Stephania Bell: Roy Oswalt
July, 24, 2012
The Texas Rangers' rotation took two hits Monday with injuries to Colby Lewis and Roy Oswalt.
Lewis has a torn flexor tendon in his right elbow and will undergo season-ending surgery to repair it later this week. While the news is not as dire as if it were a Tommy John procedure, there is still a lengthy rehab and recovery process, and it is still an injury to his throwing elbow. The flexor tendon attaches on the inner aspect of the elbow, serving as the anchor for the (wrist) flexor muscle group. These muscles literally flex the wrist but also function to assist with grip and ball control for a pitcher.
Ron T. Ennis/Fort Worth Star-Telegram/GettyImagesColby Lewis was 6-6 with a 3.43 ERA in 16 starts this season before going down with injury.
The location of the tendon renders it vulnerable to the stresses of pitching, and many throwers will deal with episodes of tendinitis and potentially some wear and tear of the tendon over time. According to ESPNDallas.com, Lewis had experienced prior episodes of forearm discomfort in years past, but it would always resolve on its own. This June he had soreness in the forearm, landing him on the DL, and at that time he was made aware of a small tear in the tendon.
Sometimes a period of rest will allow a pitcher to continue, despite the defect. In other cases, as with Lewis or Scott Baker of the Minnesota Twins, the tendon will fail under the stress of throwing and require surgery. Naturally, the proximity of the tendon to the ulnar collateral ligament raises some concern, primarily whether that ligament has been subject to additional stress given the damage in the area, or whether damage to the ligament has contributed to wear and tear of the tendon. Some pitchers have required that both structures be repaired simultaneously, a more significant procedure and a lengthier rehabilitation. Just ask Ben Sheets, now of the Atlanta Braves, who in 2010 underwent a combined Tommy John reconstruction and flexor tendon repair. His first pitch in the majors since surgery didn't happen until just a couple of weeks ago, nearly two years later.
According to ESPNDallas.com, Lewis said doctors told him it could be nine to 12 months before he's fully healthy and ready to return to major league pitching. While it certainly could be that long and the timetable depends on many factors, including the specifics of what takes place during surgery, the time frame could be less if all goes well. In isolated flexor tendon repairs with good healing, athletes often are cleared to resume throwing after about three to four months, and some return to the mound within six months.
We don't have the benefit of all the specifics related to Lewis' specific situation, but it seems that if all goes smoothly, the Rangers could have him available to pitch at or near the start of the 2013 season.
Meanwhile, Roy Oswalt was scratched from a Monday start due to stiffness in his back. While this wasn't good news, it certainly couldn't have been surprising to the Rangers. After all, Oswalt's chronic back troubles were spotlighted last year while he was with the Phillies. An episode of pain in the middle of last season was so frustrating for Oswalt that it sounded as if he might contemplate retirement. That thought seemed to pass quickly, and instead Oswalt labored his way back, finishing the season. The Rangers acquired him through free agency in late May, hoping they could get 4.5 months without incident. Unfortunately, the back issue resurfaced in less than two months.
Oswalt received an injection Monday after visiting his doctor in Houston, and the team is hopeful that he will only miss one start. According to the Fort Worth Star-Telegram, Oswalt informed the Rangers that he was susceptible to "flare-ups" but that they typically did not last long. Of course, the Rangers' medical staff would have done their own assessment of Oswalt's situation and clearly determined the risk was worth the reward. Even if he is able to take his next turn in the rotation, the risk remains.
August, 22, 2011
• It was nice to see Philadelphia Phillies righty Roy Oswalt have such a successful outing this weekend. Remember in June when Roy Oswalt expressed so much frustration with his ongoing back troubles that he thought his career might be over? That moment seemed like a distant memory Sunday when Oswalt looked like, well, vintage Oswalt tossing eight shutout innings and fanning nine in the process. Oswalt showing he indeed has quite a bit left in the tank.
• Another pitcher who is making strides is Atlanta Braves ace Tommy Hanson, currently on the DL with inflammation in his throwing shoulder. Hanson was able to play catch Saturday and is scheduled for a light bullpen Monday. The return to throwing off the mound is always a big test as it increases the stress on a pitcher's arm. If the session goes well, the Atlanta Journal-Constitution reports Hanson could make a rehab start Saturday. The key for Hanson, who currently stands at 130 innings pitched this season, will be taking it slowly to guard against setbacks.
• Meanwhile, San Francisco Giants closer Brian Wilson was placed on the 15-day DL with elbow inflammation. Wilson paid a visit to Dr. Andrews last week (the Giants were in Atlanta to play the Braves and Andrews was close by in Alabama) and was reassured that structurally the elbow was sound. Initially, it sounded as if Wilson would only miss a few days but the move to the DL should not have anyone panicking just yet. First, when Andrews has serious concern about a player's elbow health, he often recommends extended rest and rehab of at least four weeks (like the Oakland Athletics' Brett Anderson, who did just that but ultimately needed Tommy John surgery). Second, the DL remains a roster management tool and this case allows the Giants to shore up their bullpen. On Sunday, John Shea of the San Francisco Chronicle reported via Twitter that manager Bruce Bochy indicated Wilson could return at the end of the 15 days. Better to get some more rest now and not force Wilson into what could become a more serious issue.
Daniel Shirey/US PresswireBrian Wilson has 35 saves this season, but his WHIP is a subpar 1.49.
• The Chicago White Sox's Carlos Quentin has a sprained left A-C (acromioclavicular) joint, the result of a diving catch Saturday against the Texas Rangers. The A-C joint, at the tip of the shoulder, is where the collarbone (clavicle) meets the acromion, or point of the shoulderblade, and is bound together by ligaments. When those ligaments are injured, it is termed a sprain. When the sprain is severe enough to cause major ligament disruption, the bones can move apart from one another or "separate," hence the term separated shoulder, which is often used to describe more significant A-C injuries. An interesting note on Quentin. X-rays were reportedly negative of his shoulder, yet the MRI revealed the sprain. This would suggest that the damage is not severe. If the ligament damage was severe enough to result in true separation, the deformity would be visible on X-ray, even though the ligaments themselves are not. The MRI, however, can visualize soft tissue as well as inflammation in the area, confirming the diagnosis of an A-C sprain.
Even a minor A-C injury can be painful, making it difficult to lift the arm. Even though the injury is to Quentin's non-throwing shoulder, the biggest challenge will be using his arm when swinging the bat. Quentin acknowledged as much when he told the Daily Herald, "as a hitter I think your front shoulder is more important." The key early is to control pain and inflammation so that Quentin can regain the necessary range of motion to use his arm properly. Maintaining strength around the shoulder to the best degree possible while the injury winds its course will also be a focus.
• St. Louis Cardinals veteran shortstop Rafael Furcal must seriously wonder who or what is out to get him now. After breaking his left thumb in early April on a headfirst slide and then straining an oblique in June (resulting in another month away from the game), Furcal suffered a freak injury while on the road with his new team, the St. Louis Cardinals, this weekend. It wasn't even an injury sustained during the course of playing baseball. According to the St. Louis Post-Dispatch, Furcal suffered a "severe thumb sprain" when he stumbled as a wooden step leading to the batting cages at Wrigley Field broke. In an effort to brace his fall, Furcal's thumb was twisted resulting in the injury. The bad news? This injury is to his right (throwing) hand. The good news? Well, it's not the same thumb he broke this spring. And maybe, if things really do happen in threes, his 2011 injury woes are now over. As to when he'll be able to return, there's no immediate answer as much will depend on how soon the pain and swelling subside and when Furcal can regain his grip.
• Philadelphia Phillies shortstop Jimmy Rollins' calf has stayed healthy this season but he was forced to leave Sunday's game early with a groin injury. Manager Charlie Manuel indicated he did not know when or how Rollins sustained the injury, according to the Philadelphia Inquirer. However, Rollins underwent an MRI on Monday and tweeted afterward that he had a grade 2 strain and would be headed to the disabled list. As a shortstop, Rollins relies on quick lateral movement more than most, so a significant groin injury could be problematic.
Evan Habeeb/US PresswireJimmy Rollins is fourth among shortstops on the Player Rater this season.
• Teammate Placido Polanco is saying he expects to be activated from the DL on Monday. Polanco has been out most recently with a sports hernia and told the Philadelphia Inquirer he feels stronger after the rest. It will be interesting to see how Polanco fares once he returns to baseball. Many athletes try to play through this injury -- some are even successful for a while -- but often ultimately find themselves resorting to surgery. Exhibit A: Mike Cameron who fought valiantly through an early season injury last year while with the Boston Red Sox but increasingly struggled to run until the injury forced him out. Exhibit B: Washington Nationals third baseman Ryan Zimmerman, who tried to play after suffering the initial injury during spring training but was forced to undergo surgery when it worsened. It's understandable that Polanco wants to try to play through it, given the timetable for recovery almost matches what's left of the regular season. But it will be challenging, especially in light of his recent issues with a bulging disc in his lower back.
