Under The Knife: The Tipping Points

With apologies to Malcolm Gladwell, there are tipping points in each major league season. The Astros were dead and buried last season. We kept waiting for the White Sox to turn into pumpkins and they never did. Did the turn of the page to June cause some tipping point to be crossed? Injuries obviously don’t know the date, yet it seemed that the day I took off to take my grandmother to her 71st high school reunion was the day that every significant injury happened. I can’t tell yet, but I think we could look back to the turning of June as perhaps one of the most important dates in the baseball calendar for 2006, the date when some contenders lost their chances, when some teams regained some life, and when a hope for history went bust. I’ve got the date circled; we’ll know soon enough.

Powered by a Vegemite and cheese sandwich, on to the injuries:

• The injury that everyone–from the media to the over 400 emails I received–wants to know about is Albert Pujols. The slugger tore his oblique on an unusual fielding play, stabbing to his left, then quickly clutching at his lower right side. Normally, this injury is seen at the plate in hitters or on the mound in pitchers when a player has torqued his body past the point that the muscle could withstand the stress. There are some easy root causes, with dehydration, inflexibility, and trying to overswing/overrotate chief among them. This appears to be something of a fluke injury, though there is something to the idea that Pujols was “guarding” his sore back, causing unusual stress on his obliques. (Try this at home–tighten up your lower back muscles, then try and reach quickly to either side.) Sources tell me that Pujols’ injury is a Grade 2 due to the “palpable defect” in his muscle, though the official damage won’t be known until an MRI on Monday.

  Grade 2 is defined as a strain in which approximately half the thickness of the muscle is torn, creating significant pain, loss of strength and stability, discoloration and significant tenderness with possible palpable defect. If you need a definition of palpable defect, it’s a tear big enough to feel with your finger. Yeah, ouch.

  Complicating the analysis is both Pujols’ lineup value and his demonstrated ability to play through pain. Coming back too quickly can be devastating for any muscle strain. The body rebuilds the muscle with scar, weakening it by definition, though muscle can of course be strengthened around the tear. Retearing the muscle creates a vicious cycle of problems that can cause the type of career-altering cascades we’ve seen in the likes of Ken Griffey Jr. or Gil Meche. I’d expect the Cards to be ultraconservative with this injury, keeping Pujols on the shelf beyond the minimum, but less than the oft-quoted six weeks. It is going to be a Charybdean temptation for both manager and staff to write Pujols’ name on the lineup card, one that will need to be balanced by the field, medical and front office staff. The best recent comp I can find for this was Trot Nixon last season. Nixon came back in just under a month from a typical left oblique strain. Finding any comparison for Pujols is difficult, so I’m not sure how much we can learn here.

• It is even more interesting how the Cardinals replaced Pujols in the short term. After missing a week with a strained abdominal wall that many suspect is a sports hernia, Jim Edmonds was in the lineup…at first base. Edmonds’ injury is aggravated by running, so this creative use of available talent is much like the use of Pujols in the outfield a couple years back when his elbow injury prevented him from throwing. La Russa is a master at finding ways to gain an advantage or maximize his resources, so we shouldn’t be too surprised at this move.

  But while replacing Pujols with Edmonds is interesting, those familiar with Tom Gorman’s work on injury accounting know that this isn’t the actual equation; Pujols was replaced by Edmonds, but Edmonds was replaced by the illustrious Timo Perez, turning what looks like a more than adequate replacement into a significant and painful downgrade. If Edmonds is only being placed slightly at risk in order to try and hold the team’s lead in the standings, this is an inspired move. Even if he has a more significant injury, Edmonds is at the tail of his career for a team that needs to be bold. It’s an easier situation in assessing Chris Carpenter. He was adequately guarded for two missed starts and will slot back in without further worry after a 15-day rest.

