Stephania Bell: Chad Billingsley



Every Monday, in this space, we'll provide updates on a variety of players to help you make your weekly lineup decisions. We'll specifically try to hit the players who are day-to-day, have just gone on the DL or are ready to return, so that you can better decide whether you can count on them or not.

All projected return timelines should be considered fluid.

Hitters

[+] EnlargePujols
Victor Decolongon/Getty ImagesFantasy owners will have to keep a close eye on Albert Pujols' foot in the upcoming days.
Albert Pujols, 1B, Los Angeles Angels (DTD): "I'm dying." Those were the words of Pujols himself Sunday when describing trying to play through plantar fasciitis in his left foot. Not particularly encouraging. Every athlete who contends with plantar fasciitis will describe extraordinary pain (like "stepping on a nail" or "walking on broken glass") and knows it is virtually impossible to get relief, unless he stops activity altogether. As for now, the plan is for Pujols to try to manage the condition, meaning he will receive treatment directed at pain relief, stretching, supportive footwear and anything else that might help all while continuing to play, albeit limited to DH duty. Unfortunately, every time the foot hits the ground stretching the inflamed fibrous tissue of the arch, Pujols is reminded of the pain. At some point it simply may be too much for him to bear and his foot could force him to take some extended down time.

Ryan Zimmerman, 3B, Washington Nationals (placed on DL April 20): Zimmerman had been experiencing cramping in his left hamstring for several days before being forced out of last Wednesday's game early. He did not play Friday or Saturday, instead undergoing an MRI, which led to placement on the DL. While it sounds as if the strain is not serious, it was hampering him not only with his running but also while hitting. Manager Davey Johnson noted Zimmerman was not comfortable landing on his left leg when hitting. One has to wonder if some of his recent throwing inconsistencies can also be attributed, at least in part, to discomfort in his left leg. According to Amanda Comak of the Washington Times, the Nationals are hopeful that Zimmerman will only miss the minimum time, but hamstrings can be finicky. The key for the Nationals is preventing this from turning into a bigger injury, undoubtedly part of the rationale for a DL placement.

Dan Uggla, 2B, Atlanta Braves (DTD): Sometimes being a veteran means understanding when to take yourself out of a game proactively. It appears Uggla did just that on Saturday when he felt something in his left calf while trying to run out a ground ball. According to the Atlanta Journal-Constitution, Uggla let manager Fredi Gonzalez know he was having discomfort in the calf and was concerned it could get worse if he stayed in the game. Uggla then sat out Sunday's game also but was hopeful he could return Monday. Calf strains tend to be increasingly prevalent as athletes move into their thirties (Lance Berkman, Derek Jeter, Albert Pujols) and early rest may be the best medicine in trying to minimize downtime.

Asdrubal Cabrera, SS, Cleveland Indians (DTD): Slipping on the dugout steps is not how an athlete wants to incur an injury. Unfortunately that's precisely how Cabrera ended up with a contusion of his left wrist, and it's lucky it wasn't worse. X-rays taken of his wrist were negative, but as the Cleveland Plain-Dealer reported, it started to bother Cabrera during Saturday's game, so he came out early. Falls on an outstretched hand can often result in a fracture of the forearm or wrist bones but it appears Cabrera escaped both. He sat out Sunday's game and could sit longer if the wrist is still painful so fantasy owners should monitor his status daily.

Kevin Youkilis, 3B, New York Yankees (DTD): When Youkilis left Saturday's game early because of tightness in his lower back, those familiar with his history may have been a little nervous. That concern would be justified because Youkilis has a fairly extensive history of low back problems including an episode, which required a trip to the DL in 2011. This flare-up appears to be of the minor variety with manager Joe Girardi telling reporters he thinks Youkilis will be available Monday night.

Shane Victorino, OF, Boston Red Sox (DTD): Victorino also left Saturday's game early due to tightness in his lower back. He sat out Sunday's doubleheader but is expected to return to the lineup Monday. Early Sunday, manager John Farrell had considered using Victorino in the second game, suggesting he was making rapid improvements. Ultimately he was given all of Sunday off but it appears he will be back to face the Oakland Athletics.



