Some of the things Baseball Prospectus' resident injury expert ponders on a daily basis.
In the last 24 hours, I've had three men I really respect discuss three topics with me. One asked about pain and baseball. Another asked about the dangers of wall vs. player collisions. The last one asked about the cost of injuries. This is a bit of a change of pace for UTK, but it's all related, so I wanted to share the type of things I think about on a day-to-day basis.
The rest of this article is restricted to Baseball Prospectus Subscribers.
Not a subscriber?
Click here for more information on Baseball Prospectus subscriptions or use the buttons to the right to subscribe and get access to the best baseball content on the web.
A reminder that, like snowflakes, every injury and rehab is different, along with injury news from around the major leagues.
Rehabbing an elbow is always a difficult balance, but in most situations, doctors will tell you that it's always better to try and rehab through something before having the surgery. A surgery, even something predictable like Tommy John, has a defined period of loss, currently between 10 and 12 months. Using the example of Twins reliever Pat Neshek, the lost time in rehab might look like a loss—Neshek even told BP's Dan Wade that it "was the worst thing I could do" because of perception and the machismo of the locker room—but if Neshek had been able to come back inside the 2008 or 2009 seasons, it would have been a big gain. You can use the same equation I gave you in regards to why the Mets didn't put Jose Reyes on the DL, though the numbers get a lot bigger and the risks are hardly as well known. For situations like Neshek's and the hundreds of others—no, that's not an exaggeration—that face elbow surgery at all levels each year, the "right decision" is a moving target. Is it just to get the player back in the quickest amount of time? That does play into it, but does that mean "rehab might get him back in three months or might extend him out if surgery is needed"?
It's too early to tell exactly what course the Nationals will take with Stephen Strasburg and his inflamed shoulder, along with other injury news.
Stephen Strasburg (inflamed shoulder, ERD TBD) As regular readers will notice, I usually take one night a week off. To you, it's days but I write this the night before, firming up the details the morning it's published based on how players respond the next day. Trainers love getting players in early to assess how the injury progressed overnight. I was thinking that yesterday would have been a good night but then... no. It started just as I got home for dinner. My phone dinged about 30 times in the space of a minute and no, that's no exaggeration. Stephen Strasburg had been pulled from his start. Early word was that he was pulled by GM Mike Rizzo as a precaution, something Rizzo would later confirm, showing just how closely Strasburg is being monitored. The word was that Strasburg had difficulty getting loose in the bullpen and would be sent for images to determine what was going on. While they're often called precautionary, no MRI really is. Teams are still cheap enough that they won't do them for just anything, even for Strasburg. Reports are that the results showed minor inflammation in the shoulder, but no real specifics. The concerns here are where the inflammation is and what caused it, a Watergate-ian construct that Washingtonians will appreciate. Expect the Nationals to be somewhere far north of cautious with this, with the "worst case" being a shutdown for the season. We should know more in a couple days, when Strasburg will be due for his throw day. Even that's a question at this stage.
The Fish are a man down after post-game hijinks, along with other injury news from around the majors.
Chris Coghlan (torn meniscus, ERD 9/30) Between Kendry Morales and now Coghlan, post-game celebrations might get banned this year. Coghlan had an MRI yesterday, and reports vary on what was injured. Some say that it showed a sprained MCL in his knee while most, including MLB.com, say that there's a meniscal tear. Fact is, it's likely to be both. It's said to be the result of a "pieing" on Sunday. Coghlan snuck up behind Wes Helms and got him with the shaving cream to celebrate Helms' game winning hit, but somehow torqued his knee and sprained the ligament. Coghlan heads to the DL, but there's no word yet on surgery. There's no word on how significant the sprain is (if it exists), but in most cases, the MCL isn't repaired surgically even if it's ruptured, so that shouldn't affect the timing. Reports have Coghlan out for eight weeks, which would in essence end his season, but that's the high end of the estimates. Coghlan will immediately start a rehab program, and the Marlins trainers will start looking for a brace that will protect Coghlan's knee. The Marlins' slogan of "Serious Fun" has ended up a serious injury.
Magglio Ordonez and Carlos Guillen both go down for a team in the AL Central race, along with other injury news from around the majors.
Magglio Ordonez (fractured ankle, ERD 9/15)
The interesting part of the injury to Ordonez is less about the injury itself, but the ankle problems that he'd been dealing with in the week leading up to his traumatic fracture. Ordonez had a minor injury to the ankle, reported as a sprain, that was limiting him to DH. Could the two injuries be related? It's impossible to say, even now, but traumatic fractures are seldom a cascade's result. It's possible that Ordonez's ankle might have been weakened to the point where the fracture happened, when if he'd been completely healthy, it might have been more stable or the forces distributed in a different, possibly less damaging way. While it's a nice game of what if, the Tigers have to deal with what is. Ordonez's fracture has a wide recovery window based on what in fact is fractured. At a six-to-eight-week timeline, there's a couple possibilities, with the most likely being a distal fracture of the tibia or fibula. Assuming a normal healing period, Ordonez should be able to come back without significant consequences. If this slides towards the end of the timeline, Ordonez won't be able to get a rehab assignment in, which could be an issue. It's possible, even likely, that Ordonez returns this year, though the Tigers'status as a contender nearer that date will determine whether he'll be needed.
Seeing the Nats phenom up close, plus news on the injury beat from around the majors.
From the stands, 98 doesn't look that much different than 89. That was the difference between Stephen Strasburg and Bronson Arroyo. To the hitters, it was a lot different. I sat in the stands, rather than the press box, because I wanted to get as close as I could without getting too close to the $250 scout seats. (That's a good thing, since Pete Rose was attending the game.) Strasburg's delivery is easy. In warmups, there are some jumps to it, things that you notice. I think his timing is just off a bit when he slows things down. The foot strikes a little bit before the elbow is in position, but that straightens out once he turns the dial up. Strasburg was living at 98 for the first few innings, but as he sweated through jerseys, he lost some, ending at 95 as his pitch count neared 100.
