Stephania Bell: Huston Street



Just as the Washington Nationals prepare to welcome third baseman Ryan Zimmerman off the DL (he is expected to return Tuesday after an episode of inflammation in his AC joint), they lose yet another starter to injury ... for months. Outfielder Jayson Werth was attempting to make a sliding catch Sunday night when his glove caught in the grass, forcing his left wrist backward into hyperextension. The added load as his body weight came down through his forearm contributed to the immediate fracture of Werth's left radius, the forearm bone on the thumb side that forms part of the wrist joint.

[+] EnlargeJayson Werth
Greg Fiume/Getty ImagesJayson Werth may not be back until well into August.
Not only is a fall on an outstretched hand the most common mechanism for a radius fracture, the instinctive response of Werth to cradle his left arm against his body as his right hand supported his forearm bones at the wrist is a classic reaction to a break. Still, given Werth's left wrist injury history and the many possible outcomes after such an impact, the specifics of his injury could not be presumed by watching the video. The only takeaway was that this was unquestionably a serious injury that dealt Werth a painful blow.

MLB.com reported Monday that Werth underwent surgery to stabilize the fractured radius and the timetable has initially been presented as at least 12 weeks. Standard repair of distal (meaning near the wrist, as opposed to proximal or near the elbow) radial fractures involves implantation of hardware such as a plate and screws to help position the bone for optimal healing. Consider six weeks for the bone to heal, if all goes well, followed by a gradual return to activity as range of motion and strength permit. Ultimately a rehab assignment will be in order prior to Werth rejoining his team. One of the biggest challenges following this type of injury is regaining normal range of motion following the requisite period of immobilization. The initial timetable of three months is reasonable but certainly could be modified along the way depending upon how Werth is progressing. A sooner return is highly unlikely. A lengthier absence is entirely possible.

Werth's prior wrist history, which began when he was hit by a pitch while with the Los Angeles Dodgers in 2005 and eventually resulted in a 2006 surgical procedure by Dr. Richard Berger at the Mayo Clinic (the same surgeon who performed Monday's surgery, according to the Nationals) to repair a split tear of Werth's ulnotriquetral ligament, is not without importance here. While this latest injury is on the opposite (thumb) side of Werth's wrist, the wrist complex (which includes the two forearm bones-- the radius and the ulna -- their articulations with the eight small carpal bones that form the wrist and the articulations of the carpals with the metacarpals -- long bones of the hand) is precisely that, complex. Superimposing a major injury on an area that has already suffered an injury can be problematic. Although Werth clearly returned to an elite functional level from that initial injury, any alterations in his wrist motion or mechanics, however minor, can present additional challenges with a second injury in the region. Certainly Werth has to feel more comfortable with Berger performing this latest surgery, given his specific familiarity with Werth's wrist. And this is not to say Werth can't make a complete recovery; the expectation, based on the limited available information, is that he can and will. But it won't be fun.

Gonzalez tears ACL


Shortstop Alex Gonzalez has now become part of an unusual club among Milwaukee Brewers, a club whose members are relatively few but one to which no one seeks membership. That would be the torn-ACL club, and Gonzalez will join recently inducted first baseman Mat Gamel as this year's dubious honorees. Pitcher Yovani Gallardo tore his ACL back in 2008, an injury made even rarer by the fact he is a pitcher. Torn ACLs aren't as common in baseball as they appear to be in some other sports, although the potential for occurrence in any athletic endeavor always exists. Apparently this is something the Brewers know all too well.

The two infielders tore their right knee ligaments within the same week but under completely different circumstances. Gamel tore his ACL when he crashed into a wall Tuesday in Petco Park while attempting to make a play on a foul ball. Gonzalez was stealing second in Saturday's game against the San Francisco Giants when an awkward slide did the damage. Gonzalez is in the standard pre-surgery waiting period, but as the Milwaukee Journal-Sentinel reports, general manager Gordon Ash confirmed the end of his season, saying, "Alex is going to have surgery. It's just a matter of who is going to perform it." The rehabilitation program following ACL reconstruction is well established and both players should be physically capable of returning to their sport. The disadvantage for the 35-year-old Gonzalez, however, is that he was playing on a one-year deal with the Brewers. His options may be determined, in part, by how he progresses through this rehab.



Quick Hits


• And stop me if you've heard this one before. Pitcher Huston Street, no stranger to the DL, has made his first visit of 2012, this time for a strained latissimus dorsi (commonly referred to as "lat") muscle, injured during a Friday night appearance. While manager Bud Black told reporters he didn't think it was anything that would require surgery, that's not necessarily revealing since most lat injuries don't. The lat is critical to shoulder function, however, and time out can range from weeks to months, depending on severity. As of now, there is no timetable for Street.

[+] EnlargeCory Luebke
John Hefti/Icon SMICory Luebke, a popular sleeper pick entering the season, has a 3-1 record with a 2.61 ERA.
• Street's teammate Cory Luebke is out indefinitely with an elbow issue. An MRI reportedly showed damage to his ulnar collateral ligament (UCL) and his flexor tendon along with fluid in the area. Luebke says he is waiting for the inflammation to settle before making a decision. When it comes to deciding about what would be Tommy John surgery for Luebke, it's critical that the player come to that decision fully invested and without question. The rehab is incredibly long and demanding, and surgeons will often say they want the athlete to essentially come to his own decision that surgery is the only option. This is one reason athletes will sometimes take a few weeks of rest, then try to throw again to see how the elbow responds. If it fails to perform, the choice becomes clearer. And so we wait.

• There is some good news, though. Detroit Tigers pitcher Doug Fister will start Monday night in his return from a costochondral strain. After an impressive rehab outing last week, he should be good to go. As noted above, Nationals third baseman Ryan Zimmerman is expected to be back in the starting lineup Tuesday. Zimmerman has been hitting the past few days without pain -- something he could not do initially -- and barring a setback should be ready after a team day off Monday. And Philadelphia Phillies ace Cliff Lee is expected to rejoin the rotation Wednesday, as he returns from an oblique strain. While Lee was not able to come back at 15 days as he originally hoped, he certainly beat the average number of days absent for pitchers with oblique injuries. Perhaps the fact it was a low-grade injury coupled with Lee's experience in dealing with some variant of abdominal issue over the past few seasons has helped him move through the process more quickly. Two pain-free bullpens have Lee convinced he's ready. Believe him.



