Under the Knife: MLB Injury Analysis on Machado, Verlander, DeGrom and More

Will Carroll@injuryexpertSports Injuries Lead WriterAugust 13, 2014

PITTSBURGH, PA - AUGUST 11:  Justin Verlander #35 of the Detroit Tigers reacts in the first inning after giving up five hits and four runs against the Pittsburgh Pirates during inter-league play at PNC Park on August 11, 2014 in Pittsburgh, Pennsylvania.  (Photo by Justin K. Aller/Getty Images)
Justin K. Aller/Getty Images

There are a lot of debates in baseball. It's what drives the sport, I think. It's the same for injuries. How much comes down to luck and how much is preventable? How much is workload and how much is genetics? With injuries to major stars like Justin Verlander, Manny Machado and Andrew McCutchen, injuries are once again deciding pennant races and creating new debates.

The downside here is a lack of data that allows anyone to create a debate. Just as any upside brings cries of "he must be on steroids," it seems that any downside brings the cries of "he must be hurt." Without being able to know what the athletic trainers and doctors are seeing (or without me calling my sources!) observers are left guessing, often wrongly.

The easy solution would be for teams to give more information. There's no advantage in holding it. Helping fans understand what's going on behind the scenes would make them feel more included. People read this column for the kinds of things that the team should be telling them. It's a huge opportunity for a team confident enough to be open.

Until then, we'll have plenty to talk about here, so let's look around the league... 

Manny Machado 

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Patrick Semansky/Associated Press

It looked bad. In fact, it looked as if Machado had injured his other knee in a similar fashion to the knee that cost him the end of last season. Dr. David Chao tweeted that he thought the mechanism matched another sprain, one that could be devastating to Machado and the Baltimore Orioles' playoff hopes. Instead, the minor sprain may not even push Machado to the disabled list. 

There are a couple details beyond the mechanism of injury that are key. First, we don't yet know the full extent of the injury. Machado was scheduled to have imaging done on Tuesday afternoon, but there were positive signs Monday night. The team called the injury a sprain, indicating it felt there was some level of ligament damage but seemed a bit optimistic, as noted by MLB.com's Brittany Ghiroli.

Most importantly, people seem to have forgotten that last year's surgery was done to "lock in" the knee and make sure that he didn't have more recurrences. There was some debate as to whether the surgery was necessary, but Machado eventually decided that letting Dr. Neal ElAttrache fix the knee was the best decision for the long term. Once he came back, Machado has had no issues with that knee. 

There's likely an element of genetics here. Machado has two knees, so it's likely that the problem he had in one is also present in the other. It could be more or less serious and certainly hadn't presented itself as an issue until this one awkward swing, but it does seem to be there.

Now the question is about specifics. What ligament is sprained and how long will he be out? The Orioles didn't give that info, but the reaction is telling. That he's not immediately on the DL indicates that it's a low-grade sprain and that perhaps the knee's stability isn't compromised.

Details should emerge over the next few days, but the key is whether Machado can function in the field and at bat. Watch to see when Orioles head athletic trainer Richie Bancells allows him to try that. If it's this weekend, it's a major positive. If the knee isn't as stable as originally thought, the DL will remain a possibility. 

Justin Verlander

Keith Srakocic/Associated Press

"That explains a lot." One quote from a source summed up a lot of the reaction to Verlander's injury, but I think it's oversimplifying. A lot of times, when a star player has a substandard performance, the easy assumption is "he must be hurt." The problem is that there's seldom any evidence. 

Yes, Verlander has had a poor season, but until he left Monday's game just an inning in, there was no real sign that he had problems with his arm. Now, a sore shoulder pushed him out of the game and perhaps to the DL. 

An MRI showed "normal wear and tear" and some inflammation, but no major damage, according to AT Kevin Rand, by way of MLB.com's Jason Beck. The wording here is key. Pitchers with the experience of Verlander's are likely to have some issues inside the shoulder, but they are normally asymptomatic.

It's been speculated by many doctors, including James Andrews, that most pitchers have labrum, rotator cuff and ligament damage, but that they either don't know it or adjust.

That's the case with Verlander, but with a lot of money left on his deal, Tigers fans and front office types are going to be wondering whether that wear and tear is finally affecting his function. It's likely the case, which puts Verlander back on the Roger Clemens path.