• There was some excitement within the New York Mets organization Saturday after Jose Reyes did some running in the home park. Manager Terry Collins told the New York Post that Reyes looked "terrific." After his successful outing, Reyes spent Sunday running soft turns, "hugging the outfield grass" according to ESPN New York's Adam Rubin, in preparation for turning corners. The next big test is expected to come Monday when Reyes will increase the output while running the bases. If all goes well, a rehab assignment could be in short order and according to Rubin, Collins says Reyes will head to Double-A or Triple-A for that assignment. Bear in mind that Reyes' latest DL stint came just two weeks after he returned from the prior one (for the same injury) and no one wants history to repeat itself again. While it's impossible to guarantee a successful return, it seems likely the Mets will want to have Reyes repeatedly test the leg at a fairly high level before he rejoins the team.
• Speaking of hamstrings and setbacks, Texas Rangers third baseman Adrian Beltre knows a thing or two about such matters. Beltre injured his left hamstring in July, suffering a Grade 1 strain which was expected to sideline him for two to three weeks. He was nearing a return right around the three week mark. Then he tried to run the bases (there's a reason it's one of the final tests). It went well the first time, but in his second effort Beltre felt the familiar grab in his hamstring and was sent back to square one. Now, it's time for him to test the hamstring again. According to the Fort Worth Star-Telegram, Beltre is expected to run the bases Monday if cleared by the Rangers' team physician. There has to be a little anxiety around this activity not only for him but for the team as well, given the previous result. Expect a gradual progression to continue even if this activity is successful.
• And finally, the jury is still out on Florida Marlins shortstop Hanley Ramirez, on the DL with a left shoulder sprain. Ramirez has been able to work out (throwing, running) but has not been swinging the bat. The injury is to his lead shoulder (see Carlos Quentin above), the same shoulder he previously had operated on following the 2007 season to address a torn labrum. It remains to be seen whether he will be able to overcome this latest injury to return to the Marlins this season.
August, 5, 2011
It's Friday. Time to get to the business of enjoying the weekend. With that in mind, we get right to some highlights of who we're keeping an eye on in the world of injuries.
• Carlos Gonzalez could return to the Colorado Rockies' lineup Sunday if his remaining rehab games go well. Gonzalez has been on the DL with inflammation in his wrist, an issue that has been ongoing since he collided with an outfield wall in early July. Even when Gonzalez struggled with discomfort in his wrist earlier this summer, he was still able to hit the ball out of the park. The concern for Gonzalez going forward is not so much whether he'll be able to produce when he returns (he went 2-for-4 in his first rehab outing), but whether he'll be able to play the remainder of the season without incident. An awkward landing on a defensive play or a hard bat swing will test him; until Gonzalez proves those are not issues for him, fantasy owners have reason to be a little anxious.
Doug Pensinger/Getty ImagesCarlos Gonzalez has been plagued by wrist injuries since last year.
• The Philadelphia Phillies are also getting a player back this weekend as Roy Oswalt returns to the mound. As noted in Monday's blog entry, Oswalt's chronic back condition has not disappeared, but the hope is that the symptoms will remain at bay for the duration of the season.
• Cleveland Indians outfielder Shin-Soo Choo is making gains in his rehab efforts. Choo, coming off surgery to repair a broken thumb, added to his activities by taking live batting practice. As important as being able to connect the bat with the ball was Choo's report of no soreness afterward. He appears to be on track to return within the next few weeks, assuming his progression continues. What remains to be seen is how effectively (and how consistently) he will hit against live pitching. Once he participates in rehab games there will be better clues.
• New York Yankees third baseman Alex Rodriguez is at the team's complex in Tampa, Fla., now resuming baseball activities. Rodriguez has made steady progress in his recovery from meniscus surgery but now the real tests begin. According to the New York Post, Rodriguez has yet to take batting practice having only hit off a tee and fielded ground balls.
• This Sunday might mark one of the most well-attended games for the Class A Hagerstown Suns this season, when Stephen Strasburg makes an appearance. He is expected to throw only an inning or two, so get there early! At 11 months post-surgery, Strasburg is on the pace for recovery from Tommy John surgery. The rehab assignment starts the 30-day countdown but it is worth noting that the clock can be stopped anytime if the medical staff finds it necessary. If things proceed without limitation, it remains a possibility that Strasburg could deliver a handful of major league innings for the Washington Nationals in September.
• Proof that the clock on a rehab assignment can stop anytime came in the form of New York Mets pitcher Johan Santana, who will not throw for at least a week. Santana threw three scoreless innings in his minor league debut but persistent discomfort sent him back to the surgeon for a re-evaluation. Santana was reported to have "fatigue" in the shoulder and will not throw to allow his shoulder to rest but will maintain a fitness program. Once the medical staff feels he is strong enough, he can resume throwing. There is no formal timetable in place at this time.
• Milwaukee Brewers second baseman Rickie Weeks (severe ankle sprain) is out of a walking boot but manager Ron Roenicke says he is "still a long ways away," according to the Brewers' website. With the minor league season ending Sept. 5, the team acknowledges that it could make it difficult for the timing of a potential rehab assignment. "Once he's ready to go, if we don't have any places to send him, it's going to make it a lot more difficult for us," Roenicke said. Hmmm.
August, 2, 2011
On Tuesday, the Boston Red Sox confirmed the diagnosis of a low-back stress fracture for pitcher Clay Buchholz. Manager Terry Francona told reporters that the injury is to the L2 vertebra (second of the five lumbar or low-back vertebrae) and reassured everyone that this is not a career-threatening situation.
The Red Sox have made it clear they do not expect pitcher Clay Buchholz to rejoin the rotation any time soon. The transfer of Buchholz to the 60-day disabled list Sunday and the acquisition of pitcher Erik Bedard from the Seattle Mariners already had put the writing on the wall in plain view. But the Red Sox also are saying that his season is not to be written off just yet.
Kim Klement/US PresswireClay Buchholz last pitched on June 16.
Up to this point, the team had been referring to Buchholz's injury as a lower-back strain with manager Terry Francona specifically calling his injury a "muscle strain." But as ESPN Boston's Joe McDonald reported, a team source had indicated that Buchholz indeed had a stress fracture in his low back. Buchholz recently consulted with Dr. Robert Watkins, who then worked with the Red Sox's medical staff and management to formulate a plan for Buchholz going forward.
That plan, according to Francona, will consist of intensive rehabilitation, as is often the case with these types of injuries (see: New York Mets third baseman David Wright), and the Red Sox will continue to monitor Buchholz's progress. Naturally, with only a couple of months left in the regular season, there is reason to doubt that Buchholz will be able to make it back to the mound this year. But there is also reason to be optimistic that he could. After all, despite the lingering presence of pain, he had been able to increase his activity in recent weeks. Although he will be forced to retreat to basic rehabilitation measures for now, Buchholz could graduate to baseball activities once the symptoms are given adequate opportunity to subside. Remember, Wright played through pain for a month, but once he took the time to recover properly, he came back strong two months later. Red Sox fans and fantasy owners will now hope for a similar outcome with Buchholz.
• Philadelphia Phillies pitcher Roy Oswalt felt good enough after his second rehab start Monday to declare himself ready to return. He is expected to rejoin the rotation this weekend. Oswalt's back is not miraculously healed; rather, he has been able to move past the last painful episode and resume pitching amid his regular exercises for maintenance. The hope is that he will be able to successfully endure the remainder of the season without a setback. Although there are no guarantees, his optimism in the past two weeks is certainly encouraging.
• The New York Yankees were without veteran shortstop Derek Jeter on Monday as he rested his bruised right middle finger that he suffered when hit by a pitch Sunday. According to the Yankees' website, Jeter had good range of motion in the finger, always a good sign, and is expected to rejoin the lineup Tuesday. Meanwhile, teammate Alex Rodriguez got some good news Monday. He has been cleared to begin working out at the team's spring training complex in Tampa and is expected to resume baseball activities Thursday, according to the New York Daily News. His original timetable of returning to play four to five weeks post-surgery to address a torn meniscus (which took place July 11) appears to still be in effect, presuming no setbacks after he increases his workload.
• We're keeping an eye on two pitchers coming off major surgery who both appear as though they're in line for a major league appearance this season, if all continues to go well.
Washington Nationals young ace Stephen Strasburg is slated to begin a rehab assignment next week after another positive simulated game outing Tuesday. Strasburg continues to show steady progress in his return from Tommy John surgery and is inching closer to a September cameo, but nothing is set in stone. Every increase in workload is carefully monitored, and if there is any reason to hold him back, the Nationals will.
The same goes for New York Mets ace Johan Santana, who is being delayed a day from making his next rehab start after his arm "didn't feel quite as strong as he would've liked," according to Mets general manager Sandy Alderson. It's not a setback but a precautionary move, according to ESPN New York, and it's a move that makes sense. Santana is returning from major reconstructive surgery on his throwing shoulder, and it is important for him to monitor closely how his body responds to each new test.
Santana threw three scoreless innings in his first rehab start last week. Despite Santana's impressive initial outing, equally important to his performance on the mound is his shoulder's response after it. Given that he felt it was a little weak, the adjustment in the throwing schedule is not surprising. The Mets still hope to have him on the mound this season, but the shoulder will dictate if, when and where that will happen.
Fantasy owners may want to consider stashing either of these players if they have room on the bench for the potential upside of a few late-season innings, but they should be prepared for a fluid situation.
