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September 3, 2010

Under The Knife

Progress at a Snail's Pace

by Will Carroll

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UTK Flashback

Back in 2003, I visited with Dr. Tim Kremchek, touring his new facility where he helped take care of the Cincinnati Reds. We visited with him again in 2005, checking out the additions to his facility, which included a motion capture system for biomechanical analysis. (The author of that piece has gone on to do some good things as well.) I had the chance to chat with Dr. Kremchek on Wednesday morning, seven years after our first chat. So what's changed? Not much, sadly. Teams still haven't bought into doing research or using things like biomechanical analysis. "Studies take years and big samples," Kremchek said. "Baseball is a win-now game." Kremchek also decried the culture of secrecy in baseball. While there's been some sharing of information among team physicians and athletic trainers, much of what teams do or do not do is still considered proprietary. Then again, there's not much out there to be proprietary. Things seem to have gone backwards at the major-league level, but how about the youth game? "It's better," Kremcheck said, citing a reduction in the number of young pitchers he's seeing for surgery. "Parents are aware of pitch counts now. The moms know better than the coaches," he said, laughing. That's not to say that it's not still an issue, but the tide seems to be turning toward caution. The biggest problem may be that the problem can't be attacked directly. "Fatigue is what the real problem is," he said. "The Nationals did everything we know how to do and they still lost [Stephen Strasburg.] He was deeper into a season than he'd ever been, pitching to better hitters, and then this happens. We shouldn't be too surprised." Kremchek is excited about the possibilities of October baseball in Cincinnati. He's not just the team doctor, he's also a passionate fan. If the team does make it—and things are looking pretty good—then Kremchek's care for pitchers and for the rest of the team will be a part of that. Powered by the "Gourmet Gettogether" on September 8 here in Indianapolis (contact me for more details if you're in the area), on to the injuries:

Johan Santana (strained pectoral, ERD 10/1)
The quick joke on Twitter was "only on the Mets could have someone go out with a strained boob." Funny, yes, but it shows why this is a misunderstood injury. In a pitcher (or on anyone else who suffers a throwing injury—remember Vladimir Guerrero doing this a couple years back?), the strain usually happens near where the muscle inserts into the humerus just below the shoulder. If I pointed to it, most people would say "shoulder" and not "chest" (and probably not "boob.") There's no word at deadline on the severity, but expect the Mets to be very conservative with this unless it's a very minor issue. Even a Grade I strain would likely cost Santana two weeks or so, meaning the Mets could elect to shut him down. Anything above that and Santana's season is definitely over. It will likely be late today or even longer before we know the full severity on the issue, so avoid any quick pronouncements.

Ricky Nolasco (torn meniscus, ERD 10/4)
File this under "unsurprising." Just one start into trying to pitch with a torn meniscus, Nolasco is headed for surgery. Maybe the Marlins looked at the standings and realized that Nolasco's need wasn't so much that they should risk anything for a couple more starts. Sources told me during his bullpen session prior to his last start that he was having difficulties maintaining his mechanics and that's evidently the major factor in shutting him down. The knee isn't bad and surgery will have him back in a matter of weeks, meaning he'll be "normal" for spring training. Nolasco's season is pretty much in line with his 2009, meaning people are going to have to get used to this being his true talent level. Fact is, no matter what the numbers say, Nolasco isn't that good a pitcher, and until there's a good measure for pitch sequencing and a quantification of an out pitch, Nolasco's probably going to look better than he really is.

Cliff Lee (inflamed back, ERD TBD)
Ian Kinsler (strained groin, ERD 9/3)
Lee headed back to Texas to have his back looked at by team physicians and receive an epidural. The back injury might explain why Lee's performance for the Rangers doesn't match up with his early performances and even as the Rangers have gone 1-6 in Lee's starts during August, he's normally given decent starts, taking some pressure off the bullpen. Since mid-month, he's been hittable, which could coincide with a back injury, which could mean he isn't bending his back well, which could mean he's leaving pitches up in the zone. While I can't tell the former two with certainty, we can use PITCHf/x to check the latter. Using the PITCHf/x tool at BrooksBaseball.net, it's still not clear. His August 26 start doesn't give much clarity as to whether he's leaving pitches up. Looking at his very good July 26 start, I don't see a ton of difference, though I'm no PITXHf/x guru. The Rangers will count on the doctors to find out what the problem is and get Lee some relief. On the positive side, Kinsler will be back in the Rangers lineup tonight, returning from his groin strain. Kinsler is likely to be held up on the basepaths in the near term, just as a precaution, and will get extra time off here and there as long as the Rangers sustain their lead. With a full month before the playoffs start, the Rangers have time to deal with their issues.

