Ichiro Suzuki, Alex Rodriguez progressing nicely


And they're off!

Welcome to the glorious opening week of the 2009 baseball season. Despite the optimism that reigns supreme this time of year in every clubhouse, there is no avoiding the fact that injuries are already part of the equation. In fact, the Angels have to feel like it's the middle of the season considering the number of key players they already have on their DL. Then you have teams such as the Pirates, who started out the season with nobody on the DL.

There is one injury stat worth mentioning before we jump into the specifics. In 2009, there were 69 players on the disabled list to begin the season. While that might sound like a sizable number, consider that just last season, 106 players began the season on the DL. And in 2007, the number was 97. Clearly, the number of injured players at the start of the season has dropped dramatically this year, but what's the significance?

For some insight, I spoke with Stan Conte, a physical therapist and athletic trainer who is the director of medical services for the Los Angeles Dodgers. Conte closely tracks DL stints in an effort to help those who care for ballplayers better appreciate injury trends. Conte says that although looking at the number of players on the DL can be useful, he actually prefers to study total days spent on the DL, particularly as it relates to a diagnosis, because it can help convey the severity of an injury. He did point out, however, that if past history is any indication, low DL numbers at the start of the season suggest that there will be fewer injuries throughout the year.

And that's exactly what fantasy owners want to hear.

Nonetheless, there are some injuries to report already. Here are the main stories we're tracking this week:

Ichiro Suzuki, OF, Mariners: On Friday, we learned that Ichiro had been placed on the 15-day DL because of a bleeding ulcer after experiencing severe fatigue and even light-headedness. Knowing what a workhorse Ichiro is, you figure he had to be feeling pretty poorly to even complain. This announcement came as a bit of a surprise in the baseball community for a couple of reasons: First, it's no secret that Ichiro has a stellar attendance record at work; and second, bleeding ulcers are not a common ailment for baseball players. This has many wondering what exactly caused it and what can be expected in terms of Ichiro's recovery.

The good news is that there is reason to believe Ichiro will indeed be able to come off the DL when eligible April 15. Whether he will greatly depends on his ability to regain his endurance, and there is always the possibility that the DL stint could be extended if Ichiro needs extra time. The Seattle Times is reporting, however, that the Mariners seem encouraged that he'll return on the target date.

As far as the cause, there is no way to say for certain in Ichiro's case, especially without knowing all of his specific health information. What we can say is that there are several potential causes of ulcers in general, including bacterial infection, a group of medications known as NSAIDs (non-steroidal anti-inflammatory drugs) and stress (which is more likely to delay healing or aggravate an ulcer). Increased levels of acid in the stomach can damage the stomach lining and lead to an ulcer. NSAIDs, which include medications commonly available over the counter such as ibuprofen (e.g. Advil, Motrin), naproxen (e.g. Aleve) and even aspirin, have the potential to lead to damage of the stomach lining as well (which is the reason it is always recommended to take these medications with meals).

We have no information to suggest what the source of Ichiro's ulcer was. We do not know whether or not Ichiro was taking any medication, prescription or otherwise, but any time an athlete develops this type of ailment, the question needs to be raised. The consumption of NSAIDs long term is enough of a concern that many professional teams perform blood tests at regular intervals for athletes taking these medications, just to ensure that there are no adverse effects. As far as stress, one could certainly make the case for Ichiro being under a great deal of stress in recent weeks while playing for his home country of Japan in the World Baseball Classic. Not only was the travel schedule demanding, the pressure of trying to repeat as world champions had to be intense. With no opportunity to rest afterward, Ichiro rejoined the Mariners immediately after the Classic, playing in four spring training games before reporting symptoms.

The main consequence of a bleeding ulcer is, well, blood loss. Anemia, a condition where the body lacks adequate healthy red blood cells (which are critical for delivering oxygen to tissues) can result, which explains why patients often feel fatigued, dizzy or short of breath. Treatment involves rest and medication (typically directed at either decreasing or stopping acid production in the stomach, and fighting infection if necessary). The body, which is always manufacturing new blood cells, needs time to make up for any blood loss, minus the stress of activity. Time to recover depends on the extent of anemia.

In Ichiro's case, early reports indicated that the ulcer was no longer bleeding, which is a good sign, and his excellent level of conditioning will no doubt aid in his recovery. Ichiro's activity will be heavily restricted early on and then gradually increased based on follow-up blood test results and how he reports feeling. According to the Times, Ichiro is expected to have a blood test Wednesday morning to assess his progress thus far.

Bronson Arroyo, SP, Reds: Well, Arroyo is not starting the season on the DL as some, including me, thought he might. Now the question arises of whether he will be able to avoid it? He is scheduled to pitch Thursday, and how he fares in that outing might provide a big clue.

Arroyo has been dealing for some time now with a condition not usually associated with pitching. He has carpal tunnel syndrome (CTS), which is known to have a high incidence among those who spend hours at their workstation typing and/or mousing, and is also relatively common among musicians. Hmm. Arroyo is also a musician. Could there be a connection? For his part, Arroyo, who plays guitar, said in an Associated Press interview that he has put the instrument aside and is also avoiding writing in an effort to rest his hand.

CTS essentially results from inflammation within the carpal tunnel, a tunnel bound by bones and ligaments on the palmar side of the wrist ("carpal" refers to wrist) through which tendons to the fingers pass along with the median nerve. Inflammation or swelling in a contained space like a tunnel results in pressure on these structures, and the hallmark symptoms come from pressure on the nerve. The median nerve supplies sensation to the thumb, index finger, third finger and part of the fourth finger and palm, so most often people will complain of numbness, tingling or electric shock-like pain in these areas. If there is enough compression of the nerve, the hand will also become weak, obviously problematic when trying to grip a ball or control its spin. Arroyo struggled with his command late in spring training, which could have been related to his hand issues.

At this point, Arroyo claims to be feeling much better after a cortisone shot -- he apparently proved as much to management -- and reportedly is even throwing breaking pitches again in the bullpen. Consequently, he was rewarded with his originally slated Thursday start. The cortisone will certainly help the inflammation in Arroyo's wrist in the short term, but the issue will be how he holds up in the long term. After all, the concern here is not only for Arroyo's hand. Any weakness that affects a pitcher's control might cause him to attempt to compensate by making an adjustment in his mechanics. Even subtle changes can then lead to injuries further up the chain, in the elbow or shoulder for example, and that's potentially even more worrisome in the whole scheme of things. Keep a close eye on Arroyo over the first few weeks of the season.

Alex Rodriguez, 3B, Yankees: How can we not talk about the most talked-about guy in baseball? By now everyone is aware that A-Rod underwent surgery in early March to address a labral tear in his hip. The labral repair was performed, but additional bone work in the joint remains to be done in the offseason. Since the surgery, Rodriguez has been in Vail, Colo., rehabbing diligently, under close supervision and with minimal distraction. Not surprisingly, Rodriguez is doing very well (after all, he is a great athlete and is very physically fit) and could soon move to Tampa for the next phase of his rehab.

Much has been made recently of the suggestion that A-Rod could rejoin the Yankees by late April. Relax, everyone. This is not news. All along, Rodriguez was operating within a timetable that projected his return at anywhere from six to nine weeks. The Yankees originally set their goal as mid-May because they wanted to allow plenty of time for Rodriguez to recover and not force him back too soon, with the risk of then losing him to reinjury.

Whatever the timetable ends up being, it is not so much when Rodriguez rejoins the lineup, but how he performs once he gets there. Remember, he still has a long ways to go. Going to Tampa means A-Rod will initiate baseball activities, which begin with light drills and gradually become more vigorous. He will need to show that he can hit, field and slide. Then there will be minor league games to allow Rodriguez to re-engage in competition. Each step must be successful before he ultimately returns to the Yankees. One day at a time ...

On the mend

How about some good news for a change? Angels pitcher Kelvim Escobar is reportedly doing very well in his progression back to the mound since having surgery to repair a torn labrum in his right (throwing) shoulder. He threw 41 pitches Friday night in San Diego and is expected to make a rehab start for Class A Rancho Cucamonga on Thursday. If all goes well, he likely will make several minor league starts and could rejoin the Angels by late April, according to the Los Angeles Daily News.

Although manager Mike Scioscia remains optimistic that his other two injured starters, John Lackey and Ervin Santana, will return to the team by May 1, there is reason to be more cautious with both. Lackey is experiencing his second round of elbow problems in two years. He started last season on the DL but was able to return without incident. But it's more worrisome when it's the second time around, and on an arm that has thrown as many innings as Lackey's. Lackey is in a contract year, and I expect him to return, but I'm not convinced that the remainder of the season will be as uneventful as last year.

As far as Santana, we already know that he has a sprain of his ulnar collateral (Tommy John) ligament. Sure, he was throwing well until he was shut down because of pain in the elbow, but now we know that the elbow is damaged goods. It's definitely worth noting that there are plenty of pitchers out there throwing with less than fully intact elbows and shoulders. But a lack of structural integrity does not bode well for the long haul, no matter how you slice it. So yes, even if he returns, I'm concerned about Santana's ability to stay healthy throughout the season.

Across town, Dodgers pitcher Jason Schmidt is continuing his efforts to rehabilitate his ailing right (throwing) shoulder. Schmidt remains a work in progress; he is slowly and steadily trying to return, but slow remains the operative word. Consider that his original surgery to repair a torn labrum was way back in 2007. Schmidt tried to return last year, and did get as far as rehab starts for a brief period of time, but couldn't make his way past the 90 percent level, which is not good enough to compete at the major league level.

The big issue for Schmidt is that he has often felt worse in the days after throwing and has not been able to put together consecutive strong outings. Schmidt underwent another arthroscopic surgery this past year to clean up the shoulder, and he's working diligently to get his strength, and confidence, back. He is expected to throw in a simulated game this week, and the outing itself will not be as critical as how Schmidt feels the day after, and the day after that. If he continues the steady progress, though, there is reason to believe that he could eventually find his way back to the rotation. But no one is saying that out loud just yet.

Twins catchers appear to be snakebitten. Joe Mauer is still recovering from his less-than-common sacroiliac inflammation. Although the St. Paul Pioneer Press reports that Mauer says he is feeling better since he started taking the new (unnamed) medication, he has yet to try running, the one thing that really limited him this spring. Call me a bit skeptical, but until he's doing those activities, I'm still concerned. Mauer's replacement while he's on the DL, Mike Redmond, was only halfway through the first game before he suffered a blow -- from a bat. Redmond was hit in the neck by a shard of a broken bat in the fifth inning, which caused him to lose feeling in his arm for a few minutes. Not long afterward, Redmond hurt his right groin while trying to run out a double. Uh-oh. Redmond told the Minneapolis Star-Tribune that he was "a little concerned," and his manager, Ron Gardenhire, has to be more than a little concerned. Meanwhile, backup to the backup, Jose Morales, starts Tuesday night. Stay tuned.

And finally, I'm not worried about Diamondbacks ace Brandon Webb's shoulder stiffness -- yet. If he has a strong outing his next time out, let it go. Meanwhile, teammate Max Scherzer is pitching well and should be ready to go by mid-April when he is eligible to be activated from the DL. John Smoltz continues to progress toward a June return for the Red Sox. He is coming off major shoulder surgery but has met every target so far and feels good about where he is. I find it fascinating that one of his closest friends is Tiger Woods. Same competitive fire. Same determination. Pretty soon, we can probably say "same amazing comeback."