Freddie Freeman, 1B, Atlanta Braves (placed on DL April 7, activated April 22): It looks as if the decision to rest Freeman early -- despite his displeasure -- has paid off. ESPN's Jim Bowden reported Monday that manager Frank Wren indicated Freeman has been activated and is ready to play against the Colorado Rockies on Monday night. Freeman had been sidelined with a right oblique strain, but it was always considered minor; the Braves were trying to ensure that it remained that way. After a couple of uneventful rehab games, Freeman has been deemed ready to return.

Michael Saunders, OF, Seattle Mariners (placed on DL April 11, could return late in week): A crash into the outfield wall resulted in a sprained right shoulder for Saunders. Although the team did not issue a timetable initially, it looked as if it could sideline him for an extended time. There are some encouraging signs that Saunders is progressing nicely however, most notably that he took batting practice last Friday. According to Geoff Baker of the Seattle Times, Saunders hopes to return when eligible (April 26) but will need to test throwing with his injured shoulder first. One of the most difficult things to do after an injury such as this is raise the arm completely overhead. Throwing with power will perhaps present more of a challenge than hitting so fantasy owners should monitor his activity closely throughout the week.

Pitchers

Jhoulys Chacin, SP, Colorado Rockies (placed on DL retroactive to April 20): Chacin was off to a solid start but has been sidelined with a lower back strain that forced him out of Friday's game early. According to the Rockies' official website, Chacin is scheduled to undergo an MRI on Monday. As for now there is no timetable for his return in place. The Rockies have recalled right-hander Rob Scahill from Triple-A Colorado Springs to take his place.

[+] EnlargeKyuji Fujikawa
David Banks/USA TODAY SportsKyuji Fujikawa could be back this week to boost the Cubs' bullpen.
Kyuji Fujikawa, RP, Chicago Cubs (placed on DL April 13, could return when eligible, April 28): Fujikawa suffered a right forearm strain, sending him to the DL, but according to Jesse Rogers of ESPN Chicago, Fujikawa has already begun testing the forearm throwing. If all continues well, Rogers reports Fujikawa will get a couple of rehab outings under his belt this week and could return this weekend.

Brett Myers, SP, Cleveland Indians (placed on DL April 21): Myers has been fighting some tendinitis in his throwing elbow, but the picture has recently become more complex. The Indians announced via Twitter that Myers was placed on the DL Sunday with tendinitis and a mild UCL sprain. The report also indicated Myers would be shut down for two weeks and would not throw until symptom free. While the suggestion that the UCL sprain is minor is encouraging, it ultimately comes down to function. The fact that Myers experienced a drop in velocity is worrisome, but he also indicated he was not having any pain while pitching. At the very least, fantasy owners should expect him to miss four to six weeks (shutdown time followed by throwing progression), although the timeline ultimately will be dictated by how his elbow responds.



Ted Lilly, SP, Los Angeles Dodgers (opened season on DL, expected return April 24): Lilly underwent a labral repair of his left (throwing) shoulder last September and was slowed in the spring by the flu. He felt he was ready to pitch in the majors when Zack Greinke went down with a clavicle fracture, but the Dodgers preferred to keep him on a rehab assignment, moving Chris Capuano to the starting rotation instead. As it turns out, Capuano was moved to the DL with a calf strain last week and Lilly was able to get some extra innings under his belt. According to Dylan Hernandez of the Los Angeles Times, Lilly has confirmed he will start Wednesday against the New York Mets. Given the Dodgers' starter woes, a healthy -- and effective -- Lilly is badly needed.

Chad Billingsley, SP, Los Angeles Dodgers (placed on DL retroactive to April 16, could be out for the season): Did we mention the Dodgers are having some woes with their starting rotation? It looked initially as if Billingsley had survived the scare with his throwing elbow that cropped up last season. He underwent PRP injections in the fall, rested his right elbow, then resumed a progressive throwing program. The Dodgers waited during the offseason, expecting perhaps a bump in the road to recovery as often happens with partial UCL tears, but nothing went wrong with the elbow ... until now.

