July 20, 2010

Under The Knife

A Case for Encyclopedia Brown

by Will Carroll

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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.

Brandon Inge (fractured hand, ERD 9/5)
At some point, someone will suggest that everyone wear a protective glove. Until then, we'll keep having unnecessary injuries like what will cost Inge six weeks. In the AL Central, a seemingly small thing like this could tip the playoff balance since even small losses or gains could be the difference. While broken hands from an inside pitch are a small percentage of injuries and a smaller percentage of at-bat outcomes, it doesn't diminish the cost when it does happen. As with batting helmets—and I should mention the new, smaller but better helmets we saw in the All-Star Game—there's no real cost, no adjustment to more protective gloves. Inge's fracture is non-displaced and he should be able to come back, but will he have a race to come back to?

Scott Kazmir (shoulder fatigue, ERD 8/2)
It should surprise exactly no one that Kazmir is back on the DL. The Angels starter is on the shelf with what's being described as shoulder fatigue. Sources tell me there's a strength imbalance laterally more than there's any sort of weakness. His average fastball is down 0.5 mph, but the average is based on an erratic series of ups and downs, so it isn't terribly instructive in this case. Since Kazmir was helped before by heading to see Rick Peterson, there's been some thought that he'd need to do the same, but Peterson isn't a free agent this time around and it doesn't look like Milwaukee is going to take on any part of Kazmir's risk. No, the Angels are going to have to figure this one out. The shoulder fatigue gives them a little time, but he's very close to being pushed to the LOOGY role in Mike Scioscia's bullpen, or maybe the Oliver Perez role. Kazmir is expected to be out until August, which gives Tony Reagins two weeks to figure out Plan B.

Justin Morneau (concussion, ERD 7/25)
Morneau is being treated very carefully by the Twins. He's headed to see a specialist regarding his concussion, but sources tell me this is more about clearance than any sort of treatment. Morneau is still having some symptoms—headaches, a bit of nausea with activity—but the Twins think he should be back soon. The problem with concussions is that they can linger and have no discernible time frame. That's what the specialist is about, using some advanced tests to provide a bit of guidance and some confidence for Morneau. He's eligible to return on Friday, but that's 50/50 now, though it's unlikely he'll need a rehab assignment.

Scott Rolen (strained hamstring, ERD 8/1)
Rolen is having a bad week. After a solid comeback year, one that makes Walt Jocketty look really smart, Rolen is down with a hamstring strain that's very likely to push him to the DL. On top of the strain, Rolen is also dealing with flu that had him dehydrated, perhaps exacerbating the symptoms of the strain. The Reds' medical staff is holding off on a final decision until they're at least looking at just the one problem, but all signs point to a DL stint coming for Rolen, a big blow to the lineup. Rolen's long history of back problems do come into play here. Back injuries and hamstring problems are often anatomically connected—check the Carroll Guide to Sports Injuries for more info on that, if you're interested—so the Reds will have to be careful to not exacerbate existing problems while they're trying to get Rolen back in the lineup. In a tight NL Central race with Jocketty's former club, the Cardinals, this could be a tipping point. Rolen's noted "toughness" is playing into the ERD; he's likely to push hard to be back at the minimum, but the medical staff is going to have to make sure he doesn't push too hard.

Ryan Sweeney (patellar tendinitis, ERD 10/4)
Sweeney has been dealing with an ongoing knee problem, but finally, he's done trying to fight through it. There had been some question about whether the surgery he's headed for was needed now. However, Sweeney consulted with several doctors, including Richard Steadman, and decided to have the surgery now. I was on the A's pre-game show Monday night and tried to make it clear that injuries might not seem like much, but can really sap the ability of a player to stay productive. If Sweeney felt he couldn't play on it, the fact is he probably couldn't, physically or mentally. He'll have one surgery and possibly have two, on both knees, if it's determined that it's needed. The procedure he's going to have is a patellar tendon decompression. It's an involved procedure, but one that shouldn't have long-term consequences. The normal recovery time according to my best sources is between 8-10 weeks, so Sweeney's season is effectively over. 

Andrew McCutchen (sprained shoulder)
McCutchen might not be part of "The Cavalry", the nickname for the group of prospects pushed up to the Pirates this year, but he might as well be their general. (Christina Kahrl is probably twitching right now, wanting to remind us that pirates didn't have horse-born forces and that the proper term is dragoon, given the context, unless of course you bring up Eylau ... ). Pirates fans can only hope that a shoulder injury doesn't turn McCutchen and The Cavalry into a baseball equivalent of the Seventh Cavalry. McCutchen has a mild sprain of his AC (acromioclavicular) joint, where the collarbone meets the shoulder. It's painful and can linger, but doesn't tend to have serious consequences when the sprain is mild. McCutchen was available Monday night but unused and is likely to get a couple more games of rest and treatment, but won't need a trip to the DL.

Brian Roberts (herniated disc, ERD 7/26)
Roberts is up at Double-A after proving that the Rookie Leagues couldn't contain him. Even rehabbing, that shouldn't surprise anyone. Roberts is looking like the back problems that have kept him sidelined are, at least for now, under control. He's hitting, fielding, and running well, so this stint in Bowie could be a relatively short one. The O's could use the bump he'd give the team and the psychic lift. The problem is that, as before, it might not take much to push Roberts back. It was a slide last time, reminding everyone how fragile the work the medical staff has done on Roberts really is. He's going to be like that the rest of his career, so the team is going to have to be careful about his usage while Roberts is going to have to dial it back a bit on the diving and sliding. This could affect his steals total, if that's why you like him. If Roberts is activated quickly, don't believe the rumors that he's being showcased.

