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April 21, 2008

Under The Knife

Fallen Aces

by Will Carroll

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Ben Sheets (20 DXL)
If he were alive today, Franklin Adams might add to baseball's lexicon the ominous term "when healthy." Prior to Harden to Sheets doesn't have the same poetic tone or even make any logical sense, but in their own way, these three pitchers have come to symbolize this era of pitching as much as any. While pitch counts, innings limits, and mechanics have become as much a part of the discussion around baseball as wins and losses, Sheets and the others are in one of two states: dominating or broken. The frustrating part is that we're seemingly learning nothing from them regarding the process of how a pitcher stays healthy and/or breaks down. With each of them, some failure happens with little or no known cause, that symptom is worked on, and then they're returned to the rotation. With Harden, he'd made significant changes, but ended up with the same short-term result. It's a moving target, one injury after another in various locations, and it's that which might be the problem. Focusing on one part of the kinetic chain, ignores the holistic issue of how a pitcher delivers and distributes force. Those forces will find the weakest link, and if the body can't handle the repetitive stress, it will break. Sheets' latest injury, a triceps strain near the shoulder, is even more frustrating for an organization who is ahead of the curve in the use of advanced motion analysis and in possession of one of the best medical staffs around. Sheets could be headed to the DL as a conservative move while the Brewers continue trying to figure out how to keep him healthy. In the meantime, Yovani Gallardo will slide into the rotation, with Dave Bush at the ready if Sheets can't make his next start, scheduled for Wednesday.

C.C. Sabathia (0 DXL)
With poor results through three starts, it shouldn't surprise anyone that there's a suggestion that Sabathia is hurt; in one unfounded rumor, Sabathia isn't throwing sliders due to a UCL problem. Not only is this wrong, it's factually incorrect. I asked a doctor I trust about the idea that Sabathia's pitch selection has anything to do with the health of his arm. He explained the structure of the arm to me saying, "the flexor pollicis longus originates on the radius, unlike the other major ligaments that originate on the ulna. Origins are proximal (closer to the body) and attachments are distal (further from the body). The UCL originates on the medial condyle of the humerus and attaches to the coronoid process. Comparing origins and attachments is like comparing apples to oranges. All these muscles have in common are their actions (flexing) and the fact that they originate at or near the elbow. There's no medical or functional reason that a slider would be more or less affected by this than a fastball." In fact, the stress of a slider is less on the important are of concern here, Sabathia's middle finger, than it would be on a fastball. Moreover, a 1987 study by Dr. Frank Jobe and a team of biomechanists showed that there is not a significant difference between the flexor-pronator muscular forces used in a fastball and a curveball. This matches with Dr. Glenn Fleisig's 2005 study that showed there were not significant differences in kinematics for fastballs, changeups, and breaking balls, including the slider.

David Weathers (15 DXL)
Like Joe Borowski, Weathers is one of those guys that confounds fantasy players and insiders alike while proving that it doesn't always take dominant stuff-or even good stuff-to succeed as a closer. As a set-up man in front of Francisco Cordero, his fantasy value is down, and there are plenty of other options for Dusty Baker to turn to in light of the command issues that Weathers has had, problems that we can now attribute to his elbow problem. Weathers heads to the DL with ulnar nerve irritation, a more common ailment than the one Matt Garza is dealing with. It's not a serious case, but the Reds tend to be conservative managing their pitching injuries and were facing some roster choices anyway, making this both an easy and productive move. Weathers shouldn't be out much beyond the minimum, assuming that the rest and treatment clears up the irritation as it normally does. There's no need to rush, so don't be surprised to see the Reds let this one drag out beyond the expectation. I include Weathers here because his elbow problem shows that pitch selection doesn't go hand in hand with injury.

