Under the Knife: MLB Injury Analysis on Granderson, Pedroia and More
Under the Knife is constantly evolving, but yet it remains the same. If we could go back to that late April day 13 years ago when I sent out an email detailing five key injuries, maybe we could change what this is now, but it remains structurally much the same.
The spirit of UTK has shifted to football, basketball and soccer. Injuries are being considered everywhere, whether it's an "epidemic" of ACL injuries, hamstring strains or Tommy John surgeries. It's nice to see everyone else panicking and trying to catch up. Welcome to my world, folks. It's nice of you to join me after all these years.
UTK has always been about telling the story of baseball through the lens of sports medicine. It tells the story of the athletic trainers and doctors who work amazing hours trying to keep players healthy. It's about those players trying to overcome challenges or avoid them altogether. It's advances in technology, surgery and equipment.
UTK has gone from an email to a website to video and who knows what else. Team Stream would have looked like magic to me in 2002, but now, it's simply the best way to consume information. I used to wonder about how to get people to read about injuries. Now I wonder how to get them to read about injuries on their iPhone.
Experimenting with the format is just that. I want to get you the best information with a combination of speed and accuracy, and in today's fast-moving world, we're working to find that balance. Now, let's get to the injuries; analysis comes from previously published injury pieces.
The New York Yankees Infield
Right now, the MVP of the Yankees is not a player, but Steve Donahue. The longtime Yankees athletic trainer has been holding the team together with white tape and long hours, but the team is falling apart due to its very construction. If anyone thought a team with an aging Derek Jeter and Brian Roberts was going to stay healthy all season, I have a bridge to sell them.
Jeter has shown himself to be reasonably healthy, but there's obviously concerns about how he's going to hold up. While the ankle has limited him in the field and on the bases, there's the thought that the Yankees are slowly testing him while not overexposing him. Holding him on in Toronto is one thing, but there's a distinct chance that the team is at the point where they're reluctant to play him in back-to-back games, let alone day after night.
The Yankees are letting Jeter have his victory lap, but with a lack of backups, I have a hard time believing that this was the plan. Losing Brendan Ryan certainly hurt the infield more than you'd think, but if the Yankees have to disguise Jeter all season, they'll essentially be playing a man down all year.
The situation is the same with Brian Roberts. He hasn't been healthy in quite a while, and expecting him to suddenly go 120 games is folly. He's a cheap lottery ticket, and finding a backup is as easy as figuring out how to spell "Yangervis." Roberts' back spasms aren't unexpected; it was always going to be something. The question now is whether the possible production is worth the effort necessary to keep him on the field given all the other work Donahue is going to need to be doing.
The expected problem for Mark Teixeira—the wrist—is still a problem, but the proximal issue is a simple hamstring strain. He's on track to come back from it at the minimum, having progressed normally with a very conservative push to the disabled list. The question now is whether they'll use a rehab assignment to try to figure out whether his power is going to come back.
An injury to Francisco Cervelli, their light-hitting backup catcher, shouldn't create a big problem, but a minor hamstring strain has pushed him to the 60-day DL, per NJ.com. Don't take this as an indication of severity, but a roster-based necessity to shift an injury-plagued 25- and 40-man roster around. Cervelli didn't get much in the way of power or health from his work with Biogenesis, but everyone will continue to ignore that. In the meantime, John Ryan Murphy will be the backup but could be exposed if Brian McCann needs time off after taking a nasty foul tip off his hand, as noted by The New York Times.
The Yankees are juggling, but the worry has to be that they're facing a "death spiral." With only so many man-hours on the medical staff, will they be able to handle all the things they have to do and keep up the preventive work they need to keep the now-healthy out of the training room? It's a danger we've seen over and over, most notably a few years ago with the New York Mets.
It would be easy to fix. Simply "call up" a minor league trainer the way they would a player. No one else has done this, so it's hard to expect the Yankees will do so.
The medical staff does have one major win, as Michael Pineda has looked solid after missing a year to shoulder surgery. If he can recover from start to start, he's a big plus for the team. Watch to make sure he's making all his side work. Skipping that might be an indication of future issues and would make him a "sell high" immediately.
"I fought the wall and the wall won." If only I could have gotten Joe Strummer to do a version of that before he passed, we might have less stars running headlong into walls. Curtis Granderson is the latest to test the wall and come away sore, but it could have been worse.
The video is available of how Granderson slammed into the steel cage at Chase Field, which explains why he has a sore shoulder, ribs and knee. He hit it at speed and solidly, with nothing there besides a couple steps of dirt to warn and protect him. Granderson is lucky that there's nothing broken, or at least bruised more, holding him out longer.
I think the bigger question is why something like this is allowed to exist at the major league level. It's bad enough that minor league stadiums have gaps in padding that lead to near tragic consequences, but there's a lot of areas in major league stadiums that are unpadded. It's not just Wrigley that lacks padding and in that case, it's so well known that players know enough not to run headlong into the ivy.
Padding is actually one of those invisible things that you would think MLB would have a policy on. Is simple foam the best possible substance for this in 2014? Watch the next time that a ball hits a padded outfield wall and see how it reacts.
Does it bounce off like it's hit a hard substance or does it squish and drop? The reactions vary wildly, not to mention the exposed areas like steel viewing cages and scoreboards. Do outfielders need to wear some form of protection in or under their uniform?
Granderson should be fine in a couple days with enough ice and painkillers. The downside is that the Mets have lost Juan Lagares to the DL, which will put pressure on the team to get Granderson back out on the field as soon as possible. We'll have to see just how much of a long-term horizon the Mets really have when it comes to Granderson. The quest for .500 shouldn't be that important.
The streak is over. Whether you count Jason Isringhausen against the Tampa Bay Rays or not, it's still an incredible streak of health. It doesn't help Matt Moore now, as detailed by USA Today, who tested the elbow out on Monday afternoon and immediately knew that rehab wasn't going to work. He'll now head to Dr. James Andrews for ligament reconstruction and a year of rehab. Sadly, this went exactly how Angel Borrelli expected.
Quick story: Several years back, I was at the ASMI Injuries in Baseball course that Dr. Andrews and Dr. Glenn Fleisig put on. One of the presenters was Ken Crenshaw, then the head athletic trainer for the Rays and now in the same position with the Arizona Diamondbacks. He presented a great case about Tommy John rehab, including some new methods of regaining proprioception earlier in the process.
I caught him after the presentation and asked him how Seth McClung was doing. Ken was a bit surprised, since as with any medical presentation, there were no names and they'd blacked out the pitcher's face in pictures. "How did you know it's McClung?" he asked me. It was simple. They'd had no other Tommy John rehabs in the previous 24 months.
The Rays have been good at this for a while and jealously guard their methods. There are hints as to what some of these are, but it's not clear how they all come together. One of the biggest questions I have is why the methods don't travel. Crenshaw has been with the Dbacks for a while, and Nick Paparesta, another former Rays AT, has been with the A's for a couple seasons now. Neither team has nearly the same results that the Rays do, despite having great medical staffs.
Moore immediately felt pain during his throwing session, and sources tell me they weren't surprised. Pitchers have to be led to the decision and have to make it themselves. Moore is known as a hard worker, so he should have no real issues coming back from surgery. He also has the security of a long-term deal to help.
The Rays will have to deal with Moore's loss in the short term as they work to get Jeremy Hellickson back from his own minor elbow surgery. They have a number of possible solutions, but none are as good as Moore. Even though modern sports medicine can get players back, the loss is seldom as clear as it might be this season for the Rays.
Moore may well be able to come back and be the ace the Rays are likely to need if they lose David Price, but there's a lot more questions now for Moore, for their young prospect pitchers and for whether anything can help young pitchers avoid surgery.
Good news is always good, but when it comes to medical information, "good news" can often be a term of art. People usually learn that quickly, with things like a negative X-ray being a positive outcome, but in a case like Dustin Pedroia, good news on his wrist might be relative.
Pedroia played most of last season with a sprained thumb. His injury is similar to what Josh Hamilton and Yasiel Puig are currently dealing with, but with differing severity. Hamilton's ligament was ruptured, necessitating surgery, while Pedroia's sprain was just enough to annoy him all season. Of course, it also gave an opportunity for everyone to anoint St. Grit for his play.
Pedroia was able to play through all the way to a shiny new World Series ring, and yes, flags fly forever. But so does arthritis. While Pedroia's current issue is down in the wrist and there were worries about a fracture, there's now concern that playing through the injury has caused some sort of imbalance.
