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March 20, 2008

Under The Knife

Firing It Up

by Will Carroll

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It seems time to get these fired up. First, a note-as with the UTK Wrap, I'll be assigning a "days expected lost" (DXL) to each injury. I won't be making the Injury Cost calculation just yet; I have to save something to make the week-in-review UTK Wrap worth reading, even if it's just an easily calculated metric. (Salary divided by 180 times DXL, in case you were wondering.) The rest is the same as what you're used to, if you've been a reader in the past five years. On the other hand, if you're new-welcome! You'll figure out quickly that I report medical information based on a network of sources. I analyze that information with the assistance of a group of medical personnel to make it understandable, readable, and most of all, useful for you. Whether you're a fan of the game, a team, or a fantasy fanatic, there's something for everyone here. It is what you make it.

Nomar Garciaparra (0)
Andy LaRoche (60)
Garciaparra said on Tuesday that his wrist was getting "progressively better." Remember that the worst source of information on a player's injury is often the player himself. On Wednesday, an imaging* showed a small fracture. Sources tell me that the "microfracture" is something along the lines of a stress fracture, but can't be called that due to the fact that there's a known cause. The knowledge doesn't really change anything. Garciaparra is still going to continue his rehab with the goal of swinging a bat by the weekend. We know now that there's a more severe problem than just a bruise and an increased risk that he won't be able to meet his current goals. With Andy LaRoche out for what I estimate to be about half the season between healing and regaining his stroke, Garciaparra's ability to recover has to be balanced with the need for the team to have an adequate backup. Garciaparra's DXL is at zero now, but if he's not swinging by the start of next week, he'll likely open the season on the DL.

* You'll be seeing the term "imaging" or "image" more from me this season. While in the past I've often tried to differentiate between the various types, which can include MRI, X-ray, and several other techniques, I feel this ends up being more confusing than enlightening. Images are created by various means, interpreted by radiologists, and a doctor then treats based on this information. It's simpler and clearer to use one inclusive term.

Jeff Kent (0)
It's not just third base where the Dodgers are having problems. Kent may not have been "washing his truck" this time around, but he did manage to hurt himself, straining his hamstring. It was bad enough that he had a cortisone injection, but looking a bit closer, this may be an aggressive move by Stan Conte to control the injury. Conte has been at the forefront of using a technique of "targeted injections" to precisely manage inflammation early in an injury's life cycle. While there's no evidence that this is the case, it's something we have to consider. Either way, Kent still has time to come back from this, though any strain creates an increased risk of recurrence, especially in the weeks immediately following the injury. At Kent's age, it bears watching closely.

B.J. Ryan (0)
Is soreness a setback? Only if you had unreasonable expectations for Ryan's comeback. After his second bit of game action, Ryan had some trouble recovering, dancing on that thin line between "sore" and "painful." This highlights the problem that Ryan was going to have anyway, one of recovery, not of performance. Ryan was not going to be utilized on back-to-back days, even in closing situations, until later this year. Most estimates meshed with what I was hearing from sources, putting those limits on Ryan until somewhere in mid-May. Even then, all the guesses were just that-guesses. Thus, Ryan didn't have a setback, but there is now some question at whether this could become one. Ryan's ability to recover needs to allow him to be available to pitch somewhere over a certain threshold. While I don't know what the Jays' threshold will be, we can assume it will have to be something more than what they'd expect from a starter. Is he useful once every three days? Four? So far, that's what he's had to come back, three and four days, with the soreness coming immediately after the third outing. This one bears watching, and if you're in a fantasy league, Jeremy Accardo bears owning, especially paired up with Ryan.

Francisco Liriano (0)
Being limited can be almost as bad as being hurt. It's a bit counterintuitive, but if you follow that limitations often last longer than the rest required, it becomes clear that there's a mathematical point at which those limitations outweigh missed time. The difficulty is that players don't come with gages. There's no way of looking at Liriano and saying with any certainty that "he's 80 percent today." Even with objective measures or the most expert opinion of the pitching coach or or ATC* will have a hard time establishing that percentage, leaving it an imperfect tool. Add in that 80 percent of Liriano might well be better than the replacement, and the decision gets another variable. Figuring out if pitching or playing at diminished capacity increases the risk for further injury, exacerbation, or even just a lengthening of the recovery process adds yet another. So now you know what the Twins are trying to do with Liriano as they get ready for the season. He's going to start. He's going to have limitations on his pitching. Everything else is up in the air.

* Another term that you'll see this year is ATC. I've decided to use this in place of the more common athletic trainer or trainer due to the confusion with personal trainers or even strength coaches. ATC is the official designation used by the National Athletic Trainers Association (NATA), and stands for "Certified Athletic Trainer." It's inverted because "CAT" just looks silly.

Josh Beckett (0)
When the Red Sox say that Beckett's "arm strength hasn't suffered," they're not just saying it. The team is at the forefront of objective measurement of their pitching staff, doing things that few others are, at least on a systematic basis. Beckett made it through a 45-pitch side session without incident, which leaves only the recovery at issue. Beckett won't be traveling to Japan with the team; the flight could exacerbate his back-muscle problem, and by leaving him in Florida to play in minor league games, the Sox preserve the option to put him on the DL with a retroactive move, reducing the days, if any, that he would miss. It's a common move, one you'll see around the league in these last weeks. At this stage, Beckett is more likely than not to avoid the DL altogether, but it's smart to leave the option open. Assuming that Beckett recovers from this outing normally, his next step will be to pitch in a game sometime this weekend.

