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May 1, 2008

Under The Knife

Phil Hughes' Day(s) Off

by Will Carroll

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John Smoltz (30 DXL)
Nothing's changed with Smoltz since I wrote about him yesterday-besides perception. The problem is that with Smoltz's announcement, first that he was willing to move back to the pen, then that he would be at least starting out in the pen when he returns from the shoulder problem, how this latest injury was seen changed quickly and sharply. However, there's no basis for it. Smoltz's shoulder isn't better served by his being in the pen, and in fact Smoltz had just as many problems while in the pen, fatiguing at the end of the season just as he has as a starter. The real problem is that we're in May and Smoltz is experiencing the same kinds of problems-inflammation, impingement, and pain-that he has at the end of the season. He's made just a handful of starts, and with each, the recovery period has stretched and the shoulder has swelled more, to the point where Smoltz's shoulder was swelling during his last start. Asking him to recover from shorter outings might appear to be different enough to allow him to stay more productive, but there's no evidence to support it; a sprinter and a marathon runner do vastly different tasks, but their bodies fatigue the same. Pitching isn't the enemy; fatigue is, and until we get a better understanding of that in both general and specific ways, we'll be talking about this again and again.

Jacoby Ellsbury (5 DXL)
People wondered-loudly-why Ellsbury came into the season with a red flag in the Red Sox Team Health Report. We got an object lesson as to why this week: Ellsbury's a player whose value is almost completely wrapped up in his speed, and now he has a mild groin strain. Since the Red Sox have options, they've rested him, costing him a couple of games' worth of at-bats and opportunities. The thing is, Ellsbury's getting the best of this, since most teams don't have the options the Sox do. Most teams would have to play him, hoping that he could stay healthy, and risking further, more serious, and lingering damage; it's that abstract player in that scenario who is even more risky than Ellsbury. One thing I did hear in the midst of the shrieking and rending of garments when I originally waved the flag was that Ellsbury is a very smart player, savvy enough to make fine adjustments. That's an adjustment that isn't in the system, and if true it would alter things slightly, though I honestly have no idea how to calculate that. I know some teams use personality tests, so an intelligence test like the Wunderlich wouldn't surprise me. Regardless, Ellsbury should be back shortly, and the Sox are smart to be conservative and won't let him back until both feel comfortable.

Philip Hughes (30 DXL)
There's a lot about this injury move that can make people say "hmmm," so let's take a deeper look at his oblique strain. As you know, the key to faking out the DL is the strained oblique. It's a good non-specific symptom. I'm a big believer in it. A lot of people will tell you a good phoney fever is a dead lock, but you get a nervous mother, you could wind up in a doctor's office-that's worse than school. You fake a stomach cramp, and when you're bent over, moaning and wailing, you strain an oblique. It's a little childish and stupid, but then again, so is baseball. Seriously, this particular oblique strain is complex to analyze, because it didn't seem to occur during his last start and when asked early on Wednesday, Brian Cashman seemed to be strong on keeping Hughes in the rotation. It's possible that Hughes injured himself after the game or sometime during the day. It's also possible that the team wants to buy some time for him to work on things without the stigma of a demotion. Seems a bit odd, since Hughes would know that the charade was in place, if that's what it is. We'll assume that Hughes will rest for a while and then begin throwing again, likely in Tampa since extended spring training is still going on. The DXL is just an educated guess at this stage; it's sure to be adjusted as we learn more.

Moises Alou (30 DXL)
After a week where Alou's career looked in jeopardy, things have done a 180 for him and for the Mets. Images showed that Alou's ankle was not fractured as feared, and with his hernia surgery healed, he's ready to be activated. The severe bruising, post-surgical legs, and other various maladies that Alou's dealt with have never altered the fact that the guy can hit. The Mets are hoping that can continue as they activate him and slot him into left field and the middle of their order. He'll need days off and will likely get injured again at some point, but everyone that watches Alou thinks that when he's Felipe's age, he'll probably still be able to turn on a mistake.

Travis Hafner (5 DXL)
As Hafner sits, speculation is taking a life of its own. Hafner's struggles this season following those of last season, combined with some minor shoulder problems, have people asking me about injuries. In homage to Barney Stinson, let me introduce Medhead Code Article 7: "Sometimes players that are healthy just stink." The shoulder is a problem but not so much that he can look to doctors to fix his hitting. The bigger question is one of career path, one I'll leave to Nate to answer. At this stage, the shoulder is an annoyance, but hardly the problem. Expect Hafner to get a couple days off and more frequent rest until he pulls out of this tailspin ... or if.

Chad Cordero (40 DXL)
Here's the classic cascade injury. While compensating for a sore, weak shoulder, Cordero managed to tear one of the largest, strongest, and most resilient muscles in the body, the latissimus dorsi. The muscle does have a "bottleneck", the lateral aspect where it leads up to the shoulder where it's weakest and sources tell me that this is where Cordero's Grade 2 strain is located. This is a very similar injury to one that sidetracked Ben Sheets and was overcome by Jake Peavy a few seasons back. The tear will cost Cordero at least a month, but more importantly, the staff and the pitching coach especially will need to watch closely to make sure that another cascade doesn't occur. The kinetic chain is just like any chain; there's always a weak link. Problem is that for some pitchers, which link is weakest can change. I'm setting the DXL a bit longer than the announced month because I think this will linger and require more time to both heal up and get him strong enough to return to action.

