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May 4, 2009

Under The Knife

Breaking New Ground

by Will Carroll

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Xavier Nady (45 DXL)
The news broke on Sunday that Nady was having PRP, or platelet-rich plasma therapy. It's a very new technique that involves spinning out the blood's plasma, then injecting it back into the partially torn ligament in Nady's elbow. As Peter Abraham notes in his article, it's not a fun therapy, with the needles digging in. This technique was used with Takashi Saito for a ligament, for football's Hines Ward before the last Super Bowl, and in Cody Ross back in 2007 to help him with a hamstring strain; it comes with no guarantees. (I learned today that Andrew Miller is also having similar therapy done to help with his oblique.) While Saito is healthy and pitching well, there's nothing to compare this to. It's a worthwhile course even if it's just a temporary fix, though the results are "stunning" according to one source in regards to Saito's recovery. Nady could be back as early as late May as a DH, and playing in the field by the end of the year.

One of the more difficult things to understand is why this therapy-taking out blood, breaking down its components, and putting it back in-is different than blood doping, the process that cyclists, distance runners, and other stamina athletes once used to give themselves an advantage. That technique, long outlawed by WADA and others, involved taking out blood, waiting for the body to recover, and then putting it back in. In the last decade, the same process has been replaced by using recombinant forms of hormones, such as rEPO. More recently, the drug NeoRecormon from Roche, has been at the center of a doping scandal. With PRP, the substance is being injected directly into the ligament and contains few or no red blood cells; aside from promoting healing, there are no performance enhancing properties. WADA's guidelines are focused on red blood cells and drugs that cause changes, so this is legal under their standards, which are close but not identical to MLB's. It could not be detected by anything other than a blood count, and even then, two sources said that there would be almost no change in those counts. MLB does not currently conduct blood testing at any level. Nady's recovery is very difficult to judge, but the timeline from the article is entirely reasonable.

Brian McCann (20 DXL)
Glasses. That's the last chance for McCann to avoid LASIK surgery. If you're wondering how he'll catch with glasses, I don't have a good answer for you. The catcher will head out for another rehab assignment on Wednesday to test his new Oakleys. If they work, he'll be back over the weekend, but the downside here is severe. The consensus opinion is that he would be forced to miss at least six weeks, perhaps more, if he has LASIK in-season. If the glasses work for his hitting but not for his fielding, there are some options. The Braves have inquired about some kind of prescription shield for his catching mask, though this has never been done before. The Braves are also discussing using him in the outfield if necessary to keep his bat in the lineup, but the more interesting idea to me is that McCann could spell Chipper Jones on occasion at third base. We'll know a lot more after Wednesday.

Carlos Zambrano (15 DXL)
If there's any bright side to Zambrano's hamstring injury, it's that it will give him some time to rest his arm. The shoulder problems from last season haven't cropped up again, but some extra rest can't hurt. The Cubs would much rather find their ace some rest some other way, though, as his hamstring strain looks severe. On the day when Greg Maddux and Fergie Jenkins were honored at Wrigley, Zambrano injured himself laying down a bunt. Actually, it was the running after the bunt that caused the problem, but seeing as how that bunt began a solid inning for the Cubs, it's hard to fault him or the coaching staff for the play. I am a bit concerned that he argued to stay in the game, saying it was only a cramp, and then realizing after just one more pitch that he couldn't put any weight on it without pain. His shoulder problems last year were exacerbated by his having hid the problem for weeks before finally getting treatment. It doesn't look as if that habit has changed. Zambrano is heading for an MRI, and likely to the DL, as sources tell me that he was very sore after the game. With Jeff Szamardzija in the pen, that leaves Randy Wells as the likely starter on Friday.

Jason Bay (1 DXL)
The Boston Globe had an interesting story about Bay's injury. He fouled a ball off of his foot, leaving a bruise. However, Paul Lessard, the Head ATC, watched some video of the at-bat and noticed that as Bay's foot was struck, he also rolled over his ankle. That left him with a sprain that was more of a problem than the contusion. Even MLB.tv didn't have the same angle, so I can't tell you if it was an inversion or eversion, but the key is that the Red Sox know and they can treat it. Reader Steve Shaw e-mailed to ask how common the use of video is to help pinpoint the mechanism of injury, and the answer is: very common. The use of video in baseball is huge, so why wouldn't it spread to the training room? Heck, I use video to try and figure out injuries, so you know that the medical staffs are doing it. Bay should miss minimal time, if any.