July, 25, 2011
• Texas Rangers third baseman Adrian Beltre suffered his second muscle strain of the season, and this one has landed him on the DL. Beltre pulled up lame, reaching for the back of his thigh, while running to third base in the fifth inning of Friday's game. He underwent an MRI the following day and the team announced he had suffered a Grade 1 strain of his left hamstring. The Rangers have projected his absence at two to three weeks. All things considered, this doesn't sound as serious as it could have been given Beltre's description of what he felt Friday night. According to ESPN Dallas, Beltre said, "It felt like a really hard grab. It felt like it was going to tear my leg, but it didn't get to that point." Beltre reportedly has not suffered a hamstring injury severe enough to send him to the disabled list in his past, but he did have a mild (right) calf strain earlier this year. That injury happened in the spring and Beltre did not miss any regular season action. His legs have been remarkably durable throughout his career and treating this injury cautiously makes sense for Beltre and the Rangers.
Ronald Martinez/Getty ImagesAdrian Beltre entered Monday's action third on the Player Rater among third basemen this season.
• And the kid was getting off to such a great start! But that stellar start was interrupted for Cincinnati Reds shortstop Zack Cozart when he suffered a hyperextended left elbow while trying to make a catch at second base Saturday. As Cozart extended to catch the ball, his arm met Atlanta Braves baserunner Nate McClouth and was forced in a direction it does not normally go. Cozart summed it up aptly, telling reporters, "It didn't look that good and didn't feel good." He has since been placed on the 15-day DL. Cozart was clearly in pain at the time of the injury and walked off the field gingerly supporting his arm. Fortunately, X-rays were reported negative, but the pain and swelling often associated with this type of injury should not be underestimated. The hope is that the actual damage to soft tissues in the elbow (ligaments, joint capsule) is minimal to preserve stability of the joint. The first order of business is to protect the joint (Cozart is now wearing a brace and compression sleeve according to the Reds' website) and address inflammation while allowing the soft tissue to begin healing. As symptoms allow, he will be encouraged to increase his motion and will gradually work his way back toward baseball activities. Just how long that takes will be dependent on how Cozart's elbow cooperates.
• Alex Rodriguez could rejoin his teammates in the second week of August. At least that's what New York Yankees general manager Brian Cashman told ESPN's "Baseball Tonight" crew Sunday. Cashman said that Rodriguez is looking good following surgery to address a torn meniscus in his right knee, and is riding a bike and doing pool workouts. Cashman noted that Rodriguez still has a slight limp, not uncommon at this point, but it does tell us that he's not ready to progress to running just yet. Perhaps most significant in Cashman's comments was when he pointed out that the team could potentially push Rodriguez to return sooner, but why? He confirmed what we've been saying all along, that the team is employing a conservative approach in Rodriguez's rehab. This makes perfect sense given that the team has a hefty vested interest in the long-term health of their third baseman, one which far outweighs the potential risk in pressing him back into competition a few days early.
• His counterpart in the National League, the Braves' Chipper Jones, is expected to make his return Monday just over two weeks removed from a similar (meniscus) surgery on his right knee. Many have asked why Jones could return more quickly, but it's always difficult to compare recovery times -- even following similar procedures -- in two different athletes. There are many variables that come into play, most notably the extent of the injury and subsequent surgical procedure (including size, location, pattern of the tear), the condition of the knee joint itself (reflecting any past trauma, injury), the player's overall health history (remember, Rodriguez underwent surgery on his right hip two years ago, while Jones' recent ACL repair was on his opposite knee) and ultimately the player's own recovery rate. Jones has always been one to push his limits physically and is known to be tough when it comes to injury issues. Still, at 39 years old, given the mileage on his wheels, this is an impressive return. Now the team has to be hopeful that he will not have any setbacks from here forward.
• The Boston Red Sox get Jon Lester back on Monday following a DL stint for a lat strain. Lester has said he considers the injury to be behind him but is expected to be limited to approximately 80-90 pitches when he faces the Kansas City Royals. As manager Terry Francona told reporters, "He's going to go out there and fire and try to win. And that's good, but we've got to keep an eye on him."
• Roy Oswalt looks to have turned a corner and is expected to start a rehab assignment this week. According to the Philadelphia Daily News, Oswalt will be throwing for Triple-A Lehigh Valley on Wednesday and should be good for about 60 pitches. Following that outing, the team will decide whether he needs another rehab start or whether he can rejoin the Phillies. Oswalt is not out of the woods by any means.
Jeff Curry/US PresswireRoy Oswalt last pitched in the majors on June 23.
By this point, everyone is aware that Oswalt has been battling chronic low back pain associated with bulging discs. He has had back pain and leg pain to varying degrees over several years and has received multiple courses of treatment including a series of spinal injections. Oswalt noted that the most recent injection really helped him bridge a hurdle in this latest pain episode and he has been able to increase his activity ever since. Nonetheless, this is a scenario of ongoing management of a condition as opposed to completely "healing" and putting the issue in the rearview mirror.
Although the goal for Oswalt is to return to his prior level of function and not be thinking about his back before each outing, he is undoubtedly taking precautions in the form of watching his body mechanics and performing regular stretches and strengthening exercises in an effort to stay on the right side of this issue. This is still a far better outlook than the one Oswalt initially projected, sounding as if his career might be finished, after his last start in June was interrupted due to severe back pain.
• Finally, J.J. Putz looks as if he'll be returning to the mound Tuesday for the Arizona Diamondbacks, according to their official website. Putz has been out since the first of July with what the team referred to as elbow tendinitis, which may have contributed to his late June struggles. Putz has had several episodes of missed time because of his elbow although this latest incident was thought to not be particularly serious. He may not return to his closer role immediately, but if he pitches well out of the gate, it may not take long.
June, 29, 2011
Your mailbag and Twitter questions drive the blog today. Thanks to all for your thoughts, ideas, musings and perspectives. I read and enjoy them all, even though we only have space for some. And if you don't see your question answered here, it might be that I'm saving it for later, or even for the 06010 Fantasy Focus podcast, so stay tuned.
Jason Jeffrey (Fort Lauderdale, Fla.): Is there any update on Josh Johnson?
Wednesday could be a big day for Johnson as he is visiting Dr. James Andrews. Johnson, who has been on the DL since the third week of May with inflammation in his throwing shoulder, finally progressed to throwing from a mound in mid-June but apparently was not completely rid of his symptoms. According to the Palm Beach Post, Marlins president of baseball operations Larry Beinfest issued this statement regarding Johnson: "JJ says shoulder does not feel 100 percent and is going to see Andrews tomorrow before proceeding further with throwing program."
Steve Mitchell/US PresswireJosh Johnson is definitely no stranger to Dr. James Andrews.
The fact that Johnson has made it as far as throwing from a mound suggests there likely won't be any catastrophic news. Dr. Andrews is certainly familiar with Johnson, having performed his elbow (Tommy John) surgery in 2007, and this may be primarily a case of seeking reassurance that he is on the right track. But if Johnson is in fact still experiencing stiffness in his shoulder, his throwing program may be slowed or even halted for a time, depending on how serious the concerns are about what is causing his current discomfort.
Johnson was originally placed on the 15-day DL but was slow to progress and was eventually transferred to the 60-day DL. The Marlins were hoping he could pitch for them again shortly after his eligible return date in mid-July, but that now appears to be in question. Given that no timetable has held up for Johnson thus far, it continues to be a wait-and-see scenario.
@digitalbear11: What's going on with Carl Crawford?
Crawford is definitely demonstrating improvement from his left-hamstring strain. He began swinging a bat Monday. On Tuesday, he performed some light running according to the team's website, running several 90-foot intervals at half-speed. The encouraging news with Crawford is that his recovery has progressed well and he has not had any setbacks. Naturally, the team wants to be as confident as possible that when he returns to game action he will be at minimal risk of re-injury.
As ESPN Boston's Gordon Edes reported, manager Terry Francona has all but ruled out Crawford for this weekend's series against the Houston Astros (although Crawford is eligible to return Sunday and Houston is his hometown). As of now it seems more likely Crawford will return Monday, July 4, when the Boston Red Sox begin a homestand.
@bobthemule: Can Shaun Marcum really avoid going on the DL or are he and the Brewers just postponing the inevitable?
@peacechex Should I trust him [Marcum]?
We may have the answer to that very soon. Marcum is scheduled to pitch a full workload against the New York Yankees on Wednesday, so we will see how he holds up. His original injury (left hip flexor strain) was in mid-June, but Marcum made his next start, although he was limited to just three innings. He later said he felt his hip not while pitching, but during an at-bat in that game. The Brewers said they had planned to limit his innings in that game all along, staying clear of calling it any kind of a setback. For his part, Marcum told reporters Friday that his hip was a "non-issue" and expected a regular outing Wednesday. He does benefit from the scheduling that afforded him a couple of extra days rest but until he goes the distance, we won't know how his hip responds. The red-hot Yankees, who traditionally have done well against Marcum, might present a challenge, but if he is able to get through the game without incident, it will help alleviate concerns about a DL stint. And then we will have a better idea as to whether we can trust him.
@teeceli: Any word on Brett Anderson?
@PutonSwole: Will he be effective this season?
There's not much to report at this early stage. To recap, Anderson had discomfort in his elbow in early June which sent him back to the A's team physician for evaluation. He subsequently had a consultation with Dr. Andrews in Alabama, and many feared the season was over for Anderson, especially given he was on the DL twice in 2010 for issues with the elbow. The decision, however, was not for Anderson to undergo surgery, but rather to try an extended course of rehab and attempt to return to play. Anderson then received a PRP (platelet-rich-plasma) injection into the elbow, which required a follow-up immobilization period for his elbow and forearm. Anderson visited his teammates in the clubhouse on June 19 sporting his splint and tried to focus on the positive. According to the team's website, Anderson said, "The shot wasn't much fun, but it's better than having surgery."
Ezra Shaw/Getty ImagesBrett Anderson is avoiding surgery for now, but his return is still up in the air.
Anderson knows however that there are no guarantees. This is his second such injection (he had one last year), and often times these extended rehab trials are performed when there is not clear and distinct evidence that surgery is required. The hope is that the athlete will be able to return and pitch effectively and perhaps go on indefinitely without additional problems. The alternate possibility, however, is that the rehab effort will not succeed, something which may not become evident until a pitcher returns to full-scale throwing. In other words, every step along the way is a notch on the measuring stick. After each success in a rehab and return to a throwing program, the pitcher is progressed to the next level of activity. Unfortunately, success at one level is not necessarily predictive of continued success, meaning we won't know whether Anderson can return and be effective until he actually arrives at that point. His history certainly gives us reason to be concerned. Then again, there are pitchers currently pitching who have defied similar odds.
For those who might be inclined to think that Anderson should just go ahead and have surgery proactively, the response is this: The best surgeons will remind us that the decision to operate is arrived at when the indications are clear that surgery is the best option, a decision mutually agreed upon by the surgeon and the athlete. The rehab process following Tommy John surgery is lengthy and difficult and is not undertaken lightly. If there are any doubts as to whether surgery is absolutely necessary, then all other treatment options must be tried first. And that seems to be exactly what Anderson is doing.
@kristinereese: A Phillies fan wants to know about Roy Oswalt ...
The Philadelphia Inquirer reports that Oswalt is scheduled to consult with Dr. Drew Dossett in Dallas on Friday, after which we hope to learn more about his scheduled rehab. The Inquirer noted that a recent MRI showed mild disc bulging in his lower back. It's worth mentioning that many people have mild disc bulges, often without any symptoms at all, so this was not an alarming finding on its own. Phillies team physician Michael Ciccotti also indicated that Oswalt has thickening of a joint capsule in the spine, which may be contributing to his symptoms. In essence, though, the reported findings aren't devastating and don't add much to what we've known for some time, which is, simply, that Oswalt has a chronic back condition.
The issues aren't so much what's present in the pictures but how the symptoms Oswalt is experiencing are impacting his ability to perform. After Oswalt's Friday appointment, the medical personnel will discuss the rehab plan and move forward from there. Although there seems to be some debate as to how long he will be sidelined, the fact is that nobody really knows. The chronic nature of back pain and the degree to which it has limited Oswalt over the past few years are not encouraging factors. Oswalt's dejection after he was forced to leave his last start early is typical of all patients who are frustrated by the severity and frequency of recurring back (and leg) pain. After a period of rest and another round of rehabilitation, he may again be optimistic about being able to return and contribute. Unfortunately for all involved, there is no way to definitively predict just how long that could take ... and whether it will ultimately work.
June, 24, 2011
It's Friday! The weekend is almost here! And who doesn't love some good news heading into the weekend?
So that's where we begin.
The Minnesota Twins are welcoming back reliever Joe Nathan, who has been on the DL with a flexor strain near his right elbow. Of course this is the same elbow on which he had Tommy John surgery last year. Nathan has done well in his recovery, most recently with several outings for Triple-A Rochester. It sounds as if the Twins will have Nathan return in a setup role. Whether he overtakes Matt Capps for the closer role remains to be seen.
The Twins are also expected to have designated hitter Jim Thome back this weekend, according to the Minneapolis Star-Tribune. For the better part of June, Thome has been battling a back problem which led to issues with his left quadriceps. He received an epidural injection (into the spine) and has made enough progress that the Twins are ready to bring him back. He will join the team for the series against the Brewers. As Twins manager Ron Gardenhire said, "that's great to have him [to] come off the bench."
Rarely lately does it seem like the New York Mets have good news to share but they sure did Thursday night. Third baseman David Wright, out since May with a stress fracture in his lower back, was cleared to resume full baseball activities after a follow-up CT scan and doctor's visit. Wright has been working diligently on strengthening his deep abdominal muscles (which help stabilize the spine) and doing creative work like fielding grounders on his knees. Now he will progress back to baseball drills standing and taking swings, followed by an eventual rehab assignment. While his return date is not set in stone, general manager Sandy Alderson said the team hopes for "maybe three weeks." The key for Wright will be translating the core stability he's been working on to the highest level baseball activities, particularly those that stress the spine in extension and rotation (think: leaping for a catch, diving headfirst and, of course, swinging a bat). There is good reason to expect Wright to do well once he returns, especially if the rest of his rehab proceeds without incident.
Troy Taormina/US PresswireDavid Wright could be back manning the hot corner for the Mets after the All-Star break.
Notice I said we'd begin with the good news. Unfortunately Thursday also signaled a couple of setbacks, perhaps a serious one in Philadelphia.
Anyone who has been watching Phillies pitcher Roy Oswalt recently knew something wasn't right. His history of a chronic disc problem in his low back certainly raised suspicion that it was acting up once again. It came to a head Thursday night when Oswalt made an early exit because of soreness in his back. He looked stiff, awkward and clearly uncomfortable on the mound and it translated to his pitching. Oswalt described his delivery as, "... more heaving the ball than throwing it." Finally last night he confessed to just how much his back has been bothering him, telling reporters, "I feel it when I sit down, stand up, walk, pitch, sleep." Oswalt is scheduled for another MRI on Monday but little is likely to come as a surprise, given that he has been dealing with this issue off and on for years. And he seemed resigned to whatever lies ahead. "Hopefully it's not to the point where I can't throw anymore," Oswalt said. "If it's at that point, you just have to accept it." Even if he is able to return, it is not likely to be anytime soon. Fantasy owners, it might be time to move on.
New York Yankees shortstop Derek Jeter is still experiencing soreness in his right calf. In other words, he is not likely to return from the DL June 29, when eligible. At this point Jeter is limited in his workouts as a result. General manager Brian Cashman told the New York Daily News, "He can't do anything with his legs." That would indeed make it difficult to field, swing a bat and, most significantly, run. Until Jeter is symptom-free his workload will not be increased and then he will need to remain symptom-free before any sort of game play is entertained. Consider the assessment of Jeter day-to-day at this point with no definitive return date established. The Yankees' move to place him on the DL is looking even wiser in retrospect.
May, 17, 2011
Much to the dismay of fantasy owners everywhere, Monday may have been one of the busiest baseball injury days on record. Here's the spillover into Tuesday.
Adam Lind, 1B, Toronto Blue Jays: So much for hoping Lind could avoid the DL because of back issues. The team opted to place him there but it's retroactive to May 8, meaning he could return next week. He was making improvements as of the weekend so the hope is he will be ready to return when eligible.
John Lackey, P, Boston Red Sox: Lackey was placed on the DL Monday with a right elbow strain. He has been inconsistent on the mound this season, with things getting worse lately. After giving up nine runs in his last outing, an exasperated Lackey summed up his feelings by telling the Boston Herald, "It's got to turn some time. Everything in my life sucks right now, to be honest with you." Manager Terry Francona confirmed Lackey's physical ailment was responsible for the DL move, telling reporters, "He's been having some tugging in his elbow." Just how long the elbow has been bothering him this season is unclear, but he has a history of minor trouble with it. His 2009 season started late because of elbow pain, and in 2008, he missed time with a strained triceps in his throwing arm. Maybe the years are throwing are taking a toll on the 32-year-old pitcher. While there is no report of anything serious with Lackey, the caution flags are certainly flying.
David Butler II/US PresswireJohn Lackey is 2-5 with an 8.01 ERA so far this season.
Josh Johnson, P, Florida Marlins: Johnson looks to have escaped serious injury after absorbing the brunt of a Carlos Beltran line drive on his right (throwing) forearm Monday. Johnson stayed in to finish the inning but did not return to the game as the forearm got tight. The team referred to the injury as a bruised right forearm. X-rays taken Monday night were negative. According to the team's website, manager Edwin Rodriguez is optimistic Johnson will be able to make his next start against the Tampa Bay Rays on Saturday.
Derrek Lee, 1B, Baltimore Orioles: Lee exited Monday's game after just two innings with what the Baltimore Sun reported to be a left oblique strain. The team has called Lee's status day-to-day and he was expected to be evaluated further Tuesday. The severity of the injury will dictate whether Lee is likely to be absent for days or weeks. Lee has a history of low back problems (disc-related) and cannot afford to play with any compromised core strength.
Good news! The Philadelphia Phillies have to be relieved to be getting a player back from the DL instead of adding another to the list, as pitcher Roy Oswalt has been activated for his Tuesday start. He had been on the DL with inflammation in his lower back, but fortunately turned the corner fairly quickly. Still, he is likely to be limited in the number of pitches he throws as he works his way back to form. His last start was April 26 against the Arizona Diamondbacks. Since then he left the team to be with his family in the aftermath of the severe storms in the south, then returned only to be forced onto the DL because of his back.
May, 9, 2011
Yet another ace was sidelined due to injury over the weekend. Philadelphia Phillies pitcher Roy Oswalt left the team April 28 to help his family in Mississippi in the aftermath of severe storms that hit the area. He returned to Philly last week and threw a bullpen Thursday, but felt soreness in his back, something he has been experiencing intermittently since April. The next day, Oswalt was added to the disabled list (retroactive to April 27) due to inflammation in his back, something the Philadelphia Daily News reports he referred to as causing "a little bit of concern." Given that Oswalt had not pitched since returning home, the retroactive DL designation gives him approximately a week's recovery time, and he would be eligible to return Friday.
Unfortunately for the Phillies, it does not appear he will be ready just yet. After all, back problems are nothing new for him and no one, especially Oswalt, wants this episode to turn into something more drawn out and more severe. While with the Houston Astros, Oswalt experienced back and leg pain associated with a bulging disc. That injury ended his 2009 season prematurely and reared its head again in spring of 2010. Since that time, he has not had any major episodes of pain or spasm, until now. But back problems are notorious for their recurrence over time. Phillies general manager Ruben Amaro told the Philadelphia Inquirer that while Oswalt is progressing this week, "He probably is not going to be ready for the weekend." Oswalt is scheduled to throw another bullpen Tuesday. If he continues to respond well, perhaps he will rejoin the rotation next week. The bigger hope is that this will not be an ongoing challenge for Oswalt throughout the season.
Mark J. Rebilas/US PresswireRoy Oswalt struggled in his last start before leaving the team, allowing five runs in three innings against the Diamondbacks on April 26.
• The Phillies also placed catcher Carlos Ruiz on the DL this weekend. Ruiz has been having trouble with his back since late April. At the time it appeared Ruiz would miss a few days but not require a DL stint. While swinging off a tee a week later, however, Ruiz slightly aggravated the back, leaving his status as day-to-day. The Phillies placed Ruiz on the DL retroactive to April 28 and he hopes to rejoin the team when eligible Friday, if his back cooperates. He has been running and swinging the bat, and he even caught a bullpen session without incident in the past few days. He is now headed to extended spring training in Florida, according to the Philadelphia Inquirer. Beyond getting his back healthy, the rest for Ruiz may have been good for him, given the demands of his position combined with his workload.
• Meanwhile the Phillies are also getting a player back from the DL. Pitcher Joe Blanton (impingement in his throwing elbow) was activated Monday and will pitch Monday night against the Florida Marlins.
• Over in New York, the Mets made the decision to place pitcher Chris Young on the disabled list ... again. Young has been experiencing some tightness in his surgically repaired shoulder and was scratched from his scheduled Saturday start as a result, then placed on the DL on Sunday for the second time this season.
Young has not been able to pitch consistently since undergoing shoulder surgery in 2009. In 2010, he managed only 20 total innings for the San Diego Padres, most of which came in September. It seemed as if he might be off to a better start this year (two consecutive starts!) but then the biceps flared up and he was sent to the DL in mid-April. Young returned for two more starts, but his velocity was down, causing some concern. When Young reported stiffness in his posterior shoulder, the team went the conservative route and removed him from any chance of playing. Young was also sent for another MRI, which did not yield encouraging results. As ESPN New York's Adam Rubin reported, Mets general manager Sandy Alderson said of the imaging results, there is "swelling in the back of his shoulder in the area of an old injury. ... We're not sure the extent of this injury." While the team plans to proceed with caution, it's worth noting that Young says this injury does not feel as severe as the previous episode. "Last year I could barely even pick up a ball," he said. "This, I can go through the motion. It's just grabbing as I try to increase the intensity." Unfortunately, his body has failed to cooperate for any length of time in the past few years.
• Why not end on a positive note? Wednesday is the official projected return date for Chicago White Sox ace Jake Peavy, who is expected to start his first game since undergoing surgery to reattach his latissimus dorsi tendon. Peavy threw 100 pitches in his last rehab start, so it appears he is ready to take on a regular role. He will face the Los Angeles Angels in Anaheim and Peavy told reporters Sunday he wants to bring "some enthusiasm, some fire, some passion" to his club when he returns. After what he's been through, how can he not inspire his teammates to kick it up a notch?
April, 18, 2011
• The Philadelphia Phillies' much admired starting rotation has been dealt a blow, but it appears to be a minor one. Roy Oswalt left Friday's game with what the team called a lower back strain, although he later referred to the issue as back spasms. Oswalt, who has dealt with back pain over several years and has a history of a disc protrusion, told the Philadelphia Inquirer this episode was more in the middle of his back. he described the pain as, "not to the point where it's unbearable, but it's to the point where I didn't want to keep pushing it and then maybe miss my next start." By Sunday, Oswalt indicated he was feeling better and he is slated to throw a bullpen session Monday. If all goes well, he could still make his next start which has been pushed a day later (to Thursday) after Saturday's rainout.
Drew Hallowell/Getty ImagesRoy Oswalt has dealt with back issues over the past few years, but he's hoping not to miss a start.
• New York Yankees third baseman Alex Rodriguez pulled himself from the game Saturday in what he said was a precautionary move, according to ESPN New York. Rodriguez was experiencing low back and left-sided stiffness and exited the game after six innings. "I like to think that I pulled myself out, hopefully with the perfect timing," Rodriguez said. "I felt that if I went out and took a violent swing perhaps I could have put myself at risk for a couple of weeks." An MRI taken Sunday came back negative and it's possible Rodriguez could return to the lineup as soon as Tuesday. The Yankees would not be inclined to rush him and risk a more severe setback, so it will likely come down to how Rodriguez feels from day to day.
• Although San Francisco Giants pitcher Barry Zito was able to make his first start of the season shortly after a scary car accident, he has now been forced onto the DL for the first time in his 12-year career with an injury sustained in a game. According to the San Jose Mercury News, Zito's right foot was swollen and he was on crutches after spraining his arch in Saturday's game. The injury is unusual for a pitcher, and it occurred in an unusual fashion as Zito attempted to field a pop-up bunt. A sprain in the midfoot region can create problems with weight transfer, something a pitcher's landing foot must do effectively for normal ball release and follow-through. Zito is currently in a walking boot and will not return to a normal shoe until the pain and swelling have subsided. According to the San Francisco Chronicle, Zito is undergoing additional tests Monday to ensure there are no additional complicating factors. Given Zito's current diagnosis, with the time required to resume absorbing the impact of throwing off the rubber, it will undoubtedly be longer than 15 days for him to be ready to return.
• The Oakland Athletics have placed Dallas Braden on the DL on Monday after shoulder stiffness forced him to leave his Saturday start after five innings. According to Susan Slusser of the San Francisco Chronicle, Braden indicated he had never felt this type of discomfort in his shoulder before, which is always worrisome. Someone like Braden, who has performed the same activity year in and year out and who is accustomed to the standard aches and pains that come with the job, knows when there is a new sensation that warrants concern.
There is an interesting backstory here, which may or may not have relevance to Braden's current injury. In 2009 Braden underwent surgery on his left foot (stance leg) reportedly to remove a cyst. As reported on MLB.com, Braden claims he was left with peroneal nerve damage and associated complications, which he alleges were a consequence of the procedure. This led to him filing a medical negligence suit in 2010 against the surgeon. According to MLB.com, the complaint states that "damage, instability and sensitivity of his left foot will cause biomechanical problems with his pitching delivery system, which will likely result in further injury and shortening of his pitching career."
It is no secret that injuries in a pitcher's lower half are troublesome because of their potential to create compensations in the upper half. If in fact Braden has altered his delivery because of lingering foot problems, it is certainly possible that he has increased the strain on his throwing shoulder. Then again, virtually all pitchers are at risk for breaking down in their throwing arm at some point in their career, simply because of the repetitive nature of what they do. While there may be no definitive means of determining what led to Braden's current setback, it certainly makes for an interesting discussion. In the meantime the A's are hoping this will not translate to an extensive absence for Braden.
Plenty more to come this week in the way of player updates as some guys are nearing a return ... if we can just have a few days without losing someone else to the disabled list!
August, 5, 2009
A number of players went under the knife during this past week, with most of them hoping to return next season. We mentioned Chien-Ming Wang (shoulder) and Kevin Slowey (wrist) last week. Slowey had a bone chip removed, and his rehab is expected to take anywhere from two to four months, giving him plenty of time to be ready for spring training. Wang's future is less certain, both in terms of timetable and location. His surgeon, Dr. James Andrews, indicated that following surgery (reportedly to address a tear in the shoulder capsule, the fibrous tissue that surrounds the joint), Wang might require a year before he can return to pitching in the majors, according to the Journal News. Whether he will return as a Yankee remains to be seen.
This week, we add Cincinnati Reds pitcher Edinson Volquez, who struggled with back spasms earlier in the season before developing numbness in his throwing hand. It turns out the numbness was foreboding of what was to come. Back in June, when the numbness in Volquez's fourth and fifth fingers first appeared, we discussed that these ulnar nerve symptoms can be reflective of instability at the elbow, associated with ulnar collateral ligament problems. Volquez rehabbed to the point of a simulated game but then had to abort the effort because of elbow pain. The next step was indeed ulnar collateral ligament reconstruction (Tommy John surgery), along with a repair of the flexor tendon. Volquez likely won't return until late next season. This serves as a good reminder that imaging studies are not perfect, since Volquez underwent two MRIs during his injury stint, neither of which showed the tears. In fact, according to the Reds' Web site, the decision as to what specifically would be required in surgery was not made until the team's medical director, Dr. Tim Kremchek, actually looked inside the elbow.
Scott Boehm/Getty ImagesEdinson Volquez has shown promise over the past two seasons, but he probably has little value even next year.
And then there's Arizona Diamondbacks ace Brandon Webb. Webb, who made an abbreviated Opening Day appearance and then was never seen on the mound again, underwent what the team termed "minor" shoulder surgery this week. According to the Diamondbacks' Web site, Webb underwent a debridement, or clean-up procedure, of the shoulder. As Webb put it, the findings in surgery were "just normal wear and tear you get from pitching. It was as good as could be expected." He is expected to begin the rehab process later this week and plans to stay in Arizona in the offseason to continue his therapy. Webb is correct in pointing out that all the strengthening he has done for his shoulder so far can only help him with his overall recovery. For those in keeper leagues, take note: Webb has no major structural damage and did about as much "prehab" as one can do. That should bode very well for his 2010 season.
Ah, but where to begin as we tour the league looking at those players hoping to return in 2009? We start with the team that has the dubious honor of most player appearances in this column.
The New York Mets: That's right. I'm just listing the whole team now. And why not? Sadly for the Mets, the list of injured players (and injured players who have suffered setbacks) continues to grow. One of the latest Mets to succumb to the injury bug is second baseman Luis Castillo. Here's how you know things really aren't going your team's way: Your middle infielder sprains his ankle -- not while rounding the bases, nor when an opponent slides into him as he tries to turn a double play, but while stumbling down the dugout steps. Castillo might not have huge fantasy impact, but another injury sends a ripple through an already-struggling team, further limiting its available options.
It got even worse Wednesday, when starting pitcher Jonathon Niese left the game in the second inning with a hamstring injury suffered while fielding his position. And Gary Sheffield (who was just activated from the disabled list Sunday) also was pulled from the game in the sixth inning with an injury.
In last week's blog, I expressed some skepticism (despite manager Jerry Manuel's optimism) about shortstop Jose Reyes' impending return: "It's understandable that the Mets want to see the glass half-full, but fantasy owners need to see the Mets' glass as balancing on a very unstable surface, one that could tip over and spill at any minute."
Ezra Shaw/Getty ImagesJose Reyes might continue to watch from the sidelines the rest of the season.
It appears that glass indeed might have come crashing down, as the New York Daily News reported Tuesday that Reyes returned to New York to be examined by team doctors "because of continued discomfort with his right leg." Although the outcome of that visit is not known, it doesn't take great medical insight to appreciate that this is not a good thing. Throughout this process, Reyes has never progressed to the point of being able to run the bases. His fantasy owners can't say they weren't warned, at least in this column, as Reyes has had trouble with soft tissue injuries healing slowly in the past. There's at least a possibility that he will not return this season, and even if he does, it's difficult to imagine him regaining full speed.
On the positive side, the New York Daily News reports that Carlos Delgado continues to progress, but in a truly one-day-at-a-time fashion. He pretty well summed it up by saying, "I'm going to be ready when I'm ready. If by mid-August I'm not OK, it's going to be longer." Actually, the significance here is that Delgado appears to be quite aware of the importance of not pressing to return from hip surgery too quickly, despite the fact that his team is hemorrhaging players. Delgado, who has started hitting outdoors, still has to work up to running full speed straight ahead, then base running, sliding, aggressive defensive drills and, ultimately, rehab games. Although mid-August remains possible, later in the month sounds more reasonable (insert here: assuming no further setbacks).
Meanwhile, teammate Carlos Beltran is a tougher read. Beltran, who has been out since June 22 with a bone bruise, is doing more "stuff," but still has pain, something that continues to raise flags in terms of his overall recovery picture. While Delgado was hitting balls to the outfield earlier this week, Beltran was working on his defensive outfield skills. On the one hand, Beltran seemed pleased with the result, telling the Daily News, "Today was a good day for me, honestly ... because I was able to go out and move around and that gave me confidence to continue to improve and to do a little bit more every single day." On the other hand, Beltran acknowledged that he still felt pain, although the frequency and intensity were less than what he has experienced in the past, which led him to believe he is making progress.
While Beltran's determination to return is admirable and any signs of progress are encouraging, it is worth noting that the Mets' Web site noted he still had an observable limp as recently as this past Saturday. A recent MRI confirmed the bone bruise is still present, and as the New York Post reported last week, doctors advised Beltran to continue resting, but he wanted to try to increase his activity anyway. He desperately wants to return and help his team. Fantasy owners need to be cautious here because this is a very unpredictable situation that could change daily. Even if Beltran returns (which he is hoping will happen mid-month), his condition is not likely to have healed, and we know what happened the last time he tried to play through it. It will be important to see how his knee responds as he tries to increase his running work this week.
Roy Oswalt, P, Astros: Last week, the team was calling Oswalt's injury a left-side low back strain, but we discussed the concern related to his history of disc problems. So far, his treatment and symptoms have all the sounds of a disc-related problem. Add to it the fact that this is taking (not unexpectedly) a little longer than a minor muscle strain should to heal. In fact, Oswalt confirmed to the Houston Chronicle that the disc is the source of the trouble. "I got a bad disk. It's herniated. It's sticking out and it's pressing on a nerve going around to my side. And my hip and leg tends to go to sleep some time," he said. Hmm ... sounds just like what we were surmising last week.
Oswalt received an injection to help with inflammation in the area and appears to be making progress, albeit more slowly than the team initially hoped. A DL stint has not been ruled out, but he remains hopeful that he will be able to start Saturday. According to an AP report, Oswalt's recent checkup went well and he is scheduled to throw a bullpen session Wednesday. How the bullpen goes will go a long way in determining whether Oswalt is ready to go this weekend. Bear in mind that his first effort at throwing off the mound Monday did not go as well as his flat ground sessions, so this will be a big test.
On the Mend• Seattle Mariners pitcher Erik Bedard is throwing bullpen sessions, but it does not appear he will be ready to return to the rotation when eligible Monday. The never-easy-to-read Bedard said simply, "I felt OK," after his Tuesday session, according to the Tacoma (Wash.) News-Tribune. Given Bedard's history and slow progress, this remains a sketchy situation.
• Chicago Cubs catcher Geovany Soto is expected to return to the lineup Friday in Colorado, according to the Chicago Sun-Times. He has not played since early July after originally being diagnosed with a mild oblique strain that looked as if it might keep him down for only a week or so.
• Houston Astros first baseman Lance Berkman, recovering from a strained calf, is eligible to come off the DL on Friday, but it doesn't appear that he will. He tried some light running Monday and paid the price Tuesday. The Astros' Web site reported that Berkman's lingering soreness led manager Cecil Cooper to hint at a delayed return from the DL. One of the clues as to the degree of recovery of a muscle strain is whether there is any lingering soreness not only during or immediately after the activity, but a day later. A legitimate concern for the Astros would be if Berkman returns too quickly; he could end up tearing the calf muscle and miss the remainder of the season. It is worth keeping a close eye on this situation, as it could change fairly quickly.
• Newest Chicago White Sox right-hander Jake Peavy, formerly of the San Diego Padres, raised a lot of eyebrows when he was dealt while still on the DL. Peavy, who continues to work his way back from a partial tear of the posterior tibialis tendon (which courses through the leg and attaches to the foot), is hopeful that he will be able to contribute later this season, but his real value is expected to be realized in 2010 and beyond. Many people have expressed surprise that a team would be willing to deal for an injured player, but while there is naturally some risk involved, it isn't all that surprising, given the nature of Peavy's injury and where he is in his rehab program.
Specifically, Peavy's injury is of lesser concern going forward since it was not to his throwing arm. A big question after any significant arm injury that requires extended downtime for a pitcher, whether it's surgical or non-surgical, is just how well the pitcher's delivery will return to pre-injury form. Will he have the velocity, command and consistency that got him to the majors in the first place? An injury to any other body part is assumed to have less of an impact, since the arm is not directly affected and a thrower can continue to work the arm to some degree.
We have seen, though, that any injury can compromise a pitcher's return to form. Exhibit A: Chien-Ming Wang, who struggled in his return from a foot injury and then suffered an arm injury. Peavy insists that his leg is feeling good and he had a pain-free throwing session Sunday in his new town. As the Chicago Sun-Times reports, he thinks it is just a matter of returning full strength to his ankle to react defensively and restoring the endurance to his throwing arm. Peavy still hopes to contribute in September and appears on track to do so as of now.
