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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.
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.
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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:
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.
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!
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.
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: