Under the Knife: Mid-Spring Training Injury Updates for MLB's Biggest Stars
Another season of Under The Knife opens! Since 2002, I've been writing about the injuries around baseball. While I've been given great opportunities and cover more than just MLB now, it's still great to come back to this, my original column, one that still feels like home.
The original mission is still in place as well. I want to look at baseball through the lens of sports medicine. I want to tell the stories of the doctors, athletic trainers and players that overcome and prevent injuries. There's still a long way to go, since in the years I've been doing this, injuries haven't gone down and teams aren't doing enough to reverse the trend.
There will be plenty of injuries and plenty of stories this season to keep UTK filled with stories, but there's a couple things I want to focus on this year. The first is context. If you want just the basics, you can get that anywhere. Cole Hamels' shoulder is sore and Kris Medlen's elbow looked bad coming out of the game this weekend. What I want you to understand is why those happened and what is likely to happen next. Context is everything.
The other is a subfunction of context and it's really functional. Biomechanics are underused in the sport, but what's the next "oblique?" Remember about eight years ago when instead of a side strain we started hearing oblique strain? I think I know what's next and again, the why is more interesting than the what.
For now, there's plenty of injuries as we hit the halfway point in camp and gear up for fantasy draft season. Be sure to check out the Risk Ratings (which are the same system I've used for Team Health Reports for over a decade) and avoid the worst. Powered by another season of telling the stories of men like Dr. Frank Jobe, on to the injuries...
Cole Hamels, Phillies
Cole Hamels had an unexpected setback, but while Phillies fans are headed for the ledge, the Phillies themselves aren't concerned. This is, to them, a case of "dead arm" and one they trust in Hamels and their medical staff to get past.
What Hamels has is dead arm. That's a colloquial term and not a medical one. It feels like the arm is heavy and fatigued, because it is. Pitchers seem to hit a point in their spring work where the muscles become heavily fatigued, but this can be a positive. In most cases, it's purely muscular with no associated damage to any other structure.
While the Phillies don't have the roster depth they once did, the addition of AJ Burnett behind Hamels and Cliff Lee, essentially replacing the retired Roy Halladay, does give them some flexibility. If Hamels isn't ready by Opening Day, they can get by, but they don't have much depth. Jonathan Pettibone is also having shoulder issues, and Miguel Angel Gonzalez looks ticketed for Allentown (Triple-A).
This is what it seems like for Hamels, and a week off should get him back on track. He'll be behind in ramping up, but the Phillies could end up being creative. The team has discussed putting Hamels on a short pitch count and essentially putting him in a tandem for his first couple starts, which gets them past the depth problems and gives them more out of one of their best pitchers.
Watch to see if Hamels is able to throw well after his shutdown ends late this week. If he gets back into his progression and doesn't have fatigue issues, he should be back in some form quickly. I would not move him down draft boards significantly, meaning he could fall to you a round or two later due to the perception of this problem.
Justin Verlander, Tigers
Justin Verlander is coming back from sports hernia surgery—or as Dr. Bill Meyers wants it called "core muscle surgery"—and things look positive. It's the same type of surgery that Miguel Cabrera had, so the success of this kind of operation is big for the Tigers this year.
Verlander suggested that his mechanics were off last year as he compensated for his sore groin. That's very reasonable and gives hope for Verlander to make a bit of a comeback this season. He was hardly bad, but he wasn't dominant. Compared to Max Scherzer, the drop-off looked worse.
On the other hand, it is a bit worrisome that Verlander was allowed to pitch through a problem that was changing his mechanics. I went back and looked at a couple random starts from last year's version of Verlander, and I don't see significant changes. That makes me feel a bit better.
I do wonder if Verlander isn't making a bit of an excuse here. He knows he was off and that he had a physical issue, so it makes sense, even if he's not doing it consciously. I think Verlander is at that tipping point where a naturally gifted pitcher has to start making adjustments, the way that Roger Clemens did and CC Sabathia is trying to do now.
I'd bet that Verlander will be just fine, but I'd like to see some progression in his pitching. A new pitch or a focus on sequencing could be enough to keep him dominant another few years, which would keep him on the path to Cooperstown.
Kris Medlen, Braves
The Braves have had a hard time keeping their pitchers healthy over the last few years. Watching Kris Medlen grabbing his arm as he came off the field this weekend didn't look good. The initial diagnosis of a strained forearm isn't good, but he's headed back to Orlando for more tests and imaging.
Medlen had Tommy John surgery in 2010, meaning he's still in the "honeymoon period" of four to five years, though just on the edge of it. It's very unusual to break down again in that period, but not impossible.
