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August 17, 2009

Under The Knife

Caution Bells

by Will Carroll

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There are a lot of injuries to get to, so I won't bore you with this, but it's exciting. From August 28-30, I'll be joining the radio staff of the Ft. Myers Miracle, calling games with Zach Spear. He invited me down to see whether or not you can have a "smarter broadcast" the way that Ken Funck has talked about. I think we can, and you'll be able to hear me succeed or fail live on the interwebs to boot. It's a whole different kind of Baseball Prospectus Radio, but an experiment I think is well worth the trip to the humid confines of Ft. Myers in August. If you have ideas, I'd love to be powered by them, so let's get to the injuries:

Hiroki Kuroda (TBD)
The ball flew back toward Kuroda, and then almost rebounded into the stands. It's counterintuitive, but the distance the ball traveled was actually a good thing. Kuroda's skull held up and the ball deflected. Had it not, the ball would have dropped. I don't want to fault Kuroda too much here, but watching the video of the play, Kuroda was in a terrible fielding position, three-quarters of the way turned toward first base and with his glove up and at waist-level when he began to react to the liner back at him. He never had a chance at blocking it, let alone fielding it; I've often heard pitching coaches say that the best way to field is to not let the ball get hit at all. Kuroda never lost consciousness, though he was in obvious pain; there was not any broken skin, in the horrific way that we saw with Bryce Florie. There's no way to tell how much time he'll miss, though if he's asymptomatic for concussion, he could miss only a small amount of time. In other words, he's incredibly, insanely lucky, nothing more or less. The next guy might not be.

David Wright (TBD)
It was an earflap that saved Wright. The ball hit him directly on it, ricocheting up and out. Without that flap, the ball would have hit him in the temple, but even with the cushioning and hard plastic, there was enough force going into his brain to knock him senseless for a period of time. I don't mean that as an insult; it's a very literal meaning here. In some cases, the senses-especially hearing and sight-are knocked out. "Seeing stars" and ringing in the ears are common concussion symptoms. Strange smells are often noted, though they're more an olfactory hallucination than anything. Wright was kept for observation overnight on Saturday and was released, but he was still experiencing symptoms like headache, nausea, and some balance issues. These are all common and if there's one good thing, it's that Wright never seemed to lose consciousness or, if he did, it was only a second or two. Wright will be monitored closely over the next few days to see how he responds. The Mets have placed Wright on the DL in the meantime, and have acknowledged that he could be done for the year. His symptoms-or more properly, the absence of symptoms-will determine whether or not he can come back. With no playoff chase to conduct, the Mets can afford to be conservative, but to say he's not coming back when he could be fine in a couple of days or even a couple of weeks from now doesn't make much sense, either.

Scott Rolen (8/30)
As a reminder or example to Kuroda and Wright, Rolen is on the DL and just beginning to try some baseball activities. However, he's taking things very slowly, as he's still experiencing some headaches and balance impairment. There's no timetable for his return yet, but things do seem to be progressing. Concussions can be a "come and go" thing, but with the headaches being the biggest problem, Rolen will clearly know when those have passed. Unfortunately, he can't say "good enough," but he's known as a stubborn, play-through-it kind of guy. I have some worries here, so I can only hope the Reds don't get him back out there too quickly and risk a setback. "End of the month" is the most reliable guess I'm getting from sources and advisors, so we'll drop the ERD there.

Carlos Beltran (9/1)
"He'll try running in a straight line next." It's almost funny to hear that line as part of a rehab progression, but that's where Beltran finds himself. He spent part of Saturday shagging flies, which seems a bit funny as a pre-progression step to running, but it's just a glide, a jog, and with less lateral movement than you'd think. The knee is still problematic, with the bruising inside the knee not fully healed because there's still bone-on-bone grinding and "banging" with every step, whether he's shagging flies or not. I've heard that the Mets and Beltran are holding back on any decision about microfracture surgery in order to collect more information. They're watching Marlins utilityman Alfredo Amezaga's return closely, as well as that of Saints running back Reggie Bush, who one source said was a good physical comp for Beltran. They also believe that Beltran could have the surgery in October and be back in time for spring training. A lot will depend on the direction the medical staff takes this offseason, adding an element of uncertainty. If there's no change, look for the surgery to happen early so there's no "repeat of Carlos Delgado" charges. All of that said, Beltran still wants to try and play this season. I'm not sure why, and I'm not sure why the team isn't stopping him, but I do think we'll see Beltran on the field around September 1.