Billingsley managed well all through the spring but had a delayed start to the 2013 season due to a bruised index finger sustained while he was attempting a bunt. He eventually joined the rotation April 10 but it wouldn't last long. After two starts, Billingsley experienced some renewed elbow pain and now finds himself back on the DL. The bigger concern is that this may signal the beginning of the end of his season. If in fact the UCL tear has progressed to the point where Billingsley cannot function well enough to throw, he will be headed for Tommy John surgery. Given the recovery time from reconstructive elbow surgery, Billingsley stands a chance of losing time into next season if he does not address it quickly. No one wants to send an athlete to surgery when it isn't warranted and there will undoubtedly be careful evaluation of all sides of the equation, but the writing seems to be on the wall. Don't count on seeing Billingsley back in the lineup anytime soon, if at all.

Shaun Marcum, SP, New York Mets (placed on DL April 1, could return late this week): Marcum has been sidelined since the start of the month with what the team called "nerve inflammation" in his neck. After receiving injections early to help with pain and inflammation, Marcum has been on a slow and steady rehab course. There have been no reports of any setbacks thus far, an encouraging sign. According to ESPN New York's Kieran Darcy, Marcum will throw 70-75 pitches in a rehab outing Monday and, if all goes well, could return to face the Philadelphia Phillies on Saturday. This is all positive news for Marcum and the Mets, but it is worth noting that these types of ailments lend themselves to recurrence.



Brett Anderson, SP, Oakland Athletics (DTD): Anderson has been contending with a sprained right ankle, which resulted in a shortened appearance Friday and a complete day of rest Saturday. Susan Slusser of the San Francisco Chronicle reports that Anderson threw a bullpen Sunday, which went well, and he appears "likely" to make his Wednesday start. The biggest concern with an ankle sprain on the landing leg of a pitcher is that it not throw off his mechanics and risk injury to his throwing arm. The A's must like what they see if they're considering a prompt return.

Pitchers on the mend

March, 29, 2013
3/29/13
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Given the number of pitchers who are entering 2013 coming off injuries to their throwing arms, we decided to craft a quick status update list on some of the more intriguing names as the season gets underway. Given that some of these players still have a ways to go in their recovery, consider the timeline fluid and subject to change. For the purposes of ascertaining where these players stand coming out of spring training however, this is our guide.

With elbow surgery becoming virtually commonplace in pitchers, we almost take for granted that they will return to their prior level of performance. But the complexity of the surgery and the variables which can impact recovery affect each athlete differently and should not be overlooked. For more detail on the process of ulnar collateral ligament reconstruction, commonly referred to as Tommy John (TJ) surgery, please see below.

Starting Pitchers

[+] EnlargeCC Sabathia
William Perlman/THE STAR-LEDGER/US PresswireCC Sabathia's 200 innings last season were the fewest he's thrown since the 2006 season, which is also the last time he's had as few as 28 starts.
CC Sabathia, LHP, New York Yankees: Surgery to address bone spur, Oct. 25, 2012. Sabathia reluctantly went on the DL last year with swelling in his elbow, then underwent offseason surgery to address the source of the problem; his return this spring has been just how he prefers it -- uneventful -- and he is expected to be ready Opening Day; while he is racking up the years and the pitching miles, his overall durability remains impressive.

Brandon Beachy, RHP, Atlanta Braves: TJ surgery, June 21, 2012. Has thrown several bullpens this spring without incident; will continue on throwing progression with targeted return in June/July.

Chad Billingsley, RHP, Los Angeles Dodgers: elbow inflammation and sprained UCL in 2012. Underwent PRP injections in fall and threw eight bullpens in offseason without incident, saying his elbow felt "normal" entering the spring; this spring he has sustained a groin ailment and a bruised index finger; Billingsley is still hopeful to start the season on time or close to it, but the recent history of a partial UCL tear warrants caution.

Jaime Garcia, LHP, St. Louis Cardinals: rotator cuff tear (small), no surgery, injured June 2012. Garcia opted for rehab over surgery and so far it seems to be working out for him; his shoulder has not given him any trouble this spring and he is expected to be ready to start the season as a part of the Cards rotation. The concern is whether his shoulder will hold up to a full season of pitching demands.

Daniel Hudson, RHP, Arizona Diamondbacks: TJ surgery, July 9, 2012. Has been making steady progress and threw his first bullpen the last week of March; targeting a return around the All-Star Break.

C.J. Wilson, LHP, Los Angeles Angels: surgery to address bone spur, Oct. 23, 2012. Has had no issues with the elbow this spring, although his performance has not been up to par; the latter should improve and his overall durability record should be an encouraging sign going forward.

Colby Lewis, RHP, Texas Rangers: flexor tendon repair, July 27, 2012. Progress has been steady and, after throwing bullpen sessions this spring, he is hoping to progress to live batting practice in early April; so far he remains on track for a late May/early June return. If he continues to progress this well, there could be a nice second half of the season in store.

Michael Pineda, RHP, New York Yankees: labral repair, May 1, 2012. Began throwing from a mound in February and added some breaking pitches in March; he won't be ready to return until around the middle of the season but he seems to be committed to the rehab and to being in better shape in general (reportedly having dropped about 20 pounds by this spring); it remains to be seen whether he can rediscover his dominant style but he's young enough that there's a reason to believe he can.

Ted Lilly, LHP, Los Angeles Dodgers: labral repair, Sep. 21, 2012. Lilly has been remarkably durable but all good things must come to an end; his shoulder issues required surgery and at age 37 it's hard to know just how he'll bounce back; his spring outings have been limited by flu complications and he'll likely start the season on the DL with a chance to continue to progress his arm; hard to count on when his status appears uncertain.

Scott Baker, RHP, Chicago Cubs: TJ surgery April 17, 2012. Made spring debut in mid-March but inflammation afterward resulted in a shutdown for at least a month; will have to gradually resume throwing and continue to build strength. No firm timetable but could miss first couple months of season.

John Danks, LHP, Chicago White Sox: shoulder surgery Aug. 6, 2012. The surgery was for debridement of biceps tendon and rotator cuff and to repair a small capsular tear. Danks threw bullpens and live batting practice sessions this spring without incident but, as is often the case, struggled in game outings, particularly with velocity. Will open the season on the DL and it's unclear just how long he'll stay there.

John Lackey, RHP, Boston Red Sox: TJ surgery Nov. 1, 2011. If there's an upside to tearing your ulnar collateral ligament late in the year it's that you benefit from the season schedule to gain extra recovery time; Lackey is now almost 17 months post-surgery so recovery is not an issue, but he'll still need to regain the feel of competitive throwing; results may be inconsistent initially but he should be able to get through a full season.

Cory Luebke, LHP, San Diego Padres: TJ surgery and flexor tendon repair, May 23, 2012. Experienced some pain in his reconstructed elbow this spring, forcing a temporary shutdown. This is not unusual but it reinforces the notion that these recoveries cannot be rushed; his timetable suggests a return around midseason but that could always fluctuate, as could his performance in the early stages.

Relief Pitchers

[+] EnlargeFrank Francisco
Jason Szenes/Getty ImagesFrank Francisco has to contend with both his recovery, and with a challenge to his role as closer from teammate Bobby Parnell.
Frank Francisco, RHP, New York Mets: surgery to address bone spur in right elbow, Dec. 18, 2012. Began throwing from a mound in March and has only recently begun throwing to live hitters; still with some soreness and is likely to open season on DL; could be ready by late April/early May.

Casey Janssen, RHP, Toronto Blue Jays: AC joint surgery Nov. 16, 2012. Progressed slowly this spring but has recently gained ground and appears ready for Opening Day; his overall workload has been light so will need to see how he responds in season, but the Jays have help if he needs an occasional day off.

Ryan Madson, RHP, Los Angeles Angels: TJ surgery, April 2012. Experienced some soreness this spring and had to be scaled back; will open the season on the DL but may not stay there long. Now that the arm is feeling better, he still needs to build some endurance and currently looks on track to return at some point in April.

