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July 6, 2010
Under The Knife
The All-Star Effect
Starting in early June, it seems like nearly every injury story is going to have the phrase "the All-Star break" in it. A player is coming back just before it, while another player is expected back after it, and yet another is hoping to rest over the break in order to be ready for the second half. The problem is, it doesn't appear to work that way. The break is three and sometimes four days when a player doesn't have games. It's the only scheduled break like that during the long grind of the season, no doubt, but three days is seldom enough time to heal something minor, let alone be able to have some sort of medical breakthrough.
I spent several hours sifting through UTK columns and injury data over the last seven years, and while this is no scientific study, it appears that the break is nothing special. There's no increased rate of return; in fact, the opposite is true. The arbitrary break often leads teams to bring players back just after the break, artificially extending the days lost. This is just accounting and perception. It also happens at the start of months, returning to a homestand, and more noticeably at the beginning of series, though these obviously happen more often than the other events. The All-Star break is nothing more than an artificial construct that we can use to put things in relation to others.
As for the rest, it helps for some minor things, but the real value is mental. One MLB athletic trainer said that he often debates sending his guys home rather than continuing treatment. "I've seen those guys every single day since February in some cases," he told me. "I'm sick of them, they're sick of me, and we're both sick of the process. Unless it's something where a gap in treatment is a big issue, I'd rather they go home. I can tell them to ice or heat, but I think getting away, seeing the family—that's where the value is. Recharging, not healing."
The other side is for the All-Stars themselves. If most of baseball is getting a few days off, does it hurt players not to take that time off? Many players do, opting out of the event for various reasons. There are some players who have slower second halves, which some will point to and say "worn down." This has become very common for those participating in the home run derby, notably Josh Hamilton; some is simple regression to the mean, and some might have happened anyway. One thing that's notable in going through game logs is that the managers and teams don't seem to think three days off solve anything. Aside from injuries, none of the All-Stars in the last three seasons were given their own created break. A couple of teams seem to have made efforts to buy some rest, giving their All-Stars a game off before or after an off day, but not once that I can find (and I'll admit, there may be some I missed) did a team give an All-Star both the day before and after a scheduled off day off, absent an intervening event like an injury.
The effect on pitching is even more difficult to judge. I'm no statistician, but the same kind of eyeballing showed much the same effect, or lack thereof. Taking the time off didn't suddenly make a pitcher better. Even in aggregate, there's no sudden rise in Game Scores in the week just after the break. If three days off worked, teams would do it. If a pitcher going an inning in an exhibition game hurt them, no team would allow it. When it comes to injuries and fatigue, the All-Star Game doesn't count.
Joel Zumaya (fractured elbow, ERD 10/4)
So how did it break? We've known for years that, especially in youth athletes, the olecranon would impact with the humerus during the pitching motion if a pitcher did not pronate to allow for a smooth follow-through and dispersal of the energy. You can try this at home easily: pretend that you have a hammer in your hand. As you strike down at a nail, you plan so that the hammer hits the nail before your arm is fully extended. The energy goes into the distal impact (hammer on nail) rather than the proximal (bone-on-bone inside the elbow.) Now, try taking the same swing (not too hard!) and having there be no nail or board to hit. You'll feel the elbow tighten and, in the back, you'll feel the elbow impact slightly as it "locks out" in full extension. That's likely what Zumaya did—he hyperextended the elbow during a pitch, causing the olecranon to break when it impacted the humerus.
There's a second possibility that two orthopedists I spoke with mentioned. That is, that Zumaya put so much pressure on the bone during each pitch—not just the one we saw—that it worked like a stress fracture and finally gave way due to a wearing down rather than a sudden, singular impact.