• Whew. Everyone in Atlanta is breathing a little easier knowing that it was a proximal hamstring (near the top attachment by the pelvis) strain and not a setback to Braves pitcher Tim Hudson's recently reconstructed elbow. Hudson hopes to make a rehab start soon and get back on track for a late-season return.
And finally ...
Phillies pitcher Brett Myers continues his impressive return from hip surgery in June. Myers is scheduled to pitch a simulated game Thursday and has begun light jogging, according to the Philadelphia Inquirer. Although the team insists it is not counting on him, his steady progress has to be encouraging, and there remains the possibility that he could provide some bullpen support in September and October.
Despite a few days' reprieve with the All-Star break, the second half of the season is not lacking for injury content. Several players have come back from injury since the second half of the season started (David Ortiz, Alfonso Soriano), a few are still on the mend (Kerry Wood) and new injuries continue to crop up. We take a look at some of the key fantasy players dealing with injury below, and welcome back another Tommy John graduate this week.
Roy Oswalt, P, Houston Astros: Oswalt is scheduled to return to the mound Monday against the Cincinnati Reds after two uneventful bullpen sessions last week. Oswalt has been sidelined with what the team has been calling a hip abductor strain, although a recent MRI also confirmed a disk problem in his lower back. The two problems certainly appear to be connected, since Oswalt told the Houston Chronicle several weeks ago that a spinal injection left him feeling "great." In fact, it is difficult to completely dissociate the two problems since disk injury in the lower back often contributes, either directly or indirectly, to hip problems. The abductor muscles help to move the hip laterally, and perhaps more importantly in Oswalt's case since the involved leg is his landing leg, contribute to stability of the pelvis. I said in a prior blog that I would not be surprised to see Oswalt end up on the disabled list due to the complex nature of his injury. He has no doubt benefited from the rest and rehab afforded him during his stint on the disabled list, and the good news is that he has been able to throw off a mound recently without pain. His first bullpen session was Wednesday, at which point the Astros' official site reported that Oswalt threw at approximately 75-80 percent of full strength. On Friday he upped his intensity but capped the pitches at about 25-30 according to the Houston Chronicle. He also faced a pair of teammates in an effort to prepare for Monday's outing. Manager Cecil Cooper told the Chronicle that he expects Oswalt to throw about 90 pitches, which may be optimistic for his first outing. The concern with the type of problem that Oswalt has is recurrence. This is not a ligament sprain waiting to heal with a fairly definitive timetable. This is a more complex interplay of disk dysfunction, which tends to be chronic, and a related muscle group (hip abductors) involved in a very repetitive motion (pitching). If all goes well, it may still take Oswalt some time to build up the endurance to go deep into a game. Fantasy owners should be cautious.
Mitchell Layton/Getty ImagesOswalt will try to make a strong finishing kick now that he's well rested.
Aaron Harang, P, Cincinnati Reds: As Oswalt prepares to face the Reds, the Reds are hoping for the return of one of their aces in the not too distant future. Harang, who has been on the disabled list with forearm stiffness, was able to throw from a distance of 70 feet Tuesday and surprised himself with how good he felt. On the Reds' official Web site, Harang acknowledged feeling tentative at the start of the session as he wanted to make sure that there "wasn't something there," but as the arm continued to respond, Harang said he was able to let go a little. He is scheduled to throw off a mound Monday, which will further test the forearm as he will be forced to throw harder. If the session goes well, the Reds should be able to lay out a better timetable for Harang's return, but at this point it would appear that it could happen within a couple of weeks. The fact that Harang's issues appear to have been primarily muscular, as opposed to ligamentous or a joint injury in the elbow, bodes well for his successful return.
Jose Guillen, OF, Kansas City Royals: Guillen made a decision to remain in Saturday's game after reportedly feeling his groin "snap" in the fifth inning, and came to regret it, according to the Kansas City Star. Guillen acknowledged that he couldn't even walk right after the incident and seemed to be questioning aloud why he didn't put an end to his misery sooner. Guillen was not active for Sunday's game and although he is slated to play Monday, it would not be a surprise if his status changes since Guillen himself told the Star that he pulled the groin "worse than the first time this season." Keep in mind that Guillen has also missed games in July due to back spasms and in June due to a sore hip. The musculoskeletal issues seem to be catching up with Guillen and if he cannot play effectively, it would not be a surprise if the team grants him some additional rest, despite the fact that the Royals could use his services early this week as they face the Oakland A's. While it appears that the latest setback is not particularly serious, these things can have a cumulative impact. Keep a close eye on Guillen's status this week.
Rick Scuteri/US PresswireAfter a mostly healthy 2007, the nagging injuries are back for Guillen.
Brian McCann, C, Atlanta Braves: The Braves have certainly faced their share of injury woes this season and it does not appear to be letting up. McCann took on a tough collision at the plate Sunday with Phillies outfielder Shane Victorino and the end result was a concussion. He was able to walk off the field under his own power and X-rays were negative, but it is impossible to determine with any certainty how much time he will miss. Given the long absence of the Toronto Blue Jays' Aaron Hill, out since late May after a concussion, and the persistent and recurrent symptoms that the New York Mets' Ryan Church has faced this season, one thing is certain: It is impossible to truly determine the severity of a concussion at the time of injury. Loss of consciousness, while serious, is not necessarily an indicator of concussion severity. The main thing for McCann at this point is to rest until all symptoms clear. He will then be allowed to progressively resume activity and he will be monitored to see if any symptoms, such as dizziness, nausea or headache, return with that activity. McCann will not be in the Monday lineup.
And in the good news department
We always like to end on a high note, so this week's good news is that Chris Carpenter returns to the lineup for the St. Louis Cardinals. Carpenter, who has been out since 2007 following Tommy John surgery, is expected to start Wednesday for the Cardinals. This would be his first start since Opening Day last year. His recent rehab starts are encouraging in that he has showed progressively reasonable command, something pitchers often struggle with early in their return from this procedure. Although he will no doubt continue to improve during his first few outings, there is reason to believe that Carpenter can contribute immediately. For fantasy owners, don't set unreasonable expectations, but he may be a good value pitcher, especially by late August when he will likely go deeper into games.
July, 15, 2008
Hurray! It's time for the All-Star break! Besides all the fanfare and enjoyment that accompanies this spectacular three-day event, I am most excited for the brief period of rest that all baseball players will enjoy. Yes, even those who are participating in the Home Run Derby and the All-Star Game itself are included, since their appearances will be less demanding than a regular game. And yes, a few more players managed to get added to the disabled list in the first half of the season, coming in just under the wire, too. Here's my injury blog to wrap the first half of the season:
Roy Oswalt, P, Houston Astros: Oswalt has been struggling for a bit with what the team has called a left hip abductor strain. Most recently, Oswalt had to leave Friday's game after just one inning because of the pain in his hip and was still sore the next day. According to the Astros' official Web site, no decision is likely expected until Friday as to whether Oswalt will head to the disabled list or remain in the rotation. Interestingly, Oswalt told the Houston Chronicle on July 7 that he had received an injection in his back the prior weekend and that he then felt "great." He said he had been experiencing sciatic pain associated with a disc problem in his back. He also indicated this was not the first episode of this type of pain. Disc problems in the lower back often result in pain and weakness of hip muscles, so Oswalt's abductor strain (a muscle that helps control the stability of the pelvis over the leg, in his case his landing leg) may well be a consequence of his issues with his back. So the concern is that this problem could linger, and it may be more complicated than a straightforward muscle strain. One thing is certain; rest is good. Given the fact that this has been troublesome for a while, I would not be surprised to see Oswalt end up on the disabled list to try to get it under control. Stay tuned.
AP Photo/Haraz N. GhanbariThe DL or not the DL is the Astros question with Roy Oswalt.
Erik Bedard, P, Seattle Mariners: Deja vu, non? His last outing was a five-inning appearance on Independence Day. When manager Jim Riggleman reported the next day that Bedard didn't feel right, it sounded as if the hip and back that have ailed him since early in the season were still giving him trouble. But lo and behold, Bedard has a new troublesome spot, his throwing shoulder. Bedard was placed on the disabled list with what the team is calling "stiffness" in his throwing shoulder. The variety of nonspecific musculoskeletal ailments that Bedard has suffered so far this season is unsettling, but perhaps some comfort can be taken in the fact that none of them appear serious in their own right. Of greater concern is Bedard's overall durability across the demands of a season. Remember, he ended the 2007 season on the disabled list with an oblique injury, and since then he has struggled to maintain his health. The move to the disabled list for this shoulder episode sounds precautionary on the part of the Mariners, and the timing of the All-Star break may have made the decision to place him there easier.
