Stephania Bell: Alex Gordon
April, 7, 2010
It may have seemed as if all the stars were on the field on Opening Day, but many marquee players were relegated to the disabled list entering the 2010 season. Some may be just a few days from making their season debuts. Others, well, we're just hoping that we get to see them play this year.
Because fantasy owners always want to know when their injured star is expected to return, we've decided to highlight some of the key members of the group of 80-plus players starting their season at less than full health. In some cases there's reason to be very optimistic, but, as always, there are many more cases where there's cause for some level of concern.
Brandon Webb, SP, Arizona Diamondbacks (15-day DL, April 4): Webb has been a topic of injury conversation since last season. The hope coming into 2010 was that surgery, despite no significant findings, would help Webb move past his previous right shoulder problems. So far, that has not been the case. Although things initially looked promising, Webb has run into repeated setbacks that have postponed his return indefinitely.
Chirs Morrison/US PresswireBrandon Webb continues to have setbacks in his return from a shoulder injury.
The latest bit of discouraging news is that Webb received a cortisone shot in his surgical shoulder one week ago and was ordered to rest for a few days before resuming throwing. Webb's description of the shoulder is one not so much of pain, but rather a general sense of not feeling right. According to ESPN news reports, Webb said, "It doesn't feel great, but it doesn't hurt bad. I still feel like I can't let it go. I still feel like I'm not ready to get on the mound yet."
Hmmmm. A year plus one surgery later, and Webb is experiencing similar symptoms. It's impossible to thoroughly evaluate the situation from a distance, but it almost sounds as if there's more to this puzzle than the shoulder itself. Webb has made no progress in more than a month, and it is hard to be optimistic about his return, no matter when it occurs, at this point in time.
Cliff Lee, SP, Seattle Mariners (15-day DL, April 4): Lee is making some headway as he recovers from the abdominal strain that forced him to start the season on the DL. He is expected to throw a bullpen session Friday.
Lee also has made headlines in that he has been undergoing PRP (platelet-rich plasma) injections, along with all the other typical elements of rehabilitation, in an effort to aid his recovery from this injury.
It should be noted that the average missed time for these types of abdominal injuries hovers around 30 days for a thrower, and Lee is on pace for that time frame. He still needs to increase his pitch counts once he gets on the mound and appear in some rehab outings (at least two, perhaps more). The ultimate test of whether true healing has occurred doesn't happen until a pitcher throws at competitive velocity, so until he has been in that setting, the team -- and Lee's fantasy owners -- will not really be able to exhale.
Keep in mind that this is Lee's third significant abdominal injury. The hope, particularly with the addition of PRP, is that not only will the injury heal a little more quickly, but (and more importantly) it will heal more completely. To that end, one can assume the team will not rush him back. Reinjury could result in another four to six weeks of downtime. If all goes well, look for him to return in the latter half of April.
Ted Lilly, SP, Chicago Cubs (15-day DL, March 26): After undergoing a "cleanup" procedure on his left shoulder in early November, Lilly is expected to make his season debut in the third week of April. So far, his rehab course has been uneventful, which is a good sign. At 34 years old, you have to expect the presence of some wear and tear in a pitcher's shoulder. Although the goal is to avoid surgery whenever possible, in some instances it can add years to a pitcher's career. The fact that Lilly is doing so well provides much encouragement heading into the season. The disabled-list stint allows him to continue to build his throwing endurance in minor league games until everyone, including Lilly, is confident that he is indeed ready to return.
Joe Blanton, SP, Philadelphia Phillies (15-day DL, April 1): Blanton had never been on the disabled list in six major league seasons heading into this campaign. But all good things must come to an end. Blanton is being forced to start the 2010 season on the DL with a left oblique strain. The Phillies have maintained that Blanton's strain is on the mild side, but the initial projections have him missing anywhere from three to six weeks, standard for an oblique injury. According to ESPN news reports, team physician Michael Ciccotti said that if all goes well for Blanton, "we're looking at the earliest at the third week of April."
Again, the goal is to have the athlete avoid a second trip to the DL for the same injury, so it makes sense to keep Blanton out a little longer this time if it means better insurance for the long haul. The average DL stint for a pitcher with a true oblique strain is approximately 30 days, so an uneventful rehab could mean Blanton will return in late April.
Daisuke Matsuzaka, SP, Boston Red Sox (15-day DL, April 3): Matsuzaka started the season on the disabled list as a result of neck and back problems that have bothered him this spring. Currently, he is making progress with a pitching program in which he's expected to make at least three rehab starts, with his first one scheduled for Saturday. The biggest question is whether these issues are really behind Matsuzaka. He did work more closely with the team on his offseason conditioning and reportedly showed up to spring training in better shape, but there were still setbacks. The Red Sox are not sounding particularly worried at this point, and the injuries themselves do not seem serious. Last year, however, Matsuzaka was nagged by various ailments that kept him from being fully effective. The hope is that this will not be a repeat performance.
Erik Bedard, SP, Seattle Mariners (15-day DL, retroactive to March 26): In our preseason draft kit, we indicated that Bedard's offseason surgery to repair the labrum in his throwing shoulder would mean a delayed start to the season. Bedard, who has been playing long toss, is expected to throw a bullpen session of roughly 30 pitches Wednesday, according to Geoff Baker of The Seattle Times. Bullpen sessions evolve into rehab assignments, and Bedard will have to build up his endurance and velocity in his throwing arm. Assuming no setbacks, Bedard still appears on track to return around June.
AP Photo/Charlie NeibergallErik Bedard has lots of talent, but this year, his DL time is already built in.
Baker makes an interesting point regarding some of the mechanical adjustments the Mariners are working on with Bedard. Specifically, they are trying to adjust the turn in his delivery to minimize stress on his throwing shoulder without revamping his throw and making his pitches easier to read. It will be interesting to see whether the downtime has allowed Bedard's body some additional recovery. He has been plagued by soft tissue injuries in recent years and has not been the model of physical endurance. A shortened season after a lengthy time off may serve him well. He's not out of the woods yet, though; he has many hurdles to cross before he becomes a consideration in the Mariners' rotation.
