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May 6, 2009

Under The Knife

Midweek Med Report

by Will Carroll

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Jorge Posada (21 DXL)
The Yankees pushed Posada to the DL after a recurrent hamstring strain (above, but close to, a previous recent strain) showed enough damage on the MRI that the doctors were worried about the integrity of the area, and a possibly significant tearing/re-tearing risk. If that sounds bad, that's because it is, but it's a short-term bad. As the muscle repairs itself, the recurrence risk should diminish as it becomes closer to being fully healed, so this time off is a key factor. There is some concern that Posada won't be able to catch a full load with this problem, but there's already been some talk that he would need to be protected against running teams, and with Hideki Matsui making some progress, the DH slot may open up. Posada should be out a little longer than the minimum, so let's call it three weeks and see how he progresses.

Joba Chamberlain (0 DXL)
As if Chamberlain didn't have enough distractions in his life, now people are criticizing his pacing. Ed Price points out (as did 31 different e-mailers last night) that Chamberlain was down below 90 mph in the first inning with his fastball, getting knocked around before finally dialing it up and striking out 12 before being lifted after 108 pitches. Do I really need to point out to this audience that a great number of starters follow this same pattern? One pitcher I spoke with last year said that the first inning for him was about getting a feel for his pitches while trying not to get crushed. For Chamberlain, his stamina has been questioned so many times that pacing should be a smart play, assuming he can sneak past the media and a panicking fan base. He needs work on his pitch efficiency more than on his stamina, but I'm telling you right now that he's going to be a solid starter, and those are hard to find.

Daisuke Matsuzaka (40 DXL)
Things went well for Matsuzaka in his first of three planned rehab starts. His results are going to make it difficult for the Red Sox to keep him on that schedule, one that would have him back in Boston in late May or even early June. He showed zip on his fastball, hitting 93 mph on a few pitches according to one observer. (Unfortunately, not all Triple-A parks have Gameday set up yet.) It's the fastball-as-proxy for shoulder strength that was going to be the real test. While Matsuzaka didn't dominate, he did pitch reasonably well given the situation and his concern for getting in his work rather than trying to win. He was pitching with the same normal pitching routines and disdain for any adjustment in his own pattern and strike zone, so walks and efficiency will always be a concern. What doesn't look like a big problem is that shoulder.

Roy Oswalt (1 DXL)
Before the deluge, Oswalt had to leave his outing due to what was alternately called a bone bruise and a blister. It turns out that the former was correct; it was a bone bruise on his right index finger that he'd suffered while bunting, something he described as a "stinger." The bandage on his finger tells another tale, however, and suggests that he was hit. It's unknown whether the nail was broken, but since he had lost his breaking ball and there was some blood on the bandage, that was probably the issue. Oswalt has a tendency to pitch through injuries more serious than this, but it's not easy for pitcher's to work with damaged fingers. Oswalt will look to his throw day to see whether or not he'll be able to go this weekend. Early indications are that while he'll make the start, he may need an extra day.

Cole Hamels (5 DXL)
One start is all that Hamels will miss, because after completing a bullpen session yesterday, he said he was locked in for Friday's scheduled start. It was interesting to note that Hamels said that he'll have his ankles taped for the game, just as he had for his recent side work. That indicates to me that he normally pitches without his ankles taped. To be fair, a lot of pitchers go out without tape, as do many players, but this simple act might have kept him from having this problem at all. Taping is one of the first things that an ATC student learns, and they can do wonders with a roll of tape, especially some of the old-timers. With multi-million dollar technologies like cold lasers and high-tech braces, the Phillies ace could have been helped by a $2 roll of tape.

Carlos Guillen (30 DXL)
The move to disable Guillen isn't directly connected to Jim Leyland's lineup changes, but let's face it-it really is. Guillen has been struggling all season with an Achilles strain, but his chronic shoulder issue has apparently been in play more than the team has let on. Sources tell me that his bat speed and control have been dropping steadily, and that the team just couldn't wait any longer. Leyland told the press that he thought a few weeks off would help Guillen return to productivity, but all indications are that this will take more time than that. As far as where Guillen might eventually fit, a lot depends on whether or not the Tigers improve with the changes.

John Lackey (50 DXL)
Lackey got 13 runs of support, including two grand slams in the same inning, during his rehab start in Triple-A Salt Lake. Regardless, he also made it through his sixty pitches in dominating fashion, striking out three and only giving up one weak hit in the process. Lackey's going to need one more start to make sure that he has the proper stamina before being activated, but it appears as if the stuff is already there. All reports say that he showed all of his pitches, normal velocity, and that his manner on the mound was intense. With Ervin Santana one start away as well, the Angels appear to have held on through their pitching crisis without getting buried in the AL West. If the Angels win another title, the rest of the division is going to have to look back and realize that they had their chance.

Rick Ankiel (7 DXL)
It's a deep bruise. After what most were thinking after Ankiel took a header into the wall on Monday, a deep bruise on his shoulder is incredibly good news. He's showing no damage beyond that bruise, and he may even avoid the DL after one of the scariest injuries of the young season. While there was some luck involved there, it also showed good work by the medical staff and its plans and training. Chris Duncan knew not to move Ankiel, and tried to keep him calm until the ATCs arrived. That kind of emergency plan is one of the things that goes unseen, luckily, but it's something that medical staffs pride themselves on. They deserve a tip of the cap from all of us. Ankiel will miss at least a few more games before he's back in the lineup.

Shawn Kelley (30 DXL)
Think an oblique injury doesn't hurt? I got about ten tweets saying that Kelley, a Mariners reliever that I'll admit no familiarity with, went down as if he'd been shot. As you can see, that's a pretty apt description. He strained his left oblique and is headed for the DL. The interesting thing here isn't that some middle reliever strained an oblique, but that it's clear that he was feeling it a few pitches earlier and still tried to pitch through it. Watch the video again if you wonder why that's a bad idea. Kelley's strain is significant, and he could miss a month or more.

Erik Bedard (0 DXL)
A lot of people, myself included, questioned Bedard last year. Was he soft? Was he injured more seriously than the team was letting on? He didn't help himself in the clubhouse or with the media, but this year he's giving his answer on the mound. With his shoulder clear of a cyst that had been initially diagnosed as a labrum tear, Bedard is tearing up the league right now. A month's worth of great starts isn't going to erase the memories of last season, nor is it going to take away the litany of injuries that have held him back throughout his career, but it's a nice way to start changing the discussion. One front-office type I spoke with said, "I've never seen a guy go night and day like this. He's better than he's ever been, and probably better than any of us thought he even could be."

Quick Cuts: The Sox don't sound too worried about Jacoby Ellsbury's hamstring. He reported that he felt better after treatment. He left after feeling tightness on the basepaths. ... Ben Sheets' rehab is going well enough that teams are beginning to get updates on him. ... No one seems concerned about the bruise on Chase Utley's foot. He'll miss a game, and maybe two, to give it time to heal up. ... Chris Carpenter isn't too far away from a rehab start. ... Jason Schmidt made it through 100 pitches in an extended spring training game. He could begin a minor league rehab as early as next week, but the Dodgers are keeping their expectations low. ... Alex Gonzalez had a cortisone shot in his strained oblique, in hopes that he can avoid the DL. They'll make a decision tomorrow. ... Matt Capps will miss a few days due to elbow pain; an MRI showed some fluid buildup. ... Garret Anderson came back for the Braves after refusing a rehab assignment.

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