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September 18, 2009

Under The Knife

Interest Over Impact

by Will Carroll

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Billy Sadler (10/4)
Normally I pick the most important injuries to lead, so why am I picking a nearly unknown pitcher on a non-contending team? Because he was placed on the 60-day DL with a diagnosis that's meaningful. Sadler has what the team called right shoulder scapular dyskinesis, or what Dr. Ben Kibbie calls "SICK Scapula." It's no coincidence that the website there, Throwinginjuries.com, is maintained by Astros team physician Dr. David Lintner. Houston's done a lot of work with pitching injuries, and while some of that effort was sidetracked by some off-field issues, this kind of diagnosis reminds us that teams are quietly doing work that will pay off years from now. People laughed when Tampa Bay made a commitment to health, won the Dick Martin Award, and then saw that commitment help catapult them to the World Series. Teams that have focused on player health-the Brewers, Rays, White Sox, and Indians-have all seen payoffs in the form of playoff appearances. (I bet the Pirates hope that indicator is a true one.) So while Sadler isn't an important injury in the grand scheme, what the medical staff in Houston is doing might save someone down the line, even if they're not an Astro. While on the topic, I do think that SICK Scapula is one of those injuries you're going to hear a lot about over the next five years.

Zack Greinke (9/22)
The presumptive AL Cy Young Award winner was cruising once again before the angles ran out on him. Greinke took a hard shot from Miguel Cabrera off of his pitching elbow, and the Royals smartly pulled him from the lineup. Oh wait, they didn't. That's right, despite a visible mark from the ball reddening on his pitching elbow, the Royals left their most valuable asset in the game. I should stop here, before I just begin ranting about incompetence and risk. He finished off the inning and then, with a lead tacked onto by a homer in the next half-inning, Trey Hillman then finally pulled Greinke. After the game, the skipper said that he was going to pull Greinke regardless of the score, but it's hard to tell. At least the X-rays were negative, and Greinke gets points for making the play after being hit, but the Royals? Well, I'm out of words there.

Jonathan Papelbon
Kevin Youkilis

Papelbon was available yesterday and likely will be going forward, but he had been unavailable on Wednesday after slipping in the bullpen. I've always wondered why teams have so much concrete around with players in spikes, which with Gatorade and spit becomes a situation that a personal injury lawyer dreams of. Some teams have put things like cork or even what looks like railroad ties (Miller Park) on the floors of the dugout, but there's a lot of possible slippery spots elsewhere. Jeez, when did I become the overprotective parent for baseball? Anyway, Papelbon should be fine after the initial tightness was dealt with, and there should be no long-term consequences. The Red Sox also almost got Youkilis back. He was left in the on-deck circle at the end of last night's game, but hey, he was available. His back has loosened up enough that he's likely to be in the starting lineup today. Back problems can recur, so expect that Youk will be spending some extra time in the training room to keep loose.

Chan Ho Park (10/4)
The Phillies lost a key cog in their bullpen this week. If I'd asked you in April who I might write that sentence about, I doubt many of you, even the Phillies fans, would have said "Chan Ho Park." Park has had a nice comeback in the pen after being bounced from the rotation, but a severely strained hamstring might keep him out through the regular season and beyond. Early estimates on the injury ran two to three weeks, with one source saying "If this was June, he'd have gone on the DL without a thought, and no one would say he'd be back in just 15 days." By my iPhone's calendar, there's just under three weeks before the playoffs start. There's a 98 percent chance that the Phillies will be there, but Park's a big question mark. For the Division Series, it's going to be very tough for him to get to a point where the team can trust putting him on their playoff roster. Keep an eye on this, because the pen is the one place where the Phillies' Secret Sauce gets a bit sour.

Rich Harden (10/4)
We know that Harden will miss his next start, but whether he takes a turn after that or gets shut down for the season is a matter of some debate. The Tribune reported that Harden would be shut down, while Lou Piniella said he hadn't made up his mind yet beyond the next start. I always love it when managers phrase things, especially medical things, like they're The Decider. Paul Sullivan points out that Harden has had some control problems over his last few starts, which points to elbow issues, but earlier this month he was having a 10-strikeout game while walking only one. That the Cubs are even talking about this decision tells us that something's up, and with Harden about to hit the free-agent market as one of few compelling pitchers, this is a bad sign for his wallet.

Chipper Jones (9/21)
Derek Lowe (9/23)

Jones has fought injuries for much of his career, but this season has been different. Is it a bad year, filled with tweaks, pains, and time in the training room, or is it his late-30s body telling him it's time to get a standing reservation at Hooters after golf? It seems that Jones is talking about retirement, but sources in Atlanta say that it's frustration with the physical issues he's had more than any real soul-searching. They are worried that Jones isn't doing more to help his conditioning, such as upping his off-season routine. The Braves have a more immediate issue with Lowe, who has a blister on the ring finger of his pitching hand. He left after three uncharacteristically rough innings Wednesday. They'll monitor it closely, but they may need to push back his next start.

