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July 11, 2008

UTK Wrap

Progress and Anticipation

by Will Carroll

The halfway point in the season has come and gone, but the All-Star Game is still a week away. The season seems to be dominated by injury news, but it's really not. Looking back, we've had some big names go down, but not so many that it would be outside the normal variance. Injuries, in some ways, are actually down from recent levels. We're seeing players come back much more quickly than in the past, and some returning from conditions that would have been career-ending five years ago. Medical science changes faster than I can type, but we're seeing those changes work to the field's advantage in most cases. Players don't just blow out their arm and head back to Spavinaw or whatever small town they came from anymore. No, the team is on the hook for a couple million and spends a year working him back. That's tough, but in the end it makes the game better. Where would the Cubs be without Kerry Wood or Ryan Dempster, two guys that are back on the field because of Tim Kremchek and Jim Andrews? Would the Rays be in the position they're in if they'd had arm injuries, or if Ron Porterfield (and before him, Ken Crenshaw) didn't do such an outstanding job of keeping players on the field? The Red Sox, the White Sox, and the Diamondbacks are all winning teams with winning medical staffs. The two go together, so when you see the athletic trainers take the field at the All-Star Game, cheer for them. They deserve it as much as the players. Powered by the iPhone 3G, on to the injuries:

Vernon Wells (45 DXL)
It's fast becoming a lost season for Vernon Wells and because of that, it's becoming a lost season for the Jays. Wells, recently back from a wrist injury, strained his hamstring tendon trying to steal and is lost for about a month, maybe a bit more. The strain is listed at Grade II, a moderate tearing, but the location is what worried one source. "He grabbed it very low," he told me and watching this video embed shows what he saw. The tendon and not the muscle is the problem, but my advisors differed on whether this is better or worse. One doctor said "it matters on how far from the muscle it is. The transition isn't perfectly delineated and really depends on how strong the tendon is in any location." As you can see in this diagram the tendon - the white part nearest the knee - narrows from the muscle to its attachment on the bones of the lower leg. It's unclear exactly how bad it is, though one PT I spoke with liked seeing him run home. "He stayed in the game, which tells me it wasn't that painful," she said, "and he wasn't limping that bad. He could move the lower leg pretty much normal." Because this is the tendon and because the tendon doesn't have clear delineation, it's tough to get much in the way of comparables here. With the season as it is, playing on turf, and the information I got from my team of advisors, I'm going to set Wells' DXL at the back end of the four to six weeks that the Jays are saying. Wells' tendency to heal quickly could make that a bit long.

Aaron Harang (7 DXL)
"Tight forearm" sounds kind of innocuous, like "skinned knee" or "bum ankle." Colloquial always sounds better than technical, but sounds better isn't always better. Harang may seem like the prototypical workhorse, but this kind of injury is seldom just nothing. Going through the list of names, there are guys like John Patterson, Josh Johnson, and Shawn Hill who all had this type of forearm stiffness as a precursor to far more serious elbow problems. Sure, there are some like Felix Hernandez, for whom forearm stiffness was nothing more than that, but the list of players is much more negative than I'd expected. Harang's workload isn't tremendous, though he does have a number of starts of more than a 100 pitches, and the occasional period where he seems to lose it for a start or two, and then get it back. This is no different under Dusty Baker than it was in past seasons without him, so eliminating that culprit leaves me taking a hard look at the relief appearance he made at the end of May as a tipping point, despite Baker's protestations against the facts. (Just check his game logs, especially the game scores.) He's 14th on the PAP list, though his stress score of 13 is hardly worrisome, and wouldn't have made the top 50 just five years ago. Harang's velocity and control were off last time out, another big red flag. Harang is heading back for imaging and a visit with Tim Kremchek, and Reds fans may be holding their breath and hoping that Harang will only miss one start or just have a short DL stint. Initial testing makes it seem as if the UCL is intact, so we won't know much until the results are back. So far, the Reds are hoping he'll only miss the one start, replacing him with Homer Bailey, and expecting him back after the break.