• The injury to Gary Sheffield is devastating. I dug and dug to get the information on what was actually going on with Sheffield, knowing that while the Yankees were not lying about the injury, they weren’t giving anyone the whole story. Just as I was putting the pieces together, having two of my best advisors pointing me in what was the correct direction, Sheffield’s wrist made my work moot. Sheffield’s injury was not a bruise or a fracture, but a soft tissue injury. The torn ligament and translocated tendon have only an outside chance of repairing themselves without surgical intervention, but the chance that they could–along with the timetable of surgery–means it makes sense to wait. If Sheffield had surgery now, he wouldn’t be back in time for the playoffs and waiting a month just pushes it a bit further into the off-season. Yes, you’ll note that if he waits that will possibly affect him next season, but that’s not really the Yankees’ concern given his contract situation–or is there some handshake agreement that helped Sheffield stay patient on the chance he gets better? We don’t know. Sheffield has a small chance of avoiding surgery, so adjust your expectations accordingly.

• Elsewhere in Yankeeland, there are a lot of ups and downs. Derek Jeter continues to be banged up, Octavio Dotel is closer to a return, something that will put more heat on Kyle Farnsworth to produce, and Alex Rodriguez is still dealing with flu-like symptoms. The back injury to Mariano Rivera is one of those freak occurrences that will make a Jayson Stark column someday. The injury probably has nothing to do with his 25 pitch, 3 inning outing on Tuesday, but it is a coincidence that bears noting. Rivera will be available for Monday’s game and shouldn’t have much problem with it going forward. Of course, the Yankees have hired Jerome Benton to help him put his shoes on in the future.

• One of the more interesting stories I saw this weekend was this one on the Yankees official site. Mark Feinsand notes that Johnny Damon is better after rest, but that one of the main factors was having the team trainer tape his first and second toes together. This is a bit of a distraction–remember, while the rest of us have been digging to figure out exactly what was wrong with Damon, the Yankees have known all along. The idea that Gene Monahan is just now beginning to tape Damon is laughable. Damon’s injury is painful but not serious, and able to be treated with rest and the normal tools of the athletic trainer.

• The Jays have quietly been waiting on A.J. Burnett to get himself ready. The biggest question is not his elbow–that’s been examined by several of the best doctors available and given the green light. This is about confidence for the guy who scouts told me over and over was a gamer, a competitor, and a guy who wanted to beat his friend Josh Beckett in the division. I’d heard the whispers about Burnett for years, yet wanted to believe that they’d all been wrong and that Burnett was the pitcher who J.P. Ricciardi was buying into. So far, as the whispers turn into told-ya-so’s, Burnett is prepping for what is a very important rehab assignment. He’ll be working with Brad Arnsberg on the side–with bullpen sessions and a simulated game–before heading out. It’s far too early to say that Burnett is a bust, but not too early to understand why he could be. Burnett has to step up.

• Carlos Beltran has enough problems without giving himself one. The talented Met fouled a ball off the medial aspect of his right knee–the inside–that has him hobbled and out of the lineup. Beltran simply can’t run without pain, rendering him unable to play except in situations like Sunday, where he was asked to suck it up and pinch hit for his team in extra innings. The injury is not serious, merely painful and disabling in the strictest sense of the word. Time and treatment will have him back within days.

• What would UTK be without an extended discussion of the Cubs? They always seem to provide me with material. Let’s start with the sublime and head to the ridiculous. Derrek Lee had the cast removed from his fractured wrist and pronounced himself very well, thank you. Lee doesn’t believe he’ll need much in the way of rehab and doesn’t foresee a minor league stint. He’ll begin swinging this week with an expected rapid progression that could lead to his return to the lineup by this time next week. Mark Prior had a second rehab start on Saturday and had better results in the game and in his comments afterward. While Prior didn’t show better velocity, he did show nice efficiency, making it through five innings without hitting his limit. One observer said that Prior only hit 90 on his gun twice and that his pitches looked “flat.” Several reports have Prior throwing a change, something he hasn’t used much in the past.

