Under the Knife: Latest MLB Injury Updates

Will Carroll@injuryexpertSports Injuries Lead WriterJuly 2, 2013

Under the Knife: Latest MLB Injury Updates

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    The halfway point of the season is a good time to look back and look forward. I did the latter with yesterday's look at the comebacks that should have the greatest effect on races in the second half. Today, we'll take our normal UTK look around the league at the injuries.

    Behind the scenes, I'm tracking all the injuries, as I've done for the last decade. The Injury Database isn't published—sorry, I'd love to, but HIPAA regulations make it a bit dangerous—but it's one of the tools I use to dig deeper than simple days and dollars. One of the tools that we've developed over the years is Injury Cost, a measure that allows us to assess the real loss of value to injury.

    Baseball's salary structure is such that pre-arbitration and pre-free-agent players are drastically undervalued. When a player like Giancarlo Stanton is out, the Marlins lose much more than his near-minimum salary. When a player like Alex Rodriguez is out, the true cost may be much less than his hefty contract calls for. Dollars are real and concerning to teams, but they're not a good way to measure which teams are "better" and "worse" at dealing with injuries. 

    This season, it should be no surprise who's leading and lagging when it comes to injury cost here at the halfway point. While it hasn't been reflected in their wins and losses, the Mariners have at least been able to keep their talent on the field. Rick Griffin and his staff have kept Felix Hernandez intact and amazing for the better part of a decade, a symbol of their effectiveness as a staff. At this point in the season, the Mariners are on a record pace for Injury Cost.

    Other teams at the low end of the scale are the Cardinals and Royals, two teams that are outperforming their projections. At the other end, it should be no surprise to see the Yankees and Dodgers, given how many times their players have graced UTK this year. The Blue Jays and Angels are also on the part of the list no medical staff wants to be, and their records reflect that cost as well.

    Injuries tend to be a leading indicator of success. Teams that have won the Dick Martin Award in the recent past (given to the top team in terms of injury management) include the Reds last year and the Pirates just a couple years back. We'll see who takes the trophy home at the end of the season, but for now, let's look at the injuries around the league.

Alex Rodriguez (Hip)

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    Now that Alex Rodriguez and Brian Cashman are back on the same page, things are progressing. Message discipline is always a tough thing, especially in the day and age we live in with social media ruling the day. Rodriguez is starting a rehab assignment at Single-A Charleston as the New York Post detailed, which is a bit of a surprise.

    Rodriguez has shown no real issues with his hip during his rehab or his work with the Yankees staff at the Tampa complex. While this is to be expected, it is a positive. Most of the players coming back from this type of hip labrum tear have had few problems in their returns, and Rodriguez is moving along exactly as expected.

    Rodriguez has shown no problems at the plate, while running and has shown good range in the field. One play I saw on video was Rodriguez charging a bunt and making an awkward, off-balance throw. That's the kind of thing that will tax the hip, and he showed no issues whatsoever. He'll need maintenance, of course, but so far he hasn't had anything that's more than the expectation.

    Moving him to Charleston and away from the Tampa complex is a bit unusual but could be done to get him to a smaller media market. With Derek Jeter acting as something of a buffer for Rodriguez over the past week, we'll have to see if this plan works out. 

    Rodriguez will have 20 days on the clock before he has to return, and with the All-Star break coming up in just about that time, it's an easy target for a return. Watch to see if Rodriguez has any issues with game action and how quickly he's able to get up to nine innings of work. Once he does that, the Bronx won't be far away. 

David Price (Triceps)

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    David Price is scheduled to return to the Rays rotation on Tuesday, as reported by many sources, including Fox Sports. While this injury went a bit longer than I expected at the outset, there's a number of factors that went into that and keep me from worrying too much about the Rays' ace.

    First, the Rays are notoriously conservative. Ron Porterfield and his staff usually err on the side of caution, and with depth like Jake Odorizzi and Chris Archer available, there was simply no reason to rush Price back from his strain.

    Second, they went a bit longer than normal with rehab starts. Even with the time out, most teams wouldn't have extended Price the way they did. With one good first start, many teams would have said, "Looks good to us!" and brought him back. The Rays resisted, which should pay off in the long term.

    Price showed no issues with performance or recovery in his rehab starts. He had normal velocity and control and made all his side work, showing that he was recovering well between starts. It's safe to put Price back in your lineup in all formats and to expect him to lock down the top of the Rays rotation for the second half. This type of injury is a bit unusual, but the conservative rehab should keep any lingering effects at bay as well as reducing recurrence risk. 

Evan Longoria (Foot)

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    Plantar fascitis is one of the most painful and least-understood injuries in sports. That long ligament at the bottom of the foot is often a problem and getting it to a point where it's tolerable is a tough test for any medical staff. The latest to struggle with it is Evan Longoria, as detailed by MLB.com.

