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April 25, 2008

UTK Wrap

Pushing the Envelope

by Will Carroll

We all know that recovering Tommy John surgery is as close to an automatic there is in the world of sports medicine. Return, yes, but there can always be complications. Many players either change their mechanics and hurt themselves (usually the shoulder) or don't change their mechanics and end up hurting the elbow again. Some never get it all the way back, something that most think is mental. Coming back from any injury is tough, but the fact is that while a return to competition happens in upwards of 85 percent of cases, some players don't come back to level. I can remember in 2004 a pitcher was coming back from minor elbow surgery (he had some chips removed), and in the first month of the season he pitched tentatively. Through May 7, he was only 1-0 with an ERA in the mid-fives. It's said that pitching coach Rick Anderson came out in this game and told him to just "let it go." Johan Santana did, ending up with a 20-win season and becoming the pitcher we now know. Maybe it's time for that talk with Francisco Liriano. I had Eric Seidman, one of those who looks at PitchFX data, to take a look at his release point; watching the game, Liriano seemed to be hunting for it, but my eyes and the data don't match up. Liriano's not to May 3 yet, so just like C.C. Sabathia, he's still got time to turn it around.

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.

C.C. Sabathia (0 DXL)
After his dominant start, this is almost moot, but it's worth mentioning because rumors shouldn't go unaddressed when proven wrong, especially when it was baseless to begin with. With his poor results through three starts, there was a suggestion that Sabathia was hurt, and in one unfounded rumor, Sabathia was purportedly not throwing sliders due to a UCL problem. Not only was this wrong, it was 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 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 are 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 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 < a href=http://ajs.sagepub.com/cgi/content/abstract/34/3/423?rss=1>2005 study that showed there were not significant differences in kinematics for fastballs, changeups, and breaking balls, including the slider.

Josh Beckett (0 DXL)
The Red Sox pulled Beckett from his start, citing a stiff neck as the cause. They were ready, having called David Pauley up from Pawtucket (but holding off on the official roster move until it was clearly needed), which shows clearly that this didn't just happen right before the start. The Sox didn't really say much about the flu going around the clubhouse, but the Boston Globe said that Beckett was dealing with flu-like symptoms, and that likely factored into the decision. Right now, the Sox are in a wait-and-see mode with Beckett, and it's unclear whether they will skip his start or whether they'll slot him in later this weekend. I'd bet on the latter, which will also, in essence, buy them one of those extra days of rest for their young pitchers and for Daisuke Matsuzaka, who was also skipped over due to the flu; the late word is that Beckett is penciled in for Sunday after completing his side work on Thursday.

Ben Sheets (20 DXL)
The Brewers skipped Sheets in the rotation this turn through, but they're hoping that he'll be ready in another five days. They want to avoid repeating history and potentially getting stuck in another production of Waiting For Sheets. Getting Yovani Gallardo back at the same point that Sheets went down was convenient, but it doesn't help fix Sheets' continuing soreness in the area near his shoulder. Complicating the decision over what to do is the Brewers' decision to carry 14 pitchers, which is partly the result of waiting on a decision to put Sheets on the DL with a retroactive move. It's smart to wait, potentially saving two Sheets starts, but there's a big difference between playing a man short and putting your team in a position where it has few bench players. I anticipate the Brewers making a decision on the DL by Sheets' throw day, which if he stays on schedule would be Friday. We'll have to see how that goes before we know much more about the soreness in his shoulder. You can tell by the DXL which way I think this is headed.

Jake Westbrook (20 DXL)
When teams don't disclose the full story on an injury publicly, you find that they seldom do it with specifics. Instead, you'll hear them list things that it isn't, or wrap themselves in vagaries. Speculation that Westbrook's injury isn't the intracostal strain that the Indians announced when placing him on the DL is reasonable, especially given Westbrook's history of oblique strains and the proximity of the two muscles to one another; even the symptoms are alike. I find that when the Indians give information out, it's based on fact and evidence, not guesses; when they don't know, they're more general. Westbrook has an intracostal strain, painful, but not as lingering as an oblique strain due to the bloodflow and the ability to rest it. The muscle is also not as involved in the pitching motion. How Westbrook strained the muscle is still a bit unclear, but he'll miss the 15 days that come with a DL assignment, and likely a few more, perhaps making one rehab start if he's not able to keep up his arm strength. One possible fill-in is top prospect Adam Miller at Triple-A, though that would be a very aggressive move that would be out of character for the Indians.

J.J. Putz (15 DXL)
The Mariners brought their closer off of the DL as expected, and dropped him right into a closing situation. He didn't appear to have any problems or rust from the time off, getting the save efficiently, and notching a couple of strikeouts in the effort. Putz was clocked as high as 98 and showed all his pitches, so it appears that any concerns have passed. As I noted with Westbrook, intracostal strains don't have quite the recurrence risk that oblique strains do, so all signs appear positive for Putz. Expect him to have his normal usage from here on out. One thing to note here is that while Putz does seem to have some minor physical problems, they occur at some obvious weak points in the kinetic chain, which points to the important points of that chain-his shoulder and elbow-being relatively strong. Add in that his physical problems usually occur early or late in the season, and much of this could be the result of conditioning or fatigue.

