Under the Knife: Latest MLB Injury Updates

Will Carroll@injuryexpertSports Injuries Lead WriterSeptember 18, 2013

Under the Knife: Latest MLB Injury Updates

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    Every time you look at one of these tight races, these still-to-be-decided playoff slots, I want you to think of the injuries. Talent wins games, but it has to be on the field to win and too many times; some of the best players (and even some of the average ones) can cost a team just enough.

    What if the Royals hadn't lost Sal Perez to a concussion? What if David Price had made those starts at the beginning of the year? What if Dylan Bundy was in the Orioles rotation? What if Texas had Matt Harrison all season at the front of their rotation? What if the Reds had Johnny Cueto and Jonathan Broxton? 

    Injuries can be overcome. The Dodgers and Yankees are proof of that, but while all injuries aren't preventable, baseball has done a terrible job in trying to reduce them. I can't imagine any of the owners around baseball would stand for multimillion dollar losses to continue, year after year, in any of their other businesses and not address the problem.

    Baseball is pretty awesome and no time is more awesome than the last few tense week of the season. This season, some good and deserving teams are going to go home instead of to October and more than one is going to be attributable to injuries. 

    There are plenty now, so let's take a look around the league...

Matt Harvey

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    I wrote about Matt Harvey Tuesday, which you can read here, but the panic surrounding his decision to delay surgery makes no sense to me. Harvey is trying to avoid missing a full year—something that one of the best doctors in the world has told him is possible—yet fans think, "Nope, go ahead and cut." 

    Harvey's best comp, if he has the surgery, is clearly Stephen Strasburg. Strasburg has come back well and normally from his surgery, but it was a very different case. Strasburg's ligament was completely torn on one pitch. There was likely some previous damage, but his case was one of the few traumatic cases. With a rupture or a near-complete tear, there's no question. It has to be reconstructed.

    Harvey doesn't have that. His tear is somewhere below 33 percent, the highest figure where surgeons believe rehab and strengthening can work. That's not to say that Harvey's program will work, but that's where timing comes in. 

    If Harvey had the surgery today, he could conceivably be back on the mound in September 2014, much the same way that Strasburg came back for five starts a year after his surgery. If Harvey waits until February of next year and still needs surgery, he'll still be back in time for Opening Day 2015. By waiting, he's gambling a handful of starts at the end of one season for a full season of work.

    Yes, rehab can work. For every Dylan Bundy or Jonny Venters where it doesn't, there's an Adam Wainwright or Nolan Ryan where it did. It seems the Mets fans and even Mets front office would rather have the certainty, but even with surgery, even with doing everything "right" as they did, there's never any guarantees in this game.

Joe Mauer

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    Concussions are tough. The fact is that until the episode is over and the concussion cleared, we have no way of saying that a concussion is "mild" or "severe." We have no idea what the long-term consequences are, though we have no recorded cases of baseball-related CTE (chronic traumatic encephalopathy) yet. 

    Joe Mauer is reaching a point with his concussion, nearly a month in, where returning to baseball this year is of little value aside from knowing he can do it. That unknown is what he and the Twins medical staff are pushing toward, but he hasn't been able to get past the final stages of the concussion protocol. His continuing symptoms are not unusual, but they are troubling.

    Baseball does have a concussion problem, as the NFL inelegantly tried to point out, but baseball was actually ahead of the NFL in establishing concussion protocols. The system devised by MLB and the Professional Baseball Athletic Trainers Society has worked well, but Mauer shows the biggest issue for baseball: catchers.

    While some baseball concussions, like the one Minnesota dealt with a couple years back with Justin Morneau, occur from unusual hits, catchers seldom get one big head trauma. Instead, they get lots of small ones, which may end up being even more damaging. Mike Matheny, the manager of the Cardinals, saw his playing career end because of vertigo, the result of the same sort of small concussions that troubled Mauer.

    While "hockey mask" style catcher's masks came into vogue a few years ago, they were brought in to protect the side of the head from bats, not the kinds of head-on hits that foul tips normally give. The old-style mask actually does better with those. No one yet has developed a solid hybrid or a better mask. Just as the NFL is establishing a venture fund to help make better equipment, MLB should do the same.

    Mauer remains under the protocol and hopes to make progress, but we aren't yet past it. There's just no way of knowing if Mauer will be better tomorrow, next week or ever. 

Miguel Cabrera

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    Miguel Cabrera finally hit a homer in September. The chase to catch Chris Davis is likely gone and Cabrera is facing an MVP challenge from the sublime Mike Trout and more of a worry about his playoff status as the Tigers limp toward October.

    Getting a healthy Cabrera has to be job one for the team, as it appears they've reversed the shape of their season from last year. They have enough of a lead that they could rest nearly everyone on their roster and the depth to do it. The worry now is that the groin/hip/definitely-not-a-sports-hernia that he's dealt with can't heal in just a couple weeks.

    I've often wondered if Cabrera is a bit influenced by Prince Fielder, a physical freak of durability despite his size. While both big, strong players, Cabrera is significantly larger. He's a full head taller, though finding a picture that actually shows this is hard to find. Fielder is wider, no doubt, but where they are similar is in the bulk of their thighs.