Sergio Santos, RHP, Toronto Blue Jays: labral debridement surgery, July 24, 2012. Expected to be ready for Opening Day. Other than some minor triceps soreness this spring, has had a smooth progression back to the mound; Janssen is expected to function as the Jays' closer but Santos could get opportunities if Janssen is initially unable to tolerate a full workload.

Joakim Soria, RHP, Texas Rangers: TJ surgery April 2, 2012. This is Soria's second TJ surgery, making the road to recovery less certain, but so far the process has been smooth. He began throwing long toss in early October and from a mound in February, added breaking pitches in March and appears headed for a late May/early June return.

Tommy John Surgery: An updated primer


Ulnar Collateral Ligament (UCL) Reconstruction was originally performed by Dr. Frank Jobe in 1974 and is now known by the name of Jobe's first subject, pitcher Tommy John. It has become such a part of the baseball vernacular that it's a common topic of discussion amongst even casual fans. That doesn't mean there isn't more to learn about optimizing the surgical techniques or the rehab process to help ensure success or, more importantly, how to ultimately prevent or even reduce the incidence of these injuries.

The basics: The UCL is not a simple ligament. It is comprised of three bands which blend together to reinforce the medial (inner) elbow joint and runs from the medial epicondyle of the humerus (a bony prominence on the arm bone) to the medial forearm bone (ulna). Not all tears are created equal. In fact, it is rarely the case where the ligament is completely blown out. A partial tear in a critical location however can make it virtually impossible to throw because of pain, loss of control, or both. This is one of the reasons an MRI does not tell the entire picture; clinical examination will substantiate any instability in the elbow and the athlete needs to have symptoms of a magnitude sufficient to warrant surgery. This is not a procedure one enters into lightly given the intensive recovery time. One of the reasons a trial of conservative therapy is typically the first option when there is a suspected UCL tear (beyond the obvious scenario where the athlete's injury was mild and he recovers enough to return to play), is to validate for all involved the need for surgical repair.

The procedure: Typically a tendon is harvested from the forearm (most common) to serve as the replacement ligament. The tendon of choice (palmaris longus) is not present in everyone (hence the reason removing it will not hinder the athlete's function) in which case the option becomes a hamstring tendon. The surgeon drills holes in the bone (tunnels) where the new "ligament" will be implanted. In a fancy method of looping the ligament through the tunnels and tying it together, along with repairing the remaining components of the original ligament for reinforcement, the reconstruction is performed. One tricky element involves the location of the ulnar nerve in the forearm. This nerve runs adjacent to the ligament and supplies the fourth and fifth fingers in the hand. In other words, if the nerve becomes compromised, the athlete could lose feeling and muscular function in that area. (Ulnar neuritis, inflammation of the nerve, is not an uncommon ailment amongst pitchers simply due to the stress on the nerve from pitching.) Surgeons take great care to protect the nerve during surgery and in some cases will actually transpose (move the location of) the nerve to another spot on the forearm. Even when care is taken, complications related to the nerve are a risk factor with this surgery.

[+] EnlargeFrank Jobe
Nancy R. Schiff/Hulton Archive/Getty ImagesDr. Frank Jobe, pioneer of "Tommy John" surgery.
The rehab: As is the case following any new surgical procedure, the post-surgical rehab was very cautious initially. Return timetables approximated 16 months. Over time as more athletes have undergone the procedure and more is known about the healing process, that timetable has shortened to a range of nine to 12 months. The rehab schedule remains fluid as any number of factors can influence the time to return to activity, including whether the athlete is a thrower or non-thrower. Early rehab focuses on regaining elbow motion along with strengthening exercises for body parts away from the elbow and cardiovascular conditioning. Strengthening around the elbow is eventually introduced along with upper extremity coordination activities to retrain the "feel" of the arm in space. One of the biggest benefits of the rehab process is the time away from throwing. Pitchers rarely take such extended down time unless forced to do so because of injury. The rehabilitation following UCL reconstruction allows time to address shoulder imbalances, core muscle weakness, leg strength and any other areas that require attention while throwing is off limits. At approximately four months the athlete can resume light tossing and ultimately moves to a progressive throwing program. The throwing program is modified based on how the athlete responds to each outing and it is not uncommon for the progression to fluctuate at various points in the process. Even after an athlete returns to competitive throwing, it often takes time to reestablish command and consistency. So while a return to competition may occur within a year or less, a return to form can certainly take another six to eight months.

