Under the Knife: Latest MLB Injury Updates

Will Carroll@injuryexpertSports Injuries Lead WriterAugust 29, 2013

Under the Knife: Latest MLB Injury Updates

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    There's two things that are about to happen that really affect how teams manage injuries. Understanding them may help you figure out what's going on around your favorite team or help you juggle things with your fantasy team when there's injuries to big-name players like Matt Harvey, Matt Kemp and Clay Buchholz.

    First, the minor league season is drawing to a close. That means, unless a team has an affiliate who made the playoffs, the chance for a player to go on a rehab assignment is about to go away. For rehab, players will now have to play in simulated games at the team's complex. It's not the same; though some teams do it better than others. For players like Ryan Howard, this could be key.

    Second, the DL itself is about to go away. It doesn't actually go anywhere, but with the expansion of rosters, the DL becomes pointless, and most teams cease using it. The DL is about roster space, not injury management.

    If a player is injured in August, he goes on the DL so his replacement can be brought in. In September, an injured player is just shuffled aside, and his replacement is already there. This makes calculating DL days very difficult. 

    It gives some players and teams and advantage, but it also throws off the patterns you might be used to. Be sure that this new way of doing business in September helps your team as it pushes to a championship!

    Now, on to the injuries:

Matt Harvey (Elbow)

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    I said about all I could say on Matt Harvey in Tuesday's article about his injury, but in the two days we've had to digest the news, this still seems like one that's a tipping point. Joe Sheehan pointed this out in his subscription newsletter, but if we're at that point, where the pendulum swings back from the tyranny of pitch counts and innings limits, I have to hope we do it right this time.

    Instead of using proxies, teams are going to have to start using hands-on measures and active testing to determine the fatigue level of a pitcher rather than using a clicker to estimate or the pseudo-mysticism of looking into his eyes. Instead of pitching gurus touting a prospect's mechanics, like Pitching.com—as was almost universally done for Harvey—why don't we get them into a real motion-capture lab?

    We need facts—images from a portable sonogram, as outlined by the American Journal of Roentgenology, or measures from something like a Scanadu Scout. We need the trained hands of an athletic trainer bringing a player through a range-of-motion test. It's those things that will save pitchers. 

    Once upon a time, I hoped that the lessons we learned from Mark Prior and Kerry Wood would change the management of pitchers. Dusty Baker is still around and so are the tired pitching management paradigms he's come to represent. How quickly baseball can change will determine how many more Matt Harveys we have to see sent to surgeons. 

    One last note: The fact that we haven't heard anything about treatment, especially PRP, is interesting to me. Dr. David Altchek doesn't mind being a little bit different than the mainstream, and he has solid results on his resume, so I'm watching this one closely. 

Clay Buchholz (Shoulder)

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    Rehab outings can be misleading.

    Last season, A.J. Burnett came through Indy to get ready after his bunting incident pushed his season back. He looked terrible and dodged the media afterward. I thought it was a problem, but in his first start for the Pittsburgh Pirates, he was awesome. In most situations, pitchers don't care at all about results. They're there to get the work in and get out of town—simple as that.

    Still, the results of Clay Buchholz in his first rehab start at Pawtucket (Triple-A) have to be troubling. Buchholz had as much command as Miley Cyrus did this week. All over the place and not the intended result. Buchholz will have at least two more rehab starts, according to WEEI's Rob Bradford, and he's going to have to show more if he's going to come up to the Boston Red Sox. 

    The Red Sox have a little leeway in the AL East, but if they can get Buchholz back in some role, it would help them. If nothing else, Buchholz taking a couple starts might buy the rotation a little bit of extra rest to reset before the playoffs. There's still some upside here, but in the short- and long-term, Buchholz is a big issue for the Sox. 

    Here's an interesting thought on the Red Sox. While many are heaping (deserved) praise on Ben Cherington for the deal with the Los Angeles Dodgers that freed the Sox up, his move to bring John Farrell over might need an incomplete despite success.

    Farrell was brought over to help Jon Lester, Buchholz and a couple others make a step forward. With the struggles of the bullpen and the injury to Buchholz, I'm not sure Farrell's strengths have really been shown yet.

Matt Kemp (Ankle)

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    Injuries always have context. Injuries are always individual. I can write about a thousand hamstring strains or a million ankle sprains, and none will be exactly alike. Believe me, it would be easier on me if I could just cut and paste, but situations like Matt Kemp's exemplify why this job is so hard.

    Kemp is getting closer to a return, running the bases, according to Austin Laymance and Ken Gurnick of MLB.com, in what many think is the final step before a return.

    But remember, Kemp has come back several times only to have new problems. Remember Kemp is still dealing with a shoulder issue that is taking much longer to get back to full strength than most expected. Remember Sue Falsone, the Dodgers head AT, is one of the top functional movement experts around. Or, you could just let me remember all that for you.

    Add all of it up and the Dodgers aren't just going to be conservative with Kemp's return. What the Dodgers are focused on is trying to find the cause of all the issues, not just the symptoms, of which this ankle sprain is one, even if it was a traumatic, unlucky injury.

    Add in that the Dodgers are on an amazing run and there's room to take things slow and easy with Kemp. Having him ready and healthy in October is much more important than it is now. The rehab assignment might go a bit longer than many expect, but that's not a bad thing unless you're feverishly waiting on his return to your fantasy lineup. 

Brandon Beachy (Elbow)

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    Knock me all you want for repeating what my sources told me when Brandon Beachy came off the mound. They told me things looked bad, and they were right. Things looked bad. The Atlanta Braves are just lucky they weren't bad.