Our medical detective explains why a American Orthapaedic Society for Sports Medicine survey skews injury figures, along med news from around the majors.
Sometimes, things hide in plain sight. Do you remember those Encyclopedia Brown stories from about fourth grade? The brainy kid would solve the mystery inside of 10 pages, always in some sharp way. Put on your Encyclopedia Brown hat, because you're going to solve a mystery. Last week, a major study was published at the annual conference of the American Orthopaedic Society for Sports Medicine that got quite a bit of publicity. The money line from the study is that "pitchers are 34 percent more likely to be injured than fielders" and that "77 percent of all injuries to pitchers happen before the All-Star Game." The first seems like common sense, especially in this era. The second, the 77 percent, is wrong. It's correct, yes, but there's a very apparent reason. Think about it and I'll give you the answer in just a bit.
The Mets' medical staff has the best understanding of Jose Reyes, along with other injury news from around the majors.
Jose Reyes (strained oblique, ERD 7/19) Everyone’s up in arms over Reyes being out for the Mets, but there’s a reason. Any oblique strain is a tough read, but assuming that those of us out here—especially the more paranoid Mets fans out there, some of whom couldn’t think their way out of a paper bag—have better knowledge. So let’s start with that. As far as last year, it was fluke, and let’s give Mets athletic trainer Ray Ramirez and orthopedist David Altchek the benefit of the doubt. There’s also an equation, one that’s overly simplified, that lets you figure this out for yourself. The base of it is MLVr, a stat that gives us a per-game value for every player:
One of the subjects of the movie 21 discusses his upcoming book, The House Advantage, and incorporating statistics into life.
Jeff Ma is one of the few people who had a movie made about part of his life, and yet remains much more interesting than the character that Hollywood invented. He was one of the "MIT Blackjack Team" portrayed in the movie 21 and in Ben Mezrich's book Bringing Down The House. He started ProTrade and Citizen Sports, which was sold to Yahoo last year. Now, he's brought all of his background and love for sports into a new book, The House Advantage.
The saga of Jacoby Ellsbury continues, plus updates on Peavy, Greinke, and more heading into the All-Star break.
Jacoby Ellsbury (fractured ribs, TBD)
Ellsbury's notes got as much news as his ribs over the weekend. As he went through his very awkward press conference, Ellsbury showed that he was way off the pages of the Red Sox' songbook. Ellsbury took the time to break down the timeline of his fractured ribs and associated injuries, making sure that it was clear along the way that he thought the Red Sox had dropped the ball. Shortly after, Kevin Youkilis put on record what many other Red Sox are apparently thinking-that Ellsbury was getting the "bad teammate" vibe for not staying with the team and for speaking against the Red Sox medical staff. Ellsbury said many things, but the timeline for his return to the Sox still remains unclear. The strained lat and intracostal that he disclosed give us nothing more to go on. For now, he'll head down to the spring training facility in Ft. Myers. This remains a pain tolerance issue, and several weeks away from the team don't seem to have cleared that up. One source wondered if Ellsbury would be back in time for the Sox to put him up for trade, saying, "he's got to go". This will definitely be a test for the field staff and 'clubhouse leadership' as much as the medical staff.
The White Sox pitcher's detached lat muscle is such a rare baseball occurrence that there is nothing comparable.
Jake Peavy (strained lat, ERD 10/4)
Not just strained, but detached. That was the piece of info that took this from being bad news for Peavy and the White Sox to being the worst-case scenario. Peavy has pulled the muscle out at the insertion. That's the point where it connects to the upper arm, as seen here. It's not the best comparison, but if you've ever broken down a chicken, this is very similar, though obviously there's a size (and species) difference. It's the same kind of muscles and tendons that are pulled apart when taking the wings off before adding the delicious sauce. Peavy will in all likelihood need surgery to reattach the muscle. He'll get a second opinion, maybe more, but doctors and therapists I spoke with said a complete detachment of this type can't heal on its own. This detachment is what differentiates this strain (and yes, it's still a strain; a detachment is just a specific kind of rupture, which itself is a complete strain) from the ones suffered by other pitchers, such as Brad Penny, Josh Beckett, and Ben Sheets. They had strains in the "belly" of the large muscle rather than at the thinner, weaker point nearer the arm. The cause is unknown and probably always will be. SBNation quoted me early in saying this was Don Cooper's fault, but that's not what I meant at all. In changing anything about a pitcher's delivery, there can be consequences, just as if a pitcher instinctively changes something to compensate for an injury. That's why it's so tough to see a pitcher with terrible mechanics but good results; even a small change might change things for the worse. The pitcher has done this for such a long time that his body, even his bones, have adjusted to that specific motion. The question now becomes whether or not Peavy can come back at all. There are no comparables for this. Again, I went to my doctors and therapists, who think that he can come back. "It's not a cuff," said one ortho, "and putting the muscle back in place isn't difficult. It's an anchor. It's not like there's multiple structures or ways to do it really." A physical therapist put it more succinctly: "If a nail comes out of your wall, you hammer it back in place. That's all this is." We've seen players come back from detached muscles before. The one that immediately comes to mind for me is the dreadful image of Dean Palmer's biceps strain. The muscle retracted, visibly rolling up his arm as he screamed in pain. I'm glad that's not on YouTube. Peavy is looking at a significant rehab and most likely his season is done. When he might be back on a mound remains to be seen.