Harper, Strasburg Injuries Put Nationals Medical Staff Back in Spotlight

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Harper, Strasburg Injuries Put Nationals Medical Staff Back in Spotlight
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It wasn't a good weekend for the Washington Nationals. The team finally had to place Bryce Harper on the DL (according to the Washington Post) after his knee simply wasn't ready to get back on the field, while pitcher Stephen Strasburg left his last start after just two innings with a back strain. Those two high-profile injuries for what was thought to be a playoff favorite have put Lee Kuntz and the Nationals medical staff right back in the spotlight.

Harper was placed on the disabled list with a retro move that will allow him to come back in just over a week. His knee bursitis (according to the Washington Times) was causing pain and tenderness, which could have led to gait or other mechanical changes, putting him in more danger for knee problems. The Nats continue to say that there is no internal or structural issues with the knee.

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For his part, Harper believes that it was a collision with a wall that caused problems, but not the one we've been looking at. Harper pointed to a previous collision a month ago at Turner Field. Since that point, Harper has hit under .200.

That raises the point that someone, whether an AT or a coach, should have pointed that out. The likely response on most teams is to ask the player, and Harper admitted that he downplayed the injury. This has to be taken in contrast to Stephen Strasburg's treatment last season and even this season. With Strasburg, the slightest malady leads to the most conservative possible response. I'm sure Strasburg wanted to keep pitching last year and likely would with his lat strain this year. 

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Strasburg's lat strain is very minor (according to the Washington Post), a Grade I strain near the lowest point of the muscle, where it abuts several smaller muscles, including the core/obliques. While the strain is minor and common among pitchers, as noted in the Washington Post article, it appears unlikely the pitcher will make his next start, scheduled for Thursday, and could well end up on the DL as well. 

The difference between Harper and Strasburg—really between the treatment of hitters and pitchers—is of course philosophical. Hitters are celebrated for being gritty and playing through pain, while pitchers are on enforced pitch and innings limits, with the slightest injury sending them to the bench. The unusual pitchers like Justin Verlander, CC Sabathia and Yu Darvish that are consistently durable are celebrated (and very well paid), but no one seems to think that this kind of result is learned.

Harper and Strasburg are just the latest in a long line of medical issues for the Nats. At some point for a medical staff, results have to count. In the five years prior, the Nationals have ranked no better than 23rd (out of 30) in any single year in terms of days and dollars lost to the DL. If ranked for the entire five-year period, there is no team that has lost more to injuries than the Nationals. 

There is some sign that they are improving. Thus far in 2013 and prior to the DL move with Harper, the Nats were ranked fifth in terms of loss. Since injuries tend to be slightly front-loaded, it would take an avalanche of injuries to bring the Nats back to their more normal position at the lower part of the list.

Injury loss does seem to be a leading indicator for wins. Though the Nats have certainly had their share of on-field success during these last few years, it's clear that even being average in injury loss would give the talent they have more of a chance to shine. 

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It remains to be seen how well Lee Kuntz and his staff will handle the injuries to their top two stars, but with Jayson Werth returning as well, the team will have no excuse for not helping return players ahead of schedule. Harper, for instance, has already had a month of healing prior to the DL, while Strasburg's is considered minor. While not all injuries are preventable, some of them are, and even those that are not can have the lost time reduced by a good staff

I said in this year's Team Health Report for the Nationals that if Kuntz could get the team to the mid-teens in terms of injury loss, then the Nats would run away with the division. They haven't done that yet, but that may only make the situation even more key to their hopes. If they can't keep their players off the DL, the team will be faced with some very difficult decisions going forward. 

Injury stats are from a proprietary injury database. All baseball stats courtesy Baseball-Reference.

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