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Under The Knife
Under The Knife
Will Carroll's Under The Knife is called the "industry standard" by
Peter Gammons and that's good enough for us. Carroll's groundbreaking
work on injuries have led to it becoming a standard part of the
discussion in baseball. Whether you're a fantasy fan or checking out
how your team will be without a star, there's simply no other place to
get this kind of daily information.
Roster expansion and a lack of DL moves make September very difficult to judge the severity of many injuries.
September is going to be an interesting month. In this neck of the woods, September is when I have to really work hard. The DL stops being the "easy way" for teams to deal with injuries, since roster relief isn't needed with the limit expanded from 25 to 40. Teams will stop using the DL altogether, pulling some guys off even though they remain unavailable, and generally twisting and squeezing the 40-man roster as much as they can within the rules to either chase a pennant or build for next year. It makes it very difficult to judge how long players will be out. At times, we'll see a player get shut down, giving someone a chance to show their stuff and at others, teams will rest guys so they will be ready for October, mostly when they have a lead. We'll see the end of minor-league rehabs after this weekend, due to the minor-league regular season ending. It does give teams with affiliates in the playoffs a slight advantage. Just remember that the roster expansion is going to change how teams deal with injuries. You'll see guys benched with no explanation for a couple days. Injury? Rest? I'll do my best to give you guidance, but remember that you have to factor uncertainty into any projection, even when you're just trying to figure out who to put in your fantasy roster. Powered by Bell's Two Hearted Ale, which is good, but not nearly as good as their Oberon, let's get to the injuries:
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No one is to blame for the Nationals pitching phenom blowing out his elbow.
Stephen Strasburg (sprained elbow, ERD 10/4) As Strasburg heads west to have Tommy John surgery, everyone is looking to point fingers. The "inverted W," an invention of Chris O'Leary, a "modified Marshallite," is, we must remember, purported to be an indication of shoulder problems. The White Sox' Don Cooper, one of the best pitching coaches around when it comes to results, is being quoted out of context in many cases. Remember, he was speaking just after Strasburg was removed before a start due to tightness in his shoulder. I think the money quote in that article is from Stan Conte of the Dodgers, saying, "Has anybody spotted a common thread? No. It's all to be discovered." That discovery is more likely to come from scientific studies and biomechanical analysis than it is from grainy, unlicensed videos and guesswork. As for Strasburg, he's having the surgery with Lewis Yocum for several reasons. First and foremost, Yocum is one of the best in the business. The Nats seem to prefer Yocum—Yocum's work on Jordan Zimmermann was noted by many—and Yocum's base at the Kerlan-Jobe Clinic in Los Angeles allows Strasburg to be close enough to check in regularly as he lives in San Diego. There's still some question about how—or rather who—will be handling Strasburg's rehab. Some sources indicate that it will be done at the Boras Sports Training Institute in Newport Beach, California, which makes sense. Others say it will be done at the Nats' facility in Viera, Florida, which makes more sense come January or February and spring training draws near.
The Injury Expert's magic number is down to two for a career column milestone and he has further discussion of a controversial supplement.
On Monday, I wrote about the conflict of interest between Liberty Media owning a supplement company that sells substances on MLB's banned list and owning the Atlanta Braves. I want to clarify a couple things. First, Liberty Media is a giant conglomerate of assets, of which both Bodybuilding.com and the Atlanta Braves are just a small part. It's not "wrong" to sell supplements, just a conflict of interest if you also happen to own a baseball team. Also, I want to be very clear that I'm not removing the responsibility for taking the banned substance from those players that have tested positive. MLB provides a list of products and Jack3d, Oxy Elite Pro, and "any product that contains Methlyhexaneamine, DMAA, dimethylpentylamine, geranamine, Geranium oil, or extract" are specifically noted. Agents were warned as well in a memo sent out from the MLBPA with specific warning about "Jack3d" after a series of recent positive tests. MLB teams have athletic trainers, strength and conditioning coaches, and more resources available for athletes to check substances before taking them and putting themselves at risk.
The Injury Expert's countdown to his 1,000th column continues as he examines methylhexanamine, the substance that is causing minor-leaguers to get suspended.
Methylhexanamine. If you're like most people—including me just a few weeks ago—you have no idea what this substance is. It's now baseball's most abused performance enhancer. It's a powerful stimulant, described as a natural amphetamine, but legal. In the past months, eight minor-league players have been suspended in rapid succession for testing positive for methylhexanamine, a substance just added to baseball's banned list this year after WADA put the substance on its list. Please note the difference between banned and legal. "Banned" is a substance that is forbidden by a governing body, in this case MLB or WADA. "Legal" means it is not controlled by a government body. While methylhexanamine is banned in baseball and causing positive tests, it's also available at your local vitamin store or at hundreds of online retailers.