The unknowns: It is unclear just how much an athlete should throw in his first season returning from this procedure. Look no further than the case of Stephen Strasburg in 2012 to find arguments on either side of the Nationals' decision to shut him down early. The fact is there is no definitive research at present to outline a specific number of pitches to target or other such criteria for the first year post-surgery. There is some consensus amongst the medical community that the reconstructed ligament is stronger in the second year following the procedure.

Return to prior level of function, especially at the professional level, is remarkably high. Life expectancy of the reconstructed ligament, however, is unknown and may depend on a number of factors including severity of the injury and whether any of the athlete's original ligament remained intact. In recent years there has been an increase in athletes undergoing a second UCL reconstruction but the numbers are still small making meaningful analysis challenging. Based on preliminary research, it appears the success rate (defined as return to prior level of function) following a second procedure is significantly lower. It also appears that pitchers returning to a relief role fare better than those attempting to return as starters.

The prospect of facing Tommy John surgery is not viewed as career-threatening as it once was but it is still a daunting process. Although many athletes return to their prior level of function, it is not an easy path. Non-pitchers can return at a slightly faster rate, although outfielders may require additional time to make the biggest throws (outfield to home without a cutoff). For pitchers, even after they return to action, there is a high degree of variability as to when they actually return to form. As many similarities as there are among surgical techniques and rehabilitation programs, there are just as many individual variables which make each athlete's recovery unique. Prior injury history, overall tissue health, specific biomechanical demands of the athlete, follow-through with rehab and the surgical procedure itself can all impact the pace and the degree of recovery. In the end, outcomes are largely favorable but nothing should be taken for granted.



Los Angeles Dodgers pitcher Chad Billingsley was scratched from his Sunday start due to pain in his elbow. According to the Dodgers' website, Billingsley underwent an initial MRI on Sunday, which he said showed "flexor muscle and inflammation strain or whatever you want to call it."



[+] EnlargeChad Billingsley
Jeff Gross/Getty ImagesChad Billingsley is 4-9 with a 4.30 ERA and a 1.40 WHIP this season.
Not a bad effort when it comes to an athlete relaying medical information. It sounds as if he is describing inflammation in the flexor tendon region (where the muscles that control the flexing or bending of the wrist attach at the inner elbow). Billingsley noted his arm feels better after he begins throwing and it loosens up, a pattern also consistent with mild tendinitis.



The terms he used don't matter much, though, because Billingsley was expected to undergo a second MRI on Monday in order to, as he put it, "get a little bit of a better view of it." Once those results have been reviewed, there should be further indication from the team as to next steps, including whether a trip to the DL is in order.

Billingsley did not have a sudden onset of elbow pain. Apparently, he has been having discomfort for a couple of weeks but didn't mention the issue until a Saturday bullpen session. Perhaps the most notable comment from manager Don Mattingly related to his disappointment with Billingsley for keeping his symptoms from the medical staff. Mattingly acknowledged the ongoing challenge of trying to get players to speak to medical personnel as soon as something crops up but astutely noted, "They can't really help you if you don't talk to them."

Waiting on David Wright

August, 19, 2009
8/19/09
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It's a scary week in the land of fantasy baseball when you drop three places in your league's standings with less than a month to go until the playoffs. It's a terrifying week in the world of real baseball when three players get dropped by high-speed balls connecting with their heads.

The topic of batting-helmet protection was front and center last week when a New York Times article discussed the potential introduction of a new, reportedly safer helmet. The new helmets, designed with the goal of increasing protection for the player's head and its very important contents (yes, the brain), were largely rejected by players in an informal sample survey because of their "look." Many players found them unsightly, and Mets outfielder Jeff Francoeur was quoted as saying, "I am absolutely not wearing that ... We're going to look like a bunch of clowns out there."