Edinson Volquez, Cincinnati Reds (15-day DL, April 4): Volquez is another pitching ace who underwent Tommy John surgery last year on his throwing (right) elbow, but he did not go under the knife until August, making his return this season a question mark at this point in time. Although we've heard that the Reds hope to have him after the All-Star break, there's still no indication whether that means July or September, and there's no way to predict with any certainty. Typical recovery takes about a year, give or take a month or two (or longer) depending on whether any setbacks arise during the rehab process. Beyond that, it often takes a pitcher time in games to truly return to form, and he often doesn't put up typical numbers until the following year.
Currently, Volquez is throwing limited pitches at controlled speed off a mound and is doing all the right things so far. The biggest hurdles are yet to come, however, so it remains to be seen just what he can accomplish as far as returning this year.
Scott Kazmir, SP, Los Angeles Angels: (15-day DL, retroactive to March 31) Just when it seemed as if Kazmir might blow by a couple of minor spring training injuries to start the season on time ... he didn't. Not that there appears to be much to worry about. ESPNLosAngeles reports that, according to manager Mike Scioscia, "There's no setback with Kaz. It's just a matter of time and him getting stretched out to pitch a little deeper into a game."
Kazmir came into spring training with a hamstring strain which slowed him a bit. Later in the spring he developed some shoulder fatigue. Neither was believed to be serious, but it did delay the build-up of his throwing. As of now Kazmir is expected to make a rehab start Friday and is then expected to rejoin his team when they face the New York Yankees on the road April 13. Kazmir, with the help of pitching coach Mike Butcher (with whom he worked when both were with the Tampa Bay Rays), has made some adjustments that he believes will make him a bigger threat on the mound this year. He also focused on extensive offseason strengthening. Once Kazmir's season gets underway, he might restore his fantasy value if he can just stay healthy.
Relief pitchersBrad Lidge, RP, Philadelphia Phillies (15-day DL, retroactive to March 26): Lidge is coming off not one but two surgeries this offseason. First, he underwent elbow surgery in November to repair a torn flexor tendon and remove a loose body in his throwing (right) elbow. In January, he had surgery on the medial meniscus in his right knee. Lidge indicated that pain in the knee throughout the 2009 season led to changes in his throwing mechanics, which ultimately contributed to his elbow injury. The good news this spring is that Lidge has made steady progress with his rehab and had not experienced any pain ... until recently.
Lidge has had some elbow soreness, which is not unusual for him as he builds up his arm strength, but there were concerns that it might have been related to his recent procedure. Not so, said team physician Michael Ciccotti. According to The Philadelphia Inquirer, Ciccotti emphasized that the recent cortisone shot to help calm inflammation in Lidge's elbow was delivered to the lateral or outer portion of his elbow. Lidge has no discomfort on the medial side (where the repaired flexor tendon is located along with the ulnar collateral or Tommy John ligament), and his elbow is stable.
Lidge threw 25 pitches in a Sunday bullpen session and had "no pain, no issues," according to Phillies general manager Ruben Amaro. If all goes according to plan, Lidge should return in April. Whether it's in the next week when he's eligible to come off the DL or, more likely, a little later in the month, Lidge should be in good health and figures to have a strong season. Remember, the last time he entered the season on the disabled list (2008 after right knee surgery), Lidge managed to put together 41 saves and a 1.95 ERA before the year was through.
Huston Street, RP, Colorado Rockies (15-day DL, retroactive to March 26): Street began experiencing shoulder stiffness in the middle of March. Although any sign of a shoulder issue is a worry when it comes to a pitcher, the good news is that Street had no significant findings on an MRI. Despite a few setbacks in his throwing progression thus far, Street was reassured by none other than Dr. James Andrews this week that his shoulder indeed looked just fine. The plan is for Street to resume throwing in the next week, but beyond that there is no firm timetable in place. It would figure to be about a month or so before Street could be ready for competition, as he will have to return to throwing from a mound and ultimately log some innings in the minors first.
AP Photo/Ed AndrieskiA sore shoulder will keep Huston Street out of action until sometime next month.
At this point there is plenty of reason to be optimistic, but bear in mind that occasionally lingering problems evolve from trivial beginnings. Diamondbacks ace Brandon Webb is just the most recent example of a similar pattern ... and he's still not back. The Rockies have to have their fingers crossed that Street's issue is indeed of the simple variety, and if that's the case, look for him to be available for competition in mid-to-late May.
Kerry Wood, RP, Cleveland Indians (15-day DL, retroactive to March 26): Wood suffered a moderate strain to a muscle in his back (latissimus dorsi) in spring training, and the team's medical staff indicated that he would be out a minimum of six weeks. Although Wood said he hoped to be back sooner, there is really no reason to expect that. Even if the injury is not terribly serious, the message from the Indians appears to be that they will not rush him back.
Nor should they. Wood's injury history is well documented, and although everyone is thankful that the injury is not to one of the rotator cuff muscles or within the shoulder joint itself, the latissimus plays a significant role in controlling the throwing arm. A strain or weakness in one area can lead to compensations in another, something Wood cannot afford. Allowing him to recover fully before resuming the work of throwing makes perfect sense. Given what the team has projected, do not expect to see him in the closer role before mid-May. In the meantime, Chris Perez will handle the job.
Joey Devine, RP, Oakland Athletics (15-day DL, retroactive to March 26): Devine had a less-than-divine 2009 when a bout of elbow pain in the spring later deteriorated into a need for Tommy John surgery. The silver lining in his dark cloud was that surgery was early enough (April) to allow him to be available for most of the 2010 season. Devine has had a very strong rehab progression back from surgery. Other than some minor tendinitis, which is not unexpected with this particular recovery, Devine's road to return has been smooth.
Now come the big tests. Devine's first bullpen session is scheduled for Wednesday, and this is a big transition, as it involves throwing from a mound. After the bullpen sessions come the simulated batting practices and eventually real innings. If all continues well, Devine could rejoin the roster in late April. It's worth bearing in mind that pitchers generally require some time before they truly return to competitive form, but so far things are lining up in Devine's favor this year.
HittersIan Kinsler, 2B, Texas Rangers (15-day DL, retroactive to March 26): Kinsler is battling a right high-ankle sprain, an injury that can be notoriously tricky when it comes to return to full activity. Whether he comes off the DL when eligible on April 10 is still very iffy. Kinsler was able to take some swings with the bat early this week but still has not been cleared to run or perform any lateral movements.
Athletes often begin to feel better in their recovery from this injury and think they are closer to return than they really are. When they are subjected to increasingly difficult movement challenges, they often find that the ankle is still a little weak and uncomfortable. The worst-case scenario would be to return too soon only to have a second, more protracted visit to the DL. So while Kinsler told the Fort Worth Star-Telegram on Monday that he hopes to begin a rehab assignment this weekend, his body may not be quite up to that task.
