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September 3, 2009

Under The Knife

Progress?

by Will Carroll

Rick Peterson mentioned yesterday on Twitter that last season teams paid out over $300 million to pitchers who spent time on the DL. The actual figure of $328 million is, of course, bigger than any one team's payroll. It was one of those numbers that stands out, and you'd think would cause some action, especially among owners who were exposed to those losses. Instead, there was no real sea change among medical practices, no sudden adoption of scientific pitching studies or methods, and yet the amount of money lost to injuries this year is down significantly, to just under $200 million on September 1. This will inevitably go up as pitchers like Johan Santana are done for the season and have a full month of their high salaries to add to the "burn this" pile. I don't think anyone who watches baseball is going to argue that pitchers are handled better in 2009 than in 2008, but a reduction of a $100 million? That's too big to be mere fluctuation, isn't it? The answer is no. While I don't have enough historical data on injuries or salary to show this, it's a flukish peak to an underlying trend. Imagine a team that has it's health determined by a Strat-O-Matic-like dice roll. Each player has a certain number under which he's healthy, the same way the dice determine a hit. Imagine a full lineup of nine players; what are the odds that each of them gets a hit, nine hits in a row? It's low, but it's possible. The dice don't care who is more highly paid, where they were drafted, or what happened before or after; each event is more or less discreet. The element of injuries that we don't understand, we call luck. I don't believe that twenty years from now we'll believe that they are as random as a dice roll. I can only hope that Peterson or whoever does injury analysis after me can find patterns and information that help us understand more. What we have now isn't working.

Michael Young (9/12)
The Rangers got the news that, as expected, Young has a significant strain of his left hamstring. "Significant" usually means a Grade II, and early speculation on the amount of time that he's expected to miss matches that. The best-case scenario has him back in two weeks, just in time for a big series with the Angels; the more realistic case has him out until about the end of the month. Some people caught that my ERD for Young was very optimistic yesterday, spotting him at the 12th. Since Young won't have to go on the DL (almost no one will in September), the Rangers can play a bit more fast and loose than normal. Young is undergoing the fashionable treatment, platelet-rich plasma injections, to try and heal up. I think that in about ten days Young will have made enough progress that he'll push himself into a discussion with the Rangers' brass about playing. I'm not sure if it will be a full start or some lesser role such as pinch-hitting, but I think we'll end up seeing Young back more quickly than most. The downside here is the recurrence risk, but the Rangers are going to have trouble keeping Young on the bench.

Jarrod Saltalamacchia
I'd written the above before hearing, first from Jamey Newberg and later confirmed by other Rangers writers, that Saltalamacchia was going to come back. Earlier this week, I'd heard that Saltalamacchia had decided to have surgery. I'm inclined to think now that my source was right, but he (and I) never considered the possibility that Saltalamacchia would try to play through it for now. The Thoracic Outlet Syndrome isn't going to get worse, and the expected recovery should have him back during spring training either way, so a couple of weeks' delay really shouldn't matter to the ultimate outcome. It's still a surprising occurrence and there's no way of telling how Saltalamacchia will deal with it or how productive he can be while he plays.

Hanley Ramirez (9/4)
The Marlins rise and fall with Ramirez, which is no surprise, but how far they've risen just might be; Ramirez has raised his game to be a stealth MVP candidate. The Marlins are worried about a strained hamstring that Ramirez suffered on an overextension, an injury that could lead to his missing several games. Ramirez has had on-and-off leg problems throughout his career, and the Marlins have been conservative with his handling since he arrived in the organization. It will be interesting to see if their management of this changes with their being in contention at this late date. Ramirez's hamstring injury is very high up on the leg, but judging by his immediate reaction, he wasn't in any real pain. His teammates are questioning his desire, which is always going to add something to how this is covered.

Adam Jones (10/4)
Brian Matusz
Chris Tillman

Jones has been a positive for the Orioles all year long, the perfect outfield complement to Nick Markakis, so naturally they didn't want it to end early with Jones on crutches with a severe ankle sprain. The team isn't going to risk his health, as he's had some issues with his back, his hips, and his legs during his time in Baltimore. That could give Felix Pie more of a chance to establish himself for next season's outfield mix. In addition, the rotation could get a bit more thin as the team begins to look towards 2010. Matusz and Tillman have done well with their auditions, but both are bumping up towards their innings ceilings for the season. The team isn't going to take any chances with them, or with Jones, so look for all of them to get shut down before the end of the regular season. It's only bad for people holding tickets for the remaining games, who will instead have to see other auditions of less well-known players for next year's team. (Matusz and Tillman don't get ERDs since they're not injured.)

