I’ll often talk here about “cascades”–the situation where one part of the body being injured or out of whack causes another injury–but it’s interesting to see the same concept apply to a team. Since the term comes from network science, it’s not surprising that it shows up in any networked system–a body, a team, even a league.
Tim Hudson went to the DL as a precaution after he once again felt an oblique strain affecting his motion. Little did the pitching-rich A’s know that Rich Harden would have a recurrence of his non-throwing shoulder’s laxity disorder. Had Harden gone on the DL, they would have been down two starters, but even then, the A’s were ready with Kirk Saarloos and John Rheinecker. This still leaves Justin Duschscherer in the bullpen and Joe Blanton on the verge. That’s just sick depth (and part of the reason that Billy Beane will be dangerous this trading season.) My favorite part of the episode is Larry Davis’ “everybody will make their next start” quote. It’s semantics like that which makes my job so “interesting.” Hudson will be out the minimum, while Rich Harden’s absence will depend on his pain tolerance. Remember his mechanics got out of whack early in the season when his gloveside drooped.
If you think the discussion on steroids is bad, wait until you see what’s next. This month’s issue of Scientific American has a discussion on gene doping. That’s performance enhancement at the DNA level, which is not only effective, but like hGH and testosterone, nearly undetectable. With something as simple as muscle recovery, genetic changes can have amazing effects. The recent discovery of a genetic mutation in a German child proves the possibility exists. The scariest part of the article, to me, was how close this technology is to affecting sports. It’s five years away at the outside. Somewhere, there’s a geneticist who’s looking at BALCO and laughing.
Powered by Wilco’s A Ghost Is Born, on to the injuries…
Oftentimes injuries take a bit of time to affect a team. Statistics like MLVr and DLDL (dollars lost to disabled list) tell a part of the tale, but the Cubs/Cards game Tuesday night summed things up in a way that only a baseball play can. Ray Lankford ran a good route, as fast as he could, towards the ball that Aramis Ramirez dropped in for a double. The winning runs came racing home while Jim Edmonds watched from the bench. A groin strain kept Edmonds out of the lineup and away from a ball that he likely would have reached without drama. To further rub salt in the Cardinals’ wound, Edmonds popped out to end the game. The groin strain isn’t considered serious, but he will be limited for the next few games. It will be treated much like Albert Pujols’ hamstring strain, buying the center fielder rest as a DH when they head across Missouri this weekend.
The Marlins will push Josh Beckett back in the rotation to give his back a bit more time to heal. His normal side session was halted due to pain, but sources say that Beckett insisted that he stay on schedule with his throwing program. Cooler heads prevailed and he’s now scheduled to start Saturday. That start is in doubt, however. Beckett will need to prove he’s healthy in a side session Thursday or Jack McKeon is making noises that Beckett will go back to the DL. Beckett is remaining quieter this time around, but clubhouse sources say he’s growing more frustrated with the way he’s being handled by McKeon.
As if labrum tears weren’t bad enough, research from one of the top hip doctors is about to make us change our vocabulary and our thinking. According to an NATA presentation by Dr. Marc Phillipon–a University of Pittsburgh professor and consultant to the Marlins–groin injuries may be a misdiagnosis. He believes that many injuries described as groin strains are actually hip injuries, most likely acetabular labrum tears. Yes, the hip joint has a labrum, just like the shoulder. Beyond the medical research, is there other evidence that this might be true? Just last season, Ricardo Rodriguez was diagnosed with a groin strain and placed on the DL. After he was traded to the Rangers, he was examined and it was determined that he had a torn acetabular labrum. Rodriguez is coming back well, pitching at Triple-A, so this injury doesn’t appear as serious as a glenoid (shoulder) labrum.
In other words, for all these years, it’s possible that we’ve been treating the symptoms, not the cause. Phillipon is getting good results in his practice, and he’s someone I’m trying to get for BPR.
Jarrod Washburn has had his share of unique injuries. A few years back, he had a minor scapular fracture, similar to the one Kurt Ainsworth suffered last season. Now, Washburn is having neck and shoulder spasms, leading some to look to the outfield and ponder Garret Anderson’s condition. It looks minor for now, but any spasm can return, so until the root cause is found there’s definitely cause for concern. The Angels have been dreadfully unhealthy so far this season, but depth and good roster construction have kept them in the AL West race.
Things are looking up in the Bronx. Mike Mussina will make his next start, feeling that his strained groin will be healed sufficiently. He will be watched closely, however, so expect him to be pulled earlier than normal. Kevin Brown is also making good progress, but some reports have been a bit ahead of reality. While Brown is tentatively listed as next Saturday’s starter, he’ll have to make it through two bullpen sessions before Joe Torre writes his name in ink instead of pencil. Even in the minors things look better. Orlando Hernandez made it through his first rehab start and will head to Triple-A for his next. He could certainly solidify the front of the bullpen as well as help his countryman, Jose Contreras.
There’s been a swell of interest in injuries, pitcher workloads, and sports medicine that’s been making me very happy lately. Slate, for instance, has a very interesting piece up on sports injuries. At the same time, I’ve heard that you’ll want to check out ESPN Magazine next week for something by yours truly. Add in the growing influence of the legions of fantasy players who want to know why so many of their players are on the DL, and injury analysis is hot. I’ll also tip my cap to folks like PBATS, ASMI, Rick Wilton, and RotoWire. Now, it’s time we try and make a difference. Because if continue to work, flip answers like “Players aren’t as tough as they were back in my day” or “It must be steroids” will disappear into the mist, like they very well should.
Powered by wheatgrass juice, on to the injuries…
Halfway through the month of June, three months are in the books since spring training opened. While nothing has been decided on the field yet, we were supposed to see significant changes off the field, with the switch from survey drug testing to actual drug testing. Not only are we yet to see the first positive test, there’s been no decrease in injuries, power, or any of the expected indications that steroids have been rooted out. Worse, with the callup of Derek Turnbow by the Angels, both players with publicly known positive steroid tests are in the major leagues. While those tests were outside the purview of MLB, it still shows that the public relations around this issue are beyond the people in charge. MLB is sitting on a timebomb with the BALCO trial leaking out the list of positive tests, so I’d like to see something more being done. I can only hope that the negotiations on increased testing are the next step.
Despite some happy reports from the Bronx, the Yankees made the decision to give Kevin Brown more time to heal. With Mike Mussina also likely to miss a start, the team decided that they would need another pitcher, so Alex Graman is likely to be called up. Brown’s back didn’t get worse, but the Yanks are erring on the side of caution, hoping that the rest will keep Brown more effective down the stretch. While Brown will miss two starts, there’s no indication that this will go longer than the fifteen days.
As the Reds engage in a Cubs-like June swoon, the injuries keep kicking them down. D’Angelo Jimenez was once considered the equal of Alfonso Soriano, and at times this season he’s shown why. The Reds have him benched, hoping a slight oblique strain won’t turn into anything more. With Barry Larkin slowed and Brandon Larson being…well, Brandon Larson, the Reds are shorthanded up the middle. Austin Kearns is expected back on Thursday. His return won’t stop the team’s decline or the inevitable trade of some Reds players.
I’ve heard everything from a rib injury to a groin strain, but something is clearly not right with Roy Oswalt. One e-mailer said that Oswalt appeared to strain his groin in his last start, but the Astros deny that Oswalt has had any problems since his off-season surgery. Last night Rick Sutcliffe picked up the “rib injury” baton and ran with it. I’m not sure exactly what it means, but I’ll guess it’s an oblique strain. If so, with Oswalt’s delivery, he’d be cringing on every pitch, which isn’t the case. I’m not sure what the problem is, but until we get better evidence, it’s best to just note the result and watch the performances.