Noah Lowry (45 DXL)
The six-man rotation that the Giants are discussing is a big deal in that it could look like a shift. The thing is, the distribution of starts probably won't significantly change. As you can see on BP's depth chart for the Giants, the team is already spreading 162 starts among an expected seven pitchers. That they'd do this in what amounts to a six-man rotation really doesn't do much. The rotation and much of the reason that BP has suggested using a four-man rotation in the past is that there's no evidence that throwing in this type of rotation protects the arm while putting more starts in the hands of what should be the lesser starters, and reducing the opportunities for the No. 1 and 2 starters. The fifth starter or the least effective pitcher-is always on the bubble, either to be skipped or to be replaced. However, the Giants don't have as big a separation between the top and the bottom, though when you take what amounts to four starts from Tim Lincecum and Matt Cain and hand them over to Kevin Correia or Pat Misch without any guarantee that there will be any uptick in health, it's a questionable choice. The Giants already had some of the best results in the bigs for keeping players healthy, so this decision runs counter to the one strength the Giants have left. Lowry's return from forearm surgery has him on track to start a rehab assignment around the calendar flip, then back in the rotation in mid-May.

The other thing to keep in mind is that a smart modern four-man would limit a pitcher to around the same or slightly lower levels as used today. Six or seven innings would be the norm; let's use 6 1/3 as the "average" here, though that's probably not far off today's average. In a six-man (27 starts), a pitcher could be expected to go 170 innings, roughly. In a five-man, the normal 32 starts get that pitcher to 202, a mark only 18 pitchers hit last season. In a four-man, the average would get someone to 240 innings. It's a leap, but not an insurmountable one, and certainly not one unheard of in the modern pitching world. Dave Sheinin also takes a look at the factors in his recent article at the Washington Post.

Tom Glavine (15 DXL)
Glavine hits the DL for the first time in his long career. It's not that significant a strain, but the Braves do have to be careful with the veteran; keeping a streak of DL-free seasons for him wasn't as important as getting him healthy. There's a misconception out there that older players get injured more; that's not actually true, but there are two factors that make this subject a little more confusing. First, older players actually get injured less, but they take longer to heal. Second, the 'survivor effect' weeds out the more fragile guys by the time players get into their thirties, but the ravages of time do have a way of making themselves known. We see longer expected recovery times for almost all muscular injuries, but normal recovery periods for joint-based injuries. The benefits of modern medicine, nutrition, and science all have an impact, with the result that we're seeing not only more older baseball players, but more older successful baseball players. While some point to steroid use as the cause, players like Glavine, Greg Maddux, and others, as well as older athletes in other sports, such as Bernard Hopkins, Laird Hamilton, Vinny Testaverde and Randy Couture show that there's much more to it. I highly recommend the cover story in this month's Best Life magazine for more info. As for Glavine, he'll miss only the minimum with the strain and shouldn't need any special rehab before returning to the rotation, though the Braves could have him throw a rehab game just to test him.

Scott Kazmir (30 DXL)
Matt Garza (15 DXL)
The weekend was pretty good for the Rays pitching staff. Besides Andy Sonnanstine's dominating performance on Saturday, they got a little bit closer to having to make decisions about how to put their staff together. Two of their three top pitchers are closer to comebacks after a weekend of work. Kazmir threw on Friday in High-A Vero Beach, showing no problems in his three innings of work. He'll move on up to Triple-A after one more start in Vero Beach this week to finish out his rehab before making a return targeted for May 3rd. The key will be not just staying healthy, but building up Kazmir's arm strength to at least the 80-pitch mark. Garza didn't have quite the same results on Sunday in the same location, giving up eleven baserunners in 3 2/3 innings of work; his pitches were all in evidence, but none were effective, putting the Rays in a tough spot in terms of deciding what to do with him. Garza could stay down to make one more rehab start, or they could activate him, figuring out the remainder of their rotation now that Andy Sonnanstine pitched well and Jeff Niemann is already down.

