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.
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.
Is there is or is there ain't an All-Star Game effect as far as getting rest or less?
Starting in early June, it seems like nearly every injury story is going to have the phrase "the All-Star break" in it. A player is coming back just before it, while another player is expected back after it, and yet another is hoping to rest over the break in order to be ready for the second half. The problem is, it doesn't appear to work that way. The break is three and sometimes four days when a player doesn't have games. It's the only scheduled break like that during the long grind of the season, no doubt, but three days is seldom enough time to heal something minor, let alone be able to have some sort of medical breakthrough.
Ready and rested, Will dives into dissecting a week's worth of breakdowns and injuries.
¡Hola, amigos! Acabo de regresar de una semana en Mexico - una semana de playa hermosa, la cerveza, y el beisbol no. (Mi espanol mejoro un poco tambien.) Oh, wait... English now. A week away provides a perspective, the same way that a fortieth birthday does. Being away, especially during a week where player after important player seemed to go down, reminded me why I do this every day. I see baseball through the lens of health and while sometimes, it would be a bit more accurate to wait or do something like write once a week or so, the story is lost. A player is injured-how bad is it? What is the medical staff doing? How are the players reacting? Is there a roster move? Is the team capable of filling in for the lost player? So much more happens than just the injury. Some of you missed having UTK here every day, some of you didn't, and the vast majority didn't notice, reading the rest of the content here. That's okay with me. I'm telling stories that involve injuries, not writing about injuries. It took me years to realize that and a beach. No matter ... a las lesions!
Our resident medhead looks at the top 10 baseball orthopedists.
It's hard to say "ignore the rankings" when I'm about to give you a Top-10 list, but I'm telling you—ignore the rankings. From 1-10, these are some of the top orthopedic surgeons in the world. The rankings were based on a short survey I gave to several players and front-office types, but barely have any meaning. If anything, think of this as the program to the next time an athlete goes on a tour to find a doctor he likes. They say you can't tell the players without a program, but for years we've been asked to just accept that our favorite players and teams are relying on doctors. While I could write a book on this topic, a few hundred words on each is more than most know about any of them. So, tip your cap to the medical heroes, the super surgeons that have to put our athletic Humpty Dumpties together again:
Dr. James Andrews Practice: Andrews Sports Medicine (Birmingham, Alabama); The Andrews Institute (Pensacola, Florida) Team: Rays School: LSU School of Medicine Speciality: Elbow, shoulder, knee Signature Surgeries: Roger Clemens (shoulder, 1985); John Smoltz (elbow, 2000) Why He's No. 1: In baseball, Andrews is perhaps known best for things he really didn't found. Many think he invented Tommy John surgery. (That was Dr. Frank Jobe, of course.) Many think he was the first consulting surgeon. Instead, Andrews should be known for being the athlete's choice. There's a confidence that athletes seem to get when dealing with Andrews. Perhaps it's that he's known as the best, but if you get the chance to speak with him, his deep Louisiana drawl goes from being "Wow, I didn't expect that" to comforting when paired with his matchless confidence. Birmingham became synonymous with injuries, but while going to Birmingham was bad, there was always a tag on it, that a player fully expected to come back healed. An article a few years ago tabbed Andrews as "the most valuable man in sports." No one's going to argue with Andrews being at the top of the list and moreover, his American Sports Medicine Institute Fellows program helped put a couple more on the list below. His influence is going to last far beyond the careers of the men he did surgery on.
Dustin Pedroia, Victor Martinez, and Clay Buchholz all get hurt for Boston over the weekend, along with other major injury news.
Dustin Pedroia (fractured foot, ERD 8/15)
Welcome to the Red Sox Report... err, Under The Knife. Same thing, today. Pedroia has an unusual injury. It’s a non-displaced fracture of the navicular bone. It’s a common injury in horses, not so much in humans. Even then, it's usually a stress fracture rather than a traumatic injury like Pedroia's. The simple answer here is that it should take about six weeks for it to heal. The rehab goes in two-week “thirds” — first two weeks involves limited activity, second two weeks brings light activity, third two weeks ramp up to full activity, to tolerance. It’s not that Pedroia will be "normal." Remember, rehab protocols are made for people like you or me, or Grandpa, not a professional athlete with a full support and medical staff, nothing to do but rehab, and a high base for fitness. Add in the possibility of advanced therapies like pulsed electromagnetic therapy, cold lasers, or drugs that improve bone healing. It's possible, if not probable, that we could see Pedroia back sooner than six weeks. There's also the possibility that he'll have surgery, a simple procedure that would pin the bone to make sure it heals. Doctors I spoke with said that the surgery is seldom done unless there's a significant displacement. Otherwise, it doesn't do much in terms of results or timing. A final determination will be made today when Pedroia meets with Sox doctors. Looking ahead, we'll have some keys to his return. About the point he starts hitting, you’ll know he’s getting close. I doubt Mr. Low-and-Inside will need much of a rehab assignment, if any, to get his swing back. For now, he goes from putting on a laser show to maybe getting a laser shoe. Too bad; he really was crushing the ball lately.