    Beachy came out of his exam with Dr. James Andrews with a very positive note, per a tweet by David O'Brien of the Atlanta Journal-Constitution. The ligament had held, and the pain he was feeling was something else, likely some kind of scar tissue breaking loose inside the elbow. That's not usually at this stage, though it does happen earlier in the process in some cases.

    Beachy should be able to get back to pitching once the elbow calms down, which should be quickly. There's not an issue with stamina, but I'm sure Beachy will be a bit gun-shy at first. His confidence in his first mound sessions will likely guide the Braves on a return.

    It's still quite possible that Beachy returns at the minimum, and he should be part of the Braves playoff rotation, assuming that he shows he can pitch at a high level in his September starts. Watch to see any signs that Beachy is off his game when he returns, including command, velocity and those ephemerous signs of confidence.

Robinson Cano (Hand)

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    Robinson Cano took a pitch off the hand and is day-to-day, according to Anthony McCarron. Curtis Granderson wasn't so lucky. There have been a lot of these types of injuries over the past few seasons, even with pitchers coming inside less and less. 

    All these injuries are among the most infuriating to me because they're all easily preventable. Protective gloves have been worn for decades now, but most players don't wear them. While the hard plastic insert of Mike Lowell or the bulky foam of Jeff Bagwell have been supplanted by better and lighter alternatives like this one from Evoshield, a vast majority of players ignore them.

    Instead, they're still going with a thin leather glove designed for grip that's not much different from the ones Ken "Hawk" Harrelson first wore in a game. (Yes, he was the first.) Sixty bucks saves the hands of major leaguers, and we get a lot more play from Cano, Granderson, Starling Marte and more.

    Cano should be back in a few days, once the pain and swelling is gone. These injuries normally don't cause any problems in the long-term, but I hope Cano comes back with a better batting glove.

Jason Grilli (Forearm)

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    Jason Grilli finished a sim game on Wednesday and is ready for a rehab assignment, per a tweet by Tom Singer of MLB.com. It's not clear yet where he'll go, though the Pirates have options with several teams going into the playoffs. The most likely is here at UTKHQ, with the Indianapolis Indians. While it's not close, the facilities are top-notch.

    Grilli has had no real complications in coming back from his strained forearm. As bad as the injury looked at the time he suffered it, Grilli just needed to rest and strengthen the area. The worry is command, but, thus far, reports on his outings and side work haven't indicated real problems. 

    While Grilli probably won't go right back into the closer role, he could end up there once he gets some confidence back. Clint Hurdle has been doing a bit of sabemetric stealth, focusing on high-leverage situations with his best relievers. Expect Grilli back within a week, but the saves might be a bit further behind. 

    Bonus injury: The Pirates may have traded for Marlon Byrd, but they do think that Marte will be ready at or near the minimum. There's always some risk when dealing with the small, fragile ligaments and tendons in the hand, so Byrd was a smart addition. 

Neftali Feliz (Elbow)

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    The Texas Rangers come into September in much the same position they did last September. They're clearly the most talented team in the division, but talent doesn't always win. This team has overcome adversity, from the loss of their top three starters to the loss of Nelson Cruz, and is still hanging on to first. 

    The bullpen has been a strength for the team the entire season, one more feather in the cap of Mike Maddux. Useful arms like Joe Ortiz and Robbie Ross have been combined with power arms like Joe Nathan and Tanner Scheppers. Adding in a healthy Joakim Soria has helped, but adding in Neftali Feliz could be a huge step.

    Feliz threw three innings in relief on Wednesday at Round Rock (Triple-A) and showed good stuff and command. It was about all they'd hoped to see. He got in his work and dominated with four strikeouts. 

    Feliz could be activated this weekend, along with Lance Berkman, which has to be music to the ears of Jon Daniels and Rangers fans. The bullpen could end up being the strength of a shortened Rangers rotation, giving Texas a chance to avoid another blue October. 

Matt Moore (Elbow)

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    The Tampa Bay Rays have long been the masters of developing pitchers and keeping them healthy. This year, they've been a little off their game even with some luck. David Price missed much of the first half, but has been the Price of old since returning. Matt Moore's minor elbow injury should follow that pattern, if later in the season.

    Moore has been a breakout star, a "mini-Price" as described by scouts. Moore's elbow inflammation was checked, he was treated, rested and now appears to be ready to go. He's looked solid in sim games and hasn't missed any work since he began throwing again.

    The next step is a rehab game at Durham (Triple-A) on Thursday, per a tweet by Marc Topkin of the Tampa Bay Times. He could have another with Durham prepping for the International League playoffs, though the plan is for him to rejoin the Rays early next week. 

    With Jeremy Hellickson down, the Bulls could have one heck of a playoff rotation and then have both ready to supplement the Rays as they push for a playoff spot of their own.

    Watch for Moore to make his pitch count, to throw all his pitches and show some command. There's not much holding Moore back beyond stamina, and the Rays are known to be pretty creative, if conservative, with their pitching usage and management.

Matt Cain (Forearm)

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    Matt Cain has long prided himself on his durability. It took a comebacker off his pitching forearm to push him to the DL for the first time in his career. Even then, it was a conservative move done by the San Francisco Giants to make sure that Cain didn't push himself to live up to that self-image.

    Cain took a simple comebacker off the meat of his forearm. The initial worry is always that it hits the bone or worse, the joint and breaks things. After that, the worry is both more simple and complex at once. The team can't let the pitcher get back on the mound until the bruising and pain are alleviated enough to not change the pitcher's mechanics in even a subtle way.

    This is a smart move by the Giants. Unable to win now, they're protecting their resources for next time. Given that they've won a World Series every other year over the past few, it's not a bad plan. The question now is who's going to be in that next winning Giants rotation, given the likely exits of Tim Lincecum and Barry Zito.