Under the Knife: Latest News on Key MLB Injuries

Will Carroll@injuryexpertSports Injuries Lead WriterMarch 19, 2013

Under the Knife: Latest News on Key MLB Injuries

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    The World Baseball Classic has come and mostly gone, leaving us a sparsely attended but passionately watched Caribbean final that should be a boon for Puerto Rico or the Dominican Republic.

    I'll leave it for others to debate why the power teams of the USA and Venezuela went out so quickly, instead focusing on the lack of injuries. In fact, there's only one of any note, though there have been some minor injuries here and there, but nothing that doesn't happen at normal spring training. 

    The pitch limits have been especially controversial, almost becoming a part of the tactics. Some teams appeared willing to take more pitches, knowing that there were only so many any particular pitcher had in him. But where did these pitch-count restrictions come from and are they effective?

    The fact is, no one seems to have any basis for the numbers, though they appear to have served their purpose. As the game moves towards the regular season, we have to wonder why these same sorts of tactics don't work in reducing injuries.

    Will Leitch does a great job looking at how much we don't know about pitching in this article at New York, but misses the broader point. No one, aside from "some guy with a website" is looking into this. Did the Nationals commission a study that would show the exact forces of the so-called Inverted W? No, they looked at film and correlated to injury. 

    If I told you that the new car you bought had half the horsepower and got half the mileage you were told at the dealer, what would you do? I'd get it to a mechanic who would likely put it on a dynamometer. Sure, you could just drive the car and say "wow, this doesn't feel right" but I'd be very worried about driving a car in that condition. That's basically what teams are doing all the time.

    Brett Marshall, the pitcher Leitch uses as his example in the article, had Tommy John surgery, but the Yankees have never thought enough of the process to find out exactly what forces Marshall's easy motion is generating. Were the changes he says he made post-surgery positive ones or is he headed back for another elbow ligament inevitably?

    Brandon Sisk, Casey Kelly and others have added their names to the list of prospects that will miss a year of their careers rehabbing rather than competing. We'll have more, I'm sure, and even bigger names.

    At what point does a team throw everything aside and say "We've got to figure this out?" If there are any owners out there that want to save a couple million dollars this year, you know how to find me.

    Powered by the Promus exuding stent, on to the injuries:

David Wright (CORE)

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    INJURY: core strain


    David Wright finally got a nickname so something decent came from the World Baseball Classic. "Captain America" was the clear leader of the team and got the early respect of Joe Torre. That's something. Unfortunately, he also suffered a core strain just as the team was headed into its most important games, tarnishing slightly the big jump in public perception. 

    The injury was originally diagnosed as a back spasm, which gives us big clues about the location. The intracostal strain is towards the back, but by definition inside the rib cage. It is not a significant strain, but any core strain like this has a significant re-injury risk and the Mets are being careful.

    ESPN reported that Wright has had a cortisone injection, which is not unheard of for this in 2013, but it is much more likely that he had some kind of directed and targeted injection of a substance besides cortisone. ("Cortisone injection" has become something of a generic term these days, which can mean anything from another anti-inflammatory to PRP.) 

    Wright is likely to miss around two weeks before re-starting things, which puts his recovery right on the cusp of being ready for Opening Day. The Mets will be cautious, but not overly cautious with this injury in hopes of having Wright on the field to give their fans one less thing to complain about heading into what could be a very long season in Flushing. Expect Wright to get extra rest once he's back. 

    Since we can't be sure exactly when Wright will be back, I'm leaving the ERD open for now. If he misses Opening Day, the Mets will likely put him on the DL and go full conservative. 

Chase Headley (THUMB)

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    INJURY: fractured thumb

    ERD: May 3

    Chase Headley had a breakout 2012. His 2013 starts with a break—a fracture, to be precise. Headley jammed his thumb on Sunday and images Monday confirmed the worst. The location of the fracture is key and said to be at or near the tip, away from the base of the thumb.

    That type of fracture tends to heal more cleanly. The final determination hasn't been made as I publish whether he will need surgery, but this type of injury seldom needs pinned.

    He'll miss about a month while the bone heals, but how fast he gets back to normal goes beyond the normal seven to 10 days of rehab time in the minors. A thumb is key to grip strength and bat control, two things that a player like Headley relies on. The key to look for once he starts hitting is swing-and-miss. Bat control allows a hitter to make those fine adjustments as he tracks the ball. 

    For that kind of tell, we look to contact rate, which surprisingly went down for Headley last season. He went from an 80 percent rate down to fractions under 75. A dip significantly below that is tough to see in small sample sizes, so you'll actually have to watch Headley to see if he's just missing. In the minors, just strikeouts are a decent tell. 

