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March 22, 2010

Under The Knife

Breaking Down Breakdowns

by Will Carroll

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Brian Roberts (disc problem in back, ERD 4/15)
Knowing usually helps. With Roberts, the O's know, but they're no better off. Roberts continues to have problems with a disc in his back. Initial treatment offered little relief, pushing the team to send Roberts back to Baltimore. Team doctors decided at that point to give Roberts an epidural injection. While many think about childbirth when hearing the term, this is different. The full term is epidural steroid injection, but you can imagine why many try to avoid that term. This is corticosteroids, so just stop. This is a very involved procedure, as this excellent video shows. Note here that the injection is to give pain relief. It does nothing to correct the underlying problem. By breaking the pain-spasm cycle1; the hope is that the other things the medical staff is doing, like stretching and modalities, will take effect. The effects of the injection last about a week, so look to see what's going on with Roberts early this week for an indication of whether he'll get a chance to start the season on the field rather than the DL. Right now, that looks unlikely. With the depth issues behind Roberts and in their lineup, the Orioles need this one to clear up as quickly as is safe.

Andrew Bailey (lateral epicondylitis, 3/25)
Anything "elbow" sounds bad for a pitcher. Thing is, tennis elbow is called that for a reason. Well, that and it's easier to say than "lateral epicondylitis." It's typically one experienced by tennis players (surprise) due to the way the extensor muscles which attach near the elbow are used to stabilize the racket. It's painful and annoying, but tends to go away with rest and treatment. While many people you know who play rec-league tennis might tell you stories about it lasting for years, I'm guessing they didn't really do either of those. Rest is something few people really have the luxury of doing and the treatment a star athlete gets pales to what's available, even with the newly passed health care bill. It's the extensors, not the flexors, that are involved, which is important. Flexion is the more taxing activity for a pitcher, and why we often see flexor mass and tendon issues in pitchers. Bailey should be able to come back after a week off and jump right back onto the relief pitching horse2.

Bobby Jenks (strained calf, 3/25)
Jenks might be in better shape this season, but he's still inflamed. His calf apparently has some "mild inflammation" after throwing, which isn't typical. Jenks always seems to have mild issues that have to be taken care of during the season, but those usually come with fatigue and seem to point to his conditioning as the culprit. Jenks was behind on his pitching because of a renewed focus on that conditioning, but sometimes there are unintended consequences. No one can be sure why he has a strained calf, but that's all it is. He's a bit further behind, but the Sox have other options if they need to leave Jenks in Arizona for a few weeks if it comes to that; there's still time. He's already throwing and, as a known quantity at closer, he doesn't need a whole lot of work to prove to Don Cooper and Ozzie Guillen that he's ready. I'm a bit concerned about this happening, so consider this a sign that you should definitely pair a Jenks pick with Matt Thornton or even a $1 bid on J.J. Putz.

Kerry Wood (strained back, 4/30)
Kerry Wood is realistic. He's getting a bit of a second-wind career as a reliever after resisting the change for the last five years. It hasn't made him better or even much healthier, so maybe he was right all along. He has a strained muscle in his back that will shut him down for a couple weeks and the six-to-eight timetable the Indians laid on him shows just how conservative they're willing to be with this. Wood will start the season on the DL, with Chris Perez getting the first shot at the saves. There's every reason to believe that Wood could be pushed out of the role if Perez does well, or at the very least shifted a bit. Manny Acta is more willing to listen to creative ideas than most managers, so if he starts using Wood in close seventh- and eighth-inning situations, look to see if Keith Woolner is anywhere near the bullpen.

Brandon Webb (torn labrum, 4/20)
The D'backs say they want Webb to "feel like a million bucks." Problem is, they're paying him eight million bucks and he's going to miss at least a month of the season. Webb hasn't had a setback (as some are reporting), but is instead in the middle of a throwing program designed to build up arm strength. The program is mostly long toss, which in and of itself doesn't seem like much, but at the major-league level, there's a lot of controversy about the exercise. The distance that a pitcher throws at is the subject of heated debate. Some teams won't allow much more than 120 feet while others will allow 300 feet or more. The mechanics of long toss are a subject for another day, but for Webb, it's just another step in the journey back to the mound. Right now, that journey seems to have a goal of late April, but the ERD you see above is very fluid.

Ted Lilly (frayed labrum, 4/23)
Lou Piniella is planning out his rotation, not for the season, but for April. That plan has Tom Gorzelanny, Carlos Silva, and to some extent, Jeff Samardzija and Sean Marshall, fighting for the fifth slot. Once Ted Lilly is ready, which right now appears to be mid- to late-April, that becomes a tough decision, with only one of the four getting the job. While Samardzija and Marshall slot easily into the pen, it's not so easy for Gorzelanny or Silva. There's never really such a thing as too much starting pitching, especially when one of those pitchers is coming back from shoulder surgery. Lilly should be fine after his cleanout and the Cubs need him to be. Three starts from those guys is one thing, but if it's 30, it's entirely another.