  As Prior gets closer–he’ll have one more start before a decision is made–Kerry Wood continues to have problems recovering after starts. The Cubs have the pitching depth to deal with the needed extra days, though Dusty Baker already uses all 12 pitchers at his disposal to get through a season. A better solution might be to have Wood move to the pen, replacing the injured Scott Williamson and showcasing him for trade. Williamson had elbow stiffness in his twice-TJed elbow and will head to Cincinnati for a Kremchek-up on Monday. Finally, the Cubs shut down the rehab of Wade Miller, who continues to have pain in his pitching shoulder.

• There is no question in my mind that Roy Oswalt has a cascade injury. In the always-great Alyson Footer’s article at MLB.com, Oswalt all but says so himself. “I may have altered my mechanics,” he says, referring to what he did after straining his hamstring. Oswalt is now dealing with mid-back spasms, an unusual location. Elsewhere in the article, we get clues. Oswalt’s back only acted up when he threw curves, meaning that his mechanics remained altered into this session. Mid-back spasms usually involve some muscles rather than structural problems, so this isn’t as bad as it sounds. The Astros medical staff will have to stop the pain-spasm cycle, the Astros field staff will have to keep Oswalt from altering his mechanics, and Oswalt will have to listen. A decision on the DL won’t be made until mid-week and would follow an as-yet-unscheduled MRI.

• John Patterson‘s return from a forearm injury has been slow. If we speculate for a second that he’s returning from an elbow injury, the timeline is perhaps a bit aggressive, so in absence of evidence, we’ll call this one a conservative course of action by the Nats. Patterson made it through yet another simulated game over the weekend and heads now to Single-A Potomac. It’s not a long drive, yet it is a big step. The plan is fluid, so if Patterson dominates, shows all his pitches, and isn’t sore afterwards, he could be back in the Washington rotation for his next start. At most, he’ll have two rehab starts, so a Patterson return isn’t far off either way.

• Pitchers don’t leave games in the middle of a batter in the middle of an inning unless something’s up. It’s usually an injury or a particularly hard pitch count. The Red Sox insist that it was neither in the case of Matt Clement. Clement was not only coming back from taking a comebacker off the knee, he was working on several mechanical issues that he felt had been hampering him over his last few starts. Team captain and catcher Jason Varitek signaled to the bench that Clement was done and, after a visit from Terry Francona and Paul Lessard, he was removed. Let’s call this a convincing version of events and keep only an interested eye, not a suspicious one, on Clement as he moves towards his next start.

• It’s one of the better stories in baseball that Zack Greinke is back on the mound. BP has taken some heat over our projections and hopes for Greinke in the face of his results and his personal issues this season, but seeing Greinke effortlessly throwing mid-90’s heat and appearing to have fun is worth any criticism. The interesting aspect, besides his mere return, is what many have described as a mechanical change. One source said he looked “effortless” while another said that Greinke’s motion now looks completely natural and integrated. Whatever he did while he was gone worked. It’s good to see him on the road back.

• Quick Cuts: None of my White Sox sources seems too concerned with Jim Thome missing a couple games with a sore groin. Sounds like you shouldn’t be either … Cole Hamels returns on Tuesday after a solid if unspectacular rehab appearance … Shawn Estes had Tommy John. He will try for a comeback sometime in late 2007 … Milton Bradley made a rehab start over the weekend. He’ll be back in the A’s lineup on Tuesday, more or less recovered from his oblique injury … If you want to pick up a guy that could help you soon, look for Rocco Baldelli. He has a week max left on his rehab and is killing the ball … Oh look, there’s Agustin Montero and Eliezer Alfonzo on major league rosters. Good to see there’s a stigma attached to positive drug tests … Some of the best moments I’ve ever seen on TV have been “Sopranos”-related. Last night’s finale? Not one of them … Ryan Doumit left with what appears to be a more significant recurrence of his hamstring injury. If so, it’s a damn shame … Geoff Jenkins and Todd Greene both know what it’s like to be hit by a force of nature named Prince Fielder. Jenkins appears a bit luckier and won’t miss much time despite a big headache … Troy Glaus left Sunday’s game with spasms in his lower back. We’re watching this one.