I've thought for the last year-and-a-half that Verlander was transitioning from power pitcher to pitcher, just as Clemens did in the middle of his career. We'll see whether Verlander can complete that transition in the offseason.

For now, Verlander and Rand will have to focus on function. Getting the inflammation out is relatively easy with therapy and medication. How his shoulder responds after will be easy to see with velocity and command. It looks like Verlander will miss at least one start, but the team will hold off on a DL move until it sees whether he can make his next side session. 

The Tigers are in trouble, according to B/R's Scott Miller, with a real chance of missing the playoffs despite the David Price trade. Price and Max Scherzer should be enough for most teams, but adding in injuries and ineffectiveness in the bullpen makes keeping up with the streaking Royals an issue.

Kevin Rand is going to have to get these situations under control if he and the rest of the Tigers are going to have a shot at a ring for owner Mike Ilitch. 

Tyler Skaggs

Patrick Semansky/Associated Press

Add another name to this year's long roll of Tommy John pitchers. The Los Angeles Angels have lost Tyler Skaggs for the rest of the season and likely the bulk of 2015 as he recovers from impending elbow reconstruction. Seeing a young pitcher break down isn't unusual, but there's some background on this that does make it worth looking at.

Skaggs came over to the Angels this season from the Arizona Diamondbacks, a team that's traded away several pitchers over the last few seasons. At one point, Skaggs was just one of the young pitchers drafted in by the D-backs. Trevor Bauer, Jarrod Parker, Patrick Corbin and Skaggs were all set up to be the "rotation of the future", but injuries set aside some while general manager Kevin Towers sent some away.

Three of those are now rehabbing from Tommy John surgery, with Parker having his second while with Oakland. Only Bauer, a long-toss aficionado, has avoided the issue, despite the fact that Arizona has been excellent at keeping its players healthy over the last decade while under the care of Ken Crenshaw. 

So we have multiple young pitchers with different organizations and workouts, but three of four have lost at least a season to elbow issues. This is the problem that baseball faces all over, but in this collection, we have an opportunity to find out if there's any solid causation.

MLB is just beginning to study the problem, but for the Diamondbacks, figuring out any solution or change sooner rather than later could be key to turning the organization's fortunes around.

Jacob deGrom

Jeffrey Phelps/Associated Press

The answer to every pitching injury is not "shut him down!" It seems that fans have let the pendulum swing too far, just as teams have done with pitch counts, inning limits and other strategies that haven't worked to reduce injuries over the last decade. 

Remember, the question should be asked with each and every pitching injury as to what caused the injury in the first place. Too many times, teams are merely treating symptoms caused by the underlying problem, which is often mechanical or structural. Without answering those, the result is likely to be the same when the pitcher is stressed again. 

Jacob deGrom has been a revelation for the New York Mets this season, but as a young pitcher on the edge of a career high in innings and pitching at the major league level for the first time, it's not surprising that the stress on his arm would also be at an all-time high. 

DeGrom was smart enough to tell the team, and the early diagnosis, according to Kristie Ackert of the New York Daily News, is that he's dealing with minor tendinitis in his rotator cuff. DeGrom's self-reporting is unusual in a culture that denies injuries and avoids early treatment in order to not appear weak.

While DeGrom will miss the next few weeks, he'll likely return. The Mets will watch him closely as they work to make sure his shoulder is healthy both now and for the upcoming years, when he may well slot behind Matt Harvey and Rafael Montero, who will replace DeGrom in the rotation for now.  

Gerrit Cole 

LOS ANGELES, CA - MAY 29:  Gerrit Cole #45 of the Pittsburgh Pirates throws a pitch against the Los Angeles Dodgers at Dodger Stadium on May 29, 2014 in Los Angeles, California.  (Photo by Stephen Dunn/Getty Images)
Stephen Dunn/Getty Images

Sometimes, rehab assignments are tough to read. A few years back, A.J. Burnett came down to Indianapolis to throw a rehab game. If all went well, he was expected to head back to the Pirates. His outing was terrible in terms of results. His velocity was fine, but he got knocked around. He hit his pitch count, grabbed his bag and headed out.

For him, it was a success. He showed he was healthy, got his work in and headed back. Flat out, he didn't care about the result.

I don't think that's exactly the case with Gerrit Cole, but it might not be far off. What we see from the outside are results, while what Cole may be doing is simply getting in his work and adjusting some things that the Pirates aren't going to advertise. One of those things seems to be experimenting with his velocity and likely his effort level. 