    This isn't an injury that often just pops up. It's something that builds over time, with the player often not even realizing something's wrong until it's almost too late. A pain here, soreness there and the insidious march of pain and inflammation finally reaches a stage where the player realizes there's an issue. Of course, many athletes will try to push through the problem or even hide it from the team.

    It's normally an issue of maintenance, finding a way to get a player comfortable enough to be productive while finding a longer-term solution. Longoria was put into a walking boot to take pressure off it, and the team will likely use various therapies and likely put some sort of support into his shoes to help.

    Albert Pujols is probably the best comparable for Longoria. Pujols has played for years with the issue, only seeing it act up from time to time after lithotripsy early on in his baseball career. Many wonder whether Pujols' foot problems led to knee and back issues as a form of compensation. 

    Longoria plays on the very hard turf of Tropicana Field, so there's some additional complications for the Rays in keeping him healthy. While Longoria expects to be back this week, watch to see if the team tries to buy him rest over the next couple of weeks. The All-Star break might offer a chance to go for a more lasting therapy as well. 

Johnny Cueto (Shoulder)

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    There's nothing a medical staff hates like an immediate recurrence, but that's exactly what the Reds have with Johnny Cueto. Just a couple innings into his first start off the DL, Cueto re-strained the lat muscle that had sidelined him previously.

    In fact, Reds AT Paul Lessard says it's the identical injury in the identical spot, even admitting that letting Cueto come back after just 15 days was a mistake. Given the Reds are saying that Cueto won't throw at all for two weeks, it's likely that he will miss a month or even more. 

    Cueto's mechanics are in question, though his weight is also an issue. The same mechanics with an added mass can be problematic, and Cueto has gone from a listed 170 pounds to a listed 215, though he looks like he could be bigger than that. (David Wells was listed at 220 at the end of his career and...no.) Both his weight and the complex, twisting delivery he uses are going to have to be checked.

    It's the third time Cueto has been on the DL this season, a real worry for a team expected to contend in October. While Mat Latos has stepped up and become the team's true ace, Cueto is going to be necessary as a one-two punch if the team is going to get past the first round or even make it to the playoffs given the surge by the Pirates to take the NL Central. 

Trevor Cahill (Hip)

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    It's a bit surprising that it took a few starts after Trevor Cahill was hit by a comebacker before it put him on the DL, but if you follow along with how this went down, it makes sense. Ken Crenshaw is one of the top athletic trainers in the business and his work with pitchers over the last decade, both in Arizona and in his previous job with Tampa, show great results. Knowing how closely he watches pitchers and his understanding of the conjunction of mechanics and injuries, it's no surprise that he noticed some change in Cahill.

    Cahill was hit back on June 19th, a simple comebacker that we've seen time and again. (The video is available in the above link.) The team pulled him from that outing in the first inning as a precaution, but Cahill made his next two starts. It certainly explains his recent results.

    After his last start, Kirk Gibson told MLB.com that there was a change in Cahill's arm angle, which was likely an unconscious adjustment to having a sore hip. This is a smart move to make sure that the change doesn't cause further issue.

    This is the kind of smart, proactive pitcher management that has kept the Dbacks at the top of the standings and the injury rankings over the years. Cahill shouldn't miss much more than the minimum as they work to make sure his hip heals up and his mechanics get back to where they were. In the meantime, Tyler Skaggs is likely to get a couple starts in Cahill's place. 

Josh Willingham (Knee)

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    One of my favorite things to do is sneak down from the press box and sit in the scout seats. The guys are easy to find—not many people bring notebooks, binoculars and radar guns to the ball game—but their knowledge is unparalleled. They see the game a different way and if you can pick a few thoughts out of them, you'll learn a lot.

    Last season, I happened to catch a game in Milwaukee with Twig Little and Minnesota GM Terry Ryan, who is known as one of the best scouts around. They had an extended conversation during the game about Josh Willingham and why Ryan was so excited to have him on the team. While many thought Willingham was signed to be traded, it didn't sound like Ryan had any intention of doing that.

    Of course, news from Mike Berardino that Willingham is having an MRI on his knee might change the team's plans and quickly. They have young prospects that the team hopes will fill in down the line, but for right now, Willingham is one of their best offensive weapons and losing him for any period of time would be problematic for the struggling team. 

    MLB.com details that Willingham has been dealing with this condition for a while. He had a cortisone shot in mid-June, but the condition has deteriorated. The worry would be that there's cartilage or meniscus damage, something that could necessitate surgery and cost Willingham several weeks or even longer if there's extensive damage. 