Dustin McGowan (80 DXL)
News went from bad to worse for the Jays when McGowan's imaging showed a torn rotator cuff. He's done for the season, leaving him with the question of choosing surgery or rehab, though the team is still officially saying that he could return in a month. That just doesn't happen with this type of injury. If McGowan is able to avoid the operating table, he could be back by next spring, but it's a coin-flip proposition, and there always seems to be some cost. McGowan has had injury troubles previously, making this one of those slow and insidious injuries that remind us that somewhere on the kinetic chain, there's always going to be a weak link. Worse still, the Jays are spinning this, saying it's the same as last year's tear. This makes sense if you don't realize that the body repairs itself with scar that is weaker than the previously existing tissue. He's retorn it, something that will happen again and again if the muscle isn't protected. If the Jays weren't there already, McGowan's injury should push them into "next year" mode. We'll have to see if that includes McGowan, who could lose much of 2009 if he needs surgery.

Rich Harden (0 DXL)
There's one constant meme within the discussion of the Harden-to-Cubs deal. That is that the A's, understanding Harden's medical situation better than anyone, knew his true value-what Joe Sheehan called "a free Rich Harden"-and saw it as the return they got. I'll leave the trade analysis to Joe and Christina, but I'd like to look at this concept: do the A's really have a better handle? I agree with the way they've dealt with him and with the conclusions they've come to, but even with the changes made coming into the season, they don't have a great track record on injuries. Bobby Crosby has been the most vocal about his injury situation, but he's not the only player that's been unhappy. It's a new staff, and relative to expectations in 2008, the A's have had a reasonable return. With guys like Harden, Eric Chavez, Crosby, and others on this roster, they were never going to have a low DL day total.

For Harden, the focus has to be on the fact that for a couple of years now, the A's haven't been able to keep him healthy. On his own program this offseason, and making some mechanical changes, it appears that his results have been better than what the A's could provide. Is it a fluke? Who knows at this stage, but that's data. The Cubs, clearly in a win-now mode, got an upgrade with some downside. The Cubs were willing to take on that risk after a sign-off from their own doctors and the word of Lewis Yocum, though there's one outside factor that I'm still following up on. While Harden is always going to be an injury waiting to happen, I think that the risk, and the team's relative assessments of that risk, are going to be the deciding factor in the perception of who "won" this deal. Given his last start, Cubs fans ought to be watching Harden's velocity closely.

Eric Byrnes (90 DXL)
Speed players and hamstrings are a bad combination, so what does tearing it completely do for Byrnes in the long term? He's out for the season! The question now is whether the three-year deal he signed last season becomes a drag on the young D'backs. I think it does, because there are really no good comps for players having this type of injury and coming back and being productive. Some have, but none have come back to provide the speed/hustle combination that the Shaggy One uses. I'm not convinced that Byrnes without his speed is anything more than a fourth outfielder, and those players shouldn't make $10 million per year. Byrnes' leg isn't so bad that he'll need surgery, though the recovery time is going to be roughly the same. He'll be ready for spring training, but his future depends on adjusting his game.

David Ortiz (45 DXL)
Ortiz is hitting again, and hitting hard. Reports of his batting practice work gave bold-print notice of his six home runs, all pull shots. This is key, since the abduction of his wrist is where the tendon and tendon sheath would be under the most stress. Of course, Ortiz isn't much of an opposite-field hitter anyway, but the scouting reports are going to write themselves: down and away, down and away. Ortiz still has some recurrence risk, but it appears the bigger challenge is going to be whether he can make the adjustments at the plate needed to avoid being pitched around. One interesting note is that Ortiz is hitting without any sort of brace or even tape. That's a good sign for the strength in the wrist and how the medical staff feels about it. We won't see Big Papi in the Home Run Derby, but we should see him shortly after the All-Star break.