Lance Berkman, 1B, Houston Astros (15-day DL, retroactive to March 26): Persistent swelling in Berkman's left knee after a contusion suffered during spring training led to an arthroscopic procedure in mid-March. Unfortunately, he has had some lingering issues with swelling in the knee, resulting in multiple drainages to extract the fluid. On Monday, Berkman had it drained for the fifth time and also received a cortisone injection to help control the inflammation. The next day, Berkman told the Houston Chronicle that the swelling seemed to be staying down a bit, an improvement from the earlier drainages. Although he's taken batting practice, he is still a ways removed from returning to play. He will have to demonstrate that he can increase his activity without causing another flare-up. At this point, he appears to be at least a week or two from rejoining the team.
Jose Reyes, SS, New York Mets (15-day DL, retroactive to March 26): It looks as if the speedy shortstop will rejoin the team Saturday, the first day he is eligible to do so. Reyes, whose hamstring surgery and thyroid issues have been well documented here, has been looking strong since returning from New York. And for those questioning whether he had his speed back, he did net two stolen bases in an extended spring training game Monday.
Jim McIsaac/Getty ImagesAfter a lost 2009 season, Jose Reyes could be back as early as this weekend.
The bigger concern going forward will be whether Reyes can maintain his health across the season. There is no doubt that he is in great physical shape and is eager to prove that he is back in full capacity. There is some doubt, however, that his hamstrings will cooperate with the demanding grind of baseball. For fantasy owners, this is a risk-reward relationship here. Let's hope the reward wins in the end.
Carlos Beltran, OF, New York Mets (15-day DL, retroactive to March 26): Beltran has been working his way back from January surgery to address cartilage damage in his right knee, the same one that caused him to miss the majority of the 2009 season. Beltran has said that his knee is finally pain-free and he is making big improvements in strength and control.
The big tests will come with the pounding, something he has not tried until now. Beltran is scheduled to begin running Saturday, and according to reports in the New York Post, Mets general manager Omar Minaya says Beltran will need another four to eight weeks beyond that before he could rejoin the team.
It seems that the earliest Beltran could return would be mid-May; however, it would not be surprising if he does not return before early June. The hope is that a careful, steady rehab will help ensure that once he does come back, he can stay healthy for the remainder of the season. That's still a question mark, given that his knees are not quite what they once were, although likely much improved over last year. As he increases his baseball-related activities, we should get better insight as to how healthy Beltran truly looks. This is definitely a situation to watch.
Alex Gordon, 3B, Kansas City Royals (15-day DL, retroactive to March 26): For a youngster with huge potential, Gordon has not been able to reach his targets yet because of injury. Last year he dealt with a torn labrum in his hip that required surgery and missed a big chunk of the season. After an offseason of intense work with the Royals' strength and conditioning team, Gordon seemed poised to jump start 2010.
And then there was the headfirst slide on March 6 while stealing second base that resulted in a broken thumb. There's a reason managers cringe at the headfirst slide; while they seem to be a little faster, there is an increased risk of broken fingers and thumbs or cleated hands. Luckily Gordon's thumb, is nearly healed. The DL move for Opening Day was to allow Gordon some more playing time in the minors to ensure that he is fully ready to return to competition. If all goes well expect to see him back with the team by late April, probably sliding feet-first.
Freddy Sanchez, 2B, San Francisco Giants (15-day DL, retroactive to March 26): Sanchez's season with the Giants ended early last year when he was shut down in September thanks to a meniscus tear in his left knee. He ended up undergoing surgery for his knee shortly thereafter but somewhat surprisingly later underwent surgery on his left shoulder. In December, Sanchez had a procedure to address the labrum and the AC joint in his nonthrowing shoulder, but the lengthy rehab meant that he would miss Opening Day. Giants manager Bruce Bochy said that Sanchez, who remains at the team's spring training camp in Arizona, is still three to four weeks away from a minor league assignment, according to the San Jose Mercury News. For fantasy owners, this translates to a projected return of somewhere in mid-to-late May. Hopefully the wait will have been worth it, as Sanchez should exceed his performance from late last year now that his injury issues have been addressed.
If you have any other injury questions, feel to drop a note in my mailbox and I may answer it in my next blog entry.
June, 17, 2009
Any regular visitor to my blog knows I love to start with some good news. Given that new or recurring injuries are a weekly staple, it's a great feeling when I can counter with news that a guy is getting healthy and coming off the DL. Maybe it's because I feel like the Grim Reaper most of the time, bringing news of the injured to distraught fantasy owners week in and week out. And if we've learned anything this year, it's that no one is safe from the injury bug. Occasionally, though, the sun does manage to shine and athletes exceed expectations in their recovery from injury.
This week is particularly special because I've been looking forward to this announcement since John Smoltz signed with his new team. After enduring a lengthy but steady rehab following offseason shoulder surgery, the veteran righty has finally been assigned a date to debut as a member of the Red Sox. Circle June 25 on your calendar, boys and girls. Smoltz is set to rejoin the rotation when the Red Sox face the Nationals. It will be exciting just to see him back on the mound. While it's worth tempering expectations early on (after all, he is 42), I believe that the acquisition of Smoltz will prove to be a brilliant move by the Red Sox and that he will indeed be the comeback story of 2009. OK. I put it out there. Now we just have to watch and see what happens.
Oh yes, I know, there are new injuries to discuss. Here are the guys we're paying attention to in the injury world this week ...
Jake Peavy, P, Padres: By now the bad news on Peavy's right ankle has spread far and wide. Peavy could miss 8-12 weeks with a partial tear in his posterior tibialis tendon, according to team athletic trainer Todd Hutcheson, quoted in the San Diego Union-Tribune. My colleague A.J. Mass and I discussed Peavy at length right after the announcement was made, both in terms of what the injury actually is and what it means for Peavy's trade prospects.
Scott Wachter/Icon SMIDon't expect Jake Peavy back by late August or early September at best.
Here's the bottom line for fantasy owners: Move on for three months. In the very best-case scenario, Peavy returns after the All-Star break, although an August or even September return is more likely. Any delays or setbacks between now and then could lessen the chance of a return. In the worst-case scenario, if the tendon does not show signs of healing when Peavy is re-evaluated in a few weeks, the prospect exists that surgery could be warranted. That is clearly a less desirable, last-resort type of option, but until we hear that Peavy is making progress, it remains a possibility.
Given that Peavy's ankle has already been slow to heal, despite the fact that he reported feeling better since the initial injury, you can bet that the medical staff will proceed conservatively with his long-term health in mind. In other words, don't bank on Peavy beating the recovery timetable issued by Hutcheson, no matter how optimistic the team wants to be. The good news here is that if the tendon heals properly, whatever the time it takes to do so, Peavy should be able to return to form.
Grady Sizemore, OF, Indians: After resting his elbow for the better part of a week, Sizemore had a repeat MRI on Monday to help assess his progress. Apparently the Indians liked what they saw, since Sizemore was allowed to resume baseball activities this week. Sizemore did some light throwing and took some light swings in his first such activity since going on the disabled list May 31.
Now you know I like good news, but there are reasons not to get over-excited just yet. According to the Cleveland Plain Dealer, Indians head athletic trainer Lonnie Soloff indicated that Sizemore was suffering from synovitis, which is inflammation of the synovium, the smooth tissue layer that lines the joint. This condition can certainly be the type of thing that can flare up repeatedly. According to the Akron Beacon Journal, Sizemore himself said, 'There's a chance it could get worse. It could linger all year."
General manager Eric Wedge summed up the situation best when he said, "As we continue to ramp up with him, we'll know more." In other words, there is not much surprise that Sizemore feels better after completely resting the arm. The bigger question is whether the inflammation will recur as he starts to use the arm or whether he can keep it at bay through the remainder of the season.
The next big test comes this weekend. According to MLB.com, Sizemore will take batting practice and throw from his position this weekend. If he passes the test (read: no pain), then he can begin working his way back toward being ready to play. If Sizemore does experience pain, an arthroscopic surgical procedure likely awaits him. Fantasy owners need to keep their insurance options available for a while as it is simply too early to gauge this one.
Torii Hunter, OF, Angels: The outfield walls seem to be fighting back against the players who hit them hard this year. Josh Hamilton has been to the DL not once, but twice (including surgery!), after running into walls. Rick Ankiel's neck and shoulder were on the losing end of a battle with a wall. Hunter is the latest to be punished by a wall while attempting to make a play, suffering bruised ribs Monday night. Fortunately for Hunter, X-rays taken of his right rib cage (where he contacted the wall) were negative, indicating no fracture.
Cary Edmondson/US PresswireTorii Hunter suffered bruised ribs during this crash into the wall on Monday but could be back in action by the end of the week.
Not that that lessens Hunter's pain. Any rib injury is painful. Just ask Hamilton, who ended up on the DL despite early resistance to the idea. Hamilton, who also suffered a soft-tissue rib injury, pointed out that in addition to baseball activities, breathing hurt. Until the pain and inflammation settled, Hamilton was incapacitated. According to AP reports Hunter was in a rib brace Tuesday, which is designed to help limit his overall rib movement. Minimizing movement allows the soft tissue to heal by preventing muscle fibers from getting overstretched. It's virtually impossible to eliminate all rib motion, however, since sneezing, turning, even breathing all result in movement at the rib cage.
Hunter's targeted return of Friday suggests the injury is not serious, but it may very well require additional time in order for him to move as necessary to play his position.
Coco Crisp, OF, Royals: Crisp was finally placed on the DL with what the team is calling a rotator cuff strain in his right (throwing) shoulder. Crisp has been bothered by a sore shoulder since late May, but several days of rest intermittently have failed to alleviate the problem, so the team decided to give him an extended break. According to the Royals' official Web site, manager Trey Hillman was hoping that a recent six-game break -- four absences because of the shoulder, plus an additional two to attend his great-grandmother's funeral -- would be enough to allow Crisp to return at full strength, but that has not been the case. Crisp has reportedly struggled most with batting from the left side of the plate and with throwing.
From the sound of things, Crisp may require some extended time away from baseball activities, focusing on rehab alone to clear his symptoms. Given that six days of rest was not sufficient, expect Crisp to rest longer before resuming hitting and throwing, meaning he may not be ready to return at the 15-day mark.
Ervin Santana, P, Angels: Uh-oh. Santana, who missed time at the start of the season with a sprained ulnar collateral ligament in his throwing elbow, was scratched from his Tuesday start with tightness in the same elbow. After lasting just 4 2/3 innings in his last start, should fantasy owners be concerned?
There's definitely reason to be concerned, but this may not quite signal the demise of Santana's season. Santana told the Los Angeles Times that the pain he's experiencing, which actually has been described as forearm tightness, is not in the same area as his original symptoms. "That was on the inside of the elbow. This is on the outside. I know I'm going to be OK." It's good to know he's confident.
Apparently manager Mike Scioscia has confidence as well. "If I hadn't seen him throw as well as he did in Detroit and hadn't seen his stuff pick up like it has, I wouldn't be as comfortable with where he is," Scioscia said. Nonetheless, Santana is under the very watchful eye of the medical staff as they evaluate next steps. Even if the symptoms are different, the fact that he is feeling discomfort in his throwing elbow/forearm so soon after his return is somewhat worrisome. The Angels hope Santana will be able to start June 23, but if he is unable to go at that point, he could be facing a return to the DL.
On the mend
• Last week we said A's pitcher Justin Duchscherer's back had calmed, allowing him to resume his rehab activities. So much for that. Turns out Duchscherer's spine is behaving like many spines do and is flaring up again. Rehab has again been put on hold until the symptoms settle.
• The St. Petersburg Times reports that Rays lefty ace Scott Kazmir is expected to make a minor league start Wednesday. Kazmir has been feeling good and thinks his mechanics are under better control. In fact, he sought out advice from friend and former Mets pitching coach Rick Peterson as to which drills would help him maintain his improved mechanics. Several rehab starts should give him a chance to test out his improved quadriceps muscle and delivery. Although there has been no specific date given, if the rehab outings go well, Kazmir could rejoin the team by the end of next week.
• Asdrubal Cabrera's left separated shoulder is feeling better. He is now taking practice swings and doing some fielding activities. According to MLB.com, the Indians should have a better idea of when he'll be able to return by the end of this week.