With Opening Day just two days, let's take a look at update some of the key injury situations surrounding closers:

[+] EnlargeWilson
Christopher Hanewinckel/US PresswireAn oblique strain may delay Brian Wilson's 2011 debut, but likely not for long.
Brian Wilson, San Francisco Giants: Wilson suffered a left oblique strain in mid-March, and it was noted to be mild at the time. When the Giants' star closer attempted to throw a few days later and was forced to end the session early because of discomfort, alarm bells sounded around the Bay Area (and around fantasy leagues worldwide). But let's remember, that test came only six days after the injury occurred.

For his part, Wilson indicated he wasn't worried. "I mean, I'd like to feel superhuman," Wilson told the San Jose Mercury News. "Correction: I am superhuman. But at the same time, to be realistic, at six days out, I'm not going to feel 1,000 percent." As it turns out, just two days later Wilson was able to play some catch without incident. Since Friday, Wilson has had several light throwing sessions which have all gone well. Tuesday's scheduled 8-10 minute bullpen session is expected to be a deciding factor. Throwing off a mound is more demanding on the trunk than throwing from flat ground, so how a pitcher responds to that progression is a good measure of his recovery.

If Wilson begins the season on the disabled list, there is no major cause for concern. Even mild oblique strains typically require a couple of weeks to overcome. The Giants could backdate his disabled list designation 10 days, making him eligible to return as soon as April 5. The most important issue for the Giants is having a healthy Wilson for the bulk of the season, not pressing him into service for Opening Day at the risk of re-injury. Surely fantasy owners can agree with that.

Update: The Giants announced Tuesday that Wilson will indeed start the season on the DL. It is likely that he will be eligible to return on April 6 when the Giants play the Padres in San Diego.

Joe Nathan, Minnesota Twins: This was the pre-spring training Draft Kit entry on Nathan: Nathan's 2010 season ended before it ever got underway. A torn ulnar collateral ligament in March led to Tommy John surgery and he has been rehabbing his way back to the mound ever since. So far his progress has been smooth without setbacks and he is on track for spring. It typically takes a year to return, even longer to return to form. Nathan may get his first action in middle relief and work his way back to the closer role as able.

Now that we've had a chance to watch Nathan this spring, it appears that we're not far off the mark. First and foremost, Nathan's arm feels good. As is often the case with pitchers returning from this surgery, his velocity is making nice progress, but at times his control, especially with his slider, has wavered. Nathan has pitched several scoreless innings but has also yielded some multiple-run innings. The overarching impression though is that things are returning to normal for Nathan and he is gaining confidence as the spring progresses.



A key sign that the Twins are confident in Nathan's progress is that it appears they will use him in the closer role right away. But while manager Ron Gardenhire is pleased with what he's seen from Nathan, he understands that Nathan needs to continue to build endurance for consecutive outings. Consequently, he will share the closer responsibility, at least initially, with Matt Capps. According to Phil Mackey of ESPN 1500 Twin Cities, Gardenhire says, "We're going to use them both right away," adding, "I just don't think Nathan is ready to go three, four days in a row." Fantasy owners should be aware of the shared role at the outset -- probably for at least the first month -- but stay tuned as the spring progresses for Nathan to stake his claim.



Huston Street, Colorado Rockies: The news on Street this year is, well, there is no news, at least when it comes to injuries. Street has dealt with his fair share of ailments during his career, but 2010 bordered on the unusual. His season debut was delayed by a shoulder injury, only to be further delayed when he strained his groin during recovery. In July, he had a scary moment when he was hit by a pitch in the abdomen during batting practice and had to be taken away by ambulance. Street ended the season playing through a rib injury. With the goal of entering 2011 fully healthy, Street took to easing up on his offseason workouts and so far, so good. Now if Street can stay on the mound as the season progresses, patient fantasy owners should be rewarded.

[+] EnlargeAndrew Bailey
Tim Larson/Icon SMIAndrew Bailey had to visit Dr. James Andrews this preseason, but it appears he has avoided major injury for now.
Andrew Bailey, Oakland Athletics: Bailey underwent a minor cleanup procedure on his throwing (right) elbow in the offseason, the same elbow on which he had Tommy John surgery in college. Such follow-up procedures are not unusual and it appeared he was heading into the spring feeling good. Then came March 14. Bailey was pitching in a spring training game when he suddenly grabbed his elbow in pain after releasing the ball. A visit to Dr. James Andrews brought reassurance that it was just a forearm strain, but the lingering image was disconcerting.

Since that time, Bailey's return to throwing has been a little slower than anticipated (he began light throwing on flat ground just this week), but the A's are certainly not going to rush. Bailey is going to start the season on the disabled list and will be brought back through a gradual throwing progression. In the meantime, fantasy owners should temper expectations (in other words, don't count on just 15 days) and look for Brian Fuentes to get the bulk of the A's early save opportunities.

J.J. Putz, Arizona Diamondbacks: Putz had a relatively injury-free 2010 after back-to-back injury-filled seasons in 2008 and 2009. At 34 years old, he brings the experience of a successful closer to the Diamondbacks but also the wear and tear of a veteran pitcher. Putz developed back spasms a couple weeks ago and has been undergoing treatment in an effort to ready him for Opening Day. So far, his progression back to the mound has been uneventful. If a ninth-inning appearance goes well on Tuesday, Putz expects to be ready for the Diamondbacks' Friday opener.

Brad Lidge, Philadelphia Phillies: Lidge has dealt with injury issues at the outset of the last two seasons; make 2011 the trifecta. Lidge developed soreness in his right biceps in mid-March, which, by all accounts, was deemed minor. He seemed to be making progress as far as the discomfort in his arm when he developed a new and more concerning issue, pain in the back of his throwing shoulder, which happens to be where the rotator cuff musculature rests. The Phillies made it clear that Lidge would be shut down for a period of time, as is normally the case when the throwing shoulder is hurting, but the specifics are not yet known. Lidge is scheduled for an MRI Tuesday in Philadelphia but the decision to start him on the disabled list has already been made.