Yovani Gallardo (120 DXL)
In all the hype surrounding the CC Sabathia trade, there are a few interesting injury notes. Sabathia comes in as the No. 2 starter for the Brewers, taking over the spot they thought Gallardo would be filling, except that Gallardo's currently out after surgery to repair his ACL. there was some discussion that he could be back before the end of the season, and while it sounded crazy at the time, the Brewers may have something here. Gallardo is already throwing from 45 feet and could be back by September. It's a long shot, but the idea of Gallardo slotting in, perhaps even in the bullpen, is intriguing. It will be difficult to build up his arm strength enough to move him right into the rotation, and the team usually looks to the long term, but Gallardo did heal quickly from his spring knee surgery. There's a chance we'll see him again in 2008, but this is almost completely dependent on whether Sabathia is the difference maker that the Brewers think he is.

Fausto Carmona (30 DXL)
With Sabathia gone, Carmona becomes the team's ace. He won't be the immediate replacement in the rotation-that looks to be Jeff Weaver, of all people-but Carmona's signed long term, and is going to have to be the guy that the Indians saw last year and subsequently decided to pay for. He's making slow progress from his hip problem and should start a rehab assignment soon. That would put him on track for a return just after the All-Star break, though the Indians aren't likely to rush anything given the white flag that the Sabathia trade amounts to. Carmona's hip has already had one setback, so they'll be conservative in getting him to return. The long-term concern is that this doesn't become a recurrent issue, so they'll make sure he's 100 percent before letting him climb back on the mound. He's already beyond the initial expectation that he'd miss 30 days, but I think that's more a function of the team than of Carmona.

Roy Oswalt (10 DXL)
Oswalt left the Astros over the weekend and returned to Houston to see team physicians about his hip. They decided to give him a cortisone injection, not an uncommon short-term treatment. The odd phrasing in discussion of this, both by the team and by Astros writers, was that the injection was designed to "get him through the season." (Worse, I think, was Ed Wade's questioning of his own trainers, but then it is Ed Wade.) If the injection has this specific design, is there an underlying problem that will need correction in the offseason, or is this just an odd turn of phrase by Wade that was passed on in the articles? I'm relatively sure it's the former. There's no clear return date for Oswalt, though the team doesn't seem to want to place their ace on the DL either.

Brian Bruney (90 DXL)
Bruney might not seem like a big part of the Yankees' chances, but he is a kind of symbol. Bruney is making some appearances at High-A Tampa and could be back in the Bronx soon. That will help with the bullpen's depth, but where Yankees fans should be taking notice is in the success and speed with which the Yankees' medical staff brought Bruney back from his Lisfranc injury. Yes, that's the same injury that put Chien-Ming Wang on the DL, and it gives us an interesting basis for comparison. While Wang and Bruney's injuries are not identical, because any two individuals will have differences, there's enough commonality here to make some reasonable inferences. If Bruney is back at or near the 90-day expectation, that would put Wang on track for a return in mid-September. As before, Wang's return will depend on the Yankees record at that point, but if the team can get back in the race, they may get a late-season boost from their ace

Quick Cuts: I'll say this one more time-pitchers do not get faster after Tommy John surgery. They're just healthy, and you're comparing the speed that they had when they were hurting themselves to the version that's back after surgery, rehab, and rest. It's not the same. ... Where's Ichiro's stick now? Ichiro Suzuki didn't start Thursday with a tight hamstring, but he entered the game to pinch hit. ... Kosuke Fukudome fouled a ball off his leg. It didn't look too bad, but we'll have to watch to see how he reacts. ... Moises Alou tore his hamstring and is done for the season, and perhaps his career. His body just finally gave out, but he could probably still hit. ... Jason Schmidt had a solid rehab start. ... Mark Mulder heads to the DL again and it's unclear if he'll even try to rehab once more at this stage. ... Chris Young is scheduled to throw a simulated game on Friday and then could head out on a rehab assignment. ... With the All-Star break coming up, the D'backs will hold out Justin Upton through the weekend, and hold onto the possibility of making a retroactive move if the week of rest doesn't help.

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