In the ongoing debate about pitch counts, there’s some interesting questions that just aren’t making it into the debate. Is it about a macho attitude or risk management? Do you want an honest pitcher or a “bulldog”? At what point is your ace fatigued enough that even the worst reliever in a major league bullpen becomes a better option? Jake Peavy is one of the young players quickly developing a bulldog reputation. After missing only a couple weeks with a forearm injury, Peavy is back out throwing. His first bullpen session went 30 pitches, reporting no problems and no pain. He’ll have two more bullpen sessions this week, but Friday’s session is the most important. That’s where he’ll first try breaking balls. His slider is the pitch that causes pain. If all goes well, Peavy is about two weeks away, and will have one rehab start before rejoining the Pads rotation.
My hardest battle as an injury analyst is dealing with inexact information from the past. Right now, I have enough sources and advisors that it’s tough (but not impossible) to keep secrets. Things in the past seem to have a haze of history across them, but occasionally something will pop into the light that changes things. In some recent articles, I’ve discussed the difficulty pitchers have had returning from labrum injuries. One of my data points was that only one of thirty-six people have returned from labrum surgery. In fact, if I expand things a bit, there’s another. New information, uncovered by John Tomase for an upcoming article, confirms that Curt Schilling had labrum surgery in 1995. While this has been widely reported, it was not the diagnosis on his Standard Form. Without confirmation, I can’t use the data. Now, there’s a two-in-37 chance. It’s not much better, but it’s much more hopeful.
The Red Sox are hoping that rest and treatment will keep Curt Schilling on the mound. If the bone bruise that’s been bothering him fails to get any better, they will use the DL. His next start will be something of a test; if he can make it out of the start without increased pain, they’ll continue to let him pitch. However, he could end up on the DL just after the start, giving him a rest until after the ASB. While he could continue to pitch with the injury, the Red Sox are more concerned with having him at full strength for the second half of the season.
I spent about a half an hour today talking with a professional pitching coach about pitching. It was a great experience and he left with my book, but I left with something better. As I meet more people in baseball, I find more who want to make the game better, who are willing to be open-minded about new approaches, new research, and new possibilities. Stories like Dayn Perry’s Beer and Tacos article and Steven Goldman’s on Moneyball started to articulate a foundation for this new school of thought. Instead of the tired old school/new school debate that has become more holy war than revolution, there’s a “middle school” that is actually making inroads in the game. I’m firmly planting my feet there in the median.
Reports have been mixed on Kevin Brown. Early in the day, it looked like Brown’s back injury wasn’t serious. It was described to me as a “slip. His cleat didn’t catch and he overstepped, so his back took the worst of it.” Reports later in the day wavered between caution and fear. Brown will have some imaging and therapy, but there’s no determination yet on how serious the problem is. The Yanks don’t have the pitching depth to absorb an injury well, but there’s always the possibility that they’ll go get an extra arm.
Derek Jeter seems to draw more emotional responses than anyone, whether through discussions of his defense or his place in the Pantheon. His recent struggles with his injured groin have taxed my inbox, but the injury is not worth the pixels; it’s as simple as they come, a straightforward strain. Sure the injury is painful, and he’ll miss a bit of time, but it’s also predictable, treatable and healing. People seem to forget that even when they’re emotional about a player, the rules of medicine still apply. Your captain will return, likely on Wednesday.
The Cubs-Cards series is one of those great happenings, but without Sammy Sosa and Albert Pujols, fans aren’t getting exactly what they expected. Both players will miss this series, but both are making progress. Pujols is seeing a reduction in the swelling of his hamstring, enough so that Tony La Russa had him available as a pinch-hitter, but only in an emergency. (Is a 17-inning game an emergency? I’ve never seen a game go this late into the UTK process as the Angels-Brewers epic.) Sosa was able to take batting practice, but remains a week away from returning to the lineup. His back is still tender, but there’s been great improvement.
The first day of the draft has come and gone, while the baseball world spun around it. Instead of immersing myself in it, I stayed on the move, Nokia in hand, and got to spend a nice day at the ballpark. Jim Rushford and the Red Barons were in town. With a blue sky and a slight breeze, it couldn’t have been a better night at the ballpark.