    UPDATE: The Twins announced that Willingham has a torn meniscus.

    Willingham was diagnosed with a medial meniscus tear and bone bruise in his left knee #MNTwins

    — Rhett Bollinger (@RhettBollinger) July 2, 2013

Wandy Rodriguez (Elbow)

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    Wandy Rodriguez has had a fairly significant setback, leaving the Pirates in a position where they may need to go out and get another pitcher. That's essentially how Rodriguez ended up in a Pirates uniform, which should be a lesson that Neal Huntington and his staff ruminate on before going back to that well.

    Pirates president Frank Coonelly told a Pittsburgh radio station that Rodriguez will be shut down for two to three weeks. Via CBS's Dayn Perry, we also learned that Rodriguez had a PRP injection. I won't rant too much about this right now, but while PRP is fashionable right now, there's no evidence that it's effective, as the recent case of Dylan Bundy has highlighted. 

    With Rodriguez's forearm and elbow problematic and potentially missing from the rotation for another month, the rumor mills have heated up even more as the Pirates continue to hold a playoff position. (In fact, they're at an 87 percent chance of making it to October for the first time since Barry Bonds was there.) Rodriguez's continued absence, as well as the DL-ing of James McDonald and A.J. Burnett, has put pressure on young pitchers like Gerrit Cole and Jeff Locke. The Bucs will have to keep doing that or figure out how much another Wandy is worth.

Ryan Vogelsong (Hand)

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    Playing catch doesn't seem like much, but it's a good first step for Ryan Vogelsong. The San Jose Mercury News details how Vogelsong's session with AT Dave Groeschner went on the wet field of Great American Park. 

    Vogelsong has been out since mid-May since breaking his pinkie on a bunt attempt. It's a good argument for bringing the DH league-wide, but for Vogelsong, it's also a painful reminder of poor technique.

    Vogelsong will start gearing things up in his throwing program now that he can throw without pain. Over the next few weeks, he'll throw more and add distance before getting up on a mound. Given what we've seen so far, it's hard to put a solid timetable on this, but with the All-Star break as an easy target, Vogelsong may push to get on a rehab assignment before then. That will be tough and will depend entirely on stamina. The end of the month is more likely, but be sure to monitor his progress.

    I only wish I had a picture of this DL beard that was mentioned

Anibal Sanchez (Shoulder)

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    The problem for Anibal Sanchez wasn't his shoulder during a rehab start at Single-A Lakeland. Instead, Sanchez was just the latest in a line of pitchers who have been hit by comebackers this season.

    While Sanchez does appear to have escaped serious injury, as detailed by the Detroit Free Press, it did prevent him from getting in the work he wanted, pushing his rehab process back a bit. Sanchez only made 23 pitches and while those did show good velocity, it's too soon to say where Sanchez really is in the process. The Tigers will re-assess when to get him back on the mound once his leg is ready.

    It also highlights the issue of pitcher protection. While seeing injuries to pitchers' heads gets most of the focus, pitchers have also injured other parts, including arms and legs. For youth pitchers, shots to the chest are among the most serious, potentially causing death. 

    One example of this kind of injury and how easily they could be prevented happened a couple years back, when Roy Halladay took a ball off his shin. The bone was broken, shutting down his season, but it could have been prevented by wearing a simple soccer shinguard. Once again, pitchers could protect themselves but elect not to for reasons of comfort and tradition. It's time for that to change. 

    UPDATE: In a big surprise, Sanchez will not make another rehab start. Instead, the Tigers have announced that Sanchez is coming back to the team and will start on Saturday.

    According to Jim Leyland, Anibal Sanchez is on his way to Toronto and is scheduled to pitch for the #Tigers on Saturday.

    — Detroit Tigers (@tigers) July 2, 2013

Matt Harvey

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    The Mets are loving what Matt Harvey is giving them, but they want to be smart about it. There's been some discussion of how far they are willing to let Harvey go into this season, especially considering that the team is not likely to be chasing a playoff spot. 

    Unlike with Stephen Strasburg last season, the team is trying not to make this an issue, avoiding the discussion as much as possible. Behind the scenes, though, they're going about it differently and making sure that there's no hard-innings limit mentioned.

    Instead, it appears that they have several different physical factors that they will be watching as Harvey gets up toward 200 innings. They're monitoring him at each start, but as he gets into that 175- to 190-inning range, they will begin to focus more on him from a start-to-start level. NJ.com also details how they will limit Harvey's workload on an innings and pitch-count level as well. 

    Things like velocity, internal and external rotation, measurable strength and consistent mechanics will be watched closely and if necessary, Harvey will be shut down. The Mets shut Harvey down in 2012 as well, so this shouldn't come as any surprise.