Jim Thome (strained back, ERD 9/4)
Jason Kubel (bruised wrist, ERD 9/6)
Justin Morneau (concussion, ERD TBD)
Nick Punto (strained hamstring, ERD 9/9)
People have pounded me for not covering the Twins' injuries. The sheer volume is really all that makes them notable. The Twins are just running into a bad stack of injuries, but with expanded rosters, it shouldn't be that significant an issue. None of the injuries are significant in and of themselves, but an overall loss of talent available isn't what the Twins need with the White Sox not far behind them in the American League Central. Thome has a sore back, the same condition he's dealt with off and on for the latter half of his career. It's a maintenance issue, so when he's free, he can still crush the ball. When he's not, the Twins can shift things around and not lose too much. Kubel is out after getting drilled in the wrist on Wednesday. It's not thought to be serious beyond the pain and swelling. While he could be back this weekend, the team is inclined to let him rest until the swelling is down, which wasn't close yesterday. Punto was due to be back from a simple hamstring strain on Sunday, but he's not ready. Sources tell me that it's more likely to be next weekend, as they still think Punto is compensating a bit for residual soreness. If they were to bring him back now, there's a good chance of some compensation injury, though not as much as if they were still on turf. Finally, there's no news on Morneau, positive or negative. He's stuck in the holding pattern, but as long as the Twins are in it, they'll keep hoping that Morneau can come back. The longer this goes on, the more likely it is that he could have long-term problems—not weeks, but months or years.

Jay Bruce (abdominal strain, ERD 9/5)
With a lead, the Reds are going to get more conservative with injuries. One of the lead contributors to their post-sweep surge has been Bruce, but he's been shelved with an abdominal injury. It was originally reported as an oblique strain, so it's a bit tougher to get a read on this than normal. The Reds have been pretty insistent over the last few days in using "abdominal strain" instead of "oblique," so let's go with it while retaining the possibility that this isn't what it appears. Bruce is sore, but rest of just a couple days is what the Reds think he needs. Dusty Baker indicated that the medical staff thought he could play by the weekend, so we'll sit back and watch. An oblique strain would be more problematic on rotational activities, but an abdominal strain is no joke either, as Josh Hamilton and Mike Cameron could tell you. The Reds are going to err on the side of caution, so look for Bruce to get more rest as long as they can hold their lead in the NL Central, though this weekend's set against the Cardinals might push things a bit in the short term.

Dustin Pedroia (fractured foot, ERD 10/4)
With a headline like "Pedroia Refutes Surgery Report," you might think that Pedroia would have refuted those reports. Instead, he pretty much confirmed them. While Pedroia refuted that a decision had already been made, he seemed resigned to having the surgery today after meeting with doctors. The surgery would put a screw into his navicular bone to ensure that it heals properly. The need for the screw tells us that Pedroia re-injured the bone by coming back, though that doesn't necessarily mean he came back too soon. There's always some element of risk in any return, short of waiting forever. Pedroia should be able to have a relatively normal offseason, which for him normally includes spending some time at Athletes Performance Institute in Tempe, Arizona. Once the foot is healed, Pedroia shouldn't have any other issues in the short- or medium-term. For those of you comparing the Mets of 2009 to the Red Sox of 2010, stop. It's not even close. Boston has lost less than half of the dollars and significantly less payroll percentage (12 percent vs. 26 percent for the Mets). Where there is a comparison is in Injury Cost, where they could end up very close when the season is done. Losing players is bad, but losing your best players is much worse.

Conor Jackson (sports hernia, ERD 10/4)
Jackson's season hasn't gone like he or the Athletics hoped. He's spent as much time injured as he has hitting. After a year lost to Valley Fever, getting out of the valley didn't help much. I'm not sure if he'd say a sports hernia repair is worse than a fungal infection, but I can say that I'd check the box for "none of the above" on that survey. While Jackson's season is done, there's no reason to think that he won't be ready for spring training at 100 percent. Then again, as an injury-prone player that's heading into his third season of arbitration eligibility, he could price himself out of Oakland. The Athletics front office got him as a bargain and this injury could make him a bargain again, if Jackson is willing to take a similar salary. Otherwise, he could end up as this offseason's version of Nick Johnson.

Quick Cuts: Miguel Cabrera left yesterday's game with what the Tigers are calling biceps tendinitis. Watch this one closely. ... Jose Reyes took some swings and could be back over the weekend. Or not. This one's really tough to read, given the Mets' confusing context. ... Jason Varitek expects to be cleared for baseball activities after imaging yesterday. The Red Sox hope he can get a couple games in at Pawtucket over the weekend. ... Speaking of Pawtucket, remember that the minor-league season (and rehab assignments) ends on Monday. Players can still get work in at complexes and in the instructional leagues. ... Nick Swisher is still having trouble with the knee he fouled a ball off of last week. The "tightness" described usually doesn't come from a bruise. ... The Yankees pushed Damaso Marte to the 60-day DL. He's unlikely to return this season and the move opens up the playoff roster loophole for the Yankees as well. ... Marlins catcher John Baker will have Tommy John surgery today, as will Strasburg. ... Jason Kendall will have surgery to fix a torn rotator cuff. He will miss about nine months, putting his 2011 and his career in jeopardy. How he threw out 29 percent of baserunners with that is beyond me. ... Carlos Delgado re-injured his hip during his minor-league experiment with the Red Sox. He's done and likely headed for more surgery. ... Speaking of hip surgery, Kurt Warner, the NFL QB who had the same type of hip surgery as Delgado, Alex Rodriguez, Chase Utley, and others is headed for "Dancing With The Stars." That tells us something about the long-term viability of the surgery, in contrast to Delgado's problems. ... Tom Gorzelanny will miss his next start. His pinky finger was broken slightly by a comebacker.

Related Content:  A's,  Back,  Surgery,  Nick Punto,  Year Of The Injury

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