Lidge has proven in the past that he can start the season on the disabled list and turn things around, but those injuries have not been to his pitching shoulder. Shoulder ailments have wide variability in terms of recovery timeframe depending on the structures involved and the degree of injury, making it hard to speculate as to how long Lidge could truly be sidelined. The uncertainty alone should be enough to make fantasy owners wary.

Update: The MRI on Lidge revealed a posterior rotator cuff strain, according to ESPN's Jerry Crasnick. The Phillies have indicated that Lidge is expected to miss three to six weeks but according to GM Ruben Amaro Jr., Lidge will not need surgery to fix the problem. Late Tuesday, manager Charlie Manuel said he is leaning towards veteran Jose Contreras as his closer.

The Colorado Rockies and Philadelphia Phillies are under the microscope today. Let's look at a few of their key players:

Colorado Rockies

Troy Tulowitzki, SS: It's no secret that the Rockies recently lost their hottest hitter to a wrist fracture. The question everyone really wants answered is exactly how long he will be away. This is where it gets complicated. Injury scenarios are rarely straightforward, but when it comes to broken wrists, hands and fingers on hitters, they can be especially challenging.

Troy Tulowitzki
Marc Piscotty/Icon SMITroy Tulowitzki was hitting a career-high .307 at the time he got hurt.
In Tulowitzki's case, it is expected to be at least a six-week absence for the star shortstop, but it's more than a case of just getting Tulowitzki back in the lineup. The real question is when the pre-injury version of Tulowitzki will resurface. In the absence of clairvoyance, there are several things that fantasy owners should keep in mind over the next few weeks for planning purposes.

Most fractures take approximately six weeks to heal. In the case of small chips or cracks, the healing can be quicker, and some individuals heal at faster rates than others. Until the bone demonstrates adequate healing, it must be immobilized so that the broken parts fuse. Move the bones too quickly and you end up with a "non-union," or non-healing fracture. While immobilization is necessary for bone healing, it causes other problems, primarily stiffness in the adjacent joints and atrophy of the muscles that are not able to work during that time. Those problems must then be overcome once the bone is healed in order to achieve full recovery.

The key to determining how long a player will take to return to form begins with how long the immobilization period is. Without knowing the precise medical details regarding Tulowitzki's fracture, it's impossible to say at this point how long that will be. What we can say is to pay close attention to when he is able to start moving his injured wrist and hand. For instance, if he is immobilized for only 3-4 weeks, there is much less stiffness and weakness to deal with than if he has to be immobilized for six weeks. Regaining full range of motion and strength in the muscles responsible for gripping and turning the bat are key for a hitter to regain his stroke. The longer the immobilization, the longer that process takes.

Manager Jim Tracy issued a very telling comment when talking about Tulowitzki's overall timetable. According to FoxSports.com, Tracy stated, "It will be every bit of six weeks. He has to get to the point of being healed and pain free before he can resume baseball activity." And Tulowitzki's strength coming back will be largely dependent on just how long it takes for him to be cleared to resume those activities.

In my estimation, fantasy owners are looking at a best-case scenario of a return in two months, but they should be prepared for him to miss longer than that. And, like I said, the sooner he's able to get moving, the more optimistic the outlook.

Jorge De La Rosa, SP: De La Rosa has a tentative return date set, and it's right around the corner. At the moment, he hopes to rejoin the rotation July 7 after an absence of more than two months.

As I wrote back on April 29, De La Rosa has been dealing with a torn flexor band on the middle finger of his pitching (left) hand. The critical element in his recovery was allowing enough time for the soft tissue to heal before resuming the stress of throwing. After all, the injury originally happened during routine pitching, so the Rockies did not want a repeat offense.

De La Rosa's recovery has been fairly steady, and he has been throwing for about a month now, moving from catch sessions with protective tape on the finger to hard throwing without any support. The progressive intensity of adding breaking balls to the mix has been tolerated well. On Wednesday, the Rockies lefty threw four innings without incident in a rehab start, one that included a variety of breaking pitches designed to test the finger.

The goal is to build up his endurance and ensure that there are no problems in the time leading up to his return. According to the Rockies' official website, De La Rosa has two more rehab starts, interspersed with two bullpen sessions, ahead of him before his target return date. All appears in order for him to return in the first week of July.

Huston Street, RP: It was great to see Street make his big league debut this week after missing the first four months of the season with shoulder inflammation, followed by a groin injury. Street was initially told that he would be eased back into the closer role, which was no doubt good for him both mentally and physically. Without the game on the line, it is slightly less stressful getting re-acclimated to pitching in the majors, and makes it less likely that a pitcher will overdo it in a single outing. Players will often say that the adrenaline of the moment results in them throwing harder; if the moment isn't quite as dramatic, it's easier to maintain control.

That said, it appears the Rockies quickly felt Street was ready to handle the stress. On Thursday, manager Jim Tracy brought Street into a tie game in the 10th inning to face the Boston Red Sox. Unfortunately for Street, the two-run homer he gave up to Dustin Pedroia ended up being the game-winner, but in the big picture, Street getting his feet wet in a pressure situation might be more important.

Fantasy owners should feel encouraged about the fact that Street's shoulder has essentially been feeling good since mid-May. If it weren't for the groin strain, he would have returned from the DL several weeks sooner. On the plus side, having to hold back a bit because of the groin injury might have given his shoulder a little extra cushion. Now he just has to regain his comfort on the big stage.

Philadelphia Phillies

Jimmy Rollins, SS: Rollins rejoined his team this week after two successive, lengthy DL stints as a result of a calf strain. OK, so his first outing of the week was forgettable, as was much of his second. But when it counted on Wednesday night, Rollins delivered a walk-off home run that had Phillies fans praising his return.