Chad Cordero (10 DXL)
Sometimes, going to Birmingham isn't so bad. It's a nice city, picturesque with some beautiful neighborhoods, a vibrant local music scene, and better restaurants than you'd expect for a city its size. Also, visiting Jim Andrews isn't always the automatic end of a player's season that you might expect. Yes, things aren't good when there's even a need to go, but as was the case with Cordero, the news wasn't as bad as expected. Andrews diagnosed Cordero with tendonitis and weakness in the shoulder. To recover, he'll start a strengthening program immediately, and is expected to be back in days, not months. It's a very positive turn, with Cordero not even needing a trip to the DL. There's still the problem of the root cause, which with no structural damage suggests either poor conditioning or overwork. The "clicking" that Cordero reported? That's another mystery. We'll just have to wait until Cordero gets back on the mound and see what happens. I'm dropping his DXL to 10 days, but even that might be too much according to most reports.

Mike Gonzalez (45 DXL)
We've heard this story before-a hard-throwing closer blows out his elbow, gets Tommy John surgery, then comes back early. This time, it's Gonzalez who's well ahead of schedule, not B.J. Ryan, throwing a simulated game and going two innings while showing solid velocity. Although he didn't throw breaking balls, it was a big step forward. The Braves' medical staff now believes that Gonzalez is ready for an imminent rehab assignment and could be back as soon as mid-May. The typical questions apply about his stamina, stuff, and his ability to recover for use in consecutive games, but the Braves are unusually excited about Gonzalez's prospects to answer positively to all of them. With Rafael Soriano and Peter Moylan both out, getting Gonzalez back early could be huge. Look for a rehab road map to be laid out next week, with the rehab assignment starting late next week.

Cole Hamels (0 DXL)
Sometimes, you just let the readers speak. B.H. wrote: "Charlie Manuel [expletive deleted] has lost his mind. Five of five games this season he's left Cole Hamels in the game beyond 100 [expletive deleted] pitches. Never mind that he's never had five starts over 100 pitches back to back (though there was that equally [expletive deleted] run of four starts near/over 110 pitches last May) or that tonight against Milwaukee, aka the [expletive deleted] lefty killers, after rolling the dice and getting Cole to have a successful seventh (racking up two more Ks), he sends Hamels back out with 110 [expletive deleted] pitches with Braun, Fielder and Hart. Give me a [expletive deleted] break. Instead of leaving the game with a 4-3 lead, Braun doubles on three pitches and Fielder follows it up with a HR seven pitches after that. 121 pitches on the night! Never mind that we're talking Cole [expletive deleted] Hamels. He who was rushed to the majors at the first sign of health two years ago to maximize his value. He of the numerous arm injuries. He who has never gone 121 pitches in a game before... Against two lefty killers and a guy who hit a HR on him already that evening. This is two consecutive starts now that [expletive deleted] Manuel has left Hamels in for an inning too long (against the Mets it was trotting him out to load the bases (the last on an intentional walk) before pulling him... after which all inherited runners scored. To say the least, it's a bit [expletive deleted] frustrating."

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.

Quick Cuts: Gary Sheffield has had three cortisone shots and, like Todd might say, the first two didn't count. Or didn't work, which is a bad sign. ... Eric Byrnes is dealing with a pair of sore hamstrings, bad news for those counting on him for steals. This is something he's been adjusting to for a while. ... Mike Cameron is about to start a five-game tune up as he readies himself to come back from his suspension. Officially, it's called a rehab assignment, but I don't think that's the term we should use after a drug suspension. ... Rich Harden will throw a simulated game over the weekend. There's still no good guess on when he'll be back for the A's. ... Scott Rolen will be activated before Friday's game for the Jays. His finger isn't 100 percent yet, so wait if you have options. ... Hurt and playing badly? A bad combo for Mark Grudzielanek, who has an irritated disk in his back. ... Hospitalized to avoid the DL is a new one to me, but that's what Brian Schneider did. He underwent a course of intravenous antibiotics in hopes that he can avoid being shelved due to an infected finger. I thought that kind of thing only happened on Survivor. ... Jarrod Saltalamacchia could be up to replace an injured Adam Melhuse. The Rangers will make a decision later today, according to Jamey Newberg. ... Chris Capuano is starting to throw again, doing a program he hopes will keep him from having to undergo his second Tommy John procedure. ... Moises Alou is finishing up a rehab assignment and should be ready by the weekend. ... If someone's thinking of doing a blog out there and doesn't have an idea for one, here you go: keep track of rehab assignments. A reader pointed out to me that there isn't a good way to note those.

Related Content:  A's,  Back,  The Who,  Bad Start,  Year Of The Injury,  Jake Westbrook

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