Daisuke Matsuzaka (neck, 3/25)
I had the chance to see the Red Sox last Friday, but not Dice-K. (For the record, Josh Beckett looks in fine form already.) Matsuzaka has been held back by what's been variously called back, neck, and shoulder issues. All of them are of the same base problem, and it's really one of wording. The area where the neck, back, and shoulder come together is kind of a Saxe-ish issue; various people are going to call it different things. The root of the problem is muscle spasm, and while that is frustrating and painful, it's seldom something that is a long-term issue once it's dealt with. The Sox medical staff has been patient, making sure that Matsuzaka didn't apply the typical Japanese "work harder" mentality to the problem. While he hasn't thrown much, he's apparently not far behind. John Farrell was quoted as saying he wants Matsuzaka to throw 95 pitches before breaking camp. Given that he's scheduled for a two-inning relief stint later this week, he'll need to ramp it up quickly to get to that. It will be interesting to see if the Sox are willing to start him off in the pen or whether he (or someone else) might end up on the DL to start the season with the current depth.

Placido Polanco (sprained knee, 3/26)
I actually didn't see Polanco's injury happen. Like most people at the ballpark, I follow the ball. This popup, very high on a windy Florida afternoon, was blowing around, and I'm sure Polanco was, like me or you, watching the ball. That's why he didn't see the mound. He took one awkward step up the bump and down he went, grabbing his knee but making the catch. It was easy to imagine what happened, but the angle got a little lucky for him. If it had been a purely lateral force, the collateral ligament might not have held. Because he hit it at an angle, it just stretched, but remember, a stretch is a sprain. The redundant structures supporting the knee held as they were designed3. Polanco was back on the field Sunday and says he's near 100 percent. If all goes as expected, he'll be ready well before opening day.

Russell Martin (strained groin, 3/23)
When Martin first injured his groin, the reports that he'd miss opening day came quick, even after it was clear that this was nothing more than the garden-variety groin strain. Martin's durable, but groin strains are painful. The suggestions that this might have been for even more time still linger, but it looks as if the green rating that I kind of rued for Martin might nevertheless hold for now. Martin's back behind the plate and is likely to get in just enough work to convince Stan Conte and Joe Torre to let him go north ... err, west in April and start the season in Dodger Stadium. Once clear, groin strains tend not to recur. The Dodgers will be very careful with this, so don't let offdays and rest confuse you through the rest of spring training. Martin's very likely to be his normal self come April

Quick Cuts: Joe Nathan will have Tommy John surgery in the near future and will miss the 2010 season. The interesting note here is that he doesn't appear to be headed for the "docking" procedure previously discussed. ... Maybe Nathan will feel better if he hears that Edinson Volquez is throwing off a mound. Yes, really. Expect him back around the All-Star break—in the majors. We'll probably see him in the minors by June 1. ... There's really nothing new to report about Jose Reyes this week, but I knew people would jump off in comments if I didn't say something. ... The timeline on Carlos Beltran's return is sliding back a bit. We're already near the eight-week postmark since his knee 'scope, and he's not running yet. He won't even try for another couple weeks, so his return is now targeted for May, at best. ... I usually don't listen to players on things like this, but when Brad Lidge told writers he thought he could be back on April 12, that's pretty specific. It also makes sense, given where he's at in his recovery from a pair of surgeries. ... Dioner Navarro got quite a scare after a collision. His leg went numb and he had to be carted off, but it looks like nothing more than a nerve bruise. Those heal up, though they can be very painful and disconcerting. ... Chilled? J.P. Howell will miss the start of the season and possibly much more due to a shoulder issue. He'll see Dr. Koco Eaton about the issue. The Rays tend to be very conservative with pitchers. ... Cristian Guzman is running out of time to convince the Nats' staff his shoulder is ready to go. Jim Riggleman indicated that Guzman is still "thinking" about his throws. ... Nyjer Morgan has a very slight hamstring strain, but the Nats are being cautious with him. He's scheduled to test it on Monday. ... Brandon Morrow is still expected to be ready for the season, despite missing his last scheduled start. He's had some shoulder "tenderness", which is making some wonder if he's just fragile and unable to pitch at less than 100 percent. ... We've only got five more THRs to go, which means UTK will start up its normal run on Easter Sunday. We'll have an annoucement very soon about something we're doing this year that's going to mean a lot more Ballpark Events this season. I'm thinking Baltimore for the first one in mid-April. Who's in? ... Also, be sure to check out the special offer we have on 3P Sports' informational "webinar" where you'll get the chance to hear from Rick Peterson and Jim Duquette about their program. I'll have more on some of the things they're doing soon in this space.

 

Notes



1I'm not sure I've ever explained pain-spasm before, which makes me remiss. It's a simple vicious circle: when the body feels pain, it protects itself and stops further damage, sometimes by disabling the body from doing much of anything besides laying there and moaning about how bad it hurts. Pain causes spasm. The problem is the spasm causes pain. And so it goes.

2 Which sounds like a really bad sideshow act. I wouldn't pay, unless it had some kind of gimmick, like throwing submarine.

3 Or evolved. Please don't e-mail, Dr. Dawkins.
Related Content:  Back,  Groin,  Strained Groin

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