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June 23, 2010

Under The Knife

Beltran's Clock Ready to Tick

by Will Carroll

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Carlos Beltran (arthritic knee, ERD 7/15)
In what is sure to be a continuing series, the Beltran watch is now headed for a rehab assignment, which will start tomorrow at High-A St. Lucie. Beltran was watched by the Mets' top brass, including Omar Minaya, during an extended spring training game on Sunday and they felt the center fielder was ready to start his 20-day rehab clock. I've pushed the idea that Beltran needs to be up in Flushing as soon as he's physically able, but several people inside the game have told me that while there's merit in the concept, Beltran is human and needs a "spring training equivalent." The downside here is that he's going to be taxing the knee during that time. Of course, that's what rehab assignments are for. They'll be very controlled, perhaps not so much as the simulated games he's been in, but Beltran will have very specific steps and tests at each point. He'll have the DH option in most games as well, something he won't have when he makes it back to the Mets. Watching how often he needs to play there is going to be a big tell for his progress. The key will be how his knee responds and the Mets' ability to manage the inflammation and bruising that will inevitably occur inside the knee. The brace he is wearing is helping, but the continued idea that he's a center fielder is not. I'm most curious to see when that will be abandoned. One interesting concept that was tossed out by an MLB athletic trainer was the idea that Beltran could hit well enough to be in the lineup every day, but not play the field consistently. He wondered if there's a level and a cost where Beltran might make sense for an AL team. If Beltran were to show that, the idea of him being a modern-day Harold Baines would have to be intriguing for some teams as well as for the Mets escaping at least some of Beltran's contract. It's very equivalent to what the Twins did with Jim Thome, though he was a free agent.

Dustin McGowan (impinged shoulder, ERD 10/4)
Toronto to Birmingham is a challenge for Orbitz, but McGowan probably knows the route by now. Once again, McGowan's pitching arm was on Dr. James Andrews' table instead of a Blue Jays' mound. This time, McGowan was expected to have a release to increase the range of motion in his pitching shoulder. Instead, a significant rotator cuff tear was found and repaired. A cuff issue at this stage of McGowan's injury-plagued career isn't quite the tolling of the bells, but the hunchback is stretching. Pitchers can and do come back from procedures like this, but this is a situation where the kinetic chain keeps breaking down. He's 18 months out from what was termed a "frayed labrum" repair and things just keep descending. The chain of labrum-cuff injuries isn't a good one. Recent studies from Kerlan-Jobe show that cuff tears are the biggest predictor that a pitcher won't return to their previous level. Need a comp? Mark Prior. At 28, time is not on McGowan's side. He's done for this season and it wouldn't surprise me if we couldn't just say "he's done." One of the hidden costs of the J.P. Ricciardi years is a lot of pitching arms that might have helped the Jays, like McGowan, ended up helping Andrews' boat fund.

A.J. Burnett (bruised foot)
It's not speculation to say that Burnett has been off his game lately. He got pounded during his last outing, and over the last month he's tacked a run and a half onto his ERA. (Yes, I know it's not the best measure, but it's a nice, simple illustration of bad results.) Even before June, Burnett was inconsistent. He's consistent about his inconsistencies, though his 2009 campaign was everything the Yankees hoped for. Burnett has recently been dealing with a foot injury, but even that didn't show up until mid-month. The bruise on the outside of his right foot was caused by a batted ball, so we have to wonder if this explains even part of the problem. The bruise is on the area that is normally used to push off the rubber. That could reasonably reduce velocity, but I checked with Eric Seidman and according to him, the data doesn't support that conclusion. "I don't think 0.8-1.0 mph is drastic enough for players to miss versus belt it," he said. It's easy to see an injury, even a minor one, and try to tie together a cause to the effect. I don't think we see that here. Instead, we see A.J. Burnett, a guy that's almost defined by ups and downs. Chad Jennings has an interesting idea on what's been bugging Burnett and I'll say that it makes perfect sense.

Phil Hughes
At the back of the Yankees rotation, you'll find a really solid pitcher. Going into the season, I was surprised that Hughes was being pushed back to the rotation. He'd really succeeded in the pen and seemed to be avoiding the health issues that had sent him there in the first place. He won the spot outright and continued his solid pitching into the season. The Yankees realize that even with his time in the pen, Hughes is still a young pitcher shy of the injury nexus who could be overextended. The Journal News reported that the Yankees are looking to keep him around 170 innings, which seems reasonable. The plan to keep him at this level will cause him to be skipped in the rotation a few times over the next couple months, depending on the schedule. There's nothing to worry about here, and over the long term this kind of smart plan should keep Hughes effective.

Carlos Ruiz (head injury, ERD 7/5)
Whether you call it a head injury or a concussion, the effect is the same. Concussions are a huge issue that the game of football is coming to terms with at every level, but it's not the major issue in baseball because head trauma is the exception rather than the rule. It's no surprise then that catchers take a disproportionate amount of the head trauma in baseball. If it's not a foul tip, it's a collision or a backswing, which is how Ruiz was injured. Ruiz is still showing some minor symptoms several days after the original injury and the Phillies are playing it safe by DLing him after waiting to see if those symptoms would dissipate. There's always the chance that concussions go the way of Mike Matheny and never clear up, but luckily that's the exception. Ruiz should be back when eligible.