The Injury Expert gets within four of his 1,000th career column and has injury news from around the major leagues, too.
Chipper Jones (sprained knee, ERD 10/4) I'm bad at guessing knees and I should stop. The way Jones went down and the way he held his knee made me think he'd avoided an ACL injury. He didn't. Jones is headed for surgery to repair his Grade II sprain. It's a significant sprain and a rehab that will take somewhere between six and nine months. There's certainly a chance he could be on the low end. He's done it before (ACL repair in 1994), he's got a known high pain tolerance, and he's still in good condition. Milton Bradley's recovery after his ACL tear is the best-case scenario here and many are going to invoke Wes Welker, the NFL wide receiver returning to the Patriots just seven months after tearing his ACL. If Jones could be ready in April—which as I just said is possible—then the Braves will have a tough decision. Do they go another year with Chipper, who will be another year older and somewhat hobbled, or how do they move on from what some are arguing is a first ballot Hall of Famer? Jones is going to need to focus on the rehab to make the rest of this matter, but the fact that he's doing it at all tells us that he's intending to return.
After visiting four ballparks in four days, our resident injury expert is back with the scoop on aches and pains around the majors.
Thanks for waiting. I don't often put in late-edition UTKs, but I'm just back from a four-day, four-ballpark tour that was amazing. I joined the crew from Big League Tours for their trip to Detroit, Cleveland, Pittsburgh, and Cincinnati. It was a great time, great seats, great ballgames, and an experience we won't soon forget. But now it's time to get back to work. Injuries don't stop when I'm on tour, do they? One funny story—Monday night at our hotel in Cincinnati, there was a huge group of autograph seekers since we were staying at the same hotel as the Cardinals. But as Albert Pujols led the team off the bus, almost no one glanced over. Why? Apparently the hotel was also hosting the Jonas Brothers and one of them was outside taking pictures and signing autographs. I'll give whichever Jonas it was—I'm told Nick—some credit. The kid was out there for a solid hour and all reports were that he was polite and happy to talk with fans. The Cards and most teams could take a lesson from him. Anyway, let's get to the injuries:
A couple of catchers are hit with the injury bug, while several other players are out for the season.
Russell Martin (torn acetabular labrum, ERD 10/4)
Some injuries are traumatic, while some are insidious. With Martin, it's pretty clear exactly when and how his hip was injured. In virtually every other case in baseball, the mechanism is a bit different. Martin basically had his hip stuffed back into the fossa, the cup where the head of the femur connects to the pelvis. Because of this and his position, it's harder to compare this injury and the treatment to similar cases like Chase Utley and Alex Rodriguez. There are just no really good comparables here. There are going to be some that take a look at Martin's declining steals and workload and say that this did have some insidious nature. There's simply no way for us on the outside to know that and unless Stan Conte or Martin decide to share, we're left with what we do know. As a former Super-Two player, Martin is headed back to arbitration this year (or signing out of it, as he's done twice), but this complicates things. If Martin needs the FAIL surgery, he could be playing winter ball in time to get a good look at him prior to an arbitration hearing. While he's done for this season and there are no good comps, it's unlikely that Martin is done, period. The idea that Martin is a non-tender is a non-starter too; the Dodgers have nobody close in the minors after trading Lucas May to the Royals in the Scott Podsednik trade last week. In the meantime, the Dodgers will have to hope that Brad Ausmus is smart enough to handle this team for a couple months.
The Red Sox get Jacoby Ellsbury back but put Kevin Youkilis on the DL, along with other injury news from around the major leagues.
Kevin Youkilis (sprained thumb, ERD TBD) Jacoby Ellsbury (fractured ribs, ERD 8/4) If you'd asked me yesterday, I would have thought that Youkilis would be back in the lineup and that Carlos Santana would already have had surgery to repair his leg. Turns out, I was wrong on both. Youkilis is on the DL with a torn adductor muscle. This is one of the small muscles of the thumb that allows it to be such a useful digit. This particular muscle pulls the thumb in (adducts) toward the hand and is involved in the grip. When Youkilis got jammed and injured it, it was an unusual mechanism. Usually, this would be injured more in the way we saw with Chase Utley or David DeJesus, where there's a forced abduction (pulling away and back from the hand). In that case, the tendon is usually what goes, rather than the muscle itself. Because we don't know exactly where it happened and how, it's difficult to see exactly what happened that resulted in this injury... or is this the problem? Youkilis told NESN that this problem has been "going on for a while" so what we saw was the "last straw" rather than the real mechanism of injury. Youkilis is headed for tests that will determine if he needs surgery and how long he'll be out.
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.
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"?