In his last rehab start, Cole was dominant. In the start before, he got knocked around a bit, but in the fourth inning, dropped his velocity. Cole said he did it on purpose, but no one seemed to know what the purpose was. I believe, having spoken with a few pitching coaches around the league, that Cole is trying to dial down the effort in his delivery to protect his shoulder.

Power pitchers, such as Justin Verlander, often lose some velocity as their career progresses. They have to adjust on the fly to become pitchers rather than just reaching back for that fastball when they need it. If Cole is making that adjustment now, it could be read in a number of ways, but there's no sign he's lost velocity.

We'll have to see over his next few starts for the Pirates if this was an experiment or an adjustment, and if he can stay healthy with either. 

Dan Jennings 

Gene J. Puskar/Associated Press

Dan Jennings took a very scary liner off his head. He was clearly concussed, but the 101-mph liner could have done much worse. He was hospitalized for tests, but rejoined the Marlins on Monday. He won't make it back at the seven-day minimum, but the concussion DL has no maximum.

We'll see whether or not he wears any sort of protection, but it's another chance for MLB to step up and put more dollars into developing a usable protective hat for pitchers.

Andrew McCutchen

The Pirates waited on Andrew McCutchen, hoping that his rib fracture would improve in terms of pain and function without placing him on the DL. Despite some progress, the Pirates made a retro move on Monday.

With the move sliding back to August 3, he could be back as soon as this weekend if he continues making progress. It's at least a sign that McCutchen isn't going to have major problems once he returns. 

Masahiro Tanaka

Jim Mone/Associated Press

Masahiro Tanaka is making nice progress through his rehab throwing program, as noted by Brendan Kuty of NJ.com. He's been able to go out to 90 feet without any pain or inflammation after the sessions.

A few more of these sessions and he's likely to get up on a mound or half-mound. That could happen as soon as this weekend. While Tanaka is still on track for a September return, there are a lot of steps between now and then, more if the Yankees insist on building his stamina up. 

Michael Pineda

The Yankees are shifting Michael Pineda's next start from a rehab outing to a key game against Baltimore. Pineda has done well in his rehab starts, but he's not stretched out. That means he'll likely go a short outing and will be shadowed.

Remember, stuff hasn't been Pineda's issue, but recovery has. How Pineda reacts between starts will be more telling than anything he does against the Orioles. Don't be fooled by strikeouts or velocity, no matter how positive.

Wil Myers

ST. PETERSBURG, FL - JUNE 4:  Injured Wil Myers #9 of the Tampa Bay Rays reacts between innings of a baseball 
game against the Miami Marlins at Tropicana Field on June 4, 2014 in St. Petersburg, Florida. (Photo by Mike Carlson/Getty Images)
Mike Carlson/Getty Images

Wil Myers is very close to a return. The Rays could use his bat and to see what they can expect from him next year. It's been a tough second year in the majors for Myers, with both injuries and adjustments. He can still crush a mistake, but the Rays are hoping that he can become a more complete hitter while staying healthy.

He still has a ton of potential, but seeing the power back after a wrist injury is a good sign for the present.

Troy Tulowitzki

After previous groin issues, Troy Tulowitzki's problems remain, but it may be more serious than previously thought. The Rockies are sending their shortstop to Marc Philippon in Vail, Colorado, who specializes in athletes' hips.

Philippon has surgically repaired the hips of several MLB players, including Chase Utley and Alex Rodriguez. If Tulowitzki does need surgery, he could return for the start of next season, though it could complicate the idea of a trade—unless a team already has a comfort level with the doctor and rehab. Like the Yankees?

Brett Anderson 

Joe Mahoney/Associated Press

Brett Anderson is sidelined by yet another injury. This time, it's a serious back problem that could lead to surgery. Anderson consulted with multiple surgeons about his bulging disk and is now headed for surgery on Thursday, according to MLB.com's Thomas Harding. If so, that would not only end his 2014 season, but it could put the start of his 2015 season in jeopardy.

He's injury prone, but Anderson's never shown, despite those injuries, that he's lost any talent along the way. Some team will take a chance on him if the Rockies elect to pass on his option. Anderson and his agent would be smart to align him with a team that has experience rehabbing pitchers from this kind of procedure, like the White Sox or Rangers.

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