Under the Knife: More Spring Training Injuries

Will Carroll@injuryexpertSports Injuries Lead WriterMarch 21, 2014

Under the Knife: More Spring Training Injuries

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    Joe Camporeale-USA TODAY Sports

    The story this week has been pitching injuries, but while the outbreak of Tommy John across the league got headlines, it's not unusual. Tommy John surgery is happening more and more. Remember, David Wells, a player from the not-too-distant past, may have been one of the first 10 MLB players to have the surgery.

    The acceleration has come to the point where we'll likely have 10 this week. It's more than just the MLB players as well. There are several minor leaguers who will head to Birmingham, Ala. or Los Angeles for surgery and more college and high school pitchers alongside them. 

    I asked Dr. Tim Kremchek of the Reds how many Tommy John surgeries he did last year, and it was nearly 100. Add in the other surgeons that do the bulk of MLB Tommy John procedures, and we're looking not at a problem but an industry.

    We've accepted it, to some extent. There's a moment of sadness when we see a pitcher like Jarrod Parker lose another year to an injury, but we forget about it quickly.

    This week's outbreak hasn't led to any discussion of changes. Bud Selig isn't announcing a bold research initiative. Some team spent more money on a computer than the whole league will spend on sports medicine. If that's how baseball is going to be, we're going to have a lot more weeks like this and a lot more pitchers missing years. That's bad for baseball.

    For now, let's look around the league...

Jose Iglesias

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    Gene J. Puskar/Associated Press

    Shin splints don't cost someone a season. What Jose Iglesias has is far different than what the original problem was thought to be. Instead, the Tigers shortstop has a severe, career-threatening condition.

    He was diagnosed with multiple stress fractures in both tibias. He is out for this season, and there are questions about how this could affect his career.

    This is a highly unusual diagnosis, and one that has very few comparables. I'm not sure how much we can learn from Yao Ming in this case, but it's the best physical comparison. Iglesias will have all year to heal, but there's going to be no certainty about how well his shins will hold up under activity. 

    The problem got significantly worse this spring, though he's had minor irritation before. There's no indication that something changed, but with activity, the bones literally broke down. If he'd been able to play much more or forced himself through the pain, the bones could have snapped.

    One key here is that this isn't one stress fracture. He had multiple fractures on both sides, complicating any healing. While there's a wide variant on the timeframe for his return, the Tigers are going to have to be exceptionally conservative with Iglesias, allowing the recovery to come to them.

    Fantasy players should be free to drop him or take him off their draft boards in redraft leagues. The Tigers will continue looking for a fill-in, both internally and externally, without a clear solution. Anyone brought in via trade would be an immediate upgrade and, in some cases, could make a player like Nick Franklin or Stephen Drew more valuable. 

Aroldis Chapman

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    Paul Sancya/Associated Press

    Aroldis Chapman avoided the worst fate but headed into surgery Thursday not knowing how being hit by a comebacker would affect his season. He came out of the facial surgery with a new scar, a new nose and a chance to be back in April.

    He had two bones reconstructed and fixated to provide stability. The nose is no big deal in the long term, though it is painful, but the bones surrounding the eye are extremely important. By fixating the bone there, the procedure ensures the integrity of the eye and makes it possible for Chapman to remain physically active while it heals. 

    Jostling the bone with activities like running or throwing would have been impossible in the near term, if not for the fixation. Chapman would have had to basically sit and wait for the bones to heal up, putting his conditioning and throwing well behind. Now, he will miss a week or so and not lose nearly as much.

    It's possible that the closer will be back in the game by late April, although his absence could stretch into May. Physically he should be fine, but the psychological issues could be something more. It's a binary problem—either it will, or it won't and we've seen pitchers like Brandon McCarthy and Doug Fister show no real problems after similar incidents.

    The Reds will go with a committee at closer in the meantime. With Jonathan Broxton and Sean Marshall coming back from injuries, Bryan Price might be forced to look to J.J. Hoover and Sam LeCure for saves. Neither should be fantasy reaches for a couple of saves.

