September 29, 2010

Under The Knife

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by Will Carroll

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There's no easy way to say goodbye, but there's always a time when we have to do it. Life turns like a season, and as the leaves change, so do the circumstances of our life. Eight years is a long time to do any one thing at any one place. I think in some small way, I've been able to perform the core mission I hoped to when I started writing about sports medicine: to educate the public about the overlooked importance of health, safety, and the hard work of medical staffs in winning baseball.

When I hear an announcer or sportswriter talk about injuries now, sometimes, I can hear a little bit of what I said here, and often I hear that there's a lot of work left to do. That work will, I hope, be carried on long after I'm gone. There are a lot of people to thank for help along the way, from Peter Gammons to Rob Neyer and thousands of others, I'm sure, but most importantly, each and every person who read or listened to my work. Waylon Jennings once said "I didn't aim at anything but good music." I hope that I hit my mark half as well. Thank you.

So for one last time, I need you to roar as we go on to the injuries:

Miguel Cabrera (sprained ankle, ERD 10/4)
Many think that Cabrera has the upper hand in the AL MVP race for precisely the reason I voted Adam Wainwright and Dan Haren for Cy Young last season: availability. If all other things are relatively equal, how much value does being there have? For years, I've wondered why MLVr lingers in relative anonymity. I won't get into the failings of sabermetric marketing here, but with Cabrera's season-ending ankle sprain, the difference between Cabrera and Josh Hamilton narrows slightly. Cabrera's sprain is pretty severe, but nothing that will require more than time or rest, something he'll have plenty of this winter. It does highlight a couple issues that face injury analysis. First, we'll never know exactly how long it took Cabrera to heal. He'll be sitting on a beach somewhere instead of running or taking grounders at that point. It gives us less data to work with, something we already have very little of. Second, despite this being a traumatic injury that would be difficult to prevent, there's no cost to the team in days or dollars lost. Some teams have an internal system that they use to monitor injuries that uses the more informative "able/not able" designation. Simply, could a player play that day? Knowing that simple information allows them a better calculation of the value they're getting for the money.

Justin Upton (strained shoulder, ERD 10/4)
The Diamondbacks sent Upton to Dr. James Andrews on Monday... or did Upton request the second opinion? Either way, it looks as if Upton's 2010 is done. Dr. Andrews found a small labrum tear, but that surgery is not necessary yet. The lax shoulder is similar to what his brother B.J. had after the 2008 campaign and is a good guide. The older Upton might be something of a disappointment to Rays partisans, but after the surgery, Upton was essentially back to level six to eight months after surgery. Over a year out now, his stats and scouting reports at bat and in the field look substantially similar to what he was doing before the surgery. That's success, but many only remember Upton going insane during the 2008 postseason and had the expectation that the hot streak was him finally finding the next level. It wasn't, he didn't, but that doesn't make the surgery less of a success. Some have tried to say that the surgery reduced B.J.'s power, but I don't see the evidence for that. The timeline for recovery means a decision needs to be made soon. With Kevin Towers coming in as general manager, expect this to be one of the first things he'll weigh in on.

Josh Hamilton (fractured ribs, ERD 10/2)
We know now that Hamilton is getting a series of injections of painkillers into his back, some significantly higher than had been previously thought. The muscles are guarding, but to find that Hamilton is most bothered by the latissmus dorsi spasms is a bit confusing. The injections, known as nerve blocks or trigger point injections, function in much the same way as any cortisone injection but are much more specific. (Image-guided injections have shown a lot of promise for oblique strains, but aren't widely used.) The injection goes directly to the nerve rather than a more general intra-muscular or intra-articular injection. Think of it along the lines of how the dentist deadens one area of your mouth or similar to an epidural injection before childbirth. The injections aren't long lasting, but in concert with other treatments, they can break the pain/spasm cycle and allow other things to work. Hamilton will continue to progress toward a weekend start, but this is going to have to be a real team effort between all facets of the situation—Hamilton, athletic trainer Jamie Reed, team orthopedist Keith Meister, Ron Washington, and Jon Daniels' crew in the front office.

Joe Mauer (inflamed knee, ERD 9/30)
Jim Thome (strained back, ERD 10/2)
We need a word for "shut down so that he'll be rested for the playoffs but play a couple games so he's not rusty." Mauer is not expected to play until today, and the clinch has helped the Twins' medical staff keep the leash on him. The cortisone shot is getting time to work, his back and shoulder are getting some rest, and Mauer can take a deep breath before the playoffs. He could get an extra day off or even skip a game in the final series as well, but he's expected to be fine for the playoffs, or as fine as he can be at this stage. It won't surprise me at all if he needs a clean-up surgery after the season on both the knee and the shoulder. Thome isn't as banged up, but his chronic back problems have acted up a bit more over the second half despite his solid results. The medical staff has worked hard to minimize the situation and it has done a great job at keeping him productive. As with Mauer, Thome will get some more time off due to the clinch and be ready for a very interesting October. With both Mauer and Thome and other players on the field, the medical staff is going to end up a deciding factor in how the Twins compete, especially if they get deeper into the playoffs.