• Royals third baseman Alex Gordon continues to make steady progress toward his return to the lineup after right hip labral surgery. He has taken some swings this week against live pitching, according to the Kansas City Star, and has returned to light jogging. Gordon is also fielding ground balls, which ultimately may be one of the more challenging activities for him to resume full force. The team still appears to be targeting a return near the All-Star break. I suspect it won't come until after that, but the good news is that Gordon's rehab is going according to plan.
• Finally ... Angels pitcher Kelvim Escobar has been placed on the DL ... again. Somehow this seems like a good move strategically. Escobar did experience some challenges when he rejoined the rotation in early June, and the Angels had indicated he was headed to the bullpen. With Escobar experiencing some fatigue in his surgically repaired shoulder and the Angels needing to add another starter in place of Santana this week, the DL move appears to be a good option. As the Los Angeles Times reports, manager Mike Scioscia said he would be "very surprised" if Escobar was not in the bullpen next Monday, the first day he is eligible to be activated.
June, 3, 2009
I just like to start with some good news. Any good news. Trust me, some weeks -- like this one -- it's slim pickings. Nonetheless, I feel responsible to fantasy owners to keep the glass half-full, and so I scoured amidst all the downers of guys headed to the DL (including a record number of repeat customers!) and I managed to find a bit of encouraging news this week.
Jose Reyes could make his return from the DL on Friday. I always recommend the cautiously optimistic approach when it comes to returning from a muscle strain or an "-itis" (as in something inflammatory). In fact, Reyes hasn't had the opportunity to test the leg in a game situation because Tuesday's planned extended spring training game was rained out. So much for the glass being half-full. There is another game scheduled for Wednesday when the Mets hopefully will be able to put Reyes to the test. Until he proves he can run without difficulty, Friday's target remains in the category of wishful thinking.
But let's face it, we want to get to the information about who's hurt. Here's who we're talking about this week in the world of baseball injuries. ...
Josh Hamilton, OF, Rangers: Hamilton underwent an MRI on Monday in an attempt to clarify the cause of his persistent groin pain, which has been with him since his most recent collision with an outfield wall at Rangers Ballpark. On Tuesday, he met with Dr. John Preskitt, who performed a sports hernia repair on Ian Kinsler last season. According to the Fort Worth Star-Telegram, Rangers general manager Jon Daniels indicated that Hamilton's visit with Preskitt was to help rule out a hernia.
Aaron M. Sprecher/Icon SMIJosh Hamilton is making his second trip to the disabled list this year, and this could be a lot longer.
If this all sounds confusing, it is. Arriving at a diagnosis of a sports hernia is really a process of ruling out other diagnoses. Here's what we know so far.
1. First and foremost for fantasy owners, Hamilton is on the DL for the second time this season. That means you have to make alternate plans for at least another two weeks. I would recommend that you make plans for another couple of months. Continue reading.
2. Hamilton's injury started out as a groin strain and was later called an abdominal strain, according to the team's official Web site. This is the case with many of the injuries that are eventually diagnosed as sports hernias. Pain begins near the groin, then moves closer to the lower abdominal wall. With all of these muscles converging to attach at the pelvis, the pain patterns can be similar.
3. It is not a hernia. A true (abdominal) hernia represents a protrusion (herniation) of abdominal contents through a weak spot in the soft tissue around it. The hernia can often be palpable (the examining physician can feel it) and can generally be seen on imaging (via ultrasound or MRI). Since many of the symptoms can be similar, it is important to rule out a true hernia. Many sports hernias do not show any visible findings on MRI. If Hamilton had a hernia, he would be having surgery while I'm writing this column.
4. Hamilton has indicated that he faces the most difficulty when trying to run. The hallmark of a sports hernia is an athlete's inability to run. It can be a frustrating diagnosis in this regard because, depending on the degree of injury, the athlete can actually feel quite good ... until he tries to run. Because of the muscles involved and their attachment near the pelvis, the power required to run places a demand on the area that cannot be met. The athlete typically complains of pain and weakness when attempting to run. According to the Dallas Morning News, Hamilton said "I'm hurt and sore and can't run," estimating his running since the groin injury at 50 percent of normal.
The evidence here would suggest that Hamilton is, indeed, dealing with a sports hernia, which is, in essence, what the team is saying. According to the Ranger's official Web site, assistant general manager Thad Levine "likened the injury to a sports hernia" and hopes Hamilton can avoid surgery after a period of rest and anti-inflammatory medication. Hamilton will be re-evaluated at that point and, if he has not improved, likely will face sports hernia surgery that would require six to eight weeks of recovery. Although Hamilton's mechanism of injury is somewhat atypical (these injuries often seem to come on out of nowhere, with no particular incident as the cause), his symptom pattern has many features that fit the bill.
For those wondering why surgery isn't done right away, this rest period is a step in ultimately arriving at the conclusion that surgery is necessary. Since sports hernia diagnosis is often one of exclusion -- figuring out everything that the injury "isn't" -- the decision to proceed with surgery is easier if conservative measures have failed. Fantasy owners can hope for the best, but should prepare for the worst, in the event that Hamilton is headed under the knife.
Evan Longoria, 3B, Rays: Longoria was serving as the DH for the past couple days as a result of elbow soreness; now there's something of potentially bigger concern. Longoria left Tuesday's game with a left hamstring strain after running out a ground ball, and we know how these injuries can go (read: linger).
He is expected to undergo an MRI on Wednesday to determine the extent of damage, but there are a few notes of encouragement. Longoria's description of what he did NOT experience suggests that the strain is on the minor end. Longoria told the team's official Web site Tuesday after the game, "I didn't feel a pop, I didn't feel a pull, I was able to walk and ride the bike and everything." Longoria added that he considers himself day-to-day. Rays manager Joe Maddon indicated that he will act with caution, so don't be surprised if Longoria is given a couple days to rest, even if the MRI turns up nothing significant.
Edinson Volquez, P, Reds: Volquez may hold the record for shortest return from a DL stint before exiting a game only to be returned to the DL. Not a record he or his fantasy owners really want. And it's not as though he wasn't recovered from the first problem (back spasms) and aggravated the injury. Sadly, this is something altogether different.
AP Photo/Jeff RobersonEdinson Volquez lasted just one inning in Monday's start before returning to the disabled list.
Volquez lasted all of a single inning in his return Monday night before being forced out with what he described as "tingling from my elbow down to my fingers," according to the Dayton Daily News. Volquez went on to say that he had "never had this happen ... never had pain in my arm." Specifically, Volquez experienced the sensation in his ring and pinky (fourth and fifth) fingers in his right (throwing) hand. The location tells us that his ulnar nerve was talking to him, and clearly it was not happy.