A look at 10 men who should be considered to run a baseball operations department.
Welcome to Top 10 Week. All week long, various BP authors will be revealing their Top 10s in various categories. Today we start off with Will Carroll ranking the 10 best general manager candidates.
A couple years back, I did a list of the "next GM" crop. It's one of those innocuous exercises that nonetheless tells us a lot about what's going on inside of the front offices. We hear about GMs, about trades, about drafts, but even in Moneyball and earlier in Dollar Sign on the Muscle, we seldom hear about the day-to-day operations carried out by a group of people that is overworked, underpaid, and most importantly, vastly overqualified. This is a group that years ago would be more likely to be putting together a hedge fund, working for the State Department, or something a bit more "important" than the game of baseball. With the money of the modern era, teams got smarter, fast.
Was Ubadlo Jimenez's sub-par outing caused more by his illness or the Red Sox's hitters?
Here's why I do what I do. Nick Wingbermuehle was a reader who was also a college pitcher. He drove to Indianapolis from Kansas City after reading about the gyroball and we spent a couple hours working with the pitch, his grips, and then sat in a McDonalds for another hour talking pitching. I could—and would—do that every day if I could. I'd lost touch with Nick over the last year, but he sent me a nice e-mail today: "I don't know if you remember me or not, but I came to Indianapolis to learn the gyroball from you back in the winter of 2007 (or maybe it just turned 2008). In any case, I just finished up my college career at Rockhurst University in Kansas City using the gyroball as my primary off-speed pitch. I recorded 17 strikeouts in 21 innings and I think that pretty much all of them came via the gyroball, so thanks for teaching me." People can say the pitch doesn't exist. People can bring up the "all but done" all they want. I'm proudest of the little things, whether that's teaching a gyroball or getting people to talk about sports medicine as a part of baseball, not just something that happens. I may never have that day where there are no injuries, no need to talk about pitch counts or pitcher protection, but there are some little victories along the way. Let's get to the injuries:
The Mets center fielder, out all season while recovering from microfracture knee surgery, begins a rehab assignment Thursday, along with other injury news from around the majors.
Carlos Beltran (arthritic knee, ERD 7/15) In what is sure to be a continuing series, the Beltran watch is now headed for a rehab assignment, which will start tomorrow at High-A St. Lucie. Beltran was watched by the Mets' top brass, including Omar Minaya, during an extended spring training game on Sunday and they felt the center fielder was ready to start his 20-day rehab clock. I've pushed the idea that Beltran needs to be up in Flushing as soon as he's physically able, but several people inside the game have told me that while there's merit in the concept, Beltran is human and needs a "spring training equivalent." The downside here is that he's going to be taxing the knee during that time. Of course, that's what rehab assignments are for. They'll be very controlled, perhaps not so much as the simulated games he's been in, but Beltran will have very specific steps and tests at each point. He'll have the DH option in most games as well, something he won't have when he makes it back to the Mets. Watching how often he needs to play there is going to be a big tell for his progress. The key will be how his knee responds and the Mets' ability to manage the inflammation and bruising that will inevitably occur inside the knee. The brace he is wearing is helping, but the continued idea that he's a center fielder is not. I'm most curious to see when that will be abandoned. One interesting concept that was tossed out by an MLB athletic trainer was the idea that Beltran could hit well enough to be in the lineup every day, but not play the field consistently. He wondered if there's a level and a cost where Beltran might make sense for an AL team. If Beltran were to show that, the idea of him being a modern-day Harold Baines would have to be intriguing for some teams as well as for the Mets escaping at least some of Beltran's contract. It's very equivalent to what the Twins did with Jim Thome, though he was a free agent.
Colorado loses Tulo but sees Huston Street get closer to returning, along with other medical news from around the majors.
Troy Tulowitzki (fractured wrist, ERD 8/1)
Let's be clear: Tulowitzki fractured the hamate bone, one of the bones of the wrist. There have been various reports over the last few days that have said "broken hand." I'll let "broken" go; it's a colloquial term and most of us aren't confused by it. The hamate bone is one of the most commonly injured bones in the wrist. As yet, there's been no discussion of surgery, so the fracture might not be too severe. In many cases, most famously with Ken Griffey Jr., the hook of the hamate is removed surgically to speed healing. If you'll turn to page 130 in your Carroll Guide ... oh wait, you don't have one yet? What's a bit odd, but not unprecedented, here is that Tulowitzki's injury was caused by a pitch hitting him, rather than the typical "FOOSH" mechanism. FOOSH stands for "fall on out-stretched hand", the typical way that this injury occurs. A hard ball hitting the wrist at high velocity will accomplish it as well, but the forces are distributed differently. Initial images didn't show the fracture, but Tracy Ringolsby's report is a bit confusing, saying the fracture was found by Rockies doctors. I'm not sure if that means manual testing, a different reading by a radiologist, or what, and sources could not clarify. Either way, Tulowitzki is out for six weeks, maybe a bit less. Yes, I think he'll be on the low end of the six- to eight-week range because of the odd mechanism, his drive to return, and the team's need. I'm also sure that Tulowitzki will see the typical loss of power in players coming back from wrist injuries, something that lasts about as long as the initial recovery and in this case, would mean it's reasonable to expect the power loss to go the length of the season. He's still a better option that what the Rockies have available and even better than some mentioned trade possibilities, such as the Dan Uggla deal that Joe Sheehan mentioned in his newsletter over the weekend. Watch for Tulowitzki to be pulling on the reins by the end of the All-Star break and yes, that ERD is correct.