Jimmy Rollins
Christopher Szagola/Icon SMIJimmy Rollins is back, but he might not be 100 percent.
So does that mean he's out of the woods? Not exactly. Rollins told the Philadelphia Inquirer that he had an MRI performed before he returned to Clearwater for a rehab assignment, and the calf was not quite picture-perfect. "They said it was looking better, so that told me they're probably seeing something, but it's not as bad," said Rollins. Expect that to translate to intermittent rest as a means of trying to ensure that Rollins does not suffer a setback that would force him to the DL for a third time this year.

The team has indicated they will be cautious, and to that end, it gave Rollins a day off Thursday. A day game following a night game does not allow for much recovery time, so those situations would be the most likely scenarios in which Rollins will rest one of the two games. Fantasy owners with daily lineups will want to track this closely, as it likely will be the pattern for a while.

J.A. Happ, SP: The Phillies cannot be too "happ-y" with how long it is taking Happ to get his velocity back after a bout of soreness in his throwing (left) forearm. Officially the injury has been termed a forearm strain, inflammation of the flexor-pronator muscle group which has kept him out since late April. Originally the team expected him back within weeks, not months, but his continued struggles with velocity and overall command have delayed his return.

The good news is that since mid-May, Happ has repeatedly indicated that he is not experiencing any pain in his throwing forearm. Nonetheless, the long layoff has no doubt contributed to his challenges in re-establishing his velocity, so the team has continued to extend his rehab starts accordingly. Happ has another rehab outing scheduled for Tuesday, according to the Philadelphia Daily News. This outing will be important, as the timetable is approaching where the Phillies will need to make a decision as to whether to activate Happ, cease his rehab starts or send him to the minors. Stay tuned.



Earlier this week, we talked about a young pitcher expected to return soon from Tommy John surgery: the Washington Nationals' Jordan Zimmermann, who is targeting sometime in August. Another young pitcher is making his way back from the same procedure ... and he might be rejoining his team in late July. Edinson Volquez, the Cincinnati Reds' ace in 2008, struggled with various ailments last year before his right elbow ultimately gave out.

Edinson Volquez
Derrick Tuskan/Icon SMIEdinson Volquez, an All-Star in 2008, was limited to just 49 2/3 innings in 2009 before undergoing Tommy John surgery.
Volquez underwent the procedure to reconstruct his ulnar collateral ligament and flexor mass in August and is looking ever-closer to a return just after the All-Star break. His rehab has proceeded fairly uneventfully (if you don't count the 50-game suspension he was handed in the middle of it for testing positive for performance-enhancing drugs) and he has recently begun a rehab assignment. That puts him on the clock for a return in the next few weeks barring a setback.



Even in limited innings during his rehab outings, Volquez has shown that his velocity is returning. He has also been striking players out left and right, a happy and familiar sight to Volquez fans. The suspension has ended (the penalty was applied while Volquez was on the DL, resulting in loss of pay but little else) so he's eligible to return to action whenever the team deems him ready.

Volquez still needs to build up his endurance and show that he can retain his command while doing so, a task that is not always easy following a Tommy John procedure. The same cautions always issued regarding expectations for a player returning from this type of injury still apply. Given how long it's been since Volquez pitched consistently, fantasy owners should anticipate some readjustment time. But the notion that he could contribute late in the season is not unreasonable. After an increased workload in 2008, the downtime Volquez's body has had over the last season and a half should be restorative.



Fantasy owners who have room to stash someone who could be helpful down the stretch may want to consider acquiring Volquez for their arsenal.

As for other players on the injury radar:

Chris Young, SP, San Diego Padres: ESPN's Jerry Crasnick says it's the pitching that has been a major reason for the Padres' success this year. Unfortunately for him, Young has hardly been part of that good fortune so far. Young made it through a dedicated offseason of rehab to his first start without a hitch following last year's shoulder surgery (labral debridement) but soon afterward the problems began. And they haven't let up.

Young developed persistent stiffness in his shoulder and has not been able to resume regular throwing without the shoulder becoming sore. He was shut down completely in mid-May to focus on therapy alone and was transferred to the 60-day DL at that point. There are no outward signs of significant headway and Young's own confidence in his ability to get back this season appears in doubt. Young told MLB.com recently, "Hopefully I'll pitch again this year. Right now, I'm not sure."



Ouch. For a guy who has been through more than his share of injuries in the past two seasons and who has worked so hard to get off to a good start this year, this has to be exasperating. Fantasy owners should probably turn their attention elsewhere if they haven't already.

Huston Street, RP, Colorado Rockies: The Rockies expect to activate Street this Sunday, but don't necessarily expect him to return to the closer role right away.

Brandon Webb, SP, Arizona Diamondbacks: Hold on to your hats, folks. Webb is throwing from a mound again. He's only had a couple of sessions so there is still a long way to go, but this is the most encouraging news on Webb all year.

Carlos Beltran, OF, New York Mets: He has yet to start a rehab assignment, although he continues simulated game work, including fielding. According to a Newsday report, Beltran has been spotted still running with a limp. The team is being wise not to push him back, even at DH, if he cannot run properly. Stay tuned.



Welcome back! Here's to being back from an extended stay away from the team, settling into the regular routine and finishing out the season on an upswing. No, the salutation is not self-directed, although I did manage to tear myself away from the beaches of Cabo San Lucas in Mexico to get back to the business of discussing injuries. This welcome is directed to Los Angeles Dodgers shortstop Rafael Furcal, who rejoined the lineup Tuesday in Chicago after missing time with a hamstring strain.



After originally looking as if he'd be back when eligible May 14, there was enough concern about some lingering symptoms to postpone the return date until now. It wasn't exactly Furcal's most notable performance (0-for-4 and a couple of errors), but he got through the game just fine. As reported by Tony Jackson of ESPNLosAngeles.com, Furcal said after the game, "I am very disappointed with the way I played. The best thing is that I'm healthy and I didn't feel anything." Very true. Rust can be overcome quicker than reinjury. The biggest test, however, will come during the next couple of weeks as we see just how Furcal and his hamstring tolerate the grind of daily play.