Medlen's conversion to the rotation was a revelation, though part of what makes him effective is what is likely damaging him as well. He has a confounding motion that hides the ball and throws off the batter's timing. The downside is that we don't know—and the Braves don't know either—what the cost is to his pitching arm.
If the Braves lose Medlen for any period of time, they have depth, but a lot of that depth is dealing with injuries of their own. Mike Minor is still establishing himself and has had some minor shoulder issues early in camp, but with Brandon Beachy, Gavin Floyd and others dealing with their own issues, there could be more pressure on young pitchers like Julio Teheran and even Cody Martin. They definitely need Freddy Garcia to step up and take some innings.
Manny Machado, Orioles
Pain and severity don't always match up. Watching Manny Machado writhing on the dirt after his kneecap dislocated wasn't good, but it was correctable. The surgery he had done should make that recurring problem vanish and thus far, the Orioles star has had a textbook recovery.
While he could be ready for Opening Day, something he's pushing for, the Orioles simply don't need it. Even if he's cleared, I think the O's will want to see him in controlled situations like an XSL game or even a minor league game, though the weather for the O's affiliates could make that an issue.
Machado has progressed well, with lateral movement and fielding being no challenge for him over the last week. Running is the last real progression before he gets into games, but again, while no problems seem to be on the horizon, the team is being conservative.
The most likely scenario has him out until mid-April, but watch Machado closely once he does get back into games. Absent a setback, he could push Buck Showalter into taking him with when the team goes north. I'll be curious to see if the additions that Dan Duquette made late in the offseason make it more or less likely that the team will want a "26th man" to make the Opening Day roster.
Zack Greinke, Dodgers
Zach Greinke is a unique character. When he does talk to the media, he says exactly what he thinks. Saying he didn't want to go to Australia probably wasn't what the Dodgers wanted to hear, but you can't fault Greinke for honesty.
Combine that with a mild calf strain and it's no surprise that Greinke likely won't make the trip south next week. The Dodgers aren't covering for him or making up an injury, but the conservative pace of his recovery is a nice coincidence.
The calf strain shouldn't hold him back much, though he's a bit behind schedule compared to where the Dodgers hoped he would be. There's a number of ways to go and with their depth, the Dodgers have plenty of options. The most likely scenario is that he makes the Opening Day roster but is slotted in fifth and skips a start or goes late to pair him back up with Clayton Kershaw.
A couple years ago with a much more serious spring injury, Greinke had no issues once he was healthy. Greinke has a very solid knowledge of his mechanics and finds his release point quickly and is one of few pitchers that can consciously move it as necessary. I'm not worried about him and wouldn't move him down draft boards much, if at all.
Mat Latos, Reds
If you see Dr. Tim Kremchek over the next couple weeks and he looks happy, you can bet it will be because of Mat Latos. Latos is just the latest feather in the cap for the Reds team doc. Getting Latos back on the mound quickly after two surgeries is solid work.
Latos had his elbow cleaned out—reports conflict as to whether it was bone chips or bone spurs, though it could be both and neither are good—and then injured his meniscus early in camp. Both are minor surgeries, but setbacks happen, especially for pitchers trying to get their mechanics locked down. Having two things to deal with greatly complicates things.
Latos has had no problems and while he's not likely to be ready for Opening Day, he's not far behind. The Reds will likely skip him in the rotation and have him back quickly, though they could DL him and let him make a start or two at Louisville (Triple-A) just to be sure that his mechanics and his stamina are where they need to be.
Watch to see where Latos' work gets him in the next couple weeks. The normal plus-one progression of starters through the spring isn't likely to change for Latos, but getting to five innings would be a great sign.
Taijuan Walker, Mariners
There are always going to be sore arms, dead arms and worries for pitchers as spring training gears up. For younger pitchers, it's even more of a common issue since they often don't know how to ramp up and are often going through their first major league camp.
The Mariners are being very careful with Taijuan Walker but are worried that the soreness in the back of his shoulder has lingered. They have to be conservative with him, but there are concerns as to whether he'll be ready for the start of the season and how they'll replace his wicked stuff, especially with Hisashi Iwakuma also unlikely for Opening Day.
Walker could be held back even more if the Mariners decide to control his innings at the start of the season. While most are familiar with players being shut down at the end of the season as they fatigue or hit innings limits, it's possible to control the innings on the front end as well. Walker and James Paxton are both going to be stretched to go much beyond 150 innings, so staggering them makes sense.
