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June 16, 2010

Under The Knife

Gain a Pitcher, Lose a Pitcher

by Will Carroll

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Yesterday, I wrote a bit about Safari Reader. I got some e-mails about it and the use of ads and other things on BPro. I'm not the webmaster, the ad salesman, or a designer, but for the most part, I think we do OK here. We have a readable site, if nothing else. If you'd like to use AdBlock or view the site in Reader, well, that's your choice. I'm proud that the site has never used any of the tricks like multiple pages or other insidious techniques as discussed here (note: some NSFW language.) I agree completely that we have to earn your page views and your hard-earned dollars for subscriptions. The other thing we have to do is earn your trust. Anonymous sources are one of those really difficult things to deal with and more than anyone else here, I'm reliant on information from sources that are breaking confidences. Moneyball gave a good illustration of the game that reporters and teams play. It's an exchange of information. Sources give some to get some. Am I getting good information? I have to decide, report, and then let you decide if I did a good job. Things can change, things can be trial-ballooned, and at times, teams flat out lie. While you're deciding who to trust, I'm deciding which sources to listen to next time. "Fool me once, shame on you. Fool me twice, shame on me," holds very true. I wish that there was a website out there that "kept score" on these, even though I might not like seeing my score. Guys like Craig Calcaterra might get fooled once too, but he knows that if he's fooled too many times, there are other places you can go. Craig's a smart guy and knowing him the little I do, I don't think he blue-skied anything. He does a great job explaining himself in comments and I'll continue to read his column with little doubt. It happens to the best of 'em. I'm all but done, so let's get on to the injuries...

Chad Billingsley (strained groin, ERD 7/5)
Carlos Monasterios will swap places in the rotation rather than leaving it. With Vicente Padilla due back, an injury to Billingsley during his last start has kept the Dodgers plugging holes. Billingsley has a "mid-grade groin strain", according to sources, and will require a stint on the DL. At this stage, they don't think it will keep him out much longer than the minimum, and there's hope that he won't need a rehab assignment. Pitching coaches and medical staffs have come up with some odd-looking but effective ways to keep up arm strength while not taxing the legs and simultaneously keeping the pitcher from a potentially injurious change in mechanics. Billingsley's conditioning has always been his biggest question mark, but he's shown himself to be able to come back from injury on schedule in the past. The Dodgers won't rush him back, but they do need him, a semantic tug-of-war that makes me expect this will come back just slightly beyond the minimum. The big factor is whether or not he'll need a rehab start or if the stamina sticks through the injury.

Brian Roberts (herniated disc, ERD 8/1)
The report Tuesday that Roberts was, perhaps, ready for a late June return, seems to have been backed off. At some level, it was never really a "he's coming back around X date" thing, but the Orioles topped that off with news that Roberts is perhaps further away than expected. The initial report talked about four injured Orioles, and Roberts was one of them. He's the most important, to be sure, but also the one with the most difficult read on the timeline. So even if the date doesn't hold—and I'm not sure about it—the rest of what I said holds true. Roberts is at a stage where when he's comfortable and productive, he's going to need to be rushed. This seems opposite of the normal course and a bit at odds with the O's record. Simply, there's no reason to waste whatever playing time Roberts is going to be able to get in the Florida State League. Yes, he'll need some controlled work and at-bats to be ready, but at the point where it's clear he can produce, it's paramount to get that production at the major-league level. (This kind of change in information is why I do this every day. It doesn't work if it's once a week, or once every three weeks.)

Orlando Hudson (sprained wrist, ERD 6/19)
Switch-hitting is the issue keeping Hudson off the field, which seems a bit counter-intuitive. Hudson can hit right-handed and play the field without causing problems in his sprained wrist, but all along, it's been hitting left-handed that's the issue. For the Twins, it's less the side, but the lack of progress that's worrisome. They could play him in a platoon or just have him hit righty against all pitching, but they'd rather take a couple extra days and see if that helps Hudson. His wrists are a recurring issue, so this is a pretty smart play all around. Since this was a traumatic injury to a recurrent problem, it tends to act much more like the former, but it can trigger a chronic issue, which is what the Twins have to avoid in a tight division race. Also, Danny Valencia's solid performance allows them the luxury of a couple more days and gives them a look at what comes after the one-year deal with Hudson.

Marco Scutaro (pinched nerve, ERD 6/16)
"Nerve root block." That just sounds nasty, doesn't it? That's what Scutaro went through in order to get through the pain in his neck. CSN had more details on the reasons he did it, but what is the process? It's not unlike an epidural injection that many women get for childbirth, but on a smaller scale. Anasthetic is injected directly to the nerve root, breaking the pain-spasm cycle by shutting down the pain. The medical staff then has the chance to treat the cause rather than just the symptoms. If you're not squeamish, go ahead and watch this video to get an idea of a similar but not identical procedure. Scutaro is expected back today. How long he stays pain-free or at least pain-tolerant has a lot more to do with what the medical staff is able to do over the course of the post-injection period than anything else. Yes, baseball players will go through a lot to play.

