled session will help the Sox determine what's next. Sources tell me that they'd put him back in the rotation without a rehab assignment if they thought he could succeed. This one bears watching, especially if the Sox need something of a boost given their other injuries. This isn't normally a reactionary team, but these aren't normal circumstances.

Jason Heyward (thumb, ERD TBD)
Heyward is the new face of the Braves. That's a good thing. He's been hiding a thumb injury, trying to play through it despite its affect on his swing. That's not a good thing. Perhaps veteran influence—yes, I'm looking at you, Chipper Jones—has more of an impact than I thought. Heyward playing through and hiding this is such a Chipper-style move that Heyward's quote of "I want to get it taken care of sooner rather than later" after waiting two months reminds me of that scene in Bull Durham where Crash is giving Nuke a list of cliches. I have this image of Heyward on a plane with Jones, noting all the things to say. The thumb is a real problem, enough that the Braves will send him for an MRI this morning. Heyward has hit under .200 with just one homer during June, a sign that while he thinks he can play through it, he can't play well through it. There are a lot of possibilities, though this seems similar to what Aramis Ramirez went through earlier this season. Absent a very negative finding in the imaging, Heyward should be back quickly, perhaps as early as Tuesday.

Carl Crawford (strained shoulder, ERD 7/1)
Shoulder injuries and the Rays just seem to go together—not a good pairing. While speculation continues to rise that Crawford could be traded despite the Rays' success, Crawford has missed several games with a left shoulder strain that's lingering. Crawford first injured it early last week on a throw, then managed to exacerbate the condition while appearing as a pinch runner. It's his throwing shoulder, so this affects him both in the field and at bat. It's a very unusual mechanism of injury. The strong muscles and body action used in throwing usually don't break down under normal, non-repetitive conditions, which usually means minimal damage. We're left with Joe Maddon's "truly day-to-day" as the guide; this is an injury that isn't serious enough to require extensive rest, but one that hasn't gotten better in nearly a week. These are both the toughest to read and the most frustrating for both teams and fans.

Carlos Beltran (arthritic knee, ERD 7/15)
Angel Pagan (strained oblique, ERD 7/1)
Beltran's clock is ticking. Having started a rehab assignment last Thursday, he'll have 20 days maximum before the Mets will have to activate him. There's always the possibility of a setback and re-start, but let's try to think positively. He played seven innings in center field on Saturday, hitting a double and collecting a couple of RBI, the first game where I had someone there to give me a report. He's notably limping, according to observers, but it's not clear whether that's an actual honest limp or a change in his gait caused by the brace that's protecting his arthritic knee. One observer told me that Beltran didn't appear troubled running out his double, but that he wasn't very fast, either. "He used to glide out there. Now he looks more like a Molina," he said. The same held true for Beltran's play in the field, where he was able to make two routine catches. He wasn't tested there, but the observer I spoke with said that a ball to the gap looked like an issue. He did point out one reason for Beltran playing center field: "You told us a couple years ago that stopping was often the painful part, and I think that's the case here. He's jogged, run, hit, and caught, but I haven't seen him do a hard stop yet." Beltran got the day off yesterday, but after three straight days of playing, that's pretty good. Beltran's ability to play day after day and especially day after night is one reason why Pagan remains a key member of the Mets, even after Beltran is activated. There's little chance that Beltran will be able to play a full schedule, but Pagan could fill in or have some sort of time-share. Pagan, who the Mets won't trade any time soon, is out with "side spasms." Sources told me that Pagan is having some sort of reaction in his oblique, somewhere between a cramp and spasm that they feel is an early but not significant strain. The Mets will work on breaking the spasms and getting Pagan back on the field by mid-week. The DL remains a possibility, but it seems the Mets think they can avoid that.

Brian Roberts (herniated disc, ERD 8/1)
There's some progress for Roberts. He's in Florida at the team's facility and will begin what the Orioles are terming "light baseball activities." No one was able to give me the full details on what all that would entail, but let's take it at face value and say that it's just that. It didn't take too much in the way of strenuous activities to re-activate his back problems last time, so this slow and steady approach makes sense, given any sort of progress. Roberts has been on the roller coaster that a back injury can be, so even with a positive step like this, a setback can be literally one step away. Setting any sort of timeline or expectation is very difficult. At best, Roberts is going to need a couple of weeks to get into baseball shape and get his swing back, so late July is a best-case scenario. The worst is that this activity flares the back up again and he heads back to the surgical option.

Edwin Jackson
Maybe A.J. Hinch lost his clicker or listened to John Smoltz. Maybe he chose history over health. We're going to hear every variation, from "about time we got rid of the pitch count police" to "what was he thinking?!" when it comes to Jackson's 149-pitch no-hitter. Jackson is not "young" anymore, and he's had a couple solid years after struggling to establish himself. So does this announce his presence or the end of his career? The simple fact is we won't know. If Jackson has a good outing next time, we still won't know. If he has a terrible outing next time, we still won't know. If he makes it through the season, we won't know. If you're sensing a theme, it's that despite all the money we're putting into pitching, we still don't know much about how the body deals with that activity. We measure pitch counts because it's an easy, consistent proxy for fatigue. If there's any exception to the rule about not talking to a pitcher during a no-hitter, we saw it this weekend as Ken Crenshaw spoke to Jackson a couple times. He might have said "want more Gatorade?" but Crenshaw is one of the more advanced and well thought of athletic trainers in the business. Still, there's no way for Crenshaw or any other trainer to objectively measure the in-game fatigue of a pitcher. Some use subjective testing, what trainers call "putting their hands on" and that's valid, but difficult. The ATC is trusting his senses and his memory, trying to compare something from minutes or weeks ago. As good as Crenshaw or someone like Mike Reinold of the Red Sox may be, they can't be perfect. There are handheld devices that could be used to measure, but as far as I know, no team is doing so. No team is using motion capture to test players' in-season fatigue and mechanical efficiency. Baseball is leaving its million-dollar investments on the field using only educated guesswork and gut feelings to protect them. Whether or not Jackson threw too many pitches is a symptom, not the problem.

 Quick Cuts: One small step, but a good one, I think. ... Jair Jurrjens is expected back in the Braves' rotation on Wednesday after a successful series of rehab starts. ... Billy Wagner is struggling with an ankle sprain. He is day to day and the injury is not considered a long-term issue. ... Asdrubal Cabrera is making solid progress and could be back just after the All-Star break. ... Erik Bedard had a nice rehab outing, dominating Rookie ball. He had eight Ks and controlled his curve. ... Nate McLouth isn't having the constant headaches any more, a good sign in his recovery from a concussion. He took batting practice yesterday, another good sign. ... Neil Walker is doing well after suffering a concussion in a fly-ball collision. It looks like he'll avoid the DL. ... I'll be off from tomorrow through the end of the week as I head out for my first in-season vacation since I started doing this. Forgive my absence.   

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