The Mariners medical staff is one of the best around, and its work with Felix Hernandez has to give some confidence for Walker. No one I've spoken with is concerned that this is a serious problem, so it's wanting to make sure that Walker is set up for health and success this season and beyond more than it's trying to fix a major shoulder issue.
Grady Sizemore, Red Sox
I don't often write about players being healthy, but with Grady Sizemore, that's more newsworthy than him being injured. Sizemore has looked good through the start of camp and more importantly, his knees are holding up.
After several seasons, Sizemore is back on the field and showing some speed and quickness but more importantly, he is not needing significant maintenance from day to day. There's some, but this is starting to look more along the lines of Carlos Beltran than what Sizemore has needed in the past.
The problem now is that no one knows what changed, including Sizemore. It could come back quickly, but for the Red Sox, they'll take anything they get out of Sizemore. If he ends up being nothing more than a chance to give Jackie Bradley a bit more time to acclimate or even get more at-bats in Pawtucket (Triple-A), that's a win.
Sizemore remains incredibly risky so don't expect a return to All-Star or even productive form. He's a lottery ticket, late-round pick that might just have some upside, especially if John Farrell uses him properly.
Doug Fister, Nationals
Doug Fister may not say he's worried about his elbow, but the Nationals sure are. Their new starter was brought over in an "all in" kind of move, giving the team some unprecedented rotation strength. Most teams don't go four deep with solid starters, and without significant depth, the Nats are doing what they can. Health will be key.
That's why Fister's elbow is such an issue. "No structural issues" is more of a dodge than an explanation. If it's not one thing, it's another, and with inflammation, the issue can build up, change mechanics, create internal damage or even all of the above.
Most likely there's mild irritation inside, with something like bursitis. The worst case is that his elbow is loose and the bones are banging together, damaging the cartilage and causing articulation issues. That's not structural per se, but it's certainly not good.
If the inflammation is early-spring-type transitory, then Fister should come back quickly and without issue. If there's any sort of setback, any sort of mechanical change, it will be readily apparent and the deal for Fister will go under the microscope. He could be the best No. 4 in the game, but he has to be healthy.
We'll also see whether the uptick in injury stat rankings that the Nats have seen over the last few years is real. They were in dead last for so long.
Cameron Maybin will avoid surgery on his strained biceps, but largely because he essentially "did the surgery himself." Tenodesis doesn't have a long or successful track record in baseball, but if Maybin can strengthen the rest of the intact area muscles, he should be able to return, though I think the Padres' time line is aggressive. Watch to see if he can throw well and swing without pain early in his rehab to get a read on what he might be able to do.
Matt Harrison is making nice progress after an early-spring back issue. It turned out to be minor, but along with three surgeries last season, he's well behind. Harrison could be back in the currently thin Rangers rotation by May 1, meaning Joe Saunders could be a very short-term fill-in. I'd have rather seen the Rangers use one of their young power arms for a couple short starts rather than go the retread route, but few teams are willing to push arms.
The Braves hope to make a determination on Mike Minor later this week. Minor is way behind and getting him ready for Opening Day is a long shot. The real question now is how long he'll be out and whether the Braves will have to dip down to fill in for him and others.
Luke Hochevar elected to go for Tommy John surgery after getting a second opinion. The Royals wanted him to try and rehab, but it doesn't sound like there's much friction. He's out for the season.
The Dbacks signed Bronson Arroyo largely because he's been so durable. Oops, he's started his tenure with the team having pretty serious back issues. He's getting treated for the herniated disk, and surgery doesn't look necessary, but it's going to require a lot of maintenance.
Josh Hamilton has time to ramp up and be ready for Opening Day after his calf strain, but the Angels aren't happy with the pace of his rehab or his effort. Hamilton has always been "laid back" about anything that happens, but sources tell me that his lack of production and big contract are quickly turning him into Vernon Wells. "[Wells] never acted like he was struggling. Same with Josh. At least pretend to care," said one team source.
Matt Kemp's slow progress is worrying some around the Dodgers, but he's still on target. If they don't understand that Opening Day was always a question mark, it could be an organizational issue. Luckily, Gerry Hunsicker is showing a lot more hands-on influence this season.
The Dodgers do expect to get Chad Billingsley back midseason. He's coming off Tommy John surgery and is showing normal progress. He's depth for them right now but could help big time by the end of the season. He's not a bad late-round stash.
The same is true for Jason Motte, though he could be ready as soon as Opening Day. The Cardinals have options, so they can be very conservative with Motte. When healthy, he may end up a trade chip in June, since Mike Matheny seems to be very willing to go with younger players or even a committee at closer.
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