Jarrod Saltalamacchia (10/4)
Not again. Rangers fans are considering the possibility that yet another of their players might be headed for surgery to correct Thoracic Outlet Syndrome. It's not just unusual, but at the point where we have to actively question why this particular problem is hitting the Rangers so hard. There's no pattern here, especially with another non-pitcher. There's no consistently taught technique known to exacerbate or cause this condition, and a lack of consistency is where we might look due to the turnover in coaching. The symptoms fit here, and if Saltalamacchia needs corrective surgery, part of his next season could be in danger as well. It would be close, but we really don't have a good handle on how position players come back. Hank Blalock lost significant time, and it's very tough to read his career anyway. The fact that the Rangers have done so many of these rehabs helps, but it doesn't make anyone feel better.

Johnny Cueto (8/26)
I saw a Reds fan quoting my July DL days figure for the Reds in defending his favorite team. That was before most of the significant injuries, and as I've always said, days lost alone don't really tell the tale. I've looked at dollars lost, both real and in terms of "injury cost," in my attempt to make value more constant and tied to a player's real contribution. So when you look at the Reds and wonder what direction they're going in, is there anything there that doesn't include Cueto? With Edinson Volquez lost for next season and only the hope that Aaron Harang can come back to ace level, that team simply can't hope to win without a healthy Cueto. That the team isn't completely shutting him down is perhaps defensible; that they're not being ultra-conservative is beyond stubborn and into self-immolation territory. Cueto's hip problem is just the latest small thing, the signs that fatigue is breaking him down in small subtle ways, like rust before a collapse. If it's just a skipped start, the Reds just don't get it, and Hal McCoy's parting shots might be cannon-fire.

Carlos Zambrano (8/25)
I want to blame the workload, but more of the blame has to rest on Zambrano's shoulders for how his career is turning out. Or maybe the problem is a little bit higher up than his right shoulder. The issue now, his back, is a relatively minor problem, but since signing his big-dollar long-term deal, he's gained weight and lost effectiveness while dealing with a multitude of shoulder issues and other kinetic chain problems. Sure, he held up pretty well under the workload, but he's gone from reminding people of Fergie Jenkins to another Cubs great instead-Rick Sutcliffe. That's not a bad thing, given Sutcliffe's career, but look at the up-and-down nature of it; Sutcliffe was never bad, just inconsistent and average at worst. There are probably a couple more really good years left in Zambrano's arm if he buckles down a bit and gets focused, but no one seems too sure about that happening. He'll have a rehab start on Thursday, so we'll get a look at his motion. If that goes well, he'll be back in the Cubs rotation as soon as the 25th, but he's fast becoming a bigger, Latin version of Rich Harden.

Tim Wakefield (8/20)
"Everyone thinks he can pitch. We'll see if he can field." That's what Terry Francona told reporters this weekend in reference to Wakefield's rehab start. Wakefield still has a noticeable limp when walking, and the Red Sox are trying to determine whether he needs more time or if pitching exacerbated his calf strain. The Red Sox almost got swept out by Texas, with only a blown save giving them a game in Arlington. John Smoltz is gone, Brad Penny is doing his expected fade, and Clay Buchholz isn't consistent, leaving the team hoping for something stabilizing out of Wakefield. He'll pitch on Thursday, but the Red Sox won't decide until Tuesday whether it will be for Boston or for Pawtucket.

Martin Prado (8/18)
It turns out that Prado might have a virus rather than simply a heat sickness, but while I talk with all seriousness about concussions above, heat illnesses are as deadly serious, and likely more deadly. There's bound to be a story or two of heat-related deaths in high school football over the next few weeks, just as there are every year. I'm stunned there's not more of a problem in baseball, especially in warmer climates like Arlington and Miami, and even more stunned that there are no issues in the Florida State and Texas Leagues. The fact is that ATCs do a great job, but is it enough? Are we seeing some injuries that are the results of longer-term heat illness or dehydrations? It's impossible to tell. We can only hope that feeling bad is all that Prado or any other player has to deal with.

Quick Cuts: I'm proud that my Slate article on labrums is still getting quoted, but it's obsolete. I need to update it just to get it off the first Google search screen or something. ... Hideki Matsui had his knee drained, but isn't expected to miss significant time. ... Chad Billingsley is expected to start on Tuesday, missing just one turn due to his strained hamstring. ... The Red Sox are playing it conservative and keeping J.D. Drew out of the lineup until at least Wednesday; the DL remains a possibility. ... The Red Sox think Daisuke Matsuzaka will get in some games before the GCL season is done, but no one has a prediction for the timing of his return to the Red Sox. ... Jim Thome is on-again with an on-again, off-again foot problem. He's not expected to miss much time, though the Sox could buy some rest for Carlos Quentin's foot in the DH slot if Thome's given a couple of days off. ... Torii Hunter looked solid in his first few games back from the DL. He's showing no real issues with the oblique. ... There's a great takedown of me in this article. I like when people fact check me and confront me with a reasoned response. I'll be honest, though, I still don't see a significant difference in most of those years. ... Eric Byrnes started a rehab assignment in Reno yesterday; it could be a short one. ... Nelson Cruz will start a short rehab assignment today, and replace the speedy Julio Borbon in the lineup on Wednesday. ... No truth to the rumor that Brett Myers injured his eye falling out of Jeff Kent's truck. Aside from that, it's still a mystery.