Carlos Delgado (10/1)
With all of the Mets' issues, we've kind of forgotten Delgado. He had the FAIL hip surgery that several others have had and... hasn't come back. He was taking batting practice back in August, but since then, not much has happened, and I'll admit that I lost track. Delgado was said to be coming back for the end of the season, something of a courtesy to him in order to show that he was healthy before going into free agency, but there's been no movement towards that. It's notable more for the fact that Delgado is the one player to have the surgery not to return. Alex Gordon had issues that were likely interrelated with the surgery, but other than that, the returns by all of the others have been as expected and, in many cases, better than expected. There's always a downside to surgery, and maybe Delgado represents that downside, as a bigger guy who's aging and wasn't all that mobile to begin with. I'm not sure we can completely rule him out, but it's more likely that Delgado will have to play winter ball to prove that he's healthy.

Quick Cuts: The latest word on Huston Street is that he'll join the Rockies this weekend. ... Johnny Cueto will miss his next start, but don't get too worried, Reds fans, he's just ill, not injured. ... Gavin Floyd is having trouble with the hip of his landing leg; he had push-hip problems earlier this season. ... J.A. Happ heads back into the Phillies' rotation, as his oblique strain seems to have cleared up. ... Michael Young is expected to play for the Rangers this weekend, though the role depends on his hamstring. ... Jose Reyes is not running-at all. Surgery is still an option. ... Gary Sheffield made an appearance Thursday, his first since back problems sidelined him in mid-August. ... Brett Tomko has been shut down by the A's. ... Tanner Scheppers signed with the Rangers. As for his health, a bonus of "more than a million dollars" tells you that the Rangers think he's healthy, but risky. ... Congrats to friend of UTK Pete Abraham, who will be moving to the Boston Globe. ... A great article about kicking conventional wisdom in football, but what would be the baseball equivalent? ... Finally, a request: I love having conversations with you, the readers and friends of this column. Whether it's here or Twitter or a chat, one of my ways of thanking you and earning the dollars you spend with us is by answering questions. It does get really frustrating, however, when comments turns into a string of "What about this guy?" I can't write about every injury, so I pick the most impactful or interesting (as in the case of Sadler). Let's have a conversation.

Related Content:  Back,  The Who

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

BP Comment Quick Links

dalbano

Will,

You mentioned the website maintained by a doctor for the Astros. My thought is in regards to medical ethics(?) vs competitive advantages in the game.

Do team physicians that are industry leaders in diagnosing/managing/healing certain types of injuries share their findings with anyone/everyone? I would imagine the answer is yes, but I wonder how much is shared openly when it comes to innovations developed under a team in such a competitive market place.

If I had to compare this to something else, I would probably use the example of Roger Bossard from the White Sox creating fields for other teams, as he is regarded as the best in the game for what he does.

Thanks,
Dom





Sep 18, 2009 10:20 AM
rating: 3
 
BP staff member Will Carroll
BP staff

Yeah, there's a lot of sharing, just because most of the medical knowledge either trickles down or comes up to baseball. The hip stuff that's all the rage is the result of the run on hip replacements and the knowledge gained there. Pitching injuries often show up in elderly shoulders as they wear out with time rather than exceed their pitch counts. Conferences like what PBATS, ASMI, and Kerlan-Jobe put together also help.

Sep 18, 2009 12:24 PM
 
jrfukudome

Don't you think they were just trying to get Greinke the win to boost his Cy Young chances? That begs the question: is getting the Cy Young in Zack's best interest if he gets hurt? But, unlike the Royals' other travesties this year, I think Trey was trying to look out for him.

(Full Disclosure: I loathe Trey and Dayton.)

Sep 18, 2009 10:46 AM
rating: 1
 
acmcdowell

Hey Will - Great link for the punting, as usual. In baseball I'd say some of the ideas that have been challenged have already been looked at - the sacrifice bunt, the intentional walk, and break even points for stolen base success rates. A key thing to keep in mind is that they're writing about high school football - I would doubt that an NFL team would be able to recover 25% of their onside kicks (I think the success rate is ~10% when the kick is expected) and the average starting field position after a kickoff would be deeper. I'm not sure how 4th down conversion rates would compare though.

Sep 18, 2009 10:50 AM
rating: 1
 
BP staff member Will Carroll
BP staff

Agree - it's much more multifactorial. I think some team could say "We're never bunting, ever" and see what happens. Granted, it'd probably be good to drop one down in real surprise situations just to keep the defense honest. I'd be curious if we could use a five-man infield in a GBP v GBH situation and if there's an advantage ...

Sep 18, 2009 12:26 PM
 
ScottyB

I think the equivalent in baseball would be "always going for the extra base for the 20% chance you get a bad throw". Bad decision in either sport, if you ask me.

Sep 18, 2009 12:05 PM
rating: 0
 
Evan
(47)

That Greinke situation does two things.

First, it makes it more like the sabermetric community will universally select Joe Mauer as AL MVP (really, Greinke was the only other guy in the discussion).

Second, it makes me want to see if Rany's already ended his hiatus to complain about it.

Sep 18, 2009 13:58 PM
rating: -2
 
losermix

FYI, according to the papers in NY, Delgado was ready to come back and pulled a muscle in his oblique. I don't know if this was a cascade-type of injury or what, but I also don't know if Delgado not coming back is instructive as to the surgery itself.

Sep 18, 2009 14:11 PM
rating: 0
 
orlandoca7

Will, You name a few teams as having focused on health. What are they doing today that's so different? And how come my Mets haven't heard about this "focus"?:-)

Sep 20, 2009 00:18 AM
rating: 0
 
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