Under the Knife: Latest MLB Injury Updates

Will Carroll@injuryexpertSports Injuries Lead WriterSeptember 4, 2013

Under the Knife: Latest MLB Injury Updates

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    September is here and the DL is gone. That doesn't mean injuries don't affect the game. Far from it. Instead, they make an even bigger impact. While "season ending" can mean something that would normally be two to four weeks, it's the fatigue that becomes as much an enemy as the opposing team.

    Some players have made it through the heat of August unscathed. Some are seeing that the work they did in Arizona or Florida is paying off now. All that time in the cage and the weight room is keeping some players off the bench and out of the training room. 

    What bothers me at this time of year is the suggestion that injuries show some lack of character.

    David Wright, for instance, never stopped wanting to be on the field. A hamstring strain is a problem of physicality, not one of ethics. No player wants to be told his season is done or even that he's going to miss a start. 

    Despite all the hours of work by players, athletic trainers and doctors, injuries are on track to be up yet again this year. What teams are doing—or not doing—is not working, and each and every team is going to have to look for ways to reduce injuries or else they can keep burning hundreds of millions of dollars each season.

    I have ideas. For now, let's get to the injuries...

Miguel Cabrera (Hip)

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    I try not to speculate here, but occasionally, I have to. Right now, what you're about to get is pure speculation, though I asked sources with both the Tigers and teams that have recently played the Tigers.

    Looking at all the symptoms that Miguel Cabrera is dealing with, it reads like a sports hernia. 

    The sports hernia is one of those odd diagnoses. It's not really a condition but a series of symptoms that led to Dr. Tim Kremchek giving it a name to ease the explanation. The problem is focused in the area between the groin, the hip and the abdomen. Cabrera has complained of issues in all three of those areas. Despite this, the Tigers maintain that the injury is not a sports hernia.

    Of course, the real question is whether the Tigers can keep Miguel Cabrera healthy enough to be ready for the playoffs and whether Cabrera will miss enough time to make it tougher to catch Chris Davis and an historic second consecutive Triple Crown. He was back on the field Tuesday and went 0-for-4, but did show some signs of discomfort with whatever it is that is wrong. In this case, that could be everything.

Yadier Molina (Wrist)

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    Yadier Molina came back from his sore wrist and was greeted by a speedy Billy Hamilton. Even Molina had to smile when Hamilton beat a good, if rushed, throw. At bat, he had a bit more of an issue, though it's tough to tell how much was on the sore wrist. He went 0-for-3 with a K.

    The Cards are watching it closely, but in a pitched battle for the NL Central title and avoiding the "coin flip game," finding rest is going to be difficult. Mike Matheny should have an advantage here, and the medical staff will make sure that Molina is squatting like a toddler

    There has been some discussion about whether catchers have workload issues the way pitchers do. Molina has caught more than anyone over the past decade—almost 1,200 games—and age (31) and wear do have consequences.

    The tales about catchers' batting dropping off in the second half due to their hand being swollen from fastballs have been alleviated somewhat by better equipment, but there's no question they take a beating.

    What the cost is for Molina could decide whether the Cards get October 2 off this year or not. While Molina deserves some consideration for NL MVP again (he's eighth in the league in fWAR currently), he would be my selection for the player most irreplaceable to his team. 

Yasiel Puig (Knee)

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    All that can stop Yasiel Puig, it seems, is himself. It could be his attitude, if you're one of those that don't like an exuberant player. It could be that he hurts himself. The guy may not always be focused, but he does go hard when he goes.

    Puig is dealing with a right knee strain and while the Dodgers aren't being specific about the injury, the likely culprits are both relatively minor.

    The most likely reason, especially given Ken Gurnick's suggestion that Puig and the Dodgers medical staff have been maintaining this for a while, is a mild inflammation of the patellar tendon. 

    Commonly called jumper's knee, this kind of mild strain is annoying, but seldom debilitating. The concern here is to make sure it doesn't get worse and that it doesn't get chronic. Patellar tendonosis can be a big deal.

    Expect Puig to miss a game or two and to get a bit extra rest as the Dodgers start prepping for the playoffs. 

Matt Kemp (Ankle)

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    Matt Kemp ran out of minor league games before he could get his ankle right. What was supposed to be a short rehab assignment was extended and will now shift to Camelback Ranch as Kemp and the Dodgers continue to try and get Kemp healthy. It's a bit of a surprise since Rancho Cucamonga made the Cal League playoffs. 

    It's more than just the ankle, but the ankle's clearly the acute concern.

    The downside of the geographic shift is that he moves far enough that Sue Falsone won't be able to be hands-on. (For those that don't remember, Falsone is one of the world's top functional movement experts.) With the holistic focus that the Dodgers have had to take with the various issues Kemp is dealing with, that could affect things negatively.

