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The Summary: Washington is kind of the Evil Spock of consistency to Toronto's comparative randomness when it comes to injuries. That's because no team has been more injured than the Nats, despite being in different cities, stadiums, and training rooms, despite different GMs and front offices, and with a succession of trainers. The tide of DL days has broken past the sandbags every year, leaving the already short-handed team even more shorthanded. The Nats are also one of the only teams not to see any sort of positive bump from moving into a new stadium. Equipped with more money, better facilities, and starting to acquire talent, there should be a reduction, but it hasn't shown up yet. If the team stays at the bottom of the rankings for a fifth straight year, we're going to have to get a live chicken involved.

The Facts
Days Lost:
Dollars Lost: $11,760,366.85
Injury Cost: $13,633,333.33

The Cost: Washington lost $11.7 million last year, and has lost $43.6 million over the last three years. That is money that could have been used to bring in Orlando Hudson before he decided to accept the Twins' offer for just a million more guaranteed. The Nationals could have gone the other way with that money on pitching, too, and brought in a John Lackey type instead of spending the $15 million on Jason Marquis to be a "front of the rotation" starter.

The Big Risk: Stephen Strasburg has some upside. Maybe he has more upside than any pitcher since Mark Prior… and there's the problem. Pitchers get injured, burn out, or just don't make it. The can't-miss guys-remember Ryan Anderson or Luke Hochevar?-sometimes miss. Add in that Strasburg is nearly a singularity in terms of baseball talent and it gets worse, at least from a risk standpoint. With that crazy velocity comes a small group of comparables, so you'll almost always hear Nolan Ryan and Joel Zumaya. That's a pretty big range between a very few names. While it's not quite that binary, and since we have a wealth of scouting data on Strasburg, we have more to go on here.

The Comeback: There's no clear comeback player for the Nats the way there is for most teams. The Nats aren't really counting on much from Jordan Zimmermann, but he's coming off Tommy John and playing golf, which I guess is a good thing. If it's not, John Lannan's tweets just got Zimmermann in a bunch of trouble. Elijah Dukes is in a state of constant comeback-much of it his own doing-but he also seems to have some terrible timing when it comes to injuries. With a more-or-less new manager and theoretically coming into his prime, Dukes could put everything together… or continue to flush it all away.

The Trend: The Nats have been at the bottom of the THR rankings since they started, or since Ron McClain decided not to move from Montreal to DC. Some of it is the quality of players they've had. Some of it came from the facilities at RFK, which were simply bad. Some of it was the turnover of staff. But now that the team is settled in Nats Park and has some semblance of stability, those excuses are gone, and the team is still down at the bottom of the rankings. An influx of young talent is going to increase the number of injuries, but young players tend to heal faster and better, so it all evens out. A focus on prevention and conditioning could help more than anything else, which makes John Philbin the guy that could push the Nats towards respectability. It just goes to show that it's the people that no one notices that often have bigger impacts than anyone realizes.

The Ratings

Red lightOF Elijah Dukes: Dukes comes with his own breed of risk, but his injury history hasn't helped, either. Last year it was the double-whammy of back and hamstring problems that really short-circuited his season, rather than his short temper. Those two are often linked, and you have to think back a decade to when Ivan Rodriguez had similar problems. Pudge's commitment to his core/back stretching program has kept him in the game this long, so maybe that's a part of the mentor role he's supposed to fulfill.

Red lightSP Stephen Strasburg: Put down the pitchforks, Nats fans. You too, Kasten; I see you over there. Saying that Strasburg is risky is not the same as saying he's not the best pitching prospect in the game. The "TINSTAAP" phrase was built for just this kind of guy. He could be Dwight Gooden, or he could be Mark Prior… and come to think of it, Prior was pretty good his first season. The scouts spent so much time saying the kid was great that it's inevitable that we're going to hear from the usual suspects that he's not. (Yep, Mike Marshall is calling him "the worst of traditional motions" and predicts a UCL tear, as well as damage to his knee, shoulder, and back. Wow. You can read this here, question 389.) Let's let Strasburg make a major-league pitch before we bury him, but some injuries might hold him back. He had some knee problems in the fall that aren't devastating, but they are concerning. The Nats are going to handle their prize not with kid gloves, but like how art travels from museum to museum. Whether it helps or not remains to be seen, but when you see that fastball, you won't care about the risk.

Red lightSP Garret Mock: Mock is caught in a no-man's land for pitchers. As a starter, he's going to have workload concerns if he goes past 150 innings. If he can't get to that threshhold, there's going to be more pressure on young pitchers like Strasburg to pitch more innings. Mock might well end up a sacrifice to keep other arms healthy. The Nats would have done well to have found more steady arms. Jon Garland would have had real value here-or Shawn Estes, who signed while I was writing this. I'm guessing Mike Rizzo will be watching the wire during the spring for more like that to fill in behind what he has.