In fact, both could be true; a weakened bone could snap more easily. The fact is that Zumaya simply does things that few other pitchers do to their elbows, shoulders, and bodies. I've always wished that Zumaya would have been sent to Birmingham, just to see how much force he's putting on various areas of his arm. Now, that won't happen for a while. Instead Zumaya is headed for surgery for a simple procedure of fixating the bone in one of various ways. Doing the surgery will allow Zumaya to do more in a more timely fashion. I can't imagine asking him to do nothing with the arm for a period of weeks would be good, let alone the possibilities of deconditioning and loss of motion. It's impossible to say that Zumaya can or can't come back from this, because there simply are no comparable precedents. Even though olecranon fractures can and do happen in baseball, it's fair to say that no one similar to Zumaya has done this. There's certainly a chance he comes back from this and pitches normally, but that's assuming that the bone heals well—which it should. The worry here is the forces involved, something no one has a handle on. Can anyone handle this kind of force without negative consequence?
Erik Bedard (post-surgical shoulder, ERD TBD)
Edinson Volquez (sprained elbow, ERD 7/15)
The Reds also have a bit of a worry with one of the guys they're not used to worrying about. Aaron Harang missed his last start and now his Tuesday return is in a bit of jeopardy. He's seeing a chiropractor in hopes that will get him comfortable enough and functional enough to make his next start, but a decision will be made when he gets to the park today. If Harang can't go, it shuffles everything above with Volquez in regard to how the Reds will set their rotation. With the break coming up and the retro move available, Harang could miss as little as one more start (three total) if need be. Right now, things are 50-50 on Harang, but for a rotation already in trouble with innings, this could be the first domino on a lot of actions.
Aramis Ramirez (bruised thumb)
Omar Vizquel (bruised knee, ERD 7/8)
Dallas Braden (strained elbow, ERD 7/20)
Asdrubal Cabrera (fractured forearm, ERD 7/31)
"Leites" asked about Maybin's shoulder. Maybin had labrum surgery in the offseason, so it's definitely not good news that he's having to have it looked at again. It's not unusual, since this is a similar pattern to what we've seen with B.J. Upton and others. The question is whether it's normal soreness, an adjustment period, or a recurrence. He's obviously not been playing well, ending up back in New Orleans rather than locking down center field for the Loria-disappointing Marlins. He was scheduled to have an exam with Marlins doctors in Miami on Monday, but at deadline no details have been released. The Marlins will be looking to see if any of his performance can be pinned to the shoulder issue or whether this might just be a comfort/mental issue that he's going to have to push past, whether that's at Triple-A (where he's on the DL for now) or Miami.
Quick Cuts: I was on Baltimore radio with Glenn Clark this morning, and he pointed out just how good Cliff Lee has been since coming off the DL. I knew he'd been good and coveted, but I'd missed the numbers—and the impact. Lee's season matches his Philly second half and perhaps exceeds it. So what changed? … Carlos Ruiz is scheduled to meet with a concussion specialist. If he is cleared, he'll head out on a rehab assignment soon. ... Lots of people around the O's seem to think Kevin Millwood is headed for the DL, despite no mention of a specific injury. In the Pitch-FX era, will "lost velocity" become enough of a diagnosis? ... I mentioned Dave Dravecky above, but it remains one of the great mysteries of sports medicine as to why Dravecky, Tony Saunders, John Smiley and Tom Browning all had their arms fracture. They're all lefties. ... Oliver Perez is scheduled for a rehab start today. He got knocked around a bit, but showed some velocity last time out. ... Kyle Lohse has started a throwing program, but we're at least a month away from seeing anything resembling real pitching. It's still an encouraging step that he's out there so quickly after surgery. ... I missed the new Steel Train album that came out last week, but I'm catching up on some very good stuff. ... Matt LaPorta left Monday's game with what the Indians called a "head contusion." That's reasonable, given the hard contact between LaPorta's head and Elvis Andrus' knee. He had a CT scan after the game due to concussion symptoms. ... Scott Olsen is a little ahead of the rest of the pack of rehabbing Nats. He's expected to be back in late July, giving him a chance to make an impression. Now the question is whether Olsen et al will be enough to fill in the rotation or if the Nats still need to acquire some innings to protect Stephen Strasburg .... Jeff Novitzky is palling around with Floyd Landis suddenly. I guess if his $75 million dollar quest to get Barry Bonds has failed, he'll need another windmill to waste your money on.