Related Content:  Back,  Hiroki Kuroda

28 comments have been left for this article. (Click to hide comments)

BP Comment Quick Links

David Coonce

Speaking of pitchers getting hit by comebackers, Pujols' shot that injured Mujica yesterday was the second time in two seasons that Pujols has put a Padres pitcher out of commission on a comebacker (Chris Young last year). What are the chances?

Aug 17, 2009 09:43 AM
rating: 0
 
BP staff member Will Carroll
BP staff

I'm not sure of the math, but I'd think that players who get a lot of hits AND hit with power would be the type that would do this more often. Pujols is the obvious prototype. I'm not sure if there's any players that hit it up the middle more often. I guess the guy I'd think of here is Ichiro, maybe Derek Jeter.

Aug 17, 2009 09:58 AM
 
David Coonce

The thing that's more unlikely to me is that it was the same team. Completely random.
I wonder how often Gwynn or Boggs hit pitchers, and if there's even a place to look for that information.

Aug 17, 2009 10:01 AM
rating: 0
 
dtung

The new S100 batting helmets were featured in the Aflac All-American Game: http://www.nytimes.com/2009/08/15/sports/baseball/15helmet.html?_r=1

Aug 17, 2009 10:39 AM
rating: 0
 
Ben L

Any updates on Nick Johnson?

Aug 17, 2009 11:31 AM
rating: 0
 
hessshaun

Mr. Carroll: How about Carlos Zambrano is becoming Bartolo Colon's equal? Chicago's Latin El Twinkees.

Aug 17, 2009 11:54 AM
rating: 0
 
dpbuckle
(867)

Is it wrong of me to hope Brett Myers got punched in the face by someone much bigger than him?

Aug 17, 2009 12:51 PM
rating: 7
 
gaucho777

From the world of wiki: Thoracic outlet syndrome (TOS) consists of a group of distinct disorders involving compression at the superior thoracic outlet that affect the brachial plexus (nerves that pass into the arms from the neck), and/or the subclavian artery and vein (blood vessels that pass between the chest and upper extremity).

Aug 17, 2009 13:30 PM
rating: 0
 
wileecoyote121

Will:

Johan Santana was just hit by a meteor! Omar Minaya says that they are waiting for doctor's reports before deciding on whether or not to DL him, but Jerry Manuel says that he expects Santana to make his next start.

What do you hear?

Aug 17, 2009 13:34 PM
rating: -1
 
jpaternostro

I would have gone with got in a car accident in a cab on the way to the ballpark. Mets fans would have at least done a double take.

Aug 17, 2009 13:41 PM
rating: 0
 
dkelly1110

An oldie but a goodie. Tom Glavine's dentist is smiling somewhere.

Aug 17, 2009 15:25 PM
rating: 0
 
WagnerRd

Will:

JC Romero has been out about a week with forearm tendinitis, delaying his rehab. Has there been any update on his situation and when would you expect him to return?

Aug 17, 2009 15:21 PM
rating: 0
 
jacobo2u

Will,
I have heard this before from you, but you are wrong about the impact being less because it bounced back (and almost into the stands). the force delivered is proportional to the change in momentum. if the ball and just stopped at his head the force would have been half of what it would have been had it bounced straight back with the same speed.

Ex 2 is a fitting example from this link is basically what happened.
http://www.physicspost.com/articles.php?articleId=146&page=3

Aug 17, 2009 15:28 PM
rating: 0
 
Dr. Dave

School me on this if I'm wrong, but the change in momentum is proportional to force delivered to the head/helmet system, not the head. If the magnitude of Vafter is similar to that of V0, that implies a very elastic collision and suggests the helmet took the brunt of it. If the magnitude of Vafter is small or zero, that suggests a very inelastic collision, which suggests a fractured skull (or at least a lot more force transmitted to the skull through the failed helmet).

It's pretty clear that a ball lodging in your skull is worse news than a ball ricocheting away, regardless of how far it bounces. What am I missing?

Aug 17, 2009 15:45 PM
rating: 0
 
jacobo2u

Well, you are missing the fact that the helmet should take the brunt of it either way. if the ball and helmet were covered in velcro, the overall impact would be less. an easy test is to do this. take a ball of silly putty, and another bouncy ball, both of the same weight, and throw them at the same speed (so that they have the same initial momentum) at a door that is partly open, meaning to open or close it more. You will find that the ball that bounces moved the door more (almost twice as much minus friction) than the one that sticks to it.

elastic and inelastic collisions change the time of impact, which is important for the player, but the overall force is the same.