    The additional time will push things back as much as a week, according to Dylan Hernandez of the Los Angeles Times. Until Kemp starts hitting—he was 0-for-18 at Single-A—the lead the Dodgers have in the division will allow them to be patient, even as they try to rest their regulars. 

Carlos Gonzalez (Finger)

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    Carlos Gonzalez was activated on Tuesday. This is precisely the kind of move that catches many fantasy players off guard. The star player comes off the DL after rehabbing his injured finger and you'll see a lot of shifting him quickly to their active roster.

    They shouldn't.

    Gonzalez is not yet cleared to hit in games. His finger remains problematic, but with the expanded roster, Walt Weiss made the decision that Gonzalez could help the team with his running and defense. (It doesn't hurt that taking him off the DL helps with behind-the-scenes stuff like worker's comp, but I won't bore you.) 

    The team isn't sure yet whether they'll use Gonzalez in the near future, which is possible as Troy Renck of the Denver Post points out, or if he'll be shut down, which is also possible. With Gonzalez hitting poorly in his short rehab stint, it's worth sitting back and waiting, even in weekly leagues. 

Jason Grilli (Forearm)

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    I see you working, Dan Fox.

    The Pirates have far more than one smart guy on staff, but Dan's my old colleague, so allow me to tout him a bit. As a part of Neal Huntington's sharp staff, he's seen not just a sea change at PNC Park, he's seen a culture change as well. 

    The latest evidence of how smart the Pirates are is how they intend to use Jason Grilli.

    The save won't determine their strategy, just as it didn't at the start of the season. Grilli was a stunner as a "closer" for many, but only if you didn't understand the move. Dealing away an All-Star who was past the value equation for the Pirates made sense if they could shift the asset allocation to high-leverage situations instead of saves.

    Jason Grilli's good enough for saves. Actually, he's ended up good enough for almost any bullpen role, but even the Pirates won't say they expected this. Instead, they knew Grilli had the right temperament for the role.

    Now that he's also shown good stuff, they can use him in those same high-leverage situations. Clint Hurdle will get advice, I'm sure, on who fits into what roles best. If it's Grilli or Mark Melancon or the Parrot getting saves, so be it, as long as they're also flying the Jolly Roger more often than not.

    Having Grilli coming back from the forearm strain gives them coverage for those that don't see what the Pirates have done all season. Watch to see exactly what situations they use to ease him back in and where he goes when the playoffs get closer. Yes, Pirates fans: playoffs. 

Domonic Brown (Achilles)

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    The Phillies have a solid medical staff. They won the Martin-Monaghan Award a couple years back for having the best medical staff and they've been in the top half of injury stats for years. That's why I'm a bit surprised by the announcement that Domonic Brown will play "as much as he can" (via The Inquirer) over September despite a mild Achilles strain with associated bursitis.

    The Phillies aren't playing for the playoffs, nor are they assessing how (or even if) Brown fits in, as they did over the past few seasons. Instead, they seem to be a bit willing to risk Brown.

    On one hand, this seems very cavalier, especially for the organization that has watched Ryan Howard struggle for the last two years with leg issues that started with a strained Achilles. Howard himself has questioned the use of cortisone during the playoff chase just before his tendon gave way.

    On the other hand, the team does have experience with this injury, and with their quality, it's hard to believe that they would put a young player like Brown at risk in a season where they're out of contention. This seems much more like they have the situation at least under control and are looking to maintain it. They could use that to help him in the offseason and going forward, since these issues can be chronic.

    Expect Brown to get more rest, dropping his counting stats down. While he's established himself as a solid young major leaguer, this kind of injury is the kind that can shorten the time he'll stay in that role, as well as pushing him down fantasy draft boards. 

Jose Fernandez

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    Jose Fernandez is going to be on a lot of lists at the end of the season. NL Rookie of the Year? Cy Young? Probably both from many voters.

    Unfortunately, he's also on a list that's more worrisome. While the 30-inning increase has been attacked by researchers, I'll take Sandy Alderson's tack and say it's worth looking at more as history than science.

    Here's a list of starters that are 25 years old or younger and are on pace to have at least a 30-inning increase, courtesy of the indispensable Baseball Reference: Jose Fernandez (also the youngest on the list at 20), Shelby Miller, Julio Teheran, Patrick Corbin, Jeff Locke, Chris Tillman and Matt Harvey.

    I'm not going to try and draw some line between Harvey's injury and any of the pitchers on this list, but we have seen Jeff Locke hit a wall, with Corbin having a slight downturn as well. My question is how far each of these young pitchers will be asked to go. Miller and Teheran could end up pitching in the playoffs, a worry Fernandez doesn't have. 

    With none of these pitchers, there's no public plan to limit their innings. It's certainly worth watching to see how they're managed if we hope they're going to be great young pitchers next year as well. 

    (Actually, as I was writing this, the Diamondbacks discussed going to a six-man rotation and skipping or even shutting down Corbin.)