Chase Utley (sprained thumb, ERD 8/20)
Matt S writes: "Hey Will, I had a question for you about UCL tears in thumbs.  I tore mine in 2005 playing football with friends, and it was 5 months before I was free of casts, and I still didn’t have much strength in my hand for another couple months after that.  When I saw Chase Utley’s hand bend on the slide into second base when he tore his, I immediately thought it was a UCL tear because of how his hand bent and concluded he was done for the year.  He is supposedly coming back in a couple months apparently, though, and I have no idea how that’s possible.  I saw on TV that he’s wearing a cast that I wasn’t wearing until maybe 2.5 months later, and it’s been only 3 weeks.  I know that mine could easily have been a worse tear just because the orthopedist needed maybe 10 seconds to realize I needed surgery and Utley needed three opinions, but I just don’t understand how Utley is healing so quickly.  Is he very fast at healing, was I just incredibly slow, or are there a lot of flavors of right thumb UCLs?  Is Utley going to struggle after he gets back with power?  Because I didn’t have strength in my hand for a while afterwards, and I can’t imagine gripping a wooden bat and hitting a ball 400 feet even six months after the surgery.  Maybe I’m just a crappy healer, though?  I was curious if you had any explanation for me on this.  Thanks."

Thanks yourself, Matt. There's a simple answer here. I'm guessing you didn't have three trainers, two doctors, specialists, 24/7 care, and a million dollar incentive to get back. Utley won't be 100 percent when he does return, just functional, which is what the Phillies need. That could be enough or he could look terrible, one of the risks that you didn't have to take on because there was no ticking clock or Braves to chase down with your injury. The other thing to keep in mind is that athletes often take on risks that will cause problems down the line, things that no doctor would ask a 'normal' patient to take on. Fast forward 20 years and you might see Utley struggle a bit with signing autographs at Phan Phest or similar. But it's not unusual—more reminder that major-league players just look like normal people. Utley's time frame is normal for an athlete, not for you and me.

Ubaldo Jimenez
Sometimes I have conversations with some really smart and interesting people inside the game. I was talking with someone who must sadly stay anonymous (though you'd know the name) when Jimenez came up. He wasn't looking as sharp Monday night and this person started musing on the idea that the All-Star startshurt both Jimenez and David Price. We laughed it off, but he came back to it, wondering if Jimenez's better results might not be more fatiguing. "Sure, he's gone over that age you like to see. He went 220 last year (actually 218) and he's rocking the NL. But what if whatever changed was just a little more tiring? What if he's throwing just a little harder, working a bit longer, putting a bit more force on the Pedro-body of his?" I'm not sure if there's anything to this, but it was interesting enough that I thought I'd share. There's a lot we don't know about pitching and this is just one of them.

Quick Cuts: The Rockies are planning on Troy Tulowitzki starting his rehab assignment tonight. The plan would have him back in Rockies purple the following week. ... Jose Reyes was back in the lineup for the Mets, as expected. He looked healthy, though he did have a couple of errors. Those didn't seem to have anything to do with his mild oblique strain. ... Roy Oswalt scared the Astros with a bit of an ankle sprain last time out. He thinks he'll be able to go without issue on his next turn, which could end up his last as an Astro. A source reminded me that Oswalt's contract makes him very likely to clear waivers and be tradeable in August. ... Kevin Millwood will start tomorrow, a return exactly on the minimum from his arm issues. ... Look at Daisuke Matsuzaka's 2010 numbers. Now look at Ben Sheets' numbers. Why is Matsuzaka considered a "failure" while Sheets is a trade target? I don't get it, especially after their matchup last night. ... Rocco Baldelli left his "special assistant" slot and is trying a comeback. We'll see how that works out, though he can hardly be expected to be a real addition to the Rays' lineup, nor can we blame him for trying. ... Speaking of comebacks, Jason Isringhausen is going to work out for the Reds and Jocketty, his former boss. There's some hope he could be a long-roster bullpen addition in September. ... Kyle Lohse is making some progress in his return from forearm surgery. We should know by the end of July if he'll be able to return to the Cardinals this season. ... Dustin Nippert was hit in the head by a comebacker, but doesn't appear to have any serious injuries. He's lucky, as is baseball. If he goes to the DL, Tanner Scheppers is a possibility for the roster slot.

Answer: This one took me a while to figure out, but it was such a strange number that it simply couldn't be "right." (There's a difference between correct and useful. When something's not useful or that there's a major logical error that leads to a result, I feel comfortable calling it wrong.) The answer here is that the date of the All-Star Game throws things off. It's a mid-July game, so there's always three months before it. This year, there were about 100 days of the season prior to the All-Star Game. That leaves 80 or so days after in this example. Here's the problem—teams stop using the DL on September 1 when rosters expand. That means there are actually only 50 days where a pitcher could get injured after the ASG. The big difference in the size of the buckets changes everything and makes that 77 percent very explainable and not very useful. Like knowing that Encyclopedia Brown's real first name was Leroy. Yeah, Leroy. (Thanks to Bil Burke and Joe DeFrancisco for discussion and thoughts on this.)