Also returning from injury were Boston Red Sox outfielder Mike Cameron, returning from an abdominal strain, and Minnesota Twins shortstop J.J. Hardy, coming off a bone bruise in his left wrist. Cameron is going to be eased back into play, according to The Boston Globe. He will not be used daily, at least not initially, plus he will spend some time playing left field. The 37-year-old Cameron, whose superb fitness may be a reason he's even been able to return from this injury, may yet require surgery down the line. Hardy's return Tuesday was abbreviated because the Yankees-Twins game was suspended in the fifth inning by rain. That said, Hardy's first at-bat was a double to deep right, so it looks as if his wrist is not a limiting factor.

Earlier it appeared that we would be welcoming back another star in this week's blog, Philadelphia Phillies shortstop Jimmy Rollins, but he was back on the DL before we ever got the chance. On that unfortunate note, we turn to some of the key injuries in the world of baseball this week ...

Jimmy Rollins
Miles Kennedy/Getty ImagesJimmy Rollins hit a homer in his brief stint off the disabled list earlier this month.
Jimmy Rollins, SS, Philadelphia Phillies (15-day DL, May 22): Rollins' situation exemplifies the challenge for a medical staff when dealing with an athlete returning to play following a significant muscle strain. No matter how many sprints, drills or running workouts an athlete goes through to test the injured part, there is no guarantee that he is out of the woods when he returns to play. It is impossible to simulate every game situation and perhaps even more challenging to simulate the environment -- such as the intensity, the adrenaline of playing in a major league game -- and those things can factor into how the body responds. The Phillies brought Rollins along at a conservative pace, even holding him back at times as a measure of precaution. Sometimes even the best-laid plans don't unfold as anticipated.

In Rollins' case, his right calf gave him a signal that it was not going to fully cooperate with his agenda. Rollins returned to the lineup on May 17 after missing 30 games with the original injury. Just four days later, the calf bothered him while he ran to first on a single. He was forced to leave the game early and returned to the DL the next day. No fooling around here.



As Phillies general manager Ruben Amaro told The Philadelphia Inquirer, "It might not take [the entire 15-day DL stint], but we can't afford to put ourselves in a position where it gets reinjured and turns into something serious." Hmmm. It looks as though the first part (reinjury) already happened, but the hope is that this does not represent a serious setback. The fortunate aspect is that this strain is reportedly not as severe as the initial injury. The team is referring to it as a Grade I, or mild, strain (the original injury was a Grade II, or moderate, strain) and the team hopes he will not require much, if any, additional time off.



Fantasy owners are understandably frustrated (just think how Rollins feels!), but this is not time to panic.

Andre Ethier, Los Angeles Dodgers (15-day DL, retroactive to May 15):
What a difference a day -- or a splint -- makes! Ethier, who landed on the DL after suffering a fracture in his right pinkie finger while taking batting practice, could have missed up to six weeks with the injury. As it turns out, thanks to the aid of a particular splint, Ethier may be able to return when eligible on Sunday.

The emphasis is on the word "may," however, as Ethier will have to show that he can perform without limitation and that the fracture is indeed healing before he can definitively play. But so far, things are looking good. If he performs well in a simulated game Saturday, he could be activated Sunday.

Andre Ethier
Harry How/Getty ImagesAndre Ethier could be back from the disabled list as soon as he's eligible.
The fracture that Ethier suffered was bit odd, or at least the mechanism of injury was unique. Ethier sustained an avulsion fracture -- when a small chip of bone is avulsed or pulled away where the tendon attaches to the bone -- at the tip of his fifth finger. Typically this type of injury, also called mallet finger, results from hyperflexion (exaggerated bending) of the digit, most often when the finger gets jammed by a ball or by contact with another athlete. In Ethier's case, it occurred while batting, when a slight slip of his pinkie finger caused it to get jammed between the bat and his hand.



As the medical staff discussed what route to take for treatment, the Dodgers' director of medical services, Stan Conte (himself a physical therapist and athletic trainer), made a call to colleague Gary Vitti, longtime athletic trainer for the Los Angeles Lakers. Anyone who has followed the Lakers lately knows they have had their share of finger issues, as is common in basketball. Conte said that Vitti recommended use of the "Pro-Ferred" splint, a splint that uniquely maintains the joint of the tip of the finger in extension (keeps it straight) to allow it to heal while allowing the joint just below some ability to flex or bend. This ability to flex the proximal or near part of the finger is what allows Ethier to be able to handle a bat.

Conte said that the use of the splint, along with some modifications of padding at the knob of the bat to make for easier grip, have enabled Ethier to already begin taking batting practice. While Conte stresses that the Dodgers are not yet sure whether Ethier will be ready to return when eligible, he does acknowledge that they are very pleased with the progress he has been able to make. Ethier would continue to wear the splint even if he does return because the tissue will still be healing.

From a medical standpoint, the more normal motion that can be encouraged while still protecting the injured area, the better the outcome typically is. We often see hitters who struggle when returning from wrist and hand injuries, particularly as they work to regain their motion and strength even if the injury has technically healed. In this scenario, it's quite possible that many of those challenges could be avoided as a result of Ethier's being able to continue to swing the bat relatively uninterrupted.

A little interleague cooperation could prove to go a long way to make fantasy owners really, really happy here. Stay tuned.

Grady Sizemore, OF, Cleveland Indians (15-day DL, May 19): An awkward landing while diving back to first base sent Sizemore to the DL, aggravating a knee injury first sustained near the end of spring training. Sizemore's next step will not be known until he gathers several opinions on his injured knee. The team has termed Sizemore's injury a bone bruise, but based on the locales of the specialists he's reported to be visiting -- Vail, Colo., and New York -- it raises the specter of cartilage damage. Vail is home to Dr. Richard Steadman, a pioneer of microfracture surgery (he performed January surgery on the New York Mets' Carlos Beltran), and there are surgeons in New York with similar expertise in cartilage defects.



The question that every fantasy owner wants answered is whether Sizemore will require surgery. Although the bone bruise likely will have him sidelined for multiple weeks, surgery could keep him out even longer, perhaps even threatening his return this season. Until the team releases more information, a timetable remains speculative, but at the very least, fantasy owners should make alternate plans for the next month.

