Under the Knife: Injury Risk Keys Draft, Plus Harper, Strasburg, Kemp and More

Will Carroll@injuryexpertSports Injuries Lead WriterJune 4, 2013

Under the Knife: Injury Risk Keys Draft, Plus Harper, Strasburg, Kemp and More

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    Stephen Strasburg and Bryce Harper were drafted not so long ago, but the health questions they face now were also brought up at that draft. People seem to be putting more importance on the draft since players do seem to be coming up more quickly. There are five already in the big leagues from last year's draft.

    That makes assessing future health as much a key as assessing any other skill—and yes, health is a skill. 

    The downside is that there's no real way to capture this information. Scouts are left guessing at biomechanics, talking to coaches and travel teams to dig up any injury history and hoping that there's nothing that was missed. They do a great job, but not having a combine process, the way every other professional league does, leaves them at a disadvantage.

    There are always tales about pre-draft workouts, how a team fell in love with a player over one workout, but ignored an injury history.

    We'll likely see players fall some due to injury, but looking back over the past few drafts, it's clear that injuries should be at or near the top of the list. Players fail on injury much more often than they fail on talent, especially for pitchers. At best, there are lost years or delays, not to mention how much a pitcher leaves on the table after a significant injury or surgery.

    Risky players can be successful; no one is going to knock the White Sox for drafting Chris Sale, even if his career ended today. He made the majors and he won games, which is the definition of success for the scouts.

    This weekend, we'll see more players taken and a lot of talented, risky ones in the bunch as well. Taking risks is part of how teams win, but taking smart risks and understanding those risks is how teams win consistently.

Matt Kemp (Hamstring)

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    This is just the latest in a series of injuries for Matt Kemp. The question now is whether this can be fixed with time and treatment or whether he's taking talent off the top, talent that will never come back.

    Kemp's hitting has little or nothing to do with this hamstring injury, but by taking the 15 days or so that the Grade I strain will cost, the Dodgers medical staff can work on the other things, including the shoulder that is still recovering from offseason surgery. 

    The Dodgers should have an advantage here. All of Kemp's issues are movement-based and Sue Falsone, the head athletic trainer, is one of the country's top experts on human movement.

    Getting Kemp back to where he was prior to the shoulder injury is key to the Dodgers offense, which would make me think that Falsone should be focused on this above and beyond any other tasks.

    The downside is that this team is doing exactly the opposite, loading up more players both on and off the DL, that require the time and attention of the medical staff. Carl Crawford hit the DL on Monday, per the LA Times, with a hamstring strain of his own, bringing the injuries into the double digits.

    More ATs would be a good start, but there's no team in the league that has a third full-time AT on staff, though several have S&C guys who are also ATs. We'll see if the Dodgers decide to spend some of their billions on things that will help, or just things that make headlines.

Hanley Ramirez (Hamstring)

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    If there's an upside to Hanley Ramirez's season, one so far defined by two traumatic injuries, it's that he's returned quickly from both.

    Cold comfort, I know, but it's something and indicative of how raw DL numbers really don't tell us the whole story about a medical staff or a team's overall health.

    Ramirez has made good progress through the weekend on a rehab assignment and a final decision is going to be made on Tuesday. The expectation is that Ramirez will come off the DL and start for the Dodgers on Tuesday, though there's a number of permutations.

    With so much going on with the roster—a couple DL moves, the Yasiel Puig call-up and more—Ramirez could come up as "just a bat" and not go straight to the starting lineup. 

    The Dodgers are better with Ramirez in the lineup, but they'll have to look at their roster and their future to figure out how to best use Ramirez. A shift to third could be in the offing, though the preference of Ramirez and the team would be to keep him at shortstop as long as possible. 

    Keeping Ramirez healthy is going to be a task. While the thumb and hamstring have healed up, some players begin to break down, one part after another. If both Kemp and Ramirez are in that pattern, the Dodgers are in real trouble with almost no Plan B. 

Stephen Strasburg (Back)/Bryce Harper (Knee)

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    I wrote about both Stephen Strasburg and Bryce Harper yesterday, but let me fill in some information more specific to the injuries and about how the Nationals medical staff is dealing with them. 