    The Padres have a number of options at third but will most likely shift one of their second basemen, likely natural third baseman Jedd Gyorko, over to third to fill in. The Pads' lack of power will be magnified by either of those moves. 

Mark Teixeira (WRIST)

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    INJURY: strained tendon sheath, wrist

    ERD: May 15


    That's what I considered doing in writing about Mark Teixeira this week. I wrote about him last week and despite a bit of panic in Yankeeville, nothing has really changed. Teixeira is still on track for a May return, but his worry level has made me think things will go slightly longer, pushing the ERD back to mid-May rather than the start of the month. 

    It sounds like people around Teixeira have really gotten into his head, warning him against coming back too soon. It's that, much more than the injury, that is shifting this story and the timeline. Teixeira still has a partially torn tendon sheath, which at this point does not require surgery.

    If Teixeira had a fully torn sheath, surgery would be almost automatic. If he had any tendon damage in addition to a partial sheath tear, surgery would also be near-automatic. But those aren't what he has and people keep seeming to overlook this important fact.

    This is a serious injury and yes, Teixeira and those around him are smart to not push him back early. The Yankees were never moving towards that, at least not publicly. This is simply one where the sheer amount of noise that surrounds anything Yankees did not translate into signal.

    Worry is smart here, just as it would be for any hitter with an anatomical wrist problem, but panic isn't warranted.

Zack Greinke (ELBOW)

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    INJURY: strained elbow

    ERD: No Missed Time (NMT)

    Zack Greinke didn't mess around. After missing time due to inflammation in the back of his elbow and treatment that included PRP injections, he was back to throwing last Friday. He's throwing both on flat ground and a mound, though the mound work is done at "touch and feel" velocity. 

    The next step will to get back in a game, which should happen on Wednesday. The Dodgers aren't sure if that will be in the day's major league action or at the minor league complex where he could be managed more closely.

    Don't expect him to go very far in the game, maxing out around 50 pitches and typically unconcerned about the results. The key here is to get Greinke on the mound, throwing his normal stuff to real hitters and having his elbow recover without further damage. 

    Recovery is the major concern now with a secondary worry about stamina. It's going to be tough to get Greinke ready to go in full by Opening Day, but I've never understood the focus on being able to go deep into a game. If Greinke could throw a solid 75 pitches by his next start, wouldn't that be better than the alternative?

    Right now, the Dodgers are aiming towards having Greinke miss maybe one start or slotting in at the back of the rotation. It hurts his value slightly, but I'm not moving him down my draft board much.

Roy Halladay (SHOULDER)

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    INJURY: post-strain, shoulder

    ERD: NMT

    The Phillies have Chase Utley and Ryan Howard healthy through camp, giving the medical staff and the fanbase plenty of time to worry about Roy Halladay. At age 35, Halladay could be going through the inevitable decline, but the loss of velocity he showed last year has accelerated through spring training. The machine could be breaking down.

    People I have spoken with continue to insist that Halladay is not injured. What they are worried about is his inability to adjust. Halladay has always been an efficient pitching machine during his peak-phase, pounding the strike zone and forcing batters to hit his pitches, all sequenced masterfully.

    That kind of thing should work even with a slight loss of velocity, but it's not for Halladay and he seems lost in making any sort of stylistic or mechanical adjustment.

    That latter may be tougher than most think. Halladay's sidearm style is reliant on the proper sequence of mechanical events happening, from his stride to his hip turn and on up, something that he's been doing for better than a decade. Just as it took him nearly a full season to rebuild himself in the minors, changing from that style is going to take a lot of work. 

    One other factor that a scout suggested to me last weekend that might be in play is Halladay's long friendship with Chris Carpenter. Carpenter's shoulder injury has seemingly ended his career and the scout suggested that baseball mortality has gotten inside Halladay's head a bit. That's impossible to know for anyone who's not Roy Halladay, but it's worth considering.

    Halladay only lasted one inning in his last start due to illness, but he should have at least one and maybe two starts for him to show that he's on the right track. Look for any bump in velocity as well as the catcher's glove movement. When Halladay is right, the catcher barely has to move. 

Pablo Sandoval (ELBOW)

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    INJURY: irritated nerve, elbow

    ERD: NMT

    While everyone seems focused on Pablo Sandoval's weight, I'm much more interested in his health. The Panda just doesn't seem to be able to stay healthy for any long period of time. His latest problem, an irritated ulnar nerve (funny bone), is one that is unusual absent Tommy John surgery (it's the same type of thing that Carl Crawford is dealing with currently). 