Josh Beckett, SP, Boston Red Sox (15-day DL, May 19): Beckett and back problems are nothing new. In fact, he has dealt with lower back and upper back issues at different points in recent years. It seems that this year will be no different.

Beckett began having back spasms in early May after taking batting practice, and he missed a scheduled start. Days later, while pitching in rainy conditions, Beckett left his start early with tightness in his back. A DL move was natural and precautionary in trying to prevent this from being a lingering and lengthy situation. Although Beckett is eligible to return on June 3, there is certainly no guarantee that he will. So far he has thrown a few side sessions, and next up comes the bullpen. The Red Sox will want to see how he tolerates the progression to the mound before deciding on a return date.

Jorge Posada, C, New York Yankees (15-day DL, May 20): Posada has been placed on the DL with a hairline fracture in his right foot, the result of absorbing a foul tip off that foot in mid-May. Posada was hoping for just a bone bruise, but imaging tests showed the crack.

Initial projections from the team after the fracture was revealed had Posada out for three to four weeks, but he has taken a bit of a defiant position against that notion. According to the Newark Star-Ledger, Posada believes he will return earlier. "They can say whatever they're going to say. I'll be here before that," Posada said. It's worth noting that he followed up by saying he had never had a problem with his feet before, pointing out that "You've got to be able to put your weight on and all that stuff. You've got to be able to transfer your weight from one side or the other." Right. And he was immobilized in a walking boot when he made the remarks.



Given his position as a catcher where he is in a crouch, placing significant load through his feet while intermittently, explosively moving to full stance, the demands on the foot are high. Not only is he not likely to be back before three weeks, he'd be lucky to be back by then.



A hairline fracture can show evidence of healing more quickly than a complete fracture, but beyond the bone repairing itself, the foot needs to be able to tolerate loading, pivoting and twisting, without causing any symptoms before an athlete is able to return to baseball activities. Then, of course, he has to get back up to the level of playing in games. Until Posada is cleared for impact activities, it's probably too soon to even think of a return date. Fantasy owners should be planning on being without his services for the better part of a month.

Brad Penny, SP, St. Louis Cardinals: (15-day DL, May 22): Penny escaped with a relatively mild injury but was still relegated to a DL stint just to be safe. Penny, who was diagnosed with a strained lat (short for latissimus dorsi, one of the broad muscles of the back), left his Friday start early because of discomfort. Despite delivering a grand slam, Penny was not feeling good and came out of the game as a result.



According to the St. Louis Post-Dispatch, the decision to move Penny to the DL was easy for the Cardinals when considering the big picture. General manager John Mozeliak said, "It just makes sense to DL him, rather than put him out there for the next start and he makes a pitch and goes backward. It's a precaution." The team does not expect him to miss time beyond the minimum DL requirement.

Justin Duchscherer
Tony Medina/SMIJustin Duchscherer currently has a 2-1 record with a 2.89 ERA in five starts this season.
Justin Duchscherer, SP, Oakland Athletics (15-day DL, May 16): After working so hard to get back this season, Duchscherer has to be disappointed in the cards he's been dealt so far this year. He knew that keeping his lead hip healthy was the key to keeping his lower back pain-free and avoiding overload on his throwing arm, which was surgically repaired in 2008. In fact, he told me that very thing in spring training after making his first start of the year coming off pain-alleviating sacroiliac joint (where the low back joins the pelvis) injections. That's why he dedicated extra time to stretching his hips and keeping them loose.



But his anatomy is just not cooperating. Duchscherer, who already endured surgery on his right hip, is now being plagued by similar symptoms on the left side. His prior experience with the right hip is no doubt what led him to tell the San Francisco Chronicle that he anticipates needing surgery on the left hip. That statement came just after Duchscherer returned to the DL in mid-May because of continued hip discomfort one mere day after coming off it.

For the time being, Duchscherer is trying the conservative route to see whether he can delay surgery until the season ends. The Chronicle reports that he has undergone a Synvisc injection, a joint lubricant that may alleviate some of his current symptoms.

Fantasy owners who were holding out hope should probably look elsewhere, however. Synvisc was not ultimately able to stave off surgery when Duchscherer's right hip was bothering him; it's hard to be overly optimistic that this will turn out differently.

Other names to watch

Huston Street, RP, Colorado Rockies (15-day DL retroactive to March 26): Street began experiencing shoulder stiffness in mid-March. After steady progress, Street was throwing in a rehab assignment mid-May and was feeling good. So good, in fact, that he told the Rockies' official website, "I'm close -- dangerously close. I'm close enough to start getting my hopes up, and that's something I'm trying to keep together." Then, as if foreshadowing what was to come, Street added, "I got real excited last time [in spring training], and we had the setback. That set us back six more weeks."

Uh-oh. It happened again. Street suffered a setback just when it appeared he was on the verge of returning. It's important to distinguish, however, that this setback was not to his shoulder; instead, Street suffered a groin injury. Fortunately, it appears that the injury was not as serious as first thought, and Street's return may not be extensively delayed. In fact, Street threw a bullpen session Tuesday, which suggests he could be back in a rehab assignment in the not-too-distant future. Fantasy owners should keep an eye on early June if all continues well.

Brett Anderson, SP, Oakland Athletics (15-day DL, April 27): Anderson has been out since late April with a flexor tendon strain in his throwing (left) forearm. ESPN's Buster Olney originally reported that Anderson was expected to miss a month, and it appears that time frame could be right on the money.



Anderson has been progressing well since his injury and threw three innings in a rehab start in Sacramento on Monday. Although it seems like a relatively short rehab stint, the A's must be pleased with what they have seen so far, because Anderson is expected to rejoin the team Wednesday according to Contra Costa Times reporter Joe Stiglich. The plan is for Anderson to throw off the mound and, if there are no setbacks, pitch Saturday. Despite the short rehab assignment, Anderson has been throwing his repertoire of pitches without incident during flat ground sessions since mid-May, according to the San Francisco Chronicle. Although this is certainly a strong sign, the demands of throwing off the mound are always greater. It will be interesting to see how deep he goes into his first game out after the layoff.