Red lightRP Matt Capps: Capps is good when healthy, but his last couple seasons in Pittsburgh haven't been that healthy. The Nats are willing to take on the risk in the short-term, especially since they have options coming (hello Drew Storen). A series of pitching arm injuries and concerns about his conditioning led to a non-tender and a one-year deal. We'll see if it wakes Capps up a bit. At worst, he's a placeholder. At best, he's locking down things to help the confidence of a young staff.

Red lightRP Brian Bruney: Bruney had a hard time last year. He was knocked around by the New Yankee Stadium's early-season homer binge and overthrew, causing a flexor tendon strain. He struggled to come back from it and never found his mechanics. Now, he finds himself setting up Matt Capps rather than Mariano Rivera. His history of elbow issues and control problems are something he'll struggle with, and a move south won't help with that.

Yellow lightC Ivan Rodriguez: "Just" a yellow, for a guy this old and catching? While he's very close to the red threshhold, Rodriguez is the latest in a line of catchers that seems to ignore both age and workload. Bob Boone, Carlton Fisk, and now Rodriguez just shot through the normal workload concerns and managed to, for the most part, avoid injuries. There's no reason to think Rodriguez will have any more trouble this year than he did the last couple, though with any catcher, they're one play, one foul tip, or one stiff back away from the DL.

Yellow lightSS Cristian Guzman: Naturally, the Nats sign Adam Kennedy the day I post the ratings. (Kennedy is a green, btw.) Guzman is taking both the risk of a positional change and a post-surgical shoulder into the season. If things work out, he could split time with Kennedy or Ian Desmond. If not, well, this is still one of the things they can blame on Jim Bowden.

Yellow lightLF Josh Willingham: "The Hammer" had fewer problems with his back, but he's not getting any younger, either. I would have loved to hear the meetings the Nats had about moving Adam Dunn to first. They really had to have considered whether Willingham would have been better off there. (My understanding is that defense was the deciding factor.) Willingham will plod around in left field and pound at the plate, but Jim Riggleman's going to need to find a way to spot him out. Willingham should be thanking Bud Selig for his career. If we were still in an artificial turf era, I'm not sure Willingham would still be playing.

Green light1B Adam Dunn

Green light3B Ryan Zimmerman

Green lightSS Ian Desmond: The signing of Adam Kennedy might make this one moot, but an untested rookie can be a green. Minor-league injuries remain a blind spot in the system-there's just no consistent reporting outside of a team context-but Desmond's pretty clean there.

Green lightCF Nyjer Morgan: Morgan is a very high green. Just make sure you note his age as well as his speed. While he's never had serious leg problems, he doesn't have another skill that would make any reduction in his speed survivable.

Green lightSP Jason Marquis

Green lightSP John Lannan

Green lightSP J.D. Martin: So why is Martin green when most of what I said about Mock above is true here as well? A little bit of age, but mostly predicted role. The fifth starter is more likely to be replaced or skipped. I know these so-called roles are very fluid here in early February, but so is the Nats' roster. Martin could find himself in the pen just as easily as the rotation at any time, which makes this green make sense.

Thank you for reading

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Question 389 also maintains that Lincecum is due for a UCL blow out because of his motion, but the guy has thrown a ton of pitches for 6 or 7 years counting his time at the U of W, without apparent ill effect. My own take from watching him is that it seems far more likely to have back problems than arm problems, but golfers put similar torque to their backs and manage to play competitively into their 40's and 50's, so who knows?
The golf analogy is a great one, but while I too have always worried more about his back than arm, we have no idea what forces and stresses he's putting on his body. My biggest concern is that as Lincecum matures, he'll either gain weight or just "thicken up" as many do and reduce the flexibility that allows him to do that back arch. Clemens had his "tick-tock" flaw, but was strong enough in the core to overcome it. Maybe Lincecum is as well.
It would be great if we had data like W% of pitchers that do X have injury Y within Z years. Until we have that, I think predictions on which pitchers will have specific injuries are kind of suspect. I think it is pretty much a given that every pitchers will have some sort of injury that will cause them to miss starts at some point. Greg Maddux is about the only guy I can think of that was completely healthy for a long career. That being the case, were there obvious 'flaws' in Maddux's delivery? The one thing I really remember about him that stands out was that he was *always* ready to field the ball at the end of his delivery.
Didn't Tom Glavine and Mike Mussina also remain exceptionally healthy until the very end? As you mentioned, these two also finished their deliveries facing home plate, balance intact. Food for thought.
I do, but only for a small period. Is the last 8 yrs enough? Not sure. Its certainly not the same as any other period, but still there's a TON of unknowns. I don't know when a pitcher is sore, or had a bad cheeseburger, or is going through a tough time at home, or has anxiety, or when the manager is hard on him, or when his back is stiff from a hotel bed or long flight. I don't know how he recovers, how strong he is, or how much he really weighs. I don't know his genetic makeup, the condition of his shoulder on any given day ... and a million other things. That's why these are broad categories of risk, not defined predictions. You'll never hear me say "Joe BLow WILL get injured"; I simply don't know.
Why rate Ivan Rodriguez over Jesus Flores? Aren't the Nationals projecting Pudge as a backup?
Not that I'm aware. Flores is coming off elbow and shoulder surgery, so his S/T availability is a big question.
Really good comments by both you guys. We all agree that his core is the most vulnerable part of his delivery. And indeed that is the only area that has caused him to miss his one start.