    The condition is causing him problems both on throws and when batting left-handed, so a couple days off with treatment is expected to get him back in plenty of time for Opening Day. That said, this kind of nerve irritation has a tendency to recur, meaning that even if Sandoval goes for a week or so without problem, he's still quite risky for about a month.

    If he can play—and the current assumption is that he'll only miss time in spring training—then don't expect any big changes in his production. The worry is far more that he won't be able to play while the Giants medical staff tries to find a way to get the nerve calmed down than he'll have any deficits once he's back. 

    Weight issues or not, the Giants need to figure out and soon whether Sandoval is ever going to stay healthy. He's certainly been good enough and healthy at the right times to add the weight of two World Series rings, but long term, the team is going to have a very tough decision to make about this popular player. 

Jered Weaver (SHOULDER)

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    INJURY: "dead arm"/tired shoulder

    ERD: NMT

    The phrase "dead arm" sounds a lot worse than it is. The best explanation that I've heard is that a pitcher's muscles are tired, but that the ligaments and other structures remain sound. The feeling is not unlike that after a hard workout, which makes sense, and is seldom an issue of recovery or stamina. It's merely the body signaling that it needs a bit of extra rest.

    That's what the Angels will do with Jered Weaver over the next few days as he deals with what he says an annual rite for him. "A little worse than normal" isn't going to be comforting to Angels fans, but Weaver has come back from this before and no one seems overly concerned this time.

    The Angels have a solid rotation, but it lacks depth. Missing Weaver, who is now the clear ace of the staff, for any period of time or even having him off peak is going to be a major issue for a team trying to right itself and show that Jerry Dipoto knows how to do more than just spend money.

    Watch for Weaver's next start out to show a bit more feel and a normal recovery. His Opening Day doesn't seem in jeopardy at this point, but he will have to prove to Mike Scioscia that he's ready to go and doesn't need to be skipped the first time through the rotation.

Lance Lynn (WEIGHT)

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    INJURY: none

    ERD: NMT

    As someone who's trying to drop a few pounds myself, I've been watching Lance Lynn even closer than normal this spring. It's hard to isolate on any one factor when a pitcher has issues, especially in the spring, but Lynn's massive makeover is getting all the attention as he struggles through the spring.

    Maybe it shouldn't. Lynn hit a wall about August of last season, at precisely the point you'd expect from innings-increase theory. (Yes, that theory has been largely debunked by Russell Carleton, but even Russell would agree with the idea that the underlying principle, fatigue management, is still in effect. We were just using the wrong measures to do so.)

    Given that performance, it's not unusual to see an extended downturn in a pitcher even after a rest that one would expect to rectify the issue. Pitchers coming off a big increase have many times shown a downturn in the following season.

    Derrick Goold breaks down some of the issues that Lynn is dealing with this spring, but the one that stands out to me is the flexibility issues. We know that even minor changes in mechanics can lead to huge issues, so this does worry me beyond the inconsistent delivery and results. Of course, the Cardinals don't know what any of these changes actually mean since they have no biomechanical results from either the old or new delivery. 

    Watch for two things over Lynn's last two starts. The first is a consistent release point, which is much easier to tell in a PitchF/X ballpark. The second is a consistent stride length, which is a bit easier to see with video. Watch to see if he's stepping in the same spot, pitch after pitch.

Sergio Santos (SHOULDER)/Casey Janssen (SHOULDER)

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    INJURY: post-surgical shoulders

    ERD: NMT

    The Blue Jays' closer situation will be decided not by performance or John Gibbons' preference, but by health. Right now, he has two candidates coming back from shoulder surgery and whichever one is the healthiest just before Opening Day is going to get the job and the save chances.

    Casey Janssen finally got into a game this week, though it was a Triple-A game. He got four outs in just 16 pitches, a very good sign, but won't go again until late this week. He's not up for back-to-back days and probably won't be by the start of the season, though he is making progress.

    There is a question over whether Janssen would start the season on the DL if he's unable to close. That will depend entirely on Gibbons' comfort with using him. 

    Sergio Santos is a bit ahead, making him the favorite for the saves for now. Like Janssen, Santos isn't pitching back-to-back days yet, but is expected to do so next week. If he passes that final test, Santos will be the closer after missing almost all of 2012.

    He's looked good, even dominant, in his action so far this spring, but he remains risky due to the shoulder problem and his background. Santos just hasn't been pitching very long and has no track record for staying healthy. He is the more sure pick for saves if you're expecting the Jays to rack them up in the AL East. 