According to the Cincinnati Enquirer, Volquez has been placed on the DL with tendinitis in his elbow. In that scenario, inflammation in the soft tissue around his pitching elbow could result in increased pressure on the ulnar nerve (which passes just behind the bony part of the inside of the elbow, coming very near to the surface, making it an easy target for injury). The pressure would then result in irritation of the nerve, which shows up as numbness and tingling in the fourth and fifth fingers in the hand. The ulnar nerve is often problematic for pitchers because of its location and its vulnerability when there are problems at the elbow. If the joint is hypermobile, if spurs are present, if there is any ligamentous injury (yes, ulnar collateral or Tommy John ligament) or even in the presence of swelling alone, the ulnar nerve can be affected.
The hope for Volquez is that this truly is a minor condition and not the beginnings of a major problem with his throwing elbow. The plan is for him to rest for at least a week (no throwing at all) and then be re-evaluated. Stay tuned.
Joey Votto, 1B, Reds: A week ago it appeared promising that the team had been able to identify the source of Votto's frustrating intermittent dizziness. He was reportedly dealing with an ear infection and had been placed on anti-inflammatory medication. The problem, however, was that every time Votto got on a plane, the symptoms were exacerbated the next day.
On Saturday, Votto was placed on the DL with what the team is calling "stress-related issues." It's fairly safe to assume that the stress Votto is experiencing is from the on-again, off-again nature of this dizziness. I can tell you that patients who experience chronic dizziness describe it as an extremely debilitating and frustrating condition. We've all experienced feeling dizzy or light-headed at some point, and I have yet to find anyone who thinks it pleasant. Now imagine trying to do your job and performing at the same level to which you and your co-workers are accustomed, with the world spinning around you. It's just not possible.
This trip to the DL is a good move for Votto until he can truly get his symptoms under control. Let's hope that the 15-day period is all he needs.
Asdrubal Cabrera, 2B, Indians: Cabrera left Tuesday's game against the Twins in the first inning with a shoulder injury. He was clearly in pain when he left the field after taking the brunt of Twins shortstop Brendan Harris' weight on his left shoulder as he slid into second base.
The Cleveland Plain-Dealer is reporting that Cabrera suffered a dislocated left shoulder that was "put back into place." X-rays taken at Hennepin County Medical Center were reportedly inconclusive and Cabrera is scheduled to undergo an MRI Wednesday. The description makes it sound as if Cabrera actually subluxed his shoulder (in which it slips slightly off the joint but quickly pops back in) because a true dislocation is often difficult to reduce (put back), unless the athlete has a very unstable shoulder with a history of repeat dislocations. As far as I can tell, this is not the case with Cabrera.
Cabrera also told the Plain-Dealer that he did not think he would need to go on the DL, another sign that he may not have suffered that severe of an injury. It's worth noting though that players often feel far worse the next day once there is post-injury pain and inflammation. There's still a chance, either with or without a complete dislocation, that Cabrera could have suffered enough soft tissue damage to require a minimum two-week absence. Let's see how Cabrera feels over the next few days. That will probably go a lot further in determining just how long it will be before he's back in the lineup.
On the Mend
• Alex Gordon has to be pleased with the results of his latest visit with his surgeon. According to the Royals' official Web site, Gordon, who is recovering from surgery to address a torn labrum, got "glowing reports" on his trip to Colorado. His latest activity includes limited tee swings and very light, easy ground balls, so he is still a ways from truly testing his hip (hard swings, fielding bunts, throwing across his body and, ultimately, sliding). Although Gordon was originally given a timetable of 10 weeks (which would mean a return in late June), I have suspected all along that a return after the All-Star break would make the most sense. It seems that Gordon's progress has him on track for that so far.
• Rays ace Scott Kazmir is recovering from his quad strain while simultaneously addressing mechanical faults he attributes to last year's elbow injury. There is no official timetable for his return, but according to the St. Petersburg Times, Kazmir is throwing in the bullpen and hoping to avoid a minor league assignment. It's possible he could be back within another two weeks. Between the quadriceps recovery and the adjustments Kazmir is making, the hope is that his performance will improve when he rejoins the rotation.
• Brandon Webb continues to work his way back gradually from the shoulder problem that has kept him out since Opening Day. According to the Arizona Republic, he's throwing on flat ground (with another session planned for Wednesday) and will hopefully progress to a bullpen session Saturday. Don't get too excited; the Diamondbacks haven't brought him along this slowly only to speed him up now. Due to all the missed time, Webb likely will be brought along through every step in the standard return to throwing progression, including several minor league starts to build up endurance. The most encouraging words are from Webb himself, "It took a while to get there, but I feel like we're moving forward." I would not expect much before the All-Star break, but assuming he continues well, it would be a good time to think about picking him up.
• In the not so smooth recovery department, Yankees players have endured a couple of setbacks. Outfielder Xavier Nady, who suffered an injury to his previously reconstructed ulnar collateral ligament in April, threw for the first time on Monday and it apparently did not go so well. According to the Newark Star-Ledger, Nady experienced discomfort in his elbow when attempting throws from 50 to 60 feet. Although manager Joe Girardi indicated he would play Nady even if he wasn't at full strength, it's a recipe for disaster if the player and the manager are uncertain whether every throw will result in pain. Nady did throw Tuesday and, according to Newsday.com, only felt minor discomfort this time. When he's throwing consistently without any discomfort, then we can really be encouraged. Until then, everyone should temper expectations.
G Fiume/Getty ImagesXavier Nady likely isn't done for the year, but he isn't coming back in the near future, either.
• Meanwhile, Nady's teammate Jose Molina is having a repeat MRI on his injured left quadriceps after being pulled from an extended spring training game Monday. Those results are expected to guide the next steps. Even without the results, just the fact that he had to be pulled because the muscle became painful tells you what you need to know. He will not be ready to return anytime soon.
• On the other coast, Angels pitcher Kelvim Escobar faced challenges of his own as he recovers from surgery last year to repair a torn labrum. After being ahead of schedule throughout his rehab, he had a setback near the start of the season that has delayed his return. Escobar's shoulder is recovering and he is throwing without pain, but his latest rehab start Monday revealed that he does not have full control of his delivery. The Los Angeles Times reports that, as a result, Escobar has stopped throwing the slider for now. From a rehab perspective, how his shoulder feels is the most important thing. The fact that he is not experiencing pain is critical. A slider is one of the more physically demanding pitches, so it makes sense that it would take longer to get it back. Look for Escobar to rejoin the rotation within the week, perhaps Saturday, but without his slider.