Michael Bourn

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    Mark Duncan/Associated Press

    Michael Bourn is a speed player. Speed players rely on their legs. Any leg problem, especially a major one, is going to be problematic for a speed player. The fact that his legs are still feeling the effects of last year's Grade III hamstring strain is a huge red flag for the Indians and for his fantasy value.

    Bourn has a high Risk Rating coming into this season for precisely this reason. The surgery he had was considered minor and has a normal recovery time of about six weeks, but Bourn still hasn't made it all the way back. He has one of the best rehab guys around there in Lonnie Soloff, so the fact that he's not running well in mid-March is an issue.

    He is now in doubt for Opening Day, and unless we see near-miraculous progress over the next week, this could stretch into mid-April. It's going to be tougher to get Bourn back with most of Cleveland's affiliates in colder climates, so he might be left behind in Arizona for a bit. That shouldn't be considered a negative.

    Even if he only misses a couple of weeks, the indicators are there that he'll have issues with the hamstring for a while. That's going to cut down on his steal attempts, his defensive value and even his batting average and runs. It's a fantasy disaster, and Bourn has to be dropped significantly on any outstanding board.

Anibal Sanchez

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    Kathy Willens/Associated Press

    Joe Girardi doesn't have the reputation of a Dusty Baker, but the damage he left behind in his one season in Florida should be remembered. Pitchers like Anibal Sanchez taught Girardi somewhat, although his patterns in New York have only been shifted by the quality and age of his pitchers. He still has no idea what to do with a young pitcher. It's why I worried about Michael Pineda when the Yankees made the trade and why I'm still worried now.

    Sanchez is one of few to come back from labrum surgery and return to his previous level, but the shoulder is a cranky beast. The Marlins and the Tigers medical staffs have a known issue and have been able to handle it with maintenance. Now, with it acting up, the Tigers are being very conservative, as they should be.

    This isn't a significant setback, but his history and value make it an important issue for the Tigers. They have just enough depth to allow Sanchez the time he needs to get comfortable and get his stamina and mechanics back. The anti-inflammatory calmed things down, and he's back to throwing, which some interpreted as an aggressive timeline.

    Really, it's about keeping him on program.

    Look for Sanchez to miss a start. We don't know yet how Brad Ausmus will handle pitchers, but I'd expect the organization to push for a conservative approach, especially if the weather is cold. Sanchez is likely to miss one start, and being on the disabled list to start the season is possible. With a retro move, the timeline could still be very short and Sanchez's value shouldn't be significantly dropped.

    Remember, you should have the risk of his injury history priced in already.

Manny Machado

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    Gene J. Puskar/Associated Press

    Don't take anything this week about Manny Machado as a setback. The plan all along has been to get him back when he's ready, which always seemed a bit after Opening Day and even into May. He has been an athlete and competitor, saying he wanted to be back early, but that's what you want an athlete saying.

    Machado was released to full activity by Dr. Neal ElAttrache, who performed his surgery. He is one of the top sports surgeons in the world, so his pronouncements that Machado is looking better and better carry some weight.

    All that's left is to get him running and hitting, which the Orioles will do to plan. He's behind the schedule of everyone else but not behind schedule for what the O's expected for him. We could see Machado in a couple of spring training games, but there's still no clarity on where he will start the season. A lot of it is weather.

    Machado is so talented that losing a couple of weeks shouldn't drop his fantasy value significantly. In keeper leagues, don't drop him at all since this surgery was done with a long-term perspective. There are few talents with as much current value and upside, but Machado is one with both.

Cole Hamels

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    Matt Slocum/Associated Press

    Cole Hamels' injury has been shifted a bit, though nothing really changed. The Phillies and the media started referring to it as a biceps injury rather than the more general "shoulder" last week after he reported a dead arm. This isn't a real change, just semantics.

    The muscular issue is really more about tendinitis. There's some inflammation, and rather than having him push through it, the Phillies have dialed him back to try to get the situation to take care of itself. He's behind and could start the season on the DL, but this approach is designed to keep it from getting significantly worse.

    One of the keys here is that in recent years, sports medicine has discovered more of a direct relationship between the biceps and the labrum. It's such an interrelation that Dr. Stephen O'Brien, whose research has been key, started referring to it as the biceps-labrum complex (BLC). 

