Under The Knife: Cascading Along

This is another patented, super-size UTK edition, so instead of an intro where I might rant about the Freddy Garcia deal, the public unveiling of the myostatin baby in Germany, or the recent Washington Post expose on Bud Selig, I’ll just go right to the injuries….

• One of my favorite myths is that players cannot be traded while on the disabled list. It’s not true and actually happens occasionally. It’s not something I’d describe as routine, but in an age where medical information forms a reasonably complete picture, a medical staff should be able to make an informed judgement on the health and future value of any player, disabled or not. This fact might change the opinion many have of the rumored Magglio Ordonez for Andruw Jones deal. Ordonez is a few weeks away from returning after knee surgery, but it’s a predictable return. The Braves would definitely be a different team in the interim, likely shifting J.D. Drew to center, easing the load on his knees. Why make the deal now, if you’re the Braves? Because they’re not the only ones trying to make a deal for Ordonez, who is about a week away from a rehab assignment.
• While Rany Jazayerli continues to say that C.C. Sabathia isn’t as big an injury candidate as I think, he has given quite a scare to the Indians organization. With arms like Bob Wickman (who will be back soon and is hitting 93 on the gun), Billy Traber, and Brian Tallet missing time to major arm injuries, Sabathia is still the jewel of the organization. It appears that Sabathia is once again dealing with mechanics-induced bicipital tendinitis. This is the same condition that he had earlier this season. He missed two starts, so seeing Sabathia head to the DL is possible, perhaps even likely. Lonnie Soloff, the Indians rehab guru, is on the case, but Sabathia will be visiting Jim Andrews on Monday for confirmation. This situation is again mechanics-related more than injury related, so watch closely when Sabathia does return to the mound.
• I’ll often talk here about “cascades”–the situation where one part of the body being injured or out of whack causes another injury–but it’s interesting to see the same concept apply to a team. Since the term comes from network science, it’s not surprising that it shows up in any networked system–a body, a team, even a league.

  Tim Hudson went to the DL as a precaution after he once again felt an oblique strain affecting his motion. Little did the pitching-rich A’s know that Rich Harden would have a recurrence of his non-throwing shoulder’s laxity disorder. Had Harden gone on the DL, they would have been down two starters, but even then, the A’s were ready with Kirk Saarloos and John Rheinecker. This still leaves Justin Duchscherer in the bullpen and Joe Blanton on the verge. That’s just sick depth (and part of the reason that Billy Beane will be dangerous this trading season.) My favorite part of the episode is Larry Davis’ “everybody will make their next start” quote. It’s semantics like that which makes my job so “interesting.” Hudson will be out the minimum, while Rich Harden’s absence will depend on his pain tolerance. Remember his mechanics got out of whack early in the season when his gloveside drooped.