On to the injuries…
Randy Wolf will head to the DL as the Phillies activate Billy Wagner. The team doesn’t seem overly concerned about the injury. Wolf had similar problems a few years ago and came back quickly. The Phillies think the problem is simple inflammation, and rest (and medication) will correct it, allowing him to miss only a couple starts. Ryan Madson will likely take the starts, while Larry Bowa is asking for a look at Gavin Floyd.
Ray Durham is key to any run the Giants might make, and keeping him healthy will be job one once he’s back. Durham will head to Triple-A for a week of rehab, but news of a full week seems off. If Durham looks ready earlier, he’ll be eligible to come off the list as of Monday. With Durham’s chronic leg problems, an extended rehab could put him at risk. If he’s going to hurt himself again, he will likely do it trying to help the parent club, not Fresno.
As we discuss this injury, I’d like to point you to a simple, concise definition of “strain”. Dr. George Paletta has an interesting quote regarding the injury to Albert Pujols’ hamstring: “On exam, he’s got no defect. It doesn’t appear that he’s torn the muscle. So the question is, did it just spasm and cramp on him real bad, or did he strain it? Tomorrow we’ll probably be able to tell better.” The last part, at least, tells us something. Pujols will be out at least one game, probably more considering the Cardinals can’t risk losing him for an extended period. From all accounts, Pujols has a minor (Grade I) hamstring strain that is likely the result of a changed gait, part of a cascade from his strained right hip flexor. Pujols has had some past problems with the left hamstring, so keep an eye on how quickly he’s able to return.
All along, I knew something wasn’t adding up. I only hope I made it clear that I was confused. The case of Joe Mauer finally has a solution. Why did it take him significantly longer than expected to return from knee surgery? Because the knee surgery was significantly more involved, and had a more negative outcome. Instead of shaving the tears of the meniscus, Mauer had the medial meniscus removed. I’ll emphasize this: The Twins’ young catcher and top prospect now has no medial meniscus in his left knee. Even with new technology like Synvisc, a young catcher is going to take a lot of stress on that knee. I would be stunned if Mauer can stay at catcher for the next six years. I’m not sure where he might move or how this affects his value, but it certainly reduces it. Kudos to the Twins medical staff for keeping this one under wraps.
Roy Halladay heads to the DL in order to give his inflamed shoulder time to heal. Clearly, this injury is pitching-related and points to an impingement. I haven’t seen Halladay enough to notice any change in his mechanics, but the Blue Jays watch this type of thing extremely closely. If the problem is impingement, it’s easily corrected, first by treating the symptoms, then by treating the cause. Halladay has been one of the best cases of someone who has remade his mechanics at the professional level, so expecting him to adjust isn’t a stretch. Many others would be unlikely to change and remain successful while doing it.
The intro I originally started working on covered the topic of pitch counts. Instead of running it here, however, it’s now going to end up as part of a longer piece, as soon as I finish the ASMI article I’ve been promising, a Q&A I think you’ll enjoy, and an in-depth piece that I imagine will cause some controversy. So in lieu of that intro, I’ll say this about pitch counts: they’re important if that’s all you can get, but managing pitcher workloads requires context and contact.
On to the injuries…
Rain pushed Joe Mauer’s rehab back slightly. The Twins want him to catch back-to-back days to test his repaired knee before he returns to the majors. He’s scheduled to start again Tuesday and a decision will be made on Wednesday. It’s unlikely he’ll be in Minnesota before Friday, but it’s not impossible. Mauer has had a slow rehab, but that’s the result of the Twins exercising caution, not any setbacks on Mauer’s end. For Twins fans, it gets worse. Justin Morneau, someone who has nothing to prove at Triple-A, has been sent down to open up a roster slot. The Twins must know something about Morneau that no one else does, unless something bigger’s afoot.
While Mauer’s rehab is going well, if slowly, Shannon Stewart’s rehab from plantar fascitis has run into problems. His foot is not responding to therapy and he is still in significant pain. Any guess that he’d be back at the lower end of the six-to-eight-week estimates are now gone, and there are open questions about whether he can return by the All-Star break. Stewart may need to DH more, which would wreak havoc on the already jumbled Twins lineup.