    Keeping this problem minor and muscular is the goal, even if it pushes Hamels to the DL. If he gets in a game next week, it'll be a very positive sign, though it will take until mid-April at best before he could have the stamina to start. The Phillies have a lot of drama in camp, but for Hamels, he's hoping to keep the drama away from his left shoulder.

Patrick Corbin

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    Gregory Bull/Associated Press

    The problem with Patrick Corbin is that no one saw this coming. He never showed problems with his mechanics, repeating his Roy Halladay-esque tilted sidearm. (See the picture? Sidearm.) He wasn't overused. He was progressed at a normal pace. There's really only one negative sign for him, and it's one that has been shown in research as not as big a problem as we once thought.

    Corbin hit a wall last season, sometime in mid-August if we look at the starts. A more granular look shows a bit of velocity loss and some control issues, which are signs of fatigue. He did go 208 innings—an increase over the 180 he did in 2012but again, the research on innings increases has been strong.

    Maybe it's not the innings increases in and of themselves. Ignoring the lack of a multiplier for the given that pitching to major leaguers is harder than pitching to Double-A prospects, innings are a bad measure. What we may have seen with Corbin is more about the fatigue than the innings. If his arm was fatigued and he pitched through it, it doesn't really matter if the innings went up, down or sideways.

    Contrast this with Shelby Miller and Lance Lynn, two Cards pitchers who have hit similar late-season walls. They were shut down, even to the point of pulling Lynn from the rotation and not using Miller in the playoffs. That's a strong commitment.

    The Diamondbacks have a strong medical staff, one with a consistent record of keeping the entire team healthy. However, their injury stats are down a bit during the Kirk Gibson era. I don't think that's coincidence. If Corbin's injury pushes Archie Bradley into the rotation, I'll be very curious to see how they manage him.

Matt Kemp

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    A weird truism in sports medicine states that some people just don't know how to rehab. It's true and is seen in baseball quite a bit.

    I've even termed one pattern of this the "Iron Man Effect." Cal Ripken personified it. He as healthy for an extended time, and once age and minor injuries came in, he experienced a rapid descent out of the game. The same is true for a player like Johnny Damon. Once he started getting minor injuries and missing games, he quickly lost value.

    It's unclear whether Matt Kemp fits the pattern. He barely missed a game in his professional career, but once he did, he's had a very hard time getting healthy from shoulder, leg and ankle injuries. It's conceivable that he will fit that pattern, especially as he continues to struggle to return from the ankle injury. 

    He is back playing and the ankle has held up to rehab, but in games, he's been so bad that some scouts are questioning whether or not his shoulder is healthy. Kemp has gone from MVP candidate to high-risk pick in short order, and I simply don't see any sort of comparisons for a return to his previous status.

    With only a week left and the Dodgers in Australia, it will be tough for Kemp to get much game action. He could be headed for an extended rehab assignment that will act as his spring training. Without more info, I'd avoid him in drafts but hold him in keeper leagues. Just know there may not be more of a payoff this year than there was last season.

Rafael Furcal

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    Scott Rovak-USA TODAY Sports

    The Miami Marlins are gambling that Rafael Furcal has one more good season in him. They signed him cheaply and have a solid middle infield. Knowing that his back, hamstring and arm aren't likely to hold up, the Marlins are trying to shift him to second base and use him as more of a part-time player, if not a strict platoon guy.

    His elbow hasn't been a problem, but a year away hasn't helped his hamstrings. His lower-back problems are likely interrelated here, and when healthy, the reports have been that Furcal has lost some speed. "He's lost two steps, maybe three," said one scout I spoke with early in the spring. Some of that might come back, but injuries like this won't help.

    For the Marlins, it's a worthwhile gamble, but for a fantasy team, it's a lottery ticket. Some will see the name and think steals, but that's not who Furcal is now. He is likely to start the season on the DL, and I don't foresee many scenarios where he's anything more than depth behind two guys who project to have OPS in the 600s. 

    If he does start the season on the DL, they have plenty of warm weather options for him to do a rehab assignment. Watch to see if they keep him in Jupiter, Fla. to monitor him closely or push him to New Orleans to test whether he can produce. That decision, more than anything he does on the field, will tell us what the Marlins think about Furcal.