• And finally ... expect John Smoltz back in mid-June. No one will commit to it, but he looks good. Get ready, he's going to be great.
April, 22, 2009
By Stephania Bell, ESPN.com | ESPN.com
It's a busy, busy week in the world of sports. The playoffs have started in the NBA and NHL, the NFL draft is upon us and baseball is in full swing all around the country.
What strikes me is that the injuries just seem to keep on coming. Some teams are already looking at possible personnel moves simply to accommodate the rash of injuries they have already sustained. And it's only April!
On that note, here's who we're focusing on this week in the world of baseball injuries ...
Chris Carpenter, P, Cardinals: It was just a short time ago when we were celebrating Carpenter's return to the mound after virtually two years of absence due to injury. The celebration was short-lived when Carpenter was again forced to the DL, this time as the result of an oblique strain. The St. Louis-Dispatch reports that an MRI confirmed Carpenter injured a left oblique muscle, and as a right-handed thrower, this is the most commonly observed pattern (opposite side of the throwing arm). The less common aspect of his injury is that he sustained it while batting. Certainly power hitters are known to suffer oblique injuries, but no one would accuse Carpenter of being a power hitter. Pitchers, who rely on their oblique muscles to help generate the torque required to deliver the ball, often sustain the injury during throwing.
Nonetheless, whether the injury is sustained during batting or throwing, the rehab remains essentially the same. On average, an oblique injury is a six-week injury for a pitcher. In Carpenter's case, given his extensive injury history to his throwing arm, there will be no rushing his return. Any weakness in his trunk could result in compensations in his throwing arm, putting him at risk for injury. Expect Carpenter to be out for two months, but expect him to come back strong once he's ready.
Daisuke Matsuzaka, P, Red Sox: Arm fatigue? OK, so it's not a fancy medical diagnosis. But it does a pretty good job of accurately conveying the nature of the problem. Officially termed a shoulder strain by the Red Sox, his ailment manifested itself as a lack of control and command. Based on his recent struggles, the Red Sox wisely chose to place him on the DL to allow his arm some rest, perhaps pre-empting a more serious problem down the line.
Jim Rogash/Getty ImagesDice-K's tired arm is a strong argument against the WBC.
Fatigue often leads to a change in mechanics as pitchers try to compensate for less power by an alteration in their delivery. Even subtle changes, over time, can lead to significant injury. Rest now, followed by a gradual, progressive return to throwing, should allow Matsuzaka to work his way back to his normal self within a relatively short time frame. Had he tried to press through this, it might have ultimately translated into a more prolonged absence.
The good news is the Boston Globe is reporting that Matsuzaka has been cleared to begin light throwing (think: playing catch), signaling that his arm felt good enough that very little down time was required. He will work through a typical throwing progression, but barring any setbacks, he should not be absent for a protracted period.
Jed Lowrie, SS, Red Sox: Last week we talked about Lowrie's ailing wrist and the unknown path ahead. After multiple consultations, with the final stop taking him to Dr. Donald Sheridan in Arizona, Lowrie's fate has finally been decided. He opted to undergo arthroscopic surgery Tuesday to address his wrist problem. According to the Boston Herald, Lowrie's procedure involved removal of the ulnar styloid, a projection of bone at the tip of the ulna (the forearm bone that runs from the elbow to the pinky side of the hand). Lowrie told the Herald that he is scheduled to return in six to eight weeks.
The concern with any wrist surgery is not just how long it will take a player to get back into the game, but how long it will truly take for him to return to form, particularly at the plate. It is not uncommon to see hitters struggle to regain their power following a wrist injury. Lowrie fans and fantasy owners will want to plan on having insurance for three months. Meanwhile Julio Lugo, recovering from meniscal surgery, is beginning a rehab assignment at Triple-A Pawtucket on Tuesday. According to the Red Sox's official Web site, he could return within another week or so. Keep in mind that the Red Sox will not rush him simply because Lowrie is out and Lugo is still having some soreness in the knee. Best to plan on at least two weeks for Lugo's return to the lineup.
Alex Gordon, 3B, Royals: It seems like the injury du jour for third basemen is hip labral tears. Mike Lowell started the trend with his injury last season. Alex Rodriguez, who underwent hip labral surgery in early March, is perhaps the biggest celebrity of the group. Gordon is the latest addition to the list.
The Kansas City Star reported that Gordon first felt "tightness" in the hip on Opening Day. Earlier reports suggested that he first injured his hip sliding into second base a week ago, then further aggravated it during an at-bat. Either way, the limitations in his hip appeared to be impacting him at the plate. Gordon had his hip operated on Friday by Dr. Marc Philippon, the same surgeon who operated on Rodriguez. According to the Royals, Gordon is expected to miss anywhere from 10 to 12 weeks. This timetable suggests that the labral repair was the primary issue and that he did not require extensive bone work (like Lowell for instance, who had a rehab timetable that extended for several months).
The good news for the Royals here is that Gordon is young and healthy, which should aid in his recovery. Given his timetable, expect to see him back in the lineup just after the All-Star break.
Vladimir Guerrero, OF, Angels: What was initially described as a pectoral muscle strain (suggesting minor tissue damage) turned into a more serious torn pectoral muscle (suggesting more extensive bleeding and soft tissue injury), landing Guerrero on the DL for at least a month. According to the Los Angeles Times, he may not even return to the outfield once he's eligible to rejoin the lineup. Instead, the Angels may opt to keep him in a designated hitter role.
Otto Greule Jr/Getty ImagesVlad may be a DH only when he comes back, which could impact next season's fantasy eligibility.
The risk with any muscle tear is that a return too soon will result in reinjury, perhaps even more serious than the first time around. Depending on the location and extent of Guerrero's tear, the Angels could be concerned that further damage could lead to a surgical situation. He has said that the injury does not affect his swing, but the concern for further injury is likely the reason Guerrero is being forced to completely rest at this time.
Muscle tears can vary widely in terms of healing time, so it is very difficult to project a true timetable from afar. The level of the Angels' concern, though, reflects the seriousness of Guerrero's injury. Fantasy owners should make alternate plans knowing that his return is up in the air.