The good news is that as far as we know his injury seems to have been caused by a cross-country plane ride rather than by pitching. Of course, we don't know that for sure, but it is true that while Tim pitched on the preceding Thursday, we weren't aware of the issue until after his plane ride back the following Sunday.

It is also good news that Tim has been working to strengthen and improve the flexibility off his core for virtually all his pitching life. After the 2007 season he resumed doing one particular boring but effective exercise he had temporarily gotten away from.

Tim is so much different from any other pitcher that it is tough to evaluate via comparison how his health will hold up. But thus far he has endured a very large pitching load over the past six years without many visible signs of wear and tear.

And it would seem that from his delivery to his exercises, he is doing a lot to keep his health intact.

It is impressive to watch Tim begin his bullpen session with some really extreme stretching. My joints ache just watching him.
Its cool that Mike Marshall is starting to get some more mainstream exposure (like being on MLB Network) not that I agree/disagree with him at all. I don't know enough to have a solid opinion either way. Different viewpoints in baseball can never be a bad thing.

What kind of work load do you expect Stephen to get through the year? Is 150 IP the upper limit of what we'll see from him?
I dont have a really solid number. Minors-to-MLB innings translations are tough enough, so college-to-MLB is nigh impossible. I wouldn't hate 150, but I really have no basis for that other than educated guess.
No PECOTA card for Strasburg yet? I'm itching to see his comparables -- and expecting them to include a number of great-white shark-attack victims.
I know he is an expert, but how the hell does Marshall get off thinking he can predict the future? He comes off as a pompous ass.
As someone writing Team Health Reports right now, I hope you'll forgive my take on the future ...
But as you said earlier "You'll never hear me say "Joe BLow WILL get injured"; I simply don't know."

A lot of analysts out there seem to be saying things like "Strasburg will get injured", not "Strasburg has an elevated risk of injury compared to other young pitchers".
The closest I've ever seen Will get to "Joe Blow WILL get injured" has been "I don't know how Joe K-Rod HASN'T been seriously injured."

And that seems plenty reasonable. It seems like some guys tweak before they tear.
Will, I've never seen you come right out and declare "this guy will rupture his UCL."

I just think Marshall should be a bit more careful and say "I believe he's at risk for UCL problems" instead of trying to act like he's looking into a crystal ball.

I love what you do - because you don't have the God complex that Marshall seems to.
I wouldn't put Hochevar in the same sentence, paragraph or article as Ryan Anderson as a "miss" just yet. Still young enough to make it work, had a decent enough WHIP in the first half last year, and good K:BB rate in July/August (including 13 in one game) when he started using his new pitch (splitter) but gave up too many HR. Fell apart/tired in September. He's 26. He'll probably turn into a pretty decent enough pitcher---for the Royals to lose in some reverse Gil Meche free agency deal in a few years.
True. I was just throwing out first overall picks that didn't reach expectations. If I were to say Strasburg would pitch the Nats to the playoffs, but never play past 2011, would that be failure or success for $20m?
If any arm can pitch the Nats to the playoff, that must be worth a lot more than 20m. You need to put three Tim Lincecum into one body to pitch the Nats into October baseball.
Last week, Lannan tweeted that he was golfing with 'jzim' which many (including myself) thought meant Jordan Zimmerman. Lannan tweeted later that 'jzim' was a friend and not the Nats rehabbing pitcher.
Will, in an article in the Wash Post this morning by Chico Harlan, Jesus Flores seems quite unhappy with the chain of events that led him to ultimately have surgery for a SLAP tear to his throwing shoulder. Any thoughts on Flores and how the Nats' medical staff handled his situation?

"Flores questioned why the Nationals, headed by team doctor Wiemi Douoguih, failed to initially detect the labrum injury.

"Stupid," he said. "You're the doctor. You tell me one thing, and it was labrum. . . . I was getting worse every day; I wasn't getting better. And I was telling them, 'Hey, I'm not feeling good. Something is in there, something is in there.' And they kept saying, 'Don't worry; don't worry, you're gonna be fine. It's tendinitis, it's tendinitis.' Then they send me to Dr. Andrews. He wanted to see the MRI [exams], X-rays, everything, instead of just moving your arm around."