• In other A’s news, Eric Chavez is making excellent progress, Forteo or not. He had no problems hitting off a tee and will likely progress quickly to batting practice and probably a short rehab assignment. Expect him back after the All-Star break. Meanwhile, rumored deals sending Arthur Rhodes to Houston or Chicago will have to wait as Rhodes is suffering from some minor back stiffness. Of course, other sources say that Rhodes is actually being held out of games in anticipation of a deal. With the A’s, it’s hard to know the truth, so I’ll continue working the phones and sources.
• Odalis Perez left Saturday’s game with what was described as an inflammation of the rotator cuff. To Perez, it felt like a tightening that he could not work our through stretching. He’s due for a bullpen session Monday which will certainly tell us more about his availability. He’s nearly five years post-TJ, so the connection between the injuries is specious at best. Perez’s mechanics aren’t horrible, but his workload–while not high–could be to blame. Perez’s breakout 2002 campaign included a huge jump in innings and he didn’t seem the same in 2003. While certainly effective the last two seasons, an injury of overuse wouldn’t be unexpected. Pitching is a very difficult activity and analyzing it is even more complex. While some try to pigeonhole the analysis by attacking the tools, they’re missing the bigger picture. There are few “holistic” pitching coaches, ones that use all the available tools. You’ll know those by the long-term success of their pitchers.
• The relationships between teams and their doctors are often cited as a major conflict of interest, but often there is a conflict between a player and the doctors. The player’s goal is not only to play, but to be paid equitably for his skills. At times, his desire to maximize the pay can override the team’s needs. At times, the player will keep himself on the field despite injury, keeping the information from the team in order to gain more playing time. In others, like what happened with Jim Edmonds, his desire to keep himself from further injury overruled the need of the team. Edmonds was cleared to play, but according to team insiders, decided that he was not going to put his healing groin muscle at risk by running at full effort. Manager Tony La Russa pulled him after turning a double into a single. The condition of Edmonds’ groin depends on who you listen to at this stage, but he is cleared to play without restriction.
• The Cubs pitchers have been a mainstay of UTK all year, something that pains me almost as much as it’s pained those pitchers. Kerry Wood is closing in on as much lost time as Mark Prior (discounting spring training), but he’s making some positive progress. He finally made it through a simulated game, going 42 pitches including some breaking balls. Assuming he has only normal soreness on Monday, he’ll throw one more simulated game and the Cubs will then find him a comfortable spot like Lansing or Daytona for a rehab start. The bullpen is still falling apart while Jim Hendry works the phones to remake it. Mike Remlinger heads back to the DL with soreness in his recently repaired pitching shoulder.
• The Freddy Garcia trade was likely in the works before Scott Schoeneweis went down with an elbow injury, but the injury news may have hastened things for the White Sox. With no effective fifth starter all season, the White Sox can ill afford to lose their fourth starter for any length of time without adequate replacement. Jon Rauch may or may not be the answer at five, but Garcia is definitely an adequate replacement. Now, the Sox paid for Garcia to be an ace, not a fourth starter, but that’s not how this should be looked at. In a normal five-man rotation, slots become irrelevant quickly. Aces don’t always match up against aces and fives are as likely to face twos as they are fours. Whether you look at the Sox rotation and see “Garcia, Loaiza, Buehrle, Garland, and Rauch” or “Loaiza, Garland, Buehrle, Garcia, and Diaz” isn’t really significant. That rant aside, Schoeneweis’ elbow injury is a cascade injury, the result of compensating for a sore back. There’s no structural damage, so expect him back after the ASB.
• While Jose Contreras seemed to make a big leap forward with his family looking on, Kevin Brown made progress of his own this weekend. With two bullpen sessions behind him, Brown is on track to return from the DL later this week. While he’s set to match up with the Red Sox, Joe Torre might be more cautious with Brown coming off a back injury. It’s more likely that Brown will make one rehab start then come back early next week for the Bombers. Brown will undoubtedly fight for a shot at the Sox, so watch closely.
• It seems like every other player I discuss has “rumors swirling” around them, but for Carlos Delgado, those swirls have been around a while. Heading into his final half-season in Toronto, Delgado is about a week away from being activated, though it could be delayed until after the All-Star break. Delgado isn’t slow to come back from the oblique strain, as some have suggested. He’s simply not being asked to rush back to a struggling team. His value to the Jays is not just his hitting ability, but right now, it’s his potential trade value as well.
• The Red Sox are almost fully healthy, or at least as healthy as any team can be nearing the halfway point of the long season. With Pokey Reese (thumb) and Bill Mueller (knee) nearly back, the Sox have almost the lineup they expected to field on opening day. Sure, Byung-Hyun Kim is still in Pawtucket trying to solve his “leg imbalance” and Curt Schilling is dealing with a painful ankle, but this is a team that’s trailing only the Yankees and, uh, Rangers? Wow, didn’t expect that sentence. In a context-adjusted world, the Red Sox are still only behind those two, a feat that speaks to their roster construction and must worry those they are chasing. While my early-season prediction that one of the AL East favorites wouldn’t make the playoff is looking more like my HSX bet on Gigli, I’m still unsure which one you’d call the favorite heading into the ASB.
• Troy Percival returned to the Angels bullpen this weekend. His first outing was Sunday against the Dodgers. In a non-save inning, he struck out two and gave up a hit. He had good command, velocity and mechanics. Expect Percival to get the lion’s share of saves with Francisco Rodriguez and Brendan Donnelly making their pitch to close in 2005. Percival appears fully healed and while this isn’t an injury that tends to recur, be cautious with expectations.
• Jeremy Affeldt is another pitcher on the cusp of earning his “injury prone” badge. He’ll miss around two months with a torn (Grade II) intracostal muscle, leaving the Royals pen to a group of inexperienced hands and Scott Sullivan. Given Affeldt’s failure in both a starting and closing role, his value has to be plummeting. Instead of being a dominating player, he’s looking more like some of the lesser names on his PECOTA comp. Affeldt will need to have a healthy, effective season in some role next season to not drop into the realm of journeymen like Todd Van Poppel or Paul Wilson.
• Brandon Inge heads to the DL after breaking his finger on a bunt attempt. This is just another reason to eschew the sac bunt! Inge has gone from someone who looked to be a toolsy bust topping out at Triple-A to a coveted utility man in the space of a year. If there’s a weirder career path in recent years, I can’t think of it. I’m not really sure who to credit for this, so I’ll give the kudos to Inge. Given an opportunity, Inge made the most of it. While BP will often beg for sample size, often a player will be given a small chance to make the best of an opportunity. Some do, some don’t and that’s the difference in all too many cases. Inge should be back at the minimum.
• After fighting a hamstring strain for the better part of a week, Sean Casey left Sunday’s game with a calf strain. Both injuries were to the left leg, suggesting an injury cascade. It’s tough to tell when an injury will affect something else, leaving managers and medical staff to tread that fine line between utility and caution. Casey had already been on a trajectory back to his mean, but if he’s forced to the DL, Cincinnati will have a harder time hanging at the top of the standings. An MRI Monday will decide his path.