Noah Lowry (75 DXL)
The Giants could use any help that they could get at this stage-seriously, look at their lineup and see how many "who?" reactions you get-but they'll have to wait a while longer for Lowry to return. There have been some complications with Lowry's nerve decompression, and they're serious enough that the Giants are shutting him down and sending him to see Dr. Jim Andrews in Birmingham. Talk of "significant" downtime for Lowry seems to indicate a month or more, though the need to get his stamina back after that absence will likely extend it even a bit more. I'd guess based on current information-which could change after his consultation-that Lowry will be out until at least mid-June. Talk of a six-man rotation was dumb to begin with, but now it seems very premature since Lowry is out through mid-May at the earliest, and Barry Zito is... well, I don't even want to get into that.

Tom Gorzelanny (5 DXL)
Gorzelanny is considered to have the best pure stuff of the Pirates' batch of lefties, even better than northpaw Ian Snell, who has pretty good stuff. Unfortunately, he might have been a bit too good, getting perhaps too much attention last year as he closed in on 15 wins. The Pirates pushed him hard-really hard-in hopes of getting him to the milestone, and he's still paying for it. Watching his mechanics and body unwind is like one of those slow-motion car crashes; you can see everything happening and people trying to help, but things are just too far gone to stop. Gorzelanny left his last start with what appeared to be a back problem. His kinetic chain might have found another weak link than one in his arm, so this is actually something of a positive; a non-structural back injury is a lot better in the long run than a shoulder or elbow problem. A good, long rest would be the smart play, but the Pirates are a bit short of starters at this stage. I'm projecting Gorzelanny to only miss one start, but it would be better if it were more than that.

Kip Wells (30 DXL)
A blood clot in any pitcher is a bad thing, but for Wells, it's now a frightening recurrence. The details aren't clear yet, but it appears that Wells has been dealing with clotting and numbness in his pitching hand. Wells had a blocked artery in his pitching shoulder that that required surgery to correct, so this combined with his longer-term ineffectiveness has to make us question whether he ever truly recovered; it's difficult at times to tell how much is injury and how much is true performance, as seen here or with a situation like Hafner's. Wells is in that scary area where a baseball injury is carrying over into life off the field. At this point, Wells is going to need to be a lot more concerned about the latter.

Mike Hampton (45 DXL)
Some pitchers should never have rehab starts. In the same way that Gary Huckabay once pointed out that a pitcher is a pitcher and that when ready, they should be forced upwards as far as possible, the same holds true for some injury-prone pitchers. I realize that the Braves can't just toss Hampton into the rotation and hope it works, risking a long day for their increasingly thin bullpen, but that's where pairing him up with another starter, especially one like Jair Jurrjens who needs to be inning-limited and has relieved in the past, would make sense. Hampton could "start" the game, go a set number of innings, and then give way to the real starter. Brewers GM Doug Melvin has discussed this same scenario in hopes of getting starters, theoretically the best pitchers on your team, into the high-leverage later innings without increasing their pitch counts significantly. I think it's a brilliant idea, and certainly worth a try. It's done regularly when pitchers, especially relievers, are on rehab assignments and start to get 'guaranteed' work. The Braves should be taking notes on this. Hampton's simply too fragile at this stage-coming out of his rehab work with a recurrence of his pectoral strain-to risk losing any value he may have working in the minors, so getting creative might get them something for the money and roster spot he's been taking. The 45 DXL is more an indication of where the Braves seem to think he should be back than when I think he will be back. I'm not sure he will be at all.

Quick Cuts: Rich Harden will make his first rehab start on Thursday in Triple-A Sacramento. He'll make one more, putting him back in the Oakland rotation for Mother's Day. ... Dontrelle Willis will have a rehab start Friday in Triple-A Toledo. ... Randy Johnson didn't pitch well in his latest start, but sources tell me his problem was simply an off night and not an injury. ... The D'backs think Doug Davis could be back in as little as a week. Max Scherzer may not have much time to lock in a starting slot, but he's not going to be denied long. ... Kelly Johnson was just trying to be like Chipper Jones. Back spasms aren't a good thing to mimic though. He'll be back quickly. ... Josh Willingham will miss at least another day with back stiffness. ... Jason Schmidt isn't sure he's ready for a rehab assignment, but it looks like the Dodgers are going to send him on one anyway. That could start as soon as this weekend, starting the clock on his return. ... Eliezer Alfonzo was busted for steroids. Again. His fifty-game suspension is his first in the majors, but not his first suspension. Knowing that he had issues in the minors makes his quote that, "This will not happen again. I will serve my penalty and look forward to getting back on the field," ring a little hollow. While not announced, two sources told me that Alfonzo tested positive for Winstrol, a drug legally available in his native Venezuela.

Related Content:  Back,  The Who,  Shoulder,  Year Of The Injury,  Kip Wells

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