Xavier Nady, OF, Yankees: It's not as bad as it could have been. That's what the Yankees are saying now that it appears Nady will not undergo what would have been his second Tommy John surgery on his right elbow. The outfielder first underwent an ulnar collateral ligament (UCL) reconstruction in 2001 and was clearly able to enjoy a successful return to baseball. The joy of embarking on a new season in a new stadium was brought to a crashing halt last week, however, when Nady experienced sharp pain in his right elbow while making a throw.
It had all the makings of an UCL tear, and a second surgery seemed imminent. There was definitely cause for concern, since a return to baseball following a second UCL reconstruction has a much lower success rate than the return following a first-time procedure. Team physician Chris Ahmad performed various studies to image the soft tissue and the bone, and consulted with Dr. Lewis Yocum, who performed Nady's original surgery. The decision about how to proceed provided some good news for Nady and the Yankees.
According to the New York Post, Nady does have a partial tear of the ligament, but the decision has been made to have Nady undergo a course of conservative rehab instead of heading under the knife again. Given the lengthy rehab following surgery and the low success rate, this is a very reasonable course of action. After all, consider that the Angels' Ervin Santana is working on returning to pitching despite the presence of a partial tear in his UCL.
Nady is not a pitcher, so the demands on his arm are significantly less, and the Yankees do have the option of bringing him back as a DH initially while he works his way back to the outfield. Also, the presence of scar tissue in his elbow that has built up since his first UCL surgery might help provide some additional stability to the joint despite a tear in the ligament itself. Whether Nady can successfully return remains to be seen, and it will be at least a month before that happens, but at least he and his teammates can hold out some hope that he will be able to test out the new stadium after all.
On the mend
Despite the increasing body count on the DL of late, there is reason for a number of teams to be smiling this week. A number of players who started their season on the DL are seeing the light at the end of the rehab tunnel, with return dates to their major league lineups fast approaching.
In Milwaukee, the Brewers hope to have closer Trevor Hoffman back by the end of the week. Hoffman, who began the season on the DL because of an oblique strain, pitched for Triple-A Nashville on Tuesday, with no ill effects. He will throw one more rehab outing before rejoining the Brewers. There is always a risk for recurrence with oblique injuries, but Hoffman has been brought back slowly, and the fact he is a closer and throws fewer pitches per outing works in his favor. Despite his age and injury, I'm optimistic about Hoffman once he returns.
The Minnesota Twins have been quietly keeping their fingers crossed as catcher Joe Mauer passes incremental tests in his rehabilitation from an inflamed sacroiliac joint. The one thing Mauer couldn't do in spring training was run because it was simply too painful. After several months of non-impact training on an elliptical machine and a stationary bike, along with new medication, Mauer was finally given clearance to test his back with light running. He was able to run for consecutive days and was then cleared to begin running the bases. After successfully passing those tests and, perhaps more importantly, feeling well the day after running, Mauer was cleared to play in a simulated game, which he did Monday. That was the first game situation he had been in since the end of last season. The Minnesota Star-Tribune reports that Mauer will head to Class A Fort Myers on Friday for approximately six games. The goal now is to build up Mauer's endurance to ready him for a return to major league action.
AP Photo/Charles KrupaAfter plenty of down time, Joe Mauer's rehab is clicking right along.
So far this is good news for Mauer; the primary things that were limiting him (most notably running) appear to not be hindering him at all right now. But keep in mind that his activity has still been very controlled. And it is still somewhat of a mystery why he developed inflammation in the sacroiliac area, a highly unusual injury for a baseball player. The true proof that he is beyond this episode will be when he can last the season without any recurrence of symptoms. Until then, there will always be some concern as to whether the issue has truly been resolved or has just subsided for a period of time as a result of less activity.
Brandon Webb has started throwing again, making the Arizona Diamondbacks and his fantasy owners very happy. Webb was placed on the DL on April 13 because of shoulder bursitis. Webb had reported some stiffness in his shoulder, and the team opted to proactively rest him to prevent it from turning into a more serious situation. The news on Webb has been good so far, and despite the workload he has turned in over the past few years, I am not any more concerned about Webb's shoulder than that of any other pitcher. His next test likely will come Friday, when, according to the Diamondbacks' Web site, Webb will throw another bullpen session, perhaps incorporating inning breaks to see how his shoulder responds to periods of rest between throwing.
Tampa Bay's Jason Isringhausen threw two innings in an extended spring training game Saturday, followed by an outing for Double-A Montgomery on Monday. Izzy has dealt with injuries to his hip in the past and is now returning from surgery to repair a torn flexor tendon in his forearm. Look for him to potentially contribute to the Rays' bullpen by June. Despite his injury history, Isringhausen still has something to contribute, and the flexor tendon surgery he had is not nearly as serious as ulnar collateral ligament reconstruction. He will no doubt come in under the radar but could be a valuable addition.
The Angels have been hit hard by injuries, most dramatically in their pitching staff. The loss of Nick Adenhart stands alone. Three other aces were ailing to start the season, however, and all three are working toward a return. Kelvim Escobar, who was far ahead of schedule in his return from labral surgery, had a minor setback. But he is playing catch again and should be back on a more-significant throwing progression soon.
Meanwhile Ervin Santana, who has a partially torn UCL, has been able to throw his full complement of pitches in bullpen sessions. Santana's program is very structured and gradual, because the fact remains that he has tissue damage, and the team wants to bring him along slowly. So far, he has passed every test. Although the signs are encouraging, especially the fact Santana is reporting no pain, he still has some big hurdles to pass to return to major league action.
John Lackey, who started the season with inflammation in his throwing elbow, has been able to throw all of his pitches in bullpen sessions. Lackey told the Los Angeles Times that he still is "feeling something" in his elbow but feels he needs to push through it. He is expected to throw a simulated game Wednesday, and the Times notes he could begin a minor league assignment later this week. Lackey and Santana could rejoin the team at some point in May if their progressions continue well. I would not be surprised to see Lackey first, while Santana might be held out a little longer.
Last but not least, Royals outfielder Jose Guillen, who reluctantly went on the DL because of a hip flexor injury earlier this month, plans to rejoin the lineup when eligible Saturday. He told the Kansas City Star, "I'll be ready." This injury did not appear serious when it happened so I'm inclined to agree with Guillen's assessment.