Martin Prado (strained oblique, ERD 10/4)
If the play reminded you of Chipper Jones a little bit, I don't blame you. Prado went diving to his right and came down hard. Later, coming out of the batter's box, the hip tightened up, and Prado could barely make it out of the box. The original diagnosis was a hip pointer, but an MRI showed that he has a severe oblique strain. He'll be shut down with the doctors saying this will need a minimum of two months to recover from. With the Braves locked in a tight race, the slightest things can mean the difference between the playoffs and tee times. Of course, it's not just the things that happen now. It's always hard to assume anything in baseball, but there are assumptions we can safely make. Jones' availability over the second half might have improved the team by some fraction. Derek Lowe being able to pitch through a sore elbow because of the diligent work of the medical staff might be worth a win or even two. Minimizing the time that Jason Heyward missed when he had injuries has a real value. Up and down the playoff teams and those just outside it, you're going to find that short of some superstars, its the men in the training room that add the most value and all for a lot less than the minimum player salary. Now, it's up to what the Braves have left. Prado is going to be sitting beside Jones, wondering what might have been.

Adam Wainwright (inflamed elbow, ERD 10/4)
A couple years back, the Pirates nearly killed the career of Tom Gorzelanny. The regime they had then, specifically pitching coach Jim Colborn, really pushed to have Gorzelanny win his 15^th game. We knew then, as we do now, that wins are pretty poor as a measure for... anything. Fifteen isn't 20 but it doesn't make me feel much better that it seems like the Cardinals did the same thing with Wainwright that the Pirates did. Wainwright has been pitching with a sore elbow for a couple starts now but stayed with it until he racked up his 20^th win. The Cards are shutting him down now, but has the damage been done? Wainwright is one of the most valuable assets the Cardinals have, and given his performance this year, he'll be getting a lot of votes for the Cy Young again. Protecting him is a lot more important than any round number. I can only hope that the tightness in the clubhouse didn't lead to some bad decisions for the long term.

Evan Longoria (strained quad)
Longoria's injury is not the infamous cephalorectal impaction, as many were making it out to be after he and David Price vocalized the frustration over crowd size in St. Petersburg. The fire sale is coming, and yes I know the Rays have a plan, and yes I know they're smart guys with a deep farm system, but don't be a bit surprised when you start hearing comparisons to Wayne Huizenga's Marlins this offseason. Longoria's best shot at a World Series is this year, before Carl Crawford, Carlos Pena, and several others hit the road north. Longoria has a slight strain of his quad, but with the team in a tight race for the division, they haven't had a chance to rest him the way some of the clinched teams have. The medical staff is monitoring Longoria closely, but it's just one bad step or one lunge away from turning into a situation that would be much, much worse. Expect them to be careful with him and shut him down if possible over the next few days.

Brandon Webb (strained shoulder, ERD 10/4)
The Diamondbacks finally threw in the towel on Webb's season. Since spring training, Webb has been an exercise in frustration with each successive return date pushed back and pushed back. Webb won't pitch at all in 2010 and will force tough decisions by several teams as he enters free agency. Webb is hoping to sign some kind of Ben Sheets deal, but given two missed seasons and no sign that he can return, it's more likely that he'll get an incentive-laden deal with a big option, Jon Lieber-style. Some were surprised that the D'backs would allow Webb to go to their instructional league camp, but remember, players are under contract until after the World Series when they have can file for free-agency as appropriate. The team has a lot invested in him, so they're going to take every chance to see him and make a determination about next year. For Webb, it will be very interesting to see how he plays this. He'd be smart to go to a team that has a solid reputation for rehabbing pitchers, but the issue is that he's coming from a team like that, where athletic trainer Ken Crenshaw is among the best. I'm not sure if St. Louis, the White Sox, or Tampa Bay will have interest, but keep your eye on Cincinnati. 

Quick Cuts: If we were doing a Dick Martin Award this year, the three finalists would be the Yankees, White Sox, and Rays. ... Jimmy Rollins left yesterday's game after five innings. It was unclear at deadline if this was a planned move or a re-injury. … Tommy Hanson is a monster. If you watched his Monday start, you saw him pitch with a broken callus. Blood won't help you throw a spitball, but it will help start a legend. ... Jamie Moyer has avoided Tommy John surgery and is throwing well in rehab. He hasn't ruled out a return for the playoffs, though it's considered a massive longshot. One source told me it would take an injury to a pitcher during the playoffs to get him serious consideration. ... The Rangers will likely be without Frankie Francisco for at least the first round of the playoffs, but he will continue to work toward a return. They will activate Mark Lowe, the forgotten "throw in" in the Cliff Lee deal, to see if he could help out of the bullpen. ... Dan Hudson will be shut down with a finger injury. It's minor but is as good an excuse to shut him down as any. ... Alex Rios fouled one off his kneecap and was left with a nasty bruise. He won't be rushed back. ... Carlos Beltran left Sunday's game with knee pain. I've been stunned with how well he's done and how much he's played, but that knee is going to be an issue for the rest of his career. ... It was scary looking as Cameron Maybin left the field on a cart, but the Marlins say it's only a lower back strain. They're not ruling out a return this weekend, though that seems unnecessary. ... Mat Gamel will have toe surgery, ending his season. He could be in the mix to replace Prince Fielder at first base if the Brewers decide to trade away the big slugger. ... Jarrod Saltalamacchia heads to Cleveland, following Kevin Youkilis there for thumb surgery. The injuries weren't identical but were similar in mechanism. ... Some UTK quick facts: First person in it: Mike Lieberthal. Most often? Mark Prior, which shouldn't surprise anyone that remembers the DMPU. Second most? Moises Alou, who probably feels cheated. There's a justice that it's two Cubs. ... Two million words later, I tip my cap one last time to the people that made this possible: my sources. I'll never name you, but you were the real "powered by."