Stephen Strasburg (ELBOW)

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    INJURY: none

    ERD: NMT

    Stephen Strasburg is healthy.

    Now that the panic that I'm writing him up in UTK is gone, we can discuss this whole idea of him being a "workhorse" and pitching deep into games. It's a nice concept, but the wrong one. What the Nationals need to be focused on is not some arbitrary number, but a scientific concept. They need to manage Strasburg's fatigue level. 

    But if we try to define the modern usage of "workhorse," we're left grasping at vapor. There were just a handful of pitchers that hit 220 innings and less than 20 that went over 200. That's a product of the five-man strict rotation in use by every team, one that limits even the best and healthiest pitchers to 32 or 33 starts.

    At an average of seven innings a start—and ignoring pitch count altogether—that maxes out at 231 innings. Averaging just an inning less over those same starts drops a pitcher below the magic 200 inning mark. 

    Again, we have to ask if these definitions mean anything. If Strasburg were given a hard limit of 100 pitches per game, could he still be a workhorse? Maybe Roy Halladay isn't the best comp right now given his issues, but the Nats would take peak-level Halladay, who had an amazing pitch efficiency.

    A complete game under 100 pitches is possible and it took Halladay adjusting to his limits to make a feat like that happen. The same could be true for Strasburg, who has far and away better pure stuff. If Strasburg is wasting pitches, he's wasting opportunities.

    Forget workhorse and a bunch of other worthless concepts from baseball's past. Strasburg deserves to be a modern pitcher with all the advantages 2013 can offer him. Defining Strasburg by any single term, stat or limit is just a disservice to him. 

The Dots

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    Albert Pujols has pushed back playing in the field a couple times already, but the Angels expect him to finally do so on Tuesday. His knee is being brought along very slowly, though there's not yet any real concern that he will not be ready for Opening Day ... Brian McCann is doing well with the bat, but the throws? That's the real question outside of interleague play. Expect McCann back on a part-time basis in mid-April ... Aramis Ramirez made it back into the Brewers lineup after missing two weeks with a sprained knee. He should have plenty of time to get his swing and glove right. I hope to see him on Opening Day ... Stephen Drew is headed to Pittsburgh to check in with concussion specialists. His symptoms have made almost no progress since suffering his a couple weeks ago. The start of his season and much more are in danger ...  Chris Perez has proven his shoulder is back from the early spring issues enough to have Terry Francona's confidence. He'll get the saves as expected but remains a trade option for the Indians ... Avisail Garcia's heel bruise is painful, but not serious. It shouldn't take long for him to get back on the field after a couple days in a walking boot. It does offer the team the chance to fix some of its early roster issues by starting him on the DL ... Just me, or are a lot of pitchers being hit by comebackers this season? None are serious and none have been high, but it does point to a need for a better solution to this issue. Pitchers' head protection has been slow, but no one is talking about light padding, like a soccer shinguard, to protect their legs. The latest have been high-value targets like Ian Kennedy and Clayton Kershaw ... Shin-Soo Choo missed some time with back spasms. It's worrisome given his history, but the Reds have a very nice backup plan in Billy Hamilton. Wait, not yet. It will be Chris Heisey through at least the first half. Choo should be back shortly and has had a great spring, aside from his inevitable health issues ... Matt Garza is still working his arm up to long toss, meaning his April is likely done before we even get through March. The Cubs can be patient, knowing that a healthy Garza is going to be a trade chip if he's healthy by June ... Brett Anderson had nothing more than normal soreness after his weekend outing, so we can put the strained trapezius behind him. He should be ready to go for Opening Day if he has no further setbacks ...The Mets will push Daniel Murphy to the DL if he's not ready to play by the weekend. It seems an odd and arbitrary deadline, especially considering that they'll wait longer for David Wright. Jordany Valdespin's status seems to be rising ... For years, I've hoped that the Twins would protect Joe Mauer's legs with a platoon partner and a shift either to the field or DH on a part-time basis. Instead, the Twins will back him with two guys who couldn't crack the Pirates lineup in Ryan Doumit and Jeff Clement. Mauer's apparently on his own ... The Twins believe Scott Diamond is making good progress but think he'll need to start the season on the DL. The team is targeting April 12 for his first start ... I do want to take another opportunity to thank everyone at Bleacher Report for their support during these past two weeks. I can't tell you how excited I am to be here at a place with great resources and even better people so that UTK can go to the next level.


    All quotes in this article were obtained first-hand unless otherwise noted.

    Will Carroll has been writing about sports injuries for 12 years. His work has appeared at SI.com, ESPN.com and is a member of the BBWAA.