And yes, there are always more injuries than there is room to discuss here. We might even hit on some of them in tomorrow's Fantasy Focus podcast. Next week, we will take a look at some of those "forgotten" players nearing the end of their terms on the 60-day DL. Will they be ready? Check back and see what we're hearing.



Another week, another slew of injuries. This week, though, in addition to adding names to the injury roster, we learned that several players are going to be spending some additional time on the disabled list. Never music to a fantasy owner's ears but it's always better to be prepared.

Mauer
Gary A. Vasquez/US PresswireJoe Mauer may miss a few more games, but he probably isn't "week-to-week" as Twins manager Ron Gardenhire mentioned earlier.
Joe Mauer, C, Minnesota Twins (day-to-day): Mauer has been dealing with a deep bruise in his left heel since Friday night when a sharp lunge to first base left him in pain. It sounded dire by Sunday when manager Ron Gardenhire described Mauer's condition as "week-to-week" instead of day-to-day. Gardenhire also made it clear the Twins would not be rushing Mauer back, telling the Minneapolis Star-Tribune, this injury is "something you don't screw around with."

It now sounds like it's not as bad as it could have been. According to the Twins' website, an MRI confirmed a soft tissue injury (as in, there is no fracture) and the healing will be assessed on a daily basis. Mauer is reportedly feeling better and is running in a pool to maintain conditioning while eliminating impact that could aggravate the situation. It appears that the Twins have avoided a move to the DL for Mauer ... at least so far.

Rafael Furcal, SS, Los Angeles Dodgers (15-day DL, retroactive to April 28): Furcal has been pestered by a hamstring injury for the last week. On Tuesday, the Dodgers determined that more time was needed and the decision was made to place Furcal on the DL. The issue now is how concerned fantasy owners should be. Does the DL just buy Furcal another week of healing time or is this injury enough to keep him out significantly longer?



Before panic sets in, it appears that the answer is the former. Furcal has been progressing well with his hamstring injury but is not quite ready to resume full speed activity. As a shortstop, he needs to make explosive defensive movements. As a leadoff hitter, he is likely to be exposed to more sprinting situations. Consequently, Furcal is at far greater risk of a setback if he returns at less than full strength. Since it's May and not September, there is no reason for the Dodgers to take that chance. The move to the DL appears to have been largely precautionary. Expect Furcal to return when eligible, barring, of course, a setback.

Manny Ramirez, OF, Los Angeles Dodgers (15-day DL, April 23): Speaking of Dodgers placed on the DL for precautionary reasons, Ramirez began a rehab assignment Tuesday and the news is so far, so good. Ramirez, who suffered a Grade I calf strain, has been running without incident for several days. He is eligible to return May 9 and appears on track to meet that target.

Jacoby Ellsbury
Tom Szczerbowski/US PresswireJacoby Ellsbury would like to be comfortable swinging the bat before he returns from four broken ribs.
Jacoby Ellsbury, OF, Boston Red Sox (15-day DL, retroactive to April 12): Ellsbury continues to recover from the pain that comes with having four broken ribs.



From last week's injury blog: Although it can take four to six weeks for a rib fracture to heal, from the standpoint of activity this is a symptom-based condition meaning whatever he can tolerate, he can do. The fact that four bones were broken, however, tells us that it will take longer to tolerate just about everything.



That statement still holds true. The Boston Globe reported that when pressed for a timetable earlier in the week, Ellsbury declined to provide one, reminding everyone that he does indeed have broken bones "and they need to heal." It may feel like forever to fantasy owners, but it's only been three weeks, very reasonable when you consider his injury.



Ellsbury did take a positive step Tuesday when, according to the Red Sox's website, he took batting practice before the team's game against the Los Angeles Angels. Let's see how Ellsbury feels the day after this new activity before we get too excited. And keep in mind, he likely will require a rehab assignment to get his body back in the groove of playing both offense and defense. He may very well be more than just a few days away from returning. The road back may continue to feel slow, but at least we are seeing some tangible progress.

Jimmy Rollins, SS, Philadelphia Phillies (15-day DL, April 13): A week ago, we pointed out that Rollins had not done any explosive movement that would really test his calf; now we know why. According to the Phillies' website, Rollins still feels discomfort in his right calf when he has to move to his left while fielding ground balls. This makes perfect sense from an injury standpoint. As he makes that initial lateral movement to make a play on a ground ball traveling to his left, he is forced to push his full body weight through that calf muscle. While it might not be bothersome in straight-ahead running, making a quick directional movement from a stationary position requires significantly more power. The discomfort Rollins feels is his calf's way of telling him that it's not healed.

Consequently, the Phillies have expanded the time frame for his return from four weeks to six. This is hardly shocking; we have said from the outset that these injuries are unpredictable and easily aggravated. The Phillies don't want him to come back only to be forced out again. The idea is to have him back for the remainder of the season. Fantasy owners should set their sights on the latter part of May.

Kerry Wood, RP, Cleveland Indians (15-day DL, retroactive to March 26): Last week we said that Wood was scheduled to begin a rehab assignment soon. He did. We also said that when pitchers face live hitters, the adrenaline goes up and the body can react. It's also a time for pitchers to work on their velocity and location. Wood had a chance to get some work in and found out what he still needed to work on before rejoining his team.

Wood may have given up six runs in less than an inning in a rehab outing, but on the positive side, he reported feeling good afterward. Wood told the Akron Beacon Journal, "that's the most important thing for me." Certainly given his injury history that couldn't be more true. Wood may require another couple rehab appearances before he retakes the closer role with the Indians but his return date appears close.



Brian Roberts
J. Meric/Getty ImagesBrian Roberts' seemingly uncertain return frustrates many owners.
Brian Roberts, 2B, Baltimore Orioles (15-day DL, April 10): The quote heard 'round the fantasy world: "It could be three weeks, it could be three months" was Roberts' assessment of his situation, according to the Orioles' website. For fantasy owners wondering whether they should still hold out any hope, it's worth noting that Roberts was quick to add that he did not really think it would be three months.