White Sox right-hander Jake Peavy will miss his scheduled start tonight, along with other injury news from around the major leagues.
Jake Peavy (inflamed shoulder, ERD TBD) Herm Schneider is two things: effective and old school. The longtime White Sox athletic trainer uses terms like “achy shoulder” the same way trainers did back when they all had two tables, some tape, and a big tub of ointment that would work on your legs and your sinuses. Things are different now, but Schneider is still around because he’s one of the best at dealing with things like an “achy shoulder” on Peavy. Schneider will get some extra time to work on that while Ozzie Guillen juggles his rotation. A day off allowed the Sox to move everyone else up a day and plan on Peavy slotting in at the back if possible. Schneider has about three days—Peavy’s scheduled throw day—to figure out if he can get him back. There was no sign of trouble in Peavy’s last start, his latest effective, consistent outing. Almost all his starts this season have gone deep, between 98-119 pitches, a zone that Guillen and pitching coach Don Cooper use as a target zone with all their starters. There are no more specifics on the shoulder problem, so we’ll have to keep a close eye on this one.
The Dodgers get Vicente Padilla back but are forced to put Chad Billingsley on the DL, along with other injury news from around the majors.
Yesterday, I wrote a bit about Safari Reader. I got some e-mails about it and the use of ads and other things on BPro. I'm not the webmaster, the ad salesman, or a designer, but for the most part, I think we do OK here. We have a readable site, if nothing else. If you'd like to use AdBlock or view the site in Reader, well, that's your choice. I'm proud that the site has never used any of the tricks like multiple pages or other insidious techniques as discussed here (note: some NSFW language.) I agree completely that we have to earn your page views and your hard-earned dollars for subscriptions. The other thing we have to do is earn your trust. Anonymous sources are one of those really difficult things to deal with and more than anyone else here, I'm reliant on information from sources that are breaking confidences. Moneyball gave a good illustration of the game that reporters and teams play. It's an exchange of information. Sources give some to get some. Am I getting good information? I have to decide, report, and then let you decide if I did a good job. Things can change, things can be trial-ballooned, and at times, teams flat out lie. While you're deciding who to trust, I'm deciding which sources to listen to next time. "Fool me once, shame on you. Fool me twice, shame on me," holds very true. I wish that there was a website out there that "kept score" on these, even though I might not like seeing my score. Guys like Craig Calcaterra might get fooled once too, but he knows that if he's fooled too many times, there are other places you can go. Craig's a smart guy and knowing him the little I do, I don't think he blue-skied anything. He does a great job explaining himself in comments and I'll continue to read his column with little doubt. It happens to the best of 'em. I'm all but done, so let's get on to the injuries...
Good news for the long-absent Brian Roberts and Carlos Beltran, plus other news on the injury beat.
If there's one thing besides sports medicine that fascinates me, it's technology. When that meshes with writing, it definitely has my attention. While Shawn Hoffman and I are accused—rightly—of being Apple fanboys with our iPhones and iPads, it's a small, almost unnoticed feature in the latest release of Safari that interests me. The "Reader" feature is something of an offshoot of the popular Instapaper service that allows for simplified, offline reading. It mirrors and uses code from the bookmarklet Readability, which can be used on Firefox and Chrome. Both make for a more book-like reading experience. It's a simple but powerful change. BPro rocks the 1999 look-and-feel, but even when we brought ads to the site, it's been about simplicity and readability. Seeing how Reader makes my articles look makes me wish you didn't have to push a button to see them that way. Now if I can just figure out how FaceTime can be used to get my information to you faster, I'll be on to something. Then again, Microsoft and ESPN are looking to make sure that if you ever get off your couch, it's only to wave around in front of a new control scheme. The promise of on-demand highlights, essentially letting you produce your own personal SportsCenter, is pretty amazing. It's more amazing when you consider what goes in to the average highlight package—from rights issues to editing to voicing and broadcast. ESPN knows how to handle all that better than anyone, and we'll see how the average person deals with it. Right now, let's get on to the injuries: