Under the Knife: MLB Injury Analysis on Tulowitzki, Teixeira, Wacha and More

Will Carroll@injuryexpertSports Injuries Lead WriterJuly 23, 2014

Brady Aiken will go down as one of the most intriguing draft stories in the history of the MLB, no matter how it goes. Like most draft picks, it will be years before we know whether the Houston Astros missed out on a top talent (or three) or whether they dodged a bullet.

Aiken's physical cost him an agreed-upon $6.5 million as he elected to walk away. That's confidence or folly, and no one knows which.

The reason, however, is known. Aiken was found in the physical to have a smaller-than-normal UCL. That's the ligament that would be replaced in Tommy John surgery.

Many compared Aiken's situation to that of R.A. Dickey, who lost a bonus when he was discovered to have no UCL at all. The situation is different; it's not apples to apples, it's apples to no apples.

Aiken's "small" ligament is still functional, and that's the key point here. While it is demonstrably smaller than expected, it's not demonstrably weaker. The fact that it handles 97 mph stuff tells us that either Aiken is exceptionally efficient or the small ligament is stronger than it's size would indicate. 

Aiken was checked by three doctors, including Dr. James Andrews, who cleared him to pitch. However, the Astros' doctor (or doctors, more likely) indicated that the ligament was an issue.

Now, let's be clear—it is not known whether the Astros "failed" Aiken, and it's frankly semantics. They used the adverse finding to try to get a discount above what they had already negotiated, and Aiken walked.

That's a risk for both.

Are there tests that would check the strength of the ligament? Not really. I spoke with several doctors, including one that examined Aiken, and none seemed confident in any extant test. More than one of them suggested a biomechanical evaluation, but it seems that neither the Astros nor Aiken wanted that. Aiken's camp was already perturbed about leaks from the Astros about his physical. 

Aiken has some decisions, but this one will be an interesting one to follow. Maybe Aiken is another Gerrit Cole who goes to college, matures and succeeds. Maybe he'll be back in the draft next year. It's unlikely that he'll be a free agent, but we do know he won't be an Astro. Everything else is unknown, but very, very intriguing, in many ways, including medically.

There are plenty of major leaguers with injuries this week, so let's look around the league...


Garrett Richards

Jerry DiPoto told the media that the L.A. Angels weren't going to put any specific restrictions on Garrett Richards this year, as noted by Alden Gonzalez MLB.com. Part of the reason is that he doesn't have "a violent delivery." I'm not disagreeing with DiPoto here, but the fact is, he doesn't know.

The Angels aren't a team that does much with biomechanics, so he's guessing based on looks. DiPoto certainly knows pitching and has people around him that know as much, so it's a very educated guess but nonetheless a guess. He could be right, he could be wrong, and he could be gambling with Richards' arm.

I'm not advocating for an innings restriction or a shutdown here, but I'm advocating not guessing. Without biomechanical data, the Angels could measure Richards' fatigue in a number of ways. If they're doing that, awesome, but all my sources indicate that like most teams, they're not. 

Richards is facing a major innings increase if he continues at this pace, but there's no other evidence of fatigue that's noticeable. The Mariners saw 98 last time out, so his fastball isn't tired. Until Richards gets north of 180 innings, he's not in dangerous territory, and at age 26, he's not the type that's most at risk either.


Troy Tulowitzki

Another season, another injury for Troy Tulowitzki. "Tulo" stayed healthy enough to play opposite his hero, Derek Jeter, in last week's All-Star Game, but he quickly ran into more problems, literally. Tulowitzki was placed on the disabled list by the Colorado Rockies on Tuesday due to a strained hip flexor, noted by Cody Ulm of MLB.com.

The injury, suffered last Saturday, is just the latest in a string of injuries that have kept Tulowitzki off the field. When on it, he's great as all his numbers show. The downside is that these recurrent leg injuries indicate some sort of movement problem that isn't being corrected.

I asked Lenny Macrina of Champions Physical Therapy in Boston, one of the top sports PTs around, about this, and he agreed:

He most likely has some form of hip or lumbopelvic dysfunction with imbalances in ROM or core strength leading to his recurrent hip-flexor strains. If he doesn't stabilize well through his pelvis and has a dysfunctional movement pattern, then he will over-stress and overuse the surrounding musculature leading to injury.

What Macrina is saying is that Tulowitzki keeps having the symptoms fixed but not the problem. Without that, he'll continue to have similar, related issues. It's a very difficult fix, especially given his on-field success. The injury doesn't really affect his trade possibilities, since all the sources I've spoken with over the last two weeks have indicated that Tulowitzki was essentially untouchable. 

His return to the lineup will be conservative, especially if the Rockies fade further without Tulowitzki in the lineup.

It's going to be a very interesting offseason in Denver. 


George Springer

The Astros have plenty of other problems, but few of them are as important as keeping George Springer healthy. Springer has been solid for the Astros since coming up, putting up great power numbers but missing a lot of balls. The floor on Springer is pretty high, but to keep that floor stable, he'll need a solid base.

That base is the problem. Springer is having lower-body issues, if you listen to the Astros' hockey-like statements. The real problem is not dissimilar to what Joey Votto is going through. Springer has a problem in his lower quad, near the knee. This kind of soreness is often akin to "jumper's knee" but really prevents a player from getting a solid base.

Springer still has plenty of power, but even more than Votto, it's key to the Astros' future to keep this from becoming a chronic problem. Not only could it sap power, but it could hurt his range and his speed.