Kyle Blanks (inflamed elbow, ERD 7/15)
The Padres still don't have a definitive diagnosis on what's going on with Blanks' elbow. His rehab assignment was halted last week due to continued stiffness, something Blanks self-reported as "no better than when I went on the DL." The Padres weren't in a hurry with Blanks, who was hitting .157 when he went on the DL with elbow tendinitis. He made it through a couple games in Single-A, but there wasn't any power, so the rehab was halted after just one game at Triple-A Portland after more stiffness. There's been some speculation about bone chips or spurs, especially given his plantar fasciitis last year, but those are diagnoses that are pretty easy to catch. Without more information, there's just no way of putting a solid timeline on Blanks beyond the vague guidance that the Padres have given. It looks like he's out until at least the All-Star break. Beyond that is pure wait and see.

Chad Billingsley (strained groin, ERD 6/28)
No groin strain is minor. If you've had one, you know what I mean. Billingsley had a minor groin strain, went on the DL to let it heal and keep it from getting worse, and should come off when eligible next Monday. Billingsley has been able to keep up on most of his side work, so stamina shouldn't be an issue, though I'm sure the Dodgers will be careful with him, to the point of shadowing. The point that's really most interesting is that the Dodgers were so conservative, even in the face of a pitching shortage and significantly stressed replacements. Either it shows that they were worried that Billingsley could do more damage if he tried to play through it or the injuries they've suffered over the last few years are making them a bit gun shy. It's likely the former and that means we should watch this one closely.

Alex Rodriguez (strained hip flexor)
Rodriguez is back on the field, partly because the Yankees are in an NL park for the week but mostly because his hip is ready. His lateral motion has improved greatly over the past few days. The problem, sources tell me, has been as much about his confidence as it has about the actual injury. One of the hardest parts of any rehab is regaining the confidence and physical control over the injured part, knowing that the injury happened in similar circumstances. It helps that this one feels like a garden variety groin strain... wait, garden variety? What kind of garden is that? Athletes know how to deal with minor strains and sprains, especially at this level. The experience and the sheer athleticism helps. Rodriguez appears to be mostly out of any danger zone for the short term, but this one's going to be an adjustment for him. Over the next month or so, we'll see if Rodriguez gets back to running or starts to shift towards the "old-player" spectrum, preferring to trot rather than steal. One thing to keep in mind is that Rodriguez might be incented toward the trot. His contract has those "historic-level" bonuses that are all about the longball.

Dallas Braden (elbow tendinitis)
Is it the stress of having pitched that amazing perfect game, or is it just the typical Dallas Braden? It's an interesting question, one that Braden himself doesn't know the answer to. Again, cause and effect might be apparent, but it doesn't make it true. Braden's made some progress with his elbow inflammation, but he's still not able to recover quickly enough to handle side work. Against the Cubs, he couldn't spin a breaking ball, either, so Tuesday against the Reds was expected to be a test after he said he was pitching better. Using Gameday's pitch typing, Braden did throw a couple designated screwballs, but no sliders. That's not a good sign, though Braden said that wasn't the problem. This will remain one to watch as the A's cycle through their handful of available pitchers as they try to stay viable in the AL West.

Quick Cuts: Josh Beckett threw a bullpen on Monday, but was limited to fastballs. He's scheduled to throw again today, showing the Red Sox are being aggressive with the ramp-up. ... Tim Lincecum is telling everyone his shoulder is fine after being hit by a comebacker, but sources say he's got a "nasty bruise." ... Erik Bedard went 52 pitches in his first rehab outing in the Arizona Rookie League. Bad part is it took him that many to get through 2 2/3 innings. He'll start again on Saturday. The Mariners expect Bedard's rehab to last the entire 30 days allowed under MLB rules. ... Carlos Silva will have his start shifted from Thursday to Saturday to give him a couple days to let his sore push-leg hamstring heal. ... The Rangers activated Nelson Cruz yesterday and had him back in the lineup. He did manage an RBI on an 0-for-3 night. ... The Cubs are giving Aramis Ramirez a couple extra days to work with his new batting grip, necessitated by the thumb injury. He's expected back Friday. ... Erick Aybar had a cortisone injection. The Angels will give it a couple days to work, then make a decision on the DL. ... Mark DeRosa will need surgery on his troublesome wrist. Again. His season is done. ... The off day seems to have been enough for Hanley Ramirez. He's back in the lineup, but watch to see if there's any residual effects of the hamstring strain over the next week. ... Chien-Ming Wang—remember him?—threw a BP session yesterday. He's on track for an August return, which would help the Nationals by protecting some of their young arms. ... David Huff hasn't been good since being hit in the head with a liner and not missing a start. Granted, he was no great shakes before then. He was sent down on performance, not injury.

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