What the Red Sox have told us is that there's no fracture and no structural issue. With wrists, there's a lot of things going on in there. Sources tell me the likeliest culprit for Pedroia's current issues is inflammation in the TFC. Yes, the dreaded triangular fibrocartilage complex. The cortisone shot he got in his wrist, according to Alex Speier, points to this as well, so we'll see how he responds.
Pedroia could be back as soon as Wednesday, but remember with wrist injuries, there's usually a drop in power in the short term. Watch to see if Pedroia has good bat control and if he adjusts his swing to compensate. There's no fantasy move here—Pedroia is a ride or die player, so you'll have to watch and hope for the best.
The season hasn't started well for the Atlanta Braves. Before they even got to Opening Day, they'd lost two of their starters (Kris Medlen and Brandon Beachy) to Tommy John surgery. Again. They've had a below-average record with pitchers over the last few years, largely the entire Fredi Gonzalez era and looking at his usage patterns reinforces that correlation.
For Craig Kimbrel, any arm problem comes with additional worries. With arms like Jonny Venters and Cory Gearrin on the shelf, the bullpen is getting a bit thin in front of the closer. Jordan Walden had one nice season in Anaheim, but the rest? Well, they're "guys" in baseball parlance. Hard throwers who have a chance, but are unlikely to be top relievers in any context.
Kimbrel's injury isn't serious, explained here by the Atlanta Journal-Constitution's David O'Brien, but sometimes serious injuries start out that way. So far, sources tell me it's a mild strain akin to "dead arm," but Kimbrel has had some issues throughout the spring. That points to a minor strain or impingement that's being aggravated and re-aggravated by pitching. At worst, Kimbrel will have to be used more judiciously, but there's little evidence that Gonzalez knows how to do that well.
The Braves would be smart to come up with some "rules" about his usage, but those will have to be informed by how situations make him feel. Kimbrel may be fine with back-to-back games, but perhaps three days in a row would be too much. If so, none of those. There are various other scenarios, but they'll have to be tested, and unfortunately, that's very difficult to do at the major league level.
Kimbrel is unlikely to go to the DL given the current issues, but if soreness comes back this week, the Braves might make the conservative choice to push him to the DL now rather than wait and make the situation worse.
If Kimbrel misses any length of time, Walden will get the saves, but the whole bullpen would likely implode if it got to that point. Kimbrel will play catch and take treatment over the next few days. Without an off-day this week, Kimbrel and the pen won't catch a day to chain, so he could be back as soon as Thursday. The longer he's off right now, the better, but it will again be tough to do that.
Mat Latos has a lot of new scars. They match his tattoos in ways, but they're hardly fashionable. He has a couple small ones on his elbow from having bone chips removed, then another couple on his knee where his meniscus was removed.
With another arm issue, there were worries that he was headed for another new set, but the tests came back relatively positive. An MRI showed a flexor mass strain in his forearm but also showed that the UCL was strong, per Trent Rosecrans of the Cincinnati Enquirer.
Even with that, the naysayers point out that flexor strains are often precursors to other elbow injuries, pointing to cases like Dylan Bundy and A.J. Burnett. I hesitate to do more than mention these. Each case is different, and knowing that, Dr. Tim Kremchek would have not only seen the UCL on MRI but also visually during the chip removal: I have to think that a cascade to the UCL is unlikely. Not impossible, but unlikely.
Latos' strain is going to be a significant setback. He'll have to take some time off to let it heal, then start building up his stamina again. This would be a great time to get a look at his biomechanics and make some slight adjustments, if necessary.
Look for Latos' new target return date to shift toward June 1. That's just a best guess at this stage and will depend on a lot of factors, but it won't be much before that. Watch to see when he starts his throwing program back up for more of an indication.
Until then, the Reds will rely on Alfredo Simon in the five slot, though several scouts have told me Robert Stephenson is going to be ready sooner rather than later, despite starting this season in Pensacola. Stephenson is a top-rated prospect, though if you show pictures of him pitching to some pitching gurus, their head might explode from the drastic "inverted W."