The Astros can afford to be very conservative with Springer, and they'd be right to do so. While he's a nice Rookie of the Year candidate, they'd rather he be on the field healthy next year than take home a trophy this year.


Michael Wacha

The Cardinals got some good news on Michael Wacha. Not great news, but good. Wacha had an MRI on his shoulder, and things look like they're healing up on his scapula. The stress reaction is less stressed, and Wacha is a bit closer to throwing.

At this point, he's still got a couple weeks of healing, and even then, this is the kind of problem that could quickly recur. Aside from letting it heal up, there's not much the St. Louis med staff can really do here. The root cause is likely throwing, and it's not like Wacha can stop doing that. 

This type of injury has been recurrent in the small number of pitchers that have had similar injuries. The plus for Wacha is how quickly they caught it, so there's hope there. What we don't know is how much hope. Once Wacha starts throwing, every day of pain-free and injury-free throwing is a major plus.

I feel pretty positive about it, but since it's nearly impossible to make significant changes, there's just no way to have Wacha be anything but risky. Risk is fine if it's matched with reward, and Wacha has the kind of upside to make buying all the Maalox worth it. 


Mark Teixeira

"Injury prone" is a word that is thrown around too easily. It's not even the right term for Mark Teixeira. Usually a durable player, Teixeira has actually followed a nasty pattern that I hadn't seen coming. I call it the "Iron Man" effect, after Cal Ripken. Once a very durable player starts to have physical problems, things can get out of hand quickly. Ripken is one example, as is Johnny Damon. 

Teixeira hasn't been as durable as those two, but he's been above average. He was a 162-game guy a couple times and a 150-game guy otherwise, until he wasn't. Expecting him to come back to those levels now, after wrist, back and other minor problems, is folly. 

His latest issue is a minor lat strain, which is not related to his other back problems, at least not directly. The Yankees are going to try to let him have a few days off to heal up. They think he can avoid the DL, but the option is open. Joe Girardi normally doesn't like to play short, so that's a positive sign.

The downside here is that it's one more piece of maintenance work that the New York med staff has to do day to day as it tries to keep the entire team healthy. Adding in a player like Chase Headley and his back maintenance really taxes the staff even more.

If the trainers can hold this team together with the equivalent of duct tape and get it to the playoffs, that will be a feat.


CC Sabathia

CC Sabathia will have his surgery on Wednesday, and all is expected to go to plan in Los Angeles. Dr. Neal ElAttrache is doing the surgery and seems confident, as does Sabathia, that he can be back next year.

It will be tough to track this until the spring, but if Sabathia is doing normal, daily activities this offseason, that's a very good sign.

What's less clear is whether Sabathia needs to lose weight.

Weight on its own is not the best indicator of stress on the knee. It's much more biomechanical, which is something we just can't know until after the surgery and the healing. We simply won't know until January, just ahead of spring training.


Michael Pineda

The Yankees are getting some positive signs from Michael Pineda. In what some called a last chance, Pineda has made progress, though he's still having issues with his shoulder.

He'll throw two batting-practice sessions this week to gauge how much pain and inflammation he has. If they can get him through that, he'll head out on a very short rehab assignment. He won't get up to full stamina on the rehab assignment but can help a short staff with even four or five innings. He'll build up on the fly, if possible.

Pineda's issue has been between-start recovery, so the Yankees appear to be a bit desperate to get any kind of value out of him.


Yasiel Puig

It's not easy for players to switch to wearing a padded glove. Troy Renck, the longtime Denver beat writer, and I had a discussion about it, and it's as much about mental comfort as physical. Players get very comfortable with certain things, in a lucky-sock kind of way. Even when it's in their best interest, as a padded glove would be, it's hard for someone to change.

Maybe Yasiel Puig will consider it after taking a hard fastball off his hand. He got away with nothing more than a bruise, but it could have been worse.

Without changing gloves, next time might be.


Josh Beckett

Josh Beckett isn't healthy, but the hope is that the hip impingement has been helped enough by a cortisone shot that he can be effective. The Dodgers will have to watch this one closely, but Beckett isn't your normal pitcher at this stage. He understands the risks and is hoping to push for one more chance at a ring. Watch to see if he's able to get full extension or is shortening his stride or follow-through.

If he does start well, there's also the question of keeping him healthy between starts, so Stan Conte's going to have some long nights.


Michael Cuddyer

The Rockies lost Tulowitzki for a while, but that doesn't appear to change the timeframe for Michael Cuddyer. The latest MRI on his injured shoulder showed some progress, so he'll amp up his work and build towards a mid-August return.

The team may not want to trade him, as it's said, but he could be a nice waiver-trade guy for a contender who needs a bat. He could always re-sign with the Rockies if they want him that badly. That kind of "boomerang deals" happen all the time. 


Joey Votto

Dr. Tim Kremchek was on WLW with Lance McAlister on Tuesday and discussed Joey Votto. Kremchek said that Votto was doing well, but that while he wanted to be on the field, they had to keep a long-term horizon for his quad issue. Kremchek acknowledged that the Reds are going to have to stay in the race to get Votto back for September.

The bigger question now is whether Votto's situation can be kept from going chronic. At this stage, he couldn't even DH, and the Reds don't even have that option.


Late Scratches: Both Manny Machado (Orioles) and Pedro Alvarez (Pirates) left Tuesday's games with what are thought to be minor injuries. Keep your eye on both of these key players for playoff contenders.

You can follow me on Twitter (@injuryexpert) for updates.


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