Daisuke Matsuzaka (9/13)
With Tim Wakefield showing his age all at once and Josh Beckett looking like he can't find his release point, the starting rotation seems to be pining for the days of "Senator Schilling." Getting Matsuzaka back sounds like a good thing, but his first rehab start looked like a mess. He showed serious control problems in warmups that didn't get better until he'd been knocked around in the first inning. Then his control came around, and he finished out the stint showing good velocity and tolerable command. The Red Sox will watch him in a side session before sending him to Triple-A this weekend. Assuming better command and similar velocity, Matsuzaka will focus on stamina. He only lasted two innings in that first start, and the Red Sox will need at least four if they're going to activate him. They'll be hardcore with his pitch counts in an effort to make him be a bit more efficient. If he's not, don't be surprised to see the plan change.

Bengie Molina (9/3)
Molina might look at Buster Posey on the Giants' bench and see the end of his career in China Basin, but Posey's not going to immediately take over. Molina is sounding negative about his quad strain, which hasn't healed up despite indications from the Giants that go back starting last week, saying that the strain was minor. In fact, Bruce Bochy suggested yesterday that Molina could be back as soon as Sunday. One source suggested that if Molina wasn't ready to catch, they'd consider playing him at first base for a game or two. With options at catcher now that Posey's up, the team can afford to take some chances, and with the weak lineup they've fielded all season, they can't afford many games without Molina, Pablo Sandoval, and Freddy Sanchez.

Quick Cuts: The Rangers don't need any more bad news, and Josh Hamilton doesn't need another injury, but with Hamilton leaving with a sore back, they might have both down in Texas. ... Josh Beckett's arm slot was low on Wednesday night. He could be tired, or it could be something more. Let's see how the Red Sox address this. ... Grady Sizemore may have his elbow surgery before the season ends, but the Indians haven't seemed to be in any rush about it so far. ... Jeremy Hermida left Wednesday's game with an intracostal strain. No word yet on the severity. ... Hiroki Kuroda was solid in a Tuesday rehab start in A-ball. Look for him to get a start for the Dodgers this weekend, likely on Sunday. ... It's no surprise that Ozzie Guillen is talking about shutting down Jake Peavy. What is a bit surprising is that Guillen has this kind of power in the organization. ... Tough news about Dallas Braden in this solid piece from Susan Slusser. ... The Angels saw the "good" Scott Kazmir, going 106 pitches in which he showed good command. Unfortunately, Felix Hernandez was just a bit better. ... Freddy Sanchez may come off of the DL when eligible, but don't look for him to be available until next week. It's a paperwork thing, really. ... Yes, some teams are already beginning to think about their playoff rotations, or at least the fans are. ... Todd Wellemeyer got crushed in his rehab start at Triple-A Memphis; the Cards won't be in any rush to bring him back as long as John Smoltz and Mitchell Boggs hold down their spots. ... The Braves will skip Kenshin Kawakami next time through the rotation. The team is going to be creative with the tail end of the unit. ... Jay Bruce will be making a rehab start. Maybe someone will ask him which bone he broke in his wrist.

Related Content:  Back,  The Who,  Quad-a

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

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coachadams5

Regarding money paid out to pitchers who spent time on the DL, how much of that is reimbursed by insurance?

Also, regarding your comment: "I can only hope that Peterson or whoever does injury analysis after me can find patterns and information that help us understand more. What we have now isn't working." I assume the part that isn't working and is being openly questioned by organizations like the Rangers is pitch counts, no? If managing the quantity of pitches thrown isn't statistically significant to reducing injuries, shouldn't the next realm of analysis shift to the quality of pitches thrown, or a pitcher's mechanics?


Sep 03, 2009 10:36 AM
rating: 0
 
BP staff member Will Carroll
BP staff

Almost none.

Nothing's working as injuries continue to go up. Few teams even talk about mechanics, let alone have their pitchers analyzed. Baseline MRIs? Maybe five teams. Anything beyond simple pitch counts? Maybe ten.