Jose Reyes: Reyes is expected to be activated on Friday. He's currently on a rehab assignment at Dunedin (A) and if all goes well, he'll be back for the weekend series. With Adam Lind having back issues, that could make for an easy roster swap.
Mike Napoli: Late Tuesday, Mike Napoli dislocated his finger on a slide. It was an ugly injury—if you want to see it, I'm sure you can Bing up some results—but there was no fracture. Depending on whether there was any associated damage inside, Napoli could still need some DL time. We'll know within the next few days what the Boston Red Sox will do.
Aroldis Chapman: Chapman continues to make progress, getting up on a mound for a 25-pitch bullpen session. He's had no issues and could go out on a quick rehab assignment, likely to Dayton or Louisville, next week. He'll come back quickly to the closer role and could be a bump for a struggling Cincinnati Reds pen.
Adrian Beltre: Beltre wasn't happy about being pushed to the DL for his quad strain, but the Texas Rangers tend to be pretty conservative with injuries like this. Even more so early in the season and when they need to test out their backup infielders. Kevin Kouzmanoff is a nice comeback story, and if Beltre will need more rest this season, he could be a big part of the Rangers' success. Beltre should be back at the minimum and could be used more at DH than in the past.
Michael Bourn: Bourn was activated by the Cleveland Indians, bumping Nyjer Morgan from his role as the speed guy in CF. Bourn is coming off difficult hamstring surgery, so don't expect immediate speed. Any sort of sign that he's lost no range is a plus, and any steals will be a big positive. I'm not saying Bourn can't get his speed back, just not to count on it in the short term.
Alex Cobb: After Matt Moore, the Tampa Bay Rays don't need more pitching injuries. Cobb has a simple oblique strain, but that will cost him a month or more. The Rays tend to be conservative with these types of injuries. Look for Erik Bedard to try to hold down the No. 5 spot, but by definition, this would be a prime opportunity for a four-man rotation.
Colby Lewis: Lewis had a nice first start back after hip and elbow issues. He showed normal velocity and his typical sink, though he struggled at times with consistency on his release point. He puts a lot of pitches in the dirt, which taxes his catchers, but this should adjust some as he gets more comfortable. There's some question about proprioception with the hip, so see if there's any change with 58 foot fastballs in the coming weeks.
Taijuan Walker: The Seattle Mariners were expecting Walker to make one more start at Tacoma and then come up to take James Paxton's spot in the rotation. Problem is, Walker didn't make that start. He showed up with a stiff shoulder and the team is worried it's back at square one with Walker. He's definitely not going to make his next start in Seattle, but we'll have to watch to see how much of a setback this is.
Josh Johnson: Jeff Passan of Yahoo! Sports reports that Johnson is likely headed toward a second Tommy John surgery. An injury-prone pitcher went to the Toronto Blue Jays and San Diego Padres, two teams who have had their difficulties keeping pitchers healthy, and is surprised at this result? His agent needed to guide him toward the Chicago White Sox, Milwaukee Brewers or Rays, assuming they would take a shot on him at this stage. If he has the surgery, he'll get another shot since pitching is so thin and GMs always remember who a guy was.
Juan Lagares: Lagares has hit the DL with a simple hamstring strain, but with Curtis Granderson banged up as well, the team has to shuffle a bit. Kirk Nieuwenhuis will come in, but Chris Young is the more likely long-term replacement once he comes off the DL himself. Lagares is a speed guy, so watch to see how he deals with this injury and if it becomes recurrent.
Avisail Garcia: Garcia not only had his labrum repaired this week, he also had an avulsion fracture inside the shoulder. That means there's pretty extensive damage in the shoulder. While it's not his throwing shoulder, look at how Adrian Gonzalez and Matt Kemp struggled with their swings for at least a while after shoulder surgery. Neither had as serious an injury as Garcia either. He's done for the season, but this development makes it tougher to even think about him as a keeper.
Brett Anderson: Anderson has a strange injury, as he broke his finger on a swing. The X-ray showed enough damage that the Colorado Rockies were forced to DL him, and we'll see how they bring him back. The question will be about stamina, but there are ways to keep his arm going, even with the finger. He may have surgery to speed the healing and stabilize things, but even that might not get him back much faster. When healthy, he's got the best stuff on that staff, but it's a big "if."
Be sure to let me know what you think in comments or on Twitter (@injuryexpert).