Interestingly, Mets third baseman David Wright spoke in favor of the new helmets, saying, "If it provides more protection, then I'm all for it. I'm not worried about style or looking good out there. I'm worried about keeping my melon protected."

In a twist of irony, Wright was one of the three players to suffer a baseball to the head this past week. The image of Wright lying motionless on the ground was disturbing, emphasizing the point of just how serious these injuries can be. Also injured was Dodgers pitcher Hiroki Kuroda, who was without the benefit of any head protection as he took a comebacker to the forehead while on the mound. The third player hit, Rangers second baseman Ian Kinsler, was fortunate to escape a concussive injury when he was hit in the head by a pitch in the eighth inning of his first game back from the DL for a hamstring strain. While Kinsler was able to stay in the game, Kuroda and Wright are still recovering. It will be interesting to see if any players rethink their position on a safer helmet now.

Meanwhile, fantasy players might be wondering when, or even if, these athletes will be able to return. With that in mind, we take a closer look at their injuries and other updates around the league.

[+] EnlargeHideki Kuroda
Kyle Terada/US PresswireKuroda had an impressive 1.15 WHIP period to getting hurt.
Hiroki Kuroda, P, Dodgers: Rest assured that the Dodgers will take no chances when it comes to Kuroda's return from a concussion, which might translate into a DL stint. Kuroda - whose hit in the head might have posed the biggest scare since he was without a helmet at the time of impact -- had what trainer Stan Conte described to me as "pure, unadulterated luck." Conte added that the impact of a line drive at that speed could have been life-threatening, and not only was Kuroda lucky to come away with only the relatively minor symptoms he has (a headache, some nausea), but that he didn't even suffer a cut where the ball hit him. Given how easily the face and head can be lacerated, this is very unusual.

Nonetheless, all precautions will be taken before returning Kuroda to the mound, including the elimination of all symptoms at rest, followed by elimination of all symptoms with physical exertion and normalization of neurocognitive tests (which measure brain function). Although the Dodgers are optimistic that Kuroda will be able to play again this season, a 15-day absence would not come as a surprise.

David Wright, 3B, Mets: It's unfortunate that Wright felt "embarrassment" over his delegation to the DL in the wake of a frightening concussion. Athletes go to the DL for a multitude of reasons, and while some might debate the merit of any given athlete's injury warranting extended rest, it seems reasonable to think that a brain injury would qualify as unarguably serious. After all, concussions are brain injuries by definition, and there is no room for trying to "tough it out" when dealing with the brain. Wright's desire to be there every day is admirable, as is his work ethic, even in the face of his team's disastrous season. That aside, his protection not only of his athletic future but of his overall well-being could depend on how he proceeds.

The good news is that Wright seems to be feeling remarkably well, considering how he looked at the time of injury. But subjective reports can be misleading, and Wright no doubt will undergo neurocognitive tests that will help assess his readiness to return. One of the challenges with concussions is that seriousness cannot be determined at the time of injury, and symptoms do not necessarily correlate with loss of consciousness. In fact, loss of consciousness is not required in order to sustain a concussion. Just ask Hiroki Kuroda. Although statements suggesting Wright's season could be over might have been premature, there is really no way to determine how long he will be out. This is a day-to-day evaluation, and Wright, along with fantasy owners, will need to be patient.

Chad Billingsley, P, Dodgers: Tuesday night was a test ... and it's safe to say Billingsley passed it. In an amazingly quick return after a Grade 2 hamstring strain, he delivered a solid performance, allowing only three hits while securing a win for the Dodgers. It certainly looks as if there are no lingering worries about the hamstring.

On the mend...

&#8226 It certainly appears as if Roy Oswalt's back is still bothering him. He has not been himself in his past two outings, both of which came after a flare-up of a bulging disc in his back. While Oswalt says he's feeling pretty good, that does not necessarily translate to full strength. It would be surprising if his symptoms completely disappeared this quickly after an episode that was severe enough to warrant a cortisone shot. Whether he continues to progress -- both in terms of how he feels and his performance -- or whether he just guts it out for the rest of the season remains to be seen.