Brad Lidge (0)
Lidge's comeback from minor knee surgery is made slightly more complicated by previous surgery on the same knee earlier in the offseason. There's enough time between his surgery and Opening Day that having him back is quite possible, if not probable. Whether he'll be ready to close remains to be seen. The Phillies have other options, such as Tom Gordon, if they want to give Lidge extra time, but this brings up a closing-related question. If he's not healthy enough to pitch the last three outs, how can he be healthy enough to pitch outs 22 through 24? Darn good question, but closing isn't a role that's often based on logic. Given what Lidge has shown so far, he may make this a Thomistic exercise anyway.

Kerry Wood (0)
As the Cubs continue to try to "define" a single closer in the presence of three real options, any small setback is problematic in claiming the coveted role. Kerry Wood carries his injury baggage with him in any case, so another added carry-on might not seem like much, though it is. Wood still hasn't proven he can pitch back-to-back games, doesn't have an established recovery period, nor does he even have a track record of performance in the pen to fall back upon. The back spasms are muscular in nature, and one source's description of the problem makes them to be relatively minor and easily controlled. While the damage might not be internal or physical, it's likely been done here. Wood's role is going to have to be defined, but I remain unconvinced that it should be defined by his limitations rather than by finding a way to efficiently use a valuable resource.

Lastings Milledge (0)
Wily Mo Pena (45)
I jokingly asked recently whether the new Nationals Park was built on cursed ground, given all their spring injuries. I came to find out that Tropicana Field actually is built over several cemeteries; that explains a lot. (For that story and more, look for the BPR interview with the author of Haunted Baseball coming out next week.) Back to the Nats, just as Pena tore his oblique, Milledge was reported to have a toe injury. The toe seems to be sore, but Milledge hit what one observer called "a f***ing bomb" with that toe a-throbbin', a good sign that he could play through it. The news isn't so good for Pena. Oblique strains tend to linger and tend to be Grade II tears. One MLB ATC actually thinks that the majority would be accurately described as "I+", a designation halfway between the accepted muscle strain gradations of I and II. Pena's palpable tear is II+, painful and swollen, likely causing him to miss more than the generally accepted six to eight weeks for the normal oblique strain. Again, we'll note that Pena's is worse, a more complete tear, than is generally seen. If he missed time well into May, I wouldn't be a bit surprised. So why 45 days, which is exactly in the middle of the accepted six to eight weeks? Timing. If you add on the days between now and Opening Day, time that Pena will in fact miss but doesn't "count", it makes a bit more sense.

Scott Baker (0)
Baker missed time with the flu or, as teams like to say, "flu-like symptoms." People often ask me why they say this. The answer is simple, if goofy. "Flu-like symptoms" is an accurate description, while "flu" might not be. Few teams would go to the time and expense of getting a solid diagnosis and leave the semantic door slightly ajar. There's plenty of flu-like symptoms going around with various teams, just like it's going around in various offices, schools, and such. Proximity breeds vectors, epidemiologists say. Players as varied as Jose Contreras and Josh Hamilton have dealt with the dreaded flu-like symptoms. Baker's case was a bit more problematic, pushing back his return from a lat strain behind his pitching arm. Baker is slightly behind in his work and while he still has time to get on track enough to avoid the DL, the Twins will likely make use of the schedule to buy him a little extra time. He's just one small setback-even as small as flu-like symptoms or a common cold-away from seeing his DXL go up to 15.

Rich Harden (0)
What's changed? He's healthy and pitching, so that's one change, but I mean, what changed to allow him to be, even at this early stage, healthy and pitching? The problem is that the answer is apparently "nothing." Several observers say that Harden is still throwing the same, has the same tight-appearing body, and there has been no discussion of him doing anything different in the offseason. It's possible that there's something that's non-public; the A's are often inscrutable. It's more likely, Occam-style, that Harden is simply healthy. It actually means he's equally risky as he has been in the past. Harden is, in essence, a coin flip every time he goes out, equally likely to be in one part or the other of a binary state, healthy or not healthy, available or not available. As good as it might look now, it could look that bad next time.

Quick Cuts: Don't forget the Memphis event, coming up the night before the Civil Rights game. I'm starting to get wind of some of the people that will be stopping by, so get your tickets soon. ... Yovanni Gallardo is making solid progress coming back from minor knee surgery. The Brewers depth allows them to be conservative, so no decision has been made on whether they'll start him on the DL. ... Carlos Delgado suffered a nasty cut from a nasty bat incident; he won't miss any time despite his new forearm scar. ... Brad Eldred never really re-established himself after a 2006 wrist injury, but showed that he still has power this spring. The White Sox have sent him down, pairing the big man up with a bandbox in Charlotte. Don't let those kinds of stats fool you, but do enjoy the show if you're nearby. ... Scott Kazmir will start the season on the DL, but the Rays' schedule likely means that he will miss only two starts. ... Milton Bradley will test his knee by playing consecutive games this weekend. He's limited to DH duty at best.

Related Content:  Back,  Time,  Year Of The Injury

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