    That's going to act against Cabrera and I worry that at 30, he's showing some signs of wearing down. He can easily DH and put a bit of loft in his swing, switching his quest from another Triple Crown to Barry Bonds' home run crown. In the short and long term, this leg injury is going to be key to the Tigers and Cabrera's place in history. It's hard to imagine, but Cabrera may struggle to get to 500 homers.

    Quick note: Would you believe Josh Donaldson has a higher WAR than Miguel Cabrera? 

Carlos Gonzalez

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    Ferris Bueller skipped school nine times, as Ed Rooney famously said. Carlos Gonzalez isn't taking days off, but he's been to hand specialists eight times in the last couple months as he's tried to figure out how to get his finger back to function.

    The lack of answers is closing in on a lack of time, with Gonzalez almost sure to be shut down after this most recent visit. Gonzalez has been playing as a defensive replacement and pinch runner, but Walt Weiss has only found opportunity to use him a handful of times. 

    Thing is, the surgery that Gonzalez is likely to need really has about a two-month rehab time, so having it early doesn't really help him or the team. That leaves the chance open that he stays in his bench role and has surgery in a couple weeks. It comes down to personal preference and whether he and the team's medical staff feel more comfortable with a bit more time between surgery and spring training. 

Jacoby Ellsbury

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    Jacoby Ellsbury is still in the walking boot on September 17. With 10 or so games left in the season, the Red Sox still think that they'll get their center fielder and sparkplug back on the field, giving him a test and a chance to get his timing back before the playoffs.

    I'm not so sure.

    Ellsbury is still doing only very light exercises and nothing that would be stressful to the foot. Given that, it's hard to imagine that Ellsbury is going to be able to ramp up to hard running in just a few days. It's a far cry from jogging on the SwimEx to stealing a base in the playoffs. 

    Ellsbury's game is so predicated on speed that any limitation would render him pretty ordinary. Shane Victorino is certainly not Ellsbury's equivalent, but the Red Sox are going to have to take a hard look at which one gives them the best chance to win as we head into October. I wouldn't want to be the one making that decision or announcing it to the fans. 

    Remember too that Ellsbury is a free agent at the end of the season. That fact will complicate any decision tenfold, as both sides position for what could be a tough situation for both this offseason.

Hanley Ramirez

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    Hanley Ramirez gets a bit lost with the Dodgers. He wasn't in the huge deal with the Red Sox. He's not Yasiel Puig or even Matt Kemp (who also returned Tuesday night.) All Ramirez is doing is putting up huge numbers despite missing time with various injuries. He's matched his numbers from last season in about half the time.

    Were he healthier, he'd be an MVP and perhaps a Triple Crown candidate. As is, he's a bit of a secret weapon right now, so keeping him healthy and functional into the playoffs is yet another task on head trainer Sue Falsone's to-do list. It's a long one. 

    Ramirez was having a back problem that was transferring pain down his legs, but it was calmed down with relatively conservative treatment. That's a big plus, though there is the worry that it's going to recur at any time. He could have more injections if needed, but the Dodgers seem to think they have this problem covered. 

Stephen Strasburg

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    While we watch Matt Harvey, many have forgotten Stephen Strasburg.

    He's come back, and he's been good but on a disappointing team in transition. Strasburg doesn't seem as exciting. He's the iPhone 5. It was pretty darn amazing not that long ago and it's still pretty good, but there's the new hotness over there and another one coming next year. 

    It's still too early to say whether or not last year's Strasburg shutdown "worked" or not. I'm not even sure how to determine whether or not it worked. He's had some mild physical issues this year, including the forearm tightness that's putting the last two weeks of the season in a bit of jeopardy, but not appear related to previous problems. Neither do they seem alleviated by the shutdown. 

    He's going to get to 180 or so innings this season, assuming his Thursday start and the next few go as planned, but he's not going to push 190, which is actually a more important number than 200 when it comes to pitching development. His numbers are remarkably similar, so in that case, the shutdown neither helped nor hurt.

    Strasburg gets one more year under his belt, another closer to free agency and the prospect that the Nats saved his arm for someone else. The Nats have three years of arbitration left, so they'll have an interesting decision on how much they're willing to guarantee for him to avoid that process this offseason. 

Gerrit Cole

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    There was a great article this week detailing how the new-school Pirates front office got their old-school coaching staff to buy in. Dan Fox, a colleague of mine from Baseball Prospectus, has been a big part and his work is detailed there. But like Moneyball, the Pirates didn't give away all the secrets. 

    The medical staff is in on the data-based changes and, in this, they aren't slave to pitch counts or innings. When it comes to keeping the team healthy, the Pirates' young pitchers are having their workload managed in a much more holistic manner. While they're not doing the kind of fatigue management that I have often advocated, they're doing a more results-focused measure.

    Earl Weaver used to say that "the hitters will tell me when the pitcher's tired." That guy intuited things it's taken us decades to figure out. That's what the Pirates are doing with Gerrit Cole and all their pitchers. They're watching PitchFX and scouting their own pitchers looking for changes that suggest fatigue.

    It's a brilliant approach, especially if it works, though the process is the key.

    Cole will be allowed to go as deep as he can, though they may get creative if he does show signs. They don't have the luxury of resting anyone as they fight for playoff position with the Cards and Reds, so they'll have to hope that they can outsmart those two.