Brad Lidge (0 DXL)
Cole Hamels (3 DXL)

Over the weekend, the Phillies got the good news/bad news treatment with their key pitchers. Lidge came away from his side work feeling just fine, though the knee is still an issue; he pitched in a game on Saturday and was effective. The key now is keeping that problematic knee from swelling, which means figuring out what's causing the swelling and keeping it under wraps as much as possible. While the medical staff will do their best, he's likely to have some recurrences and even future surgery. On the other side of this coin, Hamels did not have a good side session, and Charlie Manuel got to juggling his rotation to push Hamels back a day. It's not a major setback, just an admission that he is after all human. He had a nasty inversion sprain and couldn't heal in time. That's not that bad, it's just reality, and that both the Phillies and Hamels dealt with it in this way was the smart play.

Tom Gordon (20 DXL)
Just three games into his Diamondback career, Gordon was carried off the field. He was covering home plate after a wild pitch, and ended up grabbing his leg after the play. It certainly looked like a classic hamstring strain, possibly a severe one. Given his injury history, one almost has to expect the worst, and watching the play, you can see that he was in pain. Gordon appears to have injured his leg as it slid across the plate, but given the terrible pitch that preceded it, I wouldn't be surprised if something had given out before that. His comments after the game don't indicate that, however. The D'backs will evaluate him on Monday, but I don't see how he won't end up back on the DL.

Alex Rodriguez (30 DXL)
Watching the Scranton Yankees in Indy this week, I'll admit that I was doing some clock-watching on Rodriguez, wondering if he might end up progressing from his stint in Tampa to one of the more popular locations for rehab. Indianapolis' Victory Field is a major league-quality field, one where teams don't mind sending their expensive stars. Right now, it doesn't look as if that will be the case. He played five innings of defense on Saturday and had no problems, leaving only the in-game sliding as the last thing on his checklist. It's unclear if Rodriguez will play in any minor league games before returning. Sources tell me that the current plan has the return date set as Friday against the Orioles.

Khalil Greene (5 DXL)
Albert Pujols (1 DXL)

Usually, coming into a game as a pinch-hitter is a positive indication that a player's injury isn't too serious; the play removes the possibility of a retro move, and shows that he's healthy enough to at least have one at-bat, and that he can run. With Tony La Russa, it's not always that clear, however; La Russa's roster machinations and in-game moves have led to a lot of wins, but he's hardly predictable or even understandable in some situations. Greene pinch-hit over the weekend, but the reports on his forearm strain remain negative. He'll be re-evaluated Monday, and the possibility of a DL trip remains. Something else to watch with the Cardinals? Pujols was given the day off on Saturday. At the time, it was called a normal rest day, but it turns out that he's dealing with a mild calf strain. He injured it on a recent steal, but it isn't considered serious. Still, my idea that he could be headed for a 20-20 season might be tripped up a bit.

Ryan Braun (1 DXL)
Braun has been dealing with an intracostal/oblique strain since spring training, but it now appears to be migrating a little. The injury itself isn't moving, but it's an easy cascade for it to go from the side to the back. His 9.1 VORP is still top ten at his position, and he's been productive, but the rib injury has been lingering, and over his past two months (September '08 and April '09) he's hardly been the power threat that NL pitchers hate to face. It's hard to break this type of cycle without missing extended time, but Braun and the Brewers' medical staff will continue to try to find ways to do it.

Quick Cuts: Chien-Ming Wang will make at least two rehab starts as he works back from a hip/foot problem. ... Oliver Perez's knee soreness seems rather convenient, doesn't it? ... Here's one you don't often hear: Garret Anderson refused a rehab assignment, saying that he didn't need to get any at-bats before returning this week. We'll see how Bobby Cox reacts to that. ... Brandon Morrow argued that he's fine, but the Mariners are worried about his shoulder. He'll head to the DL and to a strengthening program. ... Carl Crawford's hamstrings seem OK this year. ... Normally, I don't put a lot of stock in a pitcher saying that he's made a mechanical adjustment and things are better; you need more than one result. That said, I do put a lot of stock in Mike Maddux, and Matt Harrison's last two starts look like something. ... Casey Janssen had a nice rehab start in A-ball and is on track for a June return. ... Jason Isringhausen was into the mid-90s in his last outing at Triple-A, and he could be close to making his Rays debut. ... Jermaine Dye is expected back on Monday after missing time due to a hand injury. ... Jake Westbrook is making progress in his Tommy John rehab and could pitch to batters soon. Look for a return around the All-Star break. ... Daisuke Matsuzaka will have three rehab starts before returning to the Sox, essentially using his DL time as a spring training repeat of sorts.

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