Playoff Health Preview: Health Is Always a Wild Card

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Playoff Health Preview: Health Is Always a Wild Card
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Forget chemistry. Forget momentum. What the playoffs come down to is talent and execution. It's amplified even more so in the coin-flip simplicity of the Wild Card Games, where the best team doesn't always win. The team that executes, that doesn't give away outs, that doesn't make mistakes and that puts their best available talent in place? That's the team that wins.

Heading into both the NL and AL WCGs, all four teams have situations of both injured players and fatigued players. The managers and General Managers, along with the medical staffs, have to keep their teams ready. Is it any surprise then that these four teams are highly rated among medical staffs? In fact, all four have won the Martin-Monaghan Award for Best Medical Staff in the past decade, with the Reds taking home last year's trophy.

The biggest enemy is often not the opposing team, but fatigue and injury. There are several situations like that this year. Bleacher Report is lucky enough to have Dr. Tim Kremchek helping with this year's previews throughout the playoffs. His expertise will bring a unique viewpoint to these previews.

How does a team prepare for this kind of playoff game? Dr. Kremcheck explains: "The medical staff plays a huge role in playoff rosters. A nicked up player who is not 100 percent can make the difference. Two equal players and one who is mildly injured or fatigued makes a huge difference. The discussions start about the middle of September regarding certain players. Some teams have the luxury of 'tuning up some of these players' the last couple weeks, while others need them to actually get to the dance."

We'll see who's best prepared on Tuesday and Wednesday night and how that will leave them exposed as the Division Series start up.

REDS AT PIRATES

Reds Watchlist: Johnny Cueto, Ryan Ludwick, Brandon Phillips

Pirates Watchlist: Francisco Liriano, Starling Marte, Jason Grilli

The Reds and Pirates know each other well. They just played a three game set for the right to host this Wild Card Game back in Cincinnati. The PNC Park crowd will make the game loud, but we'll have to see whether it makes any difference.

Dusty Baker sends Johnny Cueto to the mound, a bit of a surprising move given Cueto's health struggles this season. Cueto fought with shoulder issues all season and was not thought to be returning to the rotation, but he did and has pitched well. Cueto should be nicely backstopped in this game.

Since the Wild Card Game is considered a "playoff round," a team can install a different lineup. Five or even four starters aren't needed, as Tony La Russa showed a couple years back. Baker should have a deeper bullpen at the ready, though getting out of his role-based handling may be tough for Baker. Both teams brought 16 position players with them to this game, meaning the pen may not be expanded as much as the starters dropped. 

Watch to see if Cueto is completing his motion. He's made subtle adjustments to the timing and the follow-through, taking some of the deceleration load off the back of his shoulder. If Cueto is able to get through five innings and gives the Reds the chance to build any sort of lead, his start will be a success. 

Kirk Irwin/Getty Images

On the field, watch for Brandon Phillips, who is coming off a severe shin bruise. Baker told the press on Monday that Phillips was "pimping, not limping," which sounds like a positive. Phillips' range may still be affected, and he might be a bit shy on a hard turn.

Ryan Ludwick came back from his Opening Day shoulder injury to play in 38 games. The power doesn't seem to be back, and Ludwick may be the player most likely to be pulled for Billy Hamilton. Hamilton should be on the roster, which was in question and may still be in question for further series if the Reds win.

The Pirates come into the series very healthy. Francisco Liriano struggled for years, but a new voice seems to have reached him in Pittsburgh. Not only has Ray Searage and Euclides Rojas really helped, but the Bucs' focus on defense quickly gave Liriano more confidence. His late start to the season, the result of a broken arm, saved a bit of mileage, and Liriano hasn't shown a dropoff in stuff or velocity. His innings count, despite vastly different usage and results, isn't up significantly.

David Maxwell/Getty Images

The Pirates will be watching Starling Marte closely. Marte missed much of September with an injured right index finger. He's not shown that his bat is back, but his excellent defense in the big left field at PNC can play huge for them. With options out there, Marte could be pulled in a key offensive situation and then replaced by a plus defender like Jose Tabata or Felix Pie. 

Jason Grilli returned from his shoulder injury just in time to see Mark Melancon hit a rough patch. Clint Hurdle has options at the back of his pen and can go matchup rather than role. The pen is filled with no-names who have excelled in their roles, so they should have no real disadvantage tonight.

Jason Miller/Getty Images

RAYS AT CLEVELAND

Rays Watchlist: Alex Cobb, Desmond Jennings

Cleveland Watchlist: Danny Salazar, Justin Masterson, Michael Bourn

October is a danger zone for young pitchers. Dr. Kremcheck has seen far too many of those overexposed and fatigued pitchers ending up in his exam room. I asked him what he looks for at this point in the season:

"It is a very long season for the pitchers. Some of the younger pitchers have never pitched this many innings in their career. We also know that fatigue is the No. 1 reason for injury. What you look for in a pitcher at this point is a significant change in their physical examination from the midseason mark. Loss of internal rotation, scapular winging and some very subtle strength changes are danger signs.

"On the mound, the first thing you see is a loss of their 'stuff' and loss of command. The velocity is the same, but because of weakness, their arm speed is less and the arm slot changes and makes movement and command changes. When the velocity is down, it is too late."

That's what the medical staffs and coaching staffs will be looking for as they both put young pitchers on the mound in pressure situations. Alex Cobb's innings count is down this year, but the Rays didn't plan it that way. His scary head injury, caused by a screaming comebacker, could have been much worse. He showed no ill effects once he returned and should be in good shape. The bullpen will be well rested after David Price's complete game win over the Rangers, so Cobb shouldn't be asked to go too far.

The Indians counter Cobb with Danny Salazar. The 23-year-old had a great September and showed he was all the way back from Tommy John surgery, subbing in for the injured Justin Masterson. While not heavily worked this year, Salazar is facing a huge innings and competition increase. He hasn't been asked to go deep into games, so the Indians have been smart with his usage. 

Behind those young starters, there's only minor issues. The biggest might be the closer role with the Indians and the back end of their bullpen. Chris Perez melted down at the end of the season, and Justin Masterson, who spent most of the season as Terry Francona's SP1, took over the role. Masterson missed most of September with an oblique strain, causing some stamina issues. This papers over that, but it's hardly a solid "Bullpen Mafia" down there.

Both teams have minor issues with their speedy CFs. Michael Bourn has a mild calf strain, suffered in the last game. He'll be backstopped with equally speedy Drew Stubbs, but it would be a big dropoff offensively if forced. Desmond Jennings showed he should be fine for the Rays on Monday night, though his hamstring strain does reduce his threat on the bases.

Timothy E. Kremchek, M.D. is in his 18th season as the Medical Director and Chief Orthopaedic Surgeon for the Cincinnati Reds. He began his practice in Orthopaedic Surgery and Sports Medicine in 1993 and has become a leader in the care of athletes across the country at Beacon Orthopaedics. 

Will Carroll has been writing about sports injuries for 12 years. His work has appeared at SI.com, ESPN.com and MLB.com.

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