Huston Street (strained shoulder, ERD 6/20)
The Rockies' plan for Street is a bit odd. After having him pitch on back-to-back days and seeing decent if not great results, the team has sent him back to Triple-A to continue rehabbing. That's not the odd part. What is odd is switching him from testing him in-role, where he'll need to be available multiple days and testing his recovery, to putting him on a three-outing, two-days-between schedule (Sun-Wed-Sat.) I spoke with a couple of physical therapists for some guidance on why this change would be made. Their thought was that Street's velocity has been down and that instead of focusing on recovery quite as much, the Rockies want to see if he can get more strength with a bit more time. While his schedule as a closer wouldn't allow that, it's kind of a "tank test" as one of the therapists called it. "They can see if there's a little bit more in the arm, a couple more ticks on the gun, that are hidden by recovery," she explained. Street is not going right back to the closer role when he does return, so look to see if Jim Tracy and the Rockies' medical staff are using this week of rehab time to figure out the best way to utilize him.

Jair Jurrjens (strained hamstring, ERD 6/25)
While Chipper Jones tries to shorten my column by retiring, Jurrjens is making some progress toward a return from his hamstring strain. The early results weren't good, from either a results perspective or a more old-school "getting his work in" tack. Jurrjens didn't get through three innings, getting knocked around by Triple-A hitters. Jurrjens had hoped to make only two rehab starts before coming back to the Braves, but the team is wanting to see more stamina before they activate him. This shouldn't be a real extension of his time missed, though he is already about 10 days behind what the average return would be for this type of injury.

Erick Aybar (torn meniscus, ERD 6/18)
Given the way it looked, a meniscus tear is really good news for Aybar. I won't go through the whole sequence of events that led to him getting upended, but immediately, I was reminded of last year's injury to Akinori Iwamura. While Iwamura was able to come back later in the season from what looked like a devastating ACL tear, Aybar is only expected to miss a few games. This is likely something that will need a cleanup at some point, but the Angels think that it's not causing enough problem to do something now. Any meniscal tear could cause some pain, swelling, and "locking" in the knee, so Aybar becomes a bit riskier now.

Brett Anderson (strained elbow, ERD 7/5)
It's been two weeks since Anderson was last seen on a mound. Now he's getting ready to start throwing again, heading to a mound on Friday. I'm sure we'll hear the normal sounds of a rehab, the normal process, and perhaps even a rehab start, but this is one where we're really not going to know anything until Anderson is back on a major-league mound. Last time, he was fine until he started pitching at 100 percent, with the sweat and adrenaline running. No simulated game or even a minor-league game can accurately simulate the demands made on a pitcher. Some say they grip the ball more tightly or have to focus in order to keep their off-hand and therefore their glove from visibly shaking. Standing in front of a big crowd, augmented by TV cameras and the sight of an opposing hitter? Those are things that just can't be simulated. I'll take any good news on Anderson, but like I said, we won't know. He's still on track for a similar timeline for his last comeback from this, but it wouldn't surprise me if the A's played it conservative and held him out until the All-Star break.

Albert Pujols ("rabbit punch")
When Pujols got popped by the throw to the plate, it looked as if it went off the back of his head. Instead, it hit him just below the helmet line in the base of the skull. That's one of the worst areas to take a blow, making his reaction of pain and nausea much more understandable. Boxing and MMA both don't allow punches to the back of the head for precisely this reason. The "good" news is that being hit in that area seldom creates a concussion, though the initial symptoms can mimic it with nausea, dizziness, and weakness in the extremities. The good news is that getting "rabbit punched" doesn't normally have long-term consequences if the initial trauma wasn't severe enough to cause more than short-term problems. (Despite my background in boxing, I had no idea how the rabbit punch got it's name. Ick.)

 Quick Cuts: Alex Rodriguez wasn't in the lineup Tuesday, but was available to pinch hit. Joe Girardi said that he would be back in the lineup today, as his hip has responded to treatment. ... Jimmy Rollins started his rehab with an 0-for-3, which is meaningless for figuring out how he's coming back. The real info is that he didn't have any problems with his calf. If things keep going well and he gets a couple hits, he'll be back this weekend. ... Josh Beckett is amping up his flat-ground and long-toss sessions, putting him on track to get back on a mound soon, perhaps as early as this weekend. He's still at least two weeks away from a return and is likely out through the All-Star break. ... J.A. Happ will make another rehab start on Friday. He could make as many as three more starts before his clock runs out. Arm strength/velocity is the big holdup. ... Anyone that thinks Jordan Zimmermann's rehab is surprisingly fast isn't paying much attention to baseball. Anyone who thinks Zimmermann is a second starter in a good rotation doesn't know baseball, period. ... The O's sound very concerned about Chris Tillman's loss of velocity and effectiveness. ... I don't need numbers and a thousand words to tell you what Cliff Lee will get in return. The M's can expect to get a "ready starter" and a "good-not-great hitting prospect," according to multiple front-office types ... The Yanks pushed Sergio Mitre to the DL after he strained his oblique during hitting practice. ... If you think it's a coincidence that John Grabow and Brandon Wood were activated on the same day, you haven't been paying attention. ... I say it's mostly #5. I also know which organization has the "VE" column.   

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