• Quick Cuts: Congratulations to the Cal State Fullerton Titans on their National Championship. I cheered…Sure, Andy Pettitte will make his start on Tuesday, but how much confidence do you have that he’ll be able to make it through the rest of the season without more elbow problems?…Jason Giambi was sent for blood work, missing Sunday’s game against the Mets. It’s suspected that he has a viral infection…Marcus Giles is still a few weeks away from a return, but it’s likely that he’ll be back around July 20th…Bobby Kielty has a mild strain of his oblique. He’ll miss a couple games, but it’s hoped he can avoid the DL…Finally, some news on Rafael Soriano. He’s cleared to throw, but not pitch. His return is targeted for August…How come every time I start to type “Austin Kearns” I accidentally type “J.D. Drew“?…Aaron Boone has signed with the Indians, but reports of him being ready in a month are beyond optimistic. At best, he’ll make a cameo appearance in September, but this is a deal for next year…It’s painful to watch Bartolo Colon pitch at this stage. He’s overthrowing in search of the lost velocity, further damaging whatever’s wrong in there…Good news for fans of Kip Wells. He had no problems in his last start or afterward. The finger problems appear to be behind him…Melvin Mora returns to the Orioles Monday. The Orioles are quietly very bad, with or without Mora.

And yes, I have to discuss this weekend’s news on the BALCO front. It’s getting to the point where no one is talking intelligently about the real issues. Should steroids be the subject of my next book? Victor Conte denies giving drugs to Barry Bonds. Barry Bonds denies using or even discussing drugs with Tim Montgomery. Montgomery’s leaked testimony is under investigation. Some of the reported testimony is dubious–there’s no advantage gained by a sprinter taking rEPO, one of the drugs Montgomery reportedly received from BALCO. The promised testing of seized baseball samples has been conveniently forgotten. I’m not even sure what’s left to be gained in this drama, but it’s sure to remain the biggest story in baseball, at least until Bud and Don get serious.

I’m not sure if this is the longest UTK ever, but my wrist is threatening to put me in my own column. Back tomorrow with more news from your favorite non-doctor.