    Both injuries are very minor. Not trivial, but minor. Strasburg's lat strain is both in a good location and a mild (Grade I) strain. Harper's knee bursitis is painful, but it's easily resolved with rest.

    The way both have been handled is indicative of the Nats' normal conservatism.

    We saw this more last season. The way Harper tried to play through it is much more indicative of his "rub some dirt on it" attitude. The Nats will never say publicly that Harper hid the injury or at the very least downplayed it, but it's very likely the case.

    The way it's been handled might make Harper a bit more open in the future, which would be a huge positive. 

    For Strasburg, things are a bit less clear. The lat strain is very low on the muscle, so it's easy to see why early reports had it as an oblique strain. The Nats want to protect Strasburg against any sort of changes to his mechanics, something that often happens when there's a new weak link in the kinetic chain. 

    The injury itself is a bit odd. Most lat strains come higher and tend to be when the kinetic chain has broken down, as it did with late-period Ben Sheets. We've also seen it post-shoulder injuries in several pitchers, so it bears watching to see if Strasburg has any mechanical issues in the near term. 

Ian Kinsler (Ribs)

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    There's no way to spin any sort of delay as a positive for Ian Kinsler or for the Rangers. Another two weeks off isn't unexpected given this type of injury. With Jurickson Profar getting either an extended audition or a pre-trade showcase, depending on your perspective, there is an upside here. 

    The original early June date wasn't likely anyway, due to it being an aggressive timeline and the fact that Kinsler hadn't started up any baseball activities. The finding of a further stress reaction in the ribs seems more like confirmation that Kinsler wasn't healing up quite enough more than a new finding. 

    Watch to see when Kinsler begins those activities, especially throwing and hitting. Those have the kind of rotational movements that will most test the ribs, at least until he gets into the diving that is necessary at his defensive position and on the basepaths.

    With Adrian Beltre and Jeff Baker a bit banged up as well, the Rangers' depth is a bit stretched, but not overly so. Kinsler's return now is shifted back to at least mid-June, but unless those activities start right away, the end of the month is much more likely.

Chris Carpenter (Shoulder)

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    Is it possible? Can Chris Carpenter come back and actually do more than he was able to last season, even after the Cardinals and Carpenter essentially wrote off the season? It's appearing more and more likely.

    Carpenter made it through another session of throwing to live batters, according to the St. Louis Post-Dispatch, and teammates said he had good stuff. Moreover, he's holding his stuff between sessions, rather than deteriorating as so often happens. That means his shoulder is dealing with the rest and recovering to at least some point.

    There's caution here. Carpenter is only throwing 20-30 pitches in these sessions, a long way from the starter's load the Cardinals say they're prepping him for.

    The Cards don't really need an ace. What they need is someone who can take some innings off the young arms at the back of their rotation, Shelby Miller and Michael Wacha. 

    Carpenter is likely to have one or two more simulated games or live batting practice sessions before heading out on a rehab assignment. Look for his pitch count to go up. Or, we might see the Cardinals do something aggressive, like pairing Carpenter with one of the younger pitchers.

    With that plan, the team would essentially have two starters—the younger, likely Miller, going five innings and Carpenter coming in as a tandem. He would have a known starting point, allowing him to warm up normally.

    There is a cost to this. The insurance on Carpenter's arm likely has a standard elimination period of 90 days. Essentially, the Cards would be giving up collecting on that policy if he comes back before the very end of June. We'll see how it all plays out over the next couple weeks.

Austin Jackson (Hamstring)

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    Things are accelerating for Austin Jackson. The speedy center fielder is going to start baseball activities on Tuesday, though he's already been doing some light running in his rehab program. If things go well, he'll be on a rehab assignment quickly.

    There's some downside here, as the light running has caused some soreness. Jackson doesn't seem 100 percent, though it's hard to think conditioning is the biggest issue.

    It almost has to be that there's still some residual soreness in the hamstring itself. That would indicate he's either pushing it—hard to believe with Kevin Rand watching closely—or there's something more keeping the muscle tight.