Jimmy Rollins (15 DXL)
The Phillies finally gave up the day-to-day tag and simply put Rollins on the DL, which at least tells us when he'll be back rather than guessing. Or does it? The mismanagement of this injury is getting talked about around the league, mostly focused on the Phillies' use of Rollins as a pinch-hitter. If he hadn't been used, a retroactive move could have been back-dated, but now Rollins will likely miss more time than he should have. The ankle injury remains a bit mysterious, since it was not a normal "rollover" sprain. The lack of improvement was what led to the Phillies finally making the move, and the hope is that they're being very conservative, resting and not putting any undue weight or stress on the ankle, allowing it to heal properly. The Phillies should be able to survive a brief absence by Rollins, just as they did last year when Chase Utley went down at the end of the season. The question is, who will step up? An additional intrigue here is the statement Rollins made on Saturday, saying he was "75 percent." Guys don't go on the DL for that, which tends to imply that they could play at a reduced level or should be back quickly. We'll have to keep a close eye on this, which might be another reason the Phillies dropped him to the DL-to keep him away from prying eyes.

Chipper Jones (TBD)
It should come as no surprise that Jones has managed to strain a quad. It always seems to be something with Jones, having spent the last five years of his career putting up big numbers in between injuries. His stubborn, stay-in-the-game nature combined with by Bobby Cox's indulging him often ends up costing the slugger, so an April injury could end up being much more costly for Jones than it would be for most others. If this is just the start, or more likely the continuation, of a season-long struggle with various strains and sprains, he's going to see a decline in his skills. Perhaps more than most, Jones would appear to be helped by moving to a DH role or even a lesser shift to first base, something made impossible by the presence of Mark Teixeira this season. It would be hard to imagine Jones in another uniform or for the Braves getting full value for him given his frailties, but at some point closer to the trading deadline, the Braves are going to have to take a hard look at themselves and see if it's not the best move. The strain doesn't appear too serious and Jones always resists a quick move, so I'll leave my DXL estimate blank for now.

Alex Rodriguez (TBD)
Last year it was hamstrings, but this year it appears the Yankees have picked quad strains as their injury of the year. There will be no jersey patch to commemorate this, and also no calls for the head of their strength and conditioning coach ... yet. A-Rod left Sunday's game with a right quad strain, saying, "I felt it a little bit in my swing, then probably four or five steps out of the box, I felt a little twinge." Sources tell me that Rodriguez's leg injury is a bit lower than Jeter's and isn't as swollen or tender immediately after, though it takes a while longer to get the full extent of the bleeding and swelling complete. If you use Jeter's time out as a downside prediction, I'd take the under, missing minimal time. I'll hold, as with Jones, until we get more information before putting up a DXL estimate.

Quick Cuts: Think UTK seems full today? It's not because injuries are up, because my injury database-which is DL moves only-has injuries down, year over year, by 12. ... Gary Sheffield will head out to have his shoulder checked. The amount of scar tissue in there and how the shoulder is healing is the question. Right now, he's feeling it on every swing. ... Travis Hafner's day off to calm down a tender shoulder has to be watched. Sources insist this is just a precaution, designed to keep the shoulder as close to full-go as possible. ... Howie Kendrick went to the DL with a strained hamstring. The Angels held out hope that he'd heal up, but the retro move was needed with some other Angels hurting, such as Torii Hunter because of a bum toe. ... John Lackey made it through a simulated game and now heads to A-ball for his first rehab start on Thursday. ... See what I meant about Johnny Cueto's release point? ... Paul Lo Duca heads to the DL with an injured hand. He tends to heal slowly, but the Nats can afford to be patient. ... Reports have Rich Harden close to re-starting things. He's at least a couple weeks from returning, though I'd expect an aggressive rehab. ... Michael Cuddyer looks like he'll need another week to get his finger back to a point where he can play every day. ... Hank Blalock's back got better in a hurry. Instead of heading to the DL, he's been hitting a ton. ... Jon Heyman threw down on Nats strength and conditioning coach Kazu Tomooka, asking if the Nats even had a strength coach. I can't imagine Manny Acta letting anyone slack around him, player or coach.

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Premium Article Under The Knife: Histo... (04/17)
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