Aug 17, 2009 16:05 PM
rating: 0
 
dianagram

I think I'm in love with you guys .... you are blinding me with science!

Aug 17, 2009 17:02 PM
rating: 1
 
elm
(41)

But Will never specifically mentioned the amount of force: he merely said that the fact that the ball traveled was good, because if it hadn't it would have been because it crushed the skull and, therefore, didn't bounce off. You're not actually disagreeing with anything Will said, as far as I can tell.

Aug 17, 2009 18:11 PM
rating: 0
 
jacobo2u

oops! I had kuroda and wright flip flopped in my head. That being said, its still true that having the ball fly away in the opposite direction as it came hits harder than it being stopped by the head. Will's statement (to paraphrase) was "its good that he got hit really hard, because if his head stopped the ball, and his head was hit less hard, it would mean that his skull fractured" which doesn't make sense. We don't know that bone cracking is the only way to stop the ball.

I'm just glad Kuroda is still living, to be honest.

Aug 17, 2009 18:38 PM
rating: 0
 
elm
(41)

I still think you're over-reading what Will is saying. This is how I interpret it: given that the ball hit Kuroda really hard, it's a good sign that it bounced since that means the skull wasn't crushed. He's not saying that the ball bouncing meant he was hit less hard, just that this is a sign he suffered less of an injury given the force applied. (Yes, if the ball was hit less hard, it also wouldn't have bounced like that, but that's not Will's point.)

Will's comment isn't about physics its about physiology.

Aug 18, 2009 06:31 AM
rating: 0
 
jacobo2u

sorry, one more thing. the ball and helmet need not have velcro to have the effect. If the ball hit the person, and dropped to the ground, it would have the same effect as I am talking about, same with the silly putty.

Aug 17, 2009 16:37 PM
rating: 0
 
Patrick

What you're saying about the bouncy ball and silly putty is true, but the analogy isn't very suitable. The ball isn't the variable, the door is. Start with two identical balls traveling at identical velocities, but vary the composition of the door and you'll get different results. The force is the same, but depending on the structure of the door or even the orientation of the door, the amount of force absorbed by the door is different. To use an extreme example, if one door is made of steel and another is made of glass, you're going to end up with one door intact and the other broken. Kuroda's head might not be significantly stronger than anybody else's, but maybe it was oriented in a way where it was able to transfer more force back to the ball instead of absorbing it. Think of a ball hitting a door locked in place at a forty-five-degree angle, compared to the same ball hitting a door at ninety degrees.

Aug 17, 2009 21:45 PM
rating: 1
 
ClubberLang

If he didn't hurt it washing Jeff Kent's truck, maybe Myers hurt his eye tripping over Brian Griese's dog.

Aug 17, 2009 15:28 PM
rating: 2
 
jnossal

He probably poked himself with a piece of venison.

Aug 18, 2009 11:06 AM
rating: 0
 
neilaknutson

Hi Will,
When you say your article on labrum tears is obsolete what do you mean? Is that to say that great progress has been made on diagnosing and surgically repairing such injuries. I had a SLAP lesion repair and a Bankart repair in the late 90s and my shoulder was never the same. I'm a former competitive tennis player who has basically given up the sport because, for all intents and purposes, I can't serve right. It would be great to know if having a 3rd procedure might have greater chances of being successful.

Thanks,
Neil Knutson(loyal BP subscriber)

Aug 17, 2009 16:33 PM
rating: 0
 
asstarr1

Will,

Does MLB allow the use of the S100 helmet? I find it sadly ironic that Wright said just last week that he would wear it to keep from being injured. While being ignorant, macho and barely above replacement level is no crime, would Jeff Franceour's response to wearing the S100 be different this week?

Aug 18, 2009 08:10 AM
rating: 1
 
deep64blue

Some sports have a mandatory lay-off period after a concussion becasue a second incident in a short space of time is so dangerous. I think the Mets were right to DL Wright - the fact he has 2/3 days clear of symptons is irrelevant.

Aug 18, 2009 13:06 PM
rating: 0
 
FastballVelociraptor

"A great takedown of me"? You're barely even mentioned in that blog, why would you take it so personally?

Aug 18, 2009 20:22 PM
rating: 0
 
elm
(41)

The linked post was was framed on whether Carrol or Perrotto were right in their statements about Girardi's bullpen usage differing from Torre's. (In fact, it said, "Which BP author is telling the truth.") It concluded that Girardi's was different and that, thus, Will was wrong. What post did you read?

(On this note, I'm not sure how Will fails to see the difference: Girardi has had only one total pitcher exceed 50 inning by this point in the season in his two seasons; Torre had three exceed 70 in the three (non-randomly) selected seasons. Unless Will is saying that there's no difference between 50 and 70 innings pitched out of the pen by game 114.)

Aug 19, 2009 08:58 AM
rating: 0
 
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