    This one is very worrisome at this stage. Jackson is a speed player to be sure, but he's not entirely reliant on his speed the way a player like Juan Pierre or Billy Hamilton is. I'd expect the Tigers to be very conservative as he returns, perhaps so much that he DH's a bit or gets extra time off.

    At the very least, he's not going to be stealing bases early. Watch to see any indication that he can run well during the upcoming rehab.

Brandon Phillips (Forearm)

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    Brandon Phillips took a very nasty pitch off his forearm. The fact that a player like Phillips, known throughout the game as a "gamer" who will play through pain, is telling the media that "I can't even squeeze my hand" is very telling.

    (It's also telling how John Fay, one of the best beat writers around, gets players to give up information like that!) 

    Phillips' injury is nothing more than a bruise, but it's a painful one. At this stage, he's got to just wait for the pain and inflammation to clear. I'm sure he'll be looking into some sort of padding for his forearm so that the area is protected going forward. 

    The downside here is the grip strength, which indicates that the inflammation is pressing on a nerve. While Dusty Baker thinks Phillips will only miss a few more days, nerves work on their own timelines and can often go beyond the expected timeline. The Reds medical staff will be working on this one hard.

    Once Phillips is back, there should be no real concerns of setback. Phillips will have to have full use of the hand before his return. The DL remains a possibility, but a slim one.

    Phillips is a bit lucky. All you have to do is look at the picture above to note how similar this was to Curtis Granderson's situations.

Josh Johnson (Triceps)

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    The Blue Jays are getting used to bad news on pitchers, including the heartbreaking video from Ramon Ortiz over the weekend. The team keeps its position players healthier than average, but for the last decade (and maybe more), they simply can't keep pitchers healthy.

    Josh Johnson is a lone spot of good news, in that he's ready to return, according to the Blue Jays' official Twitter. Johnson replaces Ortiz on the roster and will get the Tuesday start. He's been out since late April due to the triceps strain. He did well in rehab starts but struggled with both stamina and command through the process. 

    Scott Miller of CBS had the details on his upper-level rehab start, which was just another lesson on ignoring the stats of rehab starts. The focus is always getting in the work and getting through a pitch count rather than trivial matters like hits and runs. 

    Johnson will likely be on a pitch limit, but the Jays are going to have to keep Johnson healthy somehow if they hope to get back in the AL East race. As I stated back in March, Johnson's health was the linchpin to this team. 

    Rays fans should take note, since David Price is dealing with a similar injury.

Asdrubal Cabrera (Quad)

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    The Indians wasted no time in pushing Asdrubal Cabrera to the DL after he injured his quad on Monday:

    Indians place SS Asdrubal Cabrera on 15-day DL (right quad strain); Recall INF Juan Diaz from Triple-A Columbus

    — Cleveland Indians (@Indians) June 4, 2013

    Cabrera's strained quad is thought to be a moderate (Grade II) strain that will keep him out at or near the 15-day minimum. Paul Hoynes has the painful details in his Cleveland Plain Dealer piece on Monday's game. 

    Cabrera's rehab should be relatively straightforward. A quad strain is easier to deal with than a hamstring strain due to the normal strength differential, but quad strains do have a tendency to be bigger and more painful.

    Look for when Cabrera is able to run again for an indication of when he is ready to return.

Travis d'Arnaud (Foot)

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    People seem very confused by the recent news on Travis d'Arnaud. It's as confusing as that lowercase "D" in his name. I'll try to sort it out.

    Travis d'Arnaud was cleared to begin more activities, but he told the media that he would continue to wear the walking boot for the near-term as a protection. It's really as simple as that. He'll will wear the boot when he's not doing things that necessitate taking the boot off. That's smart, but people seem confused by it.

    It's not a setback and the foot isn't more susceptible to injury. He doesn't necessarily need the boot, but he feels more comfortable with it right now. I'm sure the Mets feel good about that and I'd like to see more players be proactive about things like this.

    The progress is good and has d'Arnaud on track to be back in baseball activities by the end of June. If he can meet that and get back in July, he still has a chance to get a September look in New York.