The Others

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    Brad Barr-USA TODAY Sports

    Justin Verlander

    AL Central, you've been warned. Justin Verlander seemed to be in a period of adjustment last year, going from a Springsteen pitcher—you know, blowing that speedball by you—to one who needed to actually pitch. It's a Roger Clemens-learns-a-splitter moment, and most pitchers can't do it.

    The problem is that it looks like Verlander is now more Nolan Ryan than Roger Clemens. The groin issue may have been the whole problem, and with that fixed, he looks like the dominant pitcher he was.

    Matt Harrison

    Matt Harrison is back out and throwing. He's not fully recovered, mostly due to his back, but scouts tell me that he looks normal. Given a pair of back surgeries and non-throwing shoulder surgery, normal is pretty good. He won't be ready for the start of the season, but the earlier the Rangers get him back, the less they'll need someone like Robbie Ross to step up and out of the pen. I wonder if the Rangers have discussed going with a four-man and using Ross as a swingman. 

    Elvis Andrus

    Elvis Andrus is looking more and more like a guy who has bone chips in his elbow, though the Rangers haven't given any sort of diagnosis. "No structural damage" doesn't mean "no bone chips," so now the question is: Do they risk Andrus now, or do they shift things around and make sure that he is back and healthy down the line?

    Bone chip surgery is so minor that I've been wondering why the Rangers would delay if they know that's the problem, but sources tell me that with Jurickson Profar being setback by his teeth, they're not sure if he can just shift back over to his normal shortstop. Look for this to come to a decision over the next week. Either way, it doesn't seem too serious for Andrus in the long term.

    Jacoby Ellsbury

    Jacoby Ellsbury is injury-prone but not as badly as people think. As long as he keeps from running into things, he's pretty durable. A calf strain doesn't help, but he is not the pure speed guy that people think he is either. It's funny that such a well-known and oft-watched player like this could be misunderstood, but it does open up some value in drafts for those of us who do get him.

    Johnny Cueto

    The Reds rotation is a mess right now. Mat Latos is coming back from a pair of surgeries. Homer Bailey has a groin strain. Now Johnny Cueto might have the most concerning situation.

    He has a scapula problem, which means that he's showing another injury that's moved down the kinetic chain. That's a very negative pattern and one that suggests any mechanical changes haven't made a positive effect. I'm very down on Cueto and think the Risk Ratings may have even underrated how risky he is.

    Mike Olt

    Olt has been a bust so far since coming over in the Matt Garza deal, but the shift off third that's happening now might be a good thing. His shoulder is acting up, but with Kris Bryant coming fast and thus far not being so bad that he has to move off third, Olt could be getting a jump on a needed move to first. Of course, Anthony Rizzo is there, so that won't work. The Cubs will watch Olt closely over the next week to see if he'll start at third or on the DL. Expect the latter, which could open up some playing time for Emilio Bonifacio and his speed.

    Josh Hamilton

    Hamilton got back into games this week after missing much of spring training with a calf strain. He looks fine so far, but it's Hamilton, so the Angels are expecting something weird. So far, he's shown no signs of recurrence and the bat is there. You can probably take Hamilton where you were going to in your draft, although no one has any idea what this guy is going to do. 

    Gordon Beckham

    Gordon Beckham once looked like he could be a star. Now, he's fighting to come back from an oblique injury so that he can get a last chance from the White Sox. Leury Garcia is a versatile player, but he could also lock in at second with a hot start. Beckham hopes to get in games this week, but Herm Schneider will have to make sure Beckham isn't setting himself up for a recurrence.

    Jeff Locke

    The Pirates went back to the well this offseason, bringing in Edinson Volquez. They did so well with Francisco Liriano that maybe the same team could do well with Volquez. The similarities and background are there, but so far, he has been awful. That means the Pirates will need Jeff Locke to get back from his oblique strain quickly, or they may need to go to Jameson Taillon sooner than they'd like.

    Locke is a guy who benefits from a set schedule, so these kinds of injuries set him back more than some others. If you're looking for a sleeper starting pitcher, Stolmy Pimentel could get some starts in between Volquez and Locke and ahead of Taillon.