Nonetheless, we have outlined here in past weeks that Roberts' back condition has the potential not only to linger, but to continue to be problematic across the season. Disc problems are notoriously difficult and this is behaving no differently. Roberts is still very limited in his activity as the team brings him along slowly. Because there are many hurdles to overcome, it is hard to establish a clear timeline. That brings frustration for players and fantasy owners. At this point, it's anyone's guess, including Roberts', as to when he'll be able to return.

Curtis Granderson, OF, New York Yankees (15-day DL, May 2): When Granderson pulled up sharply while rounding the bases Saturday and hobbled toward third base. it was obvious he had pulled something, it just wasn't clear exactly what it was. We have learned that he suffered a Grade II groin strain, and according to ESPN's Buster Olney, Granderson is expected to miss a month.

This is not dissimilar to the Grade II muscle strain that the Phillies' Rollins is dealing with, other than the exact location of the injury. Grade II, also called a moderate strain, represents the widest range of injury somewhere between a minor strain with no visible tissue damage (Grade I) and a complete muscle tear (Grade III). As we have seen with Rollins, it takes time for the tissue to heal, and the most challenging aspect of recovery is regaining explosiveness and speed, a critical component of Granderson's game. Fantasy owners should hope for four weeks, be prepared for six and know that his timetable could still fall outside of those parameters depending how his rehab goes.

Jorge Posada, C, New York Yankees (day-to-day): Posada's calf strain is being called mild following an MRI this week. According to the New York Daily News, Posada is not expected back before Friday. Let's face it, at age 38, these types of injuries are more apt to occur. The most fortunate thing for the Yankees is that the strain was not more serious, like Rollins' was. It looks like this will not land Posada on the DL, but if it doesn't progress as expected, he won't be an automatic start for the weekend series, even if it is the Red Sox. Fantasy owners need to be sure to check pregame lineups.

Etc.

Cliff Lee, SP, Seattle Mariners: If there were any lingering doubts as to how Lee would fare coming off the DL following his abdominal strain, he seems to have put those to rest. Lee pitched seven scoreless innings in his first start of the season while dishing up eight strikeouts.

Mike Cameron, OF, Boston Red Sox: Cameron seems to be progressing nicely with an abdominal strain that initially appeared as if it might require surgery. In fact, he could be headed for a rehab assignment within a week.

Erik Bedard, SP, Seattle Mariners: Bedard continues to move forward in his throwing progression, slightly ahead of schedule as he recovers from shoulder surgery. After a bullpen session Friday, Bedard was projected to move up to a simulated game this week. According to manager Don Wakamatsu, Bedard has adjusted his mechanics to place less stress on his throwing shoulder. The key will be whether he can maintain these mechanics as he begins to face hitters. The best case has him returning the end of May, but don't be surprised if it stretches a bit longer.

Mariano Rivera, RP, New York Yankees: Rivera shrugged off the stiffness in his left side as no big deal, much as one would expect. Pain on the opposite side of the trunk from the throwing arm always raises the specter of an oblique issue, but Rivera's confidence is convincing. So is the fact he threw a bullpen session before Tuesday's game. This does not appear to be something that will limit him beyond a few days.



Huston Street, RP, Colorado Rockies: As a pitcher returns in his throwing progression, one big hurdle comes when he moves from throwing on flat ground to throwing off a mound. Street overcame that hurdle Tuesday when he threw a bullpen session and experienced no discomfort in his shoulder afterward, according to the Examiner. The plan is for Street to throw in an extended spring training game next followed by a rehab assignment. If all goes well, he should be back with the team within a few weeks.

Jeff Weaver, SP, Los Angeles Dodgers: Weaver has been doing well in his simulated games and is expected to be activated Friday. Apparently the back issue he was dealing with was minor as these things go and he has recovered quickly, as expected.

From my mailbag

Cameron (Atlanta): Are any injuries really freak injuries? I mean, I realize that if a player slips on water in his kitchen and falls on his wrist and breaks it, then that is a freak injury. But, you often hear that somebody pulled their hamstring in a "freak injury." I would have to argue that it is never really a freak injury. I think these types of injuries happen for various reasons, especially in a non-contact sport such as baseball. For example, someone is carrying around extra weight and didn't put in the work in the offseason, they didn't warm up and stretch properly, they have tight quads or hamstrings that cause one or the other to overcompensate that eventually leads to a pull or strain. Or one part of the body has been severely overworked and leads to another part of the body being vulnerable. If any of those situations happen, then technically the injury could have been prevented if the athlete worked harder and took better care of their body. What say you?

Stephania Bell: What a great question! This is one of those philosophical questions where I'm not sure we really ever have a definitive answer. As you point out, the true "accident" such as slipping on the wet floor, or stepping in a lawn divot that is hidden from view, even a car accident in which there is no fault on the part of the injured party ... these could all be described as freak injuries.

At the same time, there are certainly "unusual" (as in uncommon) injuries that occur in sports that may be more likely to happen, as you point out, because of inadequate warm-up, less than ideal fitness or some other contributing factor. In medicine, we always feel that individuals with better fitness tend to recover better and faster from injury. In some cases, the more skilled individual may even be able to avoid an injury that would have felled the average person. To that end, we spend a lot of time encouraging proper fitness and, when possible, tailoring that fitness to the individual's activity. Someone who lifts repeatedly at work needs to be "fit" for that job, just as a baseball pitcher needs to tailor his exercise program to support his occupation.

Great food for thought, though. And if it encourages anyone to spend a little extra time on core strengthening or flexibility to help prevent injury, then we've accomplished something!

If you have any injury questions you want answered in the blog, drop a note in my mailbag, or stop by my Tuesday chats.



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.

Starting pitchers

Brandon Webb
Chirs Morrison/US PresswireBrandon Webb continues to have setbacks in his return from a shoulder injury.
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.

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
AP Photo/Charlie NeibergallErik Bedard has lots of talent, but this year, his DL time is already built in.
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.

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 pitchers

Brad 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
AP Photo/Ed AndrieskiA sore shoulder will keep Huston Street out of action until sometime next month.
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.



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.

Hitters

Ian 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
Jim McIsaac/Getty ImagesAfter a lost 2009 season, Jose Reyes could be back as early as this weekend.
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.

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.

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