Sep 03, 2009 11:31 AM
 
Ira

The Rangers Pronouncement about wanting their pitchers to go longer in games wasn't about pitch counts. No, this was about tasking pitchers to be more efficient and effective with their pitches. Challenging these pitchers to not nibble so much and let their defeense do its job. To reduce their pitches per inning and increase their innings per start without increasing their pitches per start. I'm unsure whether its worked or not, but the quality that we've seen is good.

Sep 03, 2009 15:42 PM
rating: 0
 
BP staff member Will Carroll
BP staff

Umm, no.

Sep 03, 2009 16:26 PM
 
benevento

were you implying that Jay Bruce was faking?

Sep 03, 2009 11:04 AM
rating: 0
 
BP staff member Will Carroll
BP staff

No, just that the Reds have been comical about not releasing any information on it beyond "wrist."

Sep 03, 2009 11:32 AM
 
Cromulent

Wait, is the $328 million pro-rated for time on the DL or is it all salary for pitchers who spent any time on the DL? Wasn't quite clear to me. Thanks.

Sep 03, 2009 11:48 AM
rating: 1
 
BP staff member Will Carroll
BP staff

That's the salary lost. I'm not sure prorated is the correct term, but in your usage, yes.

Sep 03, 2009 16:27 PM
 
AZMEL

"Young received an injection of platelet-rich plasma to accelerate healing of the hamstring strain."

Isn't this a performance enhancing drug, not unlike human growth hormone?How is it different? Who decides?

Sep 03, 2009 11:52 AM
rating: 1
 
Patrick

This is a great question. If performance-enhancing drugs are "bad" because they aren't natural, why isn't LASIK or ligament-replacement surgery or even a cortisone shot on the same level?

Sep 03, 2009 12:10 PM
rating: 1
 
Bill N

Prescribed by a doctor.

Sep 03, 2009 12:21 PM
rating: 0
 
AZMEL

Like Manny's?

Sep 03, 2009 12:32 PM
rating: 0
 
Evan
(47)

The A's allegedly used some off-label osteoporosis drugs to heal pitcher injuries some years ago. What about that?

There's some standard of natural vs. unnatural which seems widely held but no one can define for me where the line is. It's just as "I know it when I see it" standard, and that shouldn't be acceptable to anyone.

Sep 03, 2009 13:30 PM
rating: 2
 
krissbeth

They're "bad" when they are used illegally, improperly and have serious negative consequences, as is the case for the anabolic steroids so often discussed. Let's not drag that debate out here, again, unless you think that this one example will somehow change people's minds about it.

Sep 03, 2009 15:32 PM
rating: -3
 
cyborg

If the players feel that they must "hide" the use from other players and the media, it is a PED. You don't see them sneaking around the eating of spinach, carrots, and yams which are good for your eyes because they are high in beta-carotene.

Sep 03, 2009 16:11 PM
rating: -2
 
Ira

First off, it was his own blood. The procedure is as follows: A pint of blood is pulled from the person. This blood is then separated into platelets, then the platelets are injected directly back into the hamstring (I'm assuming to help the healing process).

So, while the technique seems unusual, its no more of a Performance enhancer than TJ surgery.

I wonder if you could do TJ surgery using somone elses ligament? :)

Sep 03, 2009 15:45 PM
rating: 0
 
Swingingbunts

They've used ligaments from cadavers.

Sep 03, 2009 16:03 PM
rating: 0
 
AZMEL

Brings a new meaning to the phrase "dead arm".

Sep 03, 2009 16:13 PM
rating: 0
 
BP staff member Will Carroll
BP staff

A) Blood doping is one of the earliest forms of PEDs. This isn't that, but close, so you can cheat with your own blood. Therefore I reject this argument.

B) While TJ isn't often done with another person's ligament, ACL surgery is now routinely done with a cadaver's Achilles. Again, I reject that this makes it performance enhancing.

Sep 03, 2009 16:29 PM
 
cdmyers

Any thoughts on Huston Street?

Sep 03, 2009 13:36 PM
rating: 0
 
BP staff member Will Carroll
BP staff

Yes.

Oh, you wanted them? Tomorrow's UTK. Note that my delivery time has changed, so I'm going to miss some late night happenings and will pick up the important ones in my next column.

Sep 03, 2009 16:30 PM
 
carpoon

Any update on Oscar Salazar? The video of him vs. wall did not look promising...

Sep 03, 2009 18:31 PM
rating: 0
 
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