&#8226 Peavy update! ... White Sox pitcher Jake Peavy is one step closer to making a start for his new team. He made his first rehab start last week and delivered three scoreless innings. Not bad for a guy who has not been on the mound since June. He told the Chicago Tribune that while his ankle is "certainly not 100 percent ... it's getting there." He said he still lacked leg strength, which is understandable after coming off a six-week immobilization of his ankle to allow his tendon to heal. Peavy will use his additional rehab starts to build his endurance before appearing in a major league start. Right now he still appears on track for a late August or early September return.

&#8226 Red Sox pitcher Daisuke Matsuzaka is gradually working his way back toward a major league return. He is expected to make a minor league rehab start soon after a couple of successful bullpen outings. As the Providence Journal reports, manager Terry Francona is particularly encouraged by the fact that Matsuzaka was able to continue to increase his intensity. Although no specific timetable is in place, if Dice-K continues along this path without a setback he could be eligible to rejoin the team sometime in September. The unknown will be whether his arm endurance will suffice to minimize the Red Sox's dependence on the bullpen.

&#8226 Meanwhile, Matsuzaka's teammate Tim Wakefield is hopeful about returning to the mound, but the jury is still out as far as the medical staff is concerned. He has been limited by weakness in his leg resulting from a bulging disc affecting his sciatic nerve. Although he says he thinks he can go, as The Boston Globe reports, the Red Sox have to evaluate the potential risk of his condition worsening and how that could affect not only this season but also his future. Wakefield has been throwing and participating in running workouts, but is still limping, a sign that his calf muscle strength is still compromised. Originally scheduled for a rehab start in Pawtucket on Friday, he might have to put that on hold depending on the outcome of his conversation with team doctors.

&#8226 Braves pitcher Tim Hudson continues his progression back from Tommy John surgery, which was slowed a bit recently due to a hamstring strain. He has recovered enough to move to rehab starts, and his improvement has been steady. He is already throwing in the low 90s as he works out the kinks of adjusting to his reconstructed elbow. Hudson's services could be available to the team in September.

[+] EnlargeCarlos Beltran
G Fiume/Getty ImagesOh Carlos. If only recovery was determined by the spirit of the player.
&#8226 Mets outfielder Carlos Beltran has been running increased distances this week and might soon attempt to run from first to third, according to the New York Daily News. Beltran spent last weekend shagging fly balls and performing drills in the outfield and told The Star-Ledger his knee did not bother him. He added that he is "working harder than when [he] was playing every day." While that might be true, and while his intent to return is admirable, there is still some question as to how much he should really push the knee. Remember, it was Beltran who wanted to increase his workout activity despite precautions from team physicians who were concerned about the lack of evidence of healing on imaging. Beltran, who was diagnosed with a bone bruise in his right knee, is scheduled to have another MRI at the end of the month. According to The Star-Ledger, he says if he feels good, he wants to play, regardless of what the tests show. While it's certainly true that how a player feels factors into the decision of when and how to progress him, the condition of his knee is not to be taken lightly. The tests of base running and rapid acceleration and deceleration will likely stress his knee to a greater degree than anything he has done so far. How he reacts to the next level of activity might be the key in determining whether or not he is able to return this season.

&#8226 Beltran's teammate, shortstop Jose Reyes, continues to receive therapy treatments to address the scar tissue in the region of his ailing hamstring. The Mets have been very quiet on this front lately. In this case, the saying "no news is good news" does not apply. Although the team has not made any definitive statement with regard to his status, it's hard to imagine him returning this season.

&#8226 As if the Mets needed any more disappointments or setbacks, first baseman Carlos Delgado, recovering from May hip surgery at age 37, now has a strained right oblique. Although it's not altogether uncommon for an athlete to suffer a muscle strain while working his way back from surgery, the reality of this latest ailment is that it makes his return this season look all the less likely. And to think just a few weeks ago he looked like the most likely to return of the Mets trio.

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