Vernon Wells, OF, Toronto Blue Jays: Oh, things are blue in Toronto, all right. A less than steamrolling offense just lost the guy who managed to lead that offense in home runs and runs batted in, despite missing three weeks earlier in the season with a broken wrist. Wells is out with a Grade II left hamstring strain, apparently suffered when he hyperextended his knee while trying to steal third base Wednesday night. The location of the injury is near the knee itself where the hamstring tendons attach, which typically requires some extra healing time. A Grade II or moderate strain represents a wide range of injury, so it is hard to say exactly what percent of the hamstring is damaged. The best hint comes from the team's own indication on their official Web site that Wells will be out at least 4-6 weeks. Unlike with his wrist, Wells will not be able to push this return time up much because of the risk not only of reinjury but also of more severe injury. Somehow the Blue Jays will try to muster up some offense from elsewhere.
Dustin McGowan, P, Toronto Blue Jays: The aforementioned Jays will be hurting a little more on the defensive side also, now that McGowan is sidelined with a small rotator cuff tear in his pitching shoulder. The good news is that this tear has been present since at least last year, and on MRI the images from this year compared to last year appear no different, according to the Blue Jays' official Web site. In other words, the tear has not increased in size. Why the symptoms? It is a fascinating concept, but one that reminds us that the picture does not always tell the whole story. Many pitchers have evidence on imaging such as this (small cuff tears, biceps tendon damage) of the wear and tear their job places on their shoulders, yet they can still perform. But all of a sudden, some trigger -- and it may be an unknown one -- comes along to aggravate that weak area, and pain and inflammation result. The solution is a familiar refrain: Rest and rehab. So this is exactly what McGowan will do for the next month or so to allow his shoulder to recuperate from this apparently minor setback. McGowan is scheduled to seek a second opinion this week, so there is a small possibility that the program changes, but it appears for now that he will avoid surgery.
Jeff Gross/Getty ImagesMcgowan is just another name to add to the bad injury luck for the Jays.
Aaron Harang, P, Cincinnati Reds: Harang has been placed on the disabled list with a forearm strain, but the good news for the Reds is that all of his imaging tests came back negative, indicating no serious structural damage. The team's statements suggest that the problem is musculature in nature and that there are no concerns about elbow ligament damage, always a reassuring bit of news for a pitcher. He has been instructed not to pick up a baseball for at least one week, according to the Cincinnati Enquirer, while he undergoes treatment (plus that all-important antidote, rest). He will be eligible to pitch again July 24, and it sounds at this point as if he will make that target.
Bobby Jenks, P, Chicago White Sox: It might seem a bit unusual for a pitcher to have an upper back injury on the opposite side of his throwing arm, but that is exactly what is sidelining the White Sox closer right now. Jenks was placed on the disabled list last week, but he had not pitched since June 29, so the move was retroactive to the end of June. Jenks had been feeling tightness in the upper back since late June but tried to persevere. The exact location of his pain seems to have moved around somewhat, which is certainly not unusual in this area. Pain under the shoulder blade on the left upper back could range from a muscular problem to a minor joint sprain in the neck, upper back or even the rib area. All scans (CT and MRI) came back negative, according to the Chicago Sun-Times, but Jenks acknowledged the value in resting now in order to be ready to make a second-half push.
And in the good news department...
Right now, the good news is that there's a little break! Here's to hoping for a healthy and happy All-Star event, and to all those nursing sore shoulders and hampered hamstrings, sit back, relax, rehab and we look forward to your productive second half of the season.
May, 23, 2008
I started off the most recent blog talking about the bad luck the San Diego Padres' pitching staff has had recently. Apparently that streak had not fully run its course just yet, and it has now extended beyond their pitching staff as catcher Josh Bard is among the wounded. Closers continue to struggle with their delivery and their health, and Eric Gagne is the latest to be put on mandatory rest. But how long will he be out? Hmm. The latest injuries remind us that there is often some overlap between injury and poor performance, and the trick is figuring out the ratio in order to make the fix.
Chris Young, P, and Josh Bard, C, San Diego Padres: Albert Pujols is single-handedly taking down the Padres, not only with his bat, but with his body as well. Wednesday night during the third inning of the St. Louis Cardinals' visit to Petco Park, Pujols lined a shot off the face of Padres pitcher Chris Young. The hit netted Pujols a single, but Young ended up with a broken nose, a facial laceration and a trip to the hospital according to the North County Times. Two batters later, Pujols headed home to score but arrived at the same time as the ball in Josh Bard's mitt. On the slide, Pujols' front (right) leg collided with Bard's extended left leg and Bard clearly lost that battle. Bard was assisted from the field, in a great deal of pain with his leg visibly impaired and, per the North County Times, the injury was called a high left ankle sprain. Bard has been placed on the DL, and we know from past experience that high ankle sprains often mean at least a month of missed time, generally more. Considering that catchers spend a good portion of time in the crouch, which places extra stress on the ankle, and then have to push through the ankles to jump into position, Bard's recovery may be on the slower side.
Andy Hayt/Getty ImagesThis is one instance in which Young didn't want to use his head.
The good news here is that the bloody and battered Young, who was treated at the hospital and released, did not suffer any worse damage. The nose provides a barrier for the face that slows the impact of an object, such as a baseball traveling at warp speed, and hopefully that slowing prevents brain injury. A hard-hit line drive that hits a pitcher in the face runs the risk of shoving the nose back toward the brain and causing further damage. The ball could also hit another portion of the face or skull, resulting in a facial or skull fracture, which can result in surgery and significantly worse potential complications. The Padres have not yet indicated whether Young will be placed on the DL, but it would not be surprising for him to at least miss his next scheduled start. All this happened, of course, in the wake of the Padres' announcement Tuesday that their young ace Jake Peavy would be placed on the DL for inflammation in his throwing elbow. An MRI reportedly showed no structural damage to the ulnar collateral (Tommy John) ligament, but Peavy himself told the San Diego Union-Tribune that this ailment is much closer to the ligament than the injury that took him to the DL in 2004 (a flexor muscle strain that kept him out for six weeks). There is no set timetable for his return at this point, but given the nagging behavior of his condition, expect him to miss more than the automatic 15 days.
Eric Gagne, P, Milwaukee Brewers: Gagne has been instructed to rest by team physician Dr. William Raasch after receiving a cortisone shot to address rotator cuff tendinitis. Gagne will not be permitted to throw for at least three days, at which point he will be re-evaluated. He will rejoin his team Friday and at this point does not appear to be headed to the DL, although the team has indicated that that could change. Gagne has struggled this season to close consistently, and was removed from the position briefly to get a mental break. According to ESPN reports, Gagne said that he originally developed some soreness in his shoulder a week ago when he threw daily in an effort to address problems in his delivery. Then Tuesday, while facing the Pirates, Gagne developed stiffness in his shoulder and was removed from the game. Gagne has a history of elbow problems in his throwing arm, including recurrent nerve-related pain which was causing him to have numbness in his fingers and ultimately resulted in surgery. Gagne did experience a bout of shoulder tendinitis last fall which caused him to miss a couple of weeks, but after he rested during the offseason there were no reported lingering issues. Three days is a short recovery time if indeed there is significant inflammation. Even if his symptoms have resolved with a few days' rest, the likelihood is that the team brings him back via a throwing progression that will unfold over at least a week. Don't be surprised if Gagne is out of the mix for at least a week, or even if he ultimately goes the route of the DL in an effort to address all that's been ailing him this season.
Austin Kearns, OF, Washington Nationals: Kearns has been dealing with a sore right elbow and is going to have it addressed, surgically. Kearns is expected to undergo arthroscopic surgery Friday to remove some bone chips in the elbow. Initially it did not appear that Kearns would be going under the knife but with the swelling and soreness persisting, and after collecting several opinions, the decision was made to treat the elbow surgically. At this point Kearns is expected to miss three to four weeks, assuming that there are no additional findings during surgery, and assuming recovery goes as planned. He will need to regain his range of motion, his arm strength and, given his role as an outfielder, will have to progress his throwing program to long range. If Kearns' elbow is otherwise healthy, he should be able to recover from this episode and return to his role successfully.
Andruw Jones, OF, Los Angeles Dodgers: Jones definitely has something going on with his knee; the question is whether he will have surgery to address it or whether he will be able to play through it. According to a report in the Los Angeles Times, one of the main factors in the decision is whether the swelling persists in the knee. Jones, who had been feeling increasing discomfort in the knee over a couple of games, underwent an MRI early in the week which revealed a small cartilage tear. The Dodgers' official Web site also describes the presence of a Baker's cyst in Jones' knee. Such cysts, which are really fluid-filled pouches, are problematic because the swelling occupies a great deal of space in the back side of the knee and, in addition to being painful, can severely limit the range of motion. Interestingly, these "cysts" often develop in association with meniscal or cartilage injury, and when those injuries are addressed, the cysts can spontaneously resolve. The Los Angeles Times reported that Jones felt better after a few days' rest and was hopeful that he might be able to play Friday if the swelling remained minimal. Jones, who has never made a trip to the DL, would like to do all in his power to continue to avoid it. There is a possibility that Jones is in the lineup Friday, but if he suffers any setbacks, the next step is sure to be surgical intervention that would likely keep him away from the game for at least four to six weeks.
Paul Spinelli/MLB Photos/Getty ImagesAt least Jones has a reason now for his poor numbers.
Roy Oswalt, P, Houston Astros: Oswalt made his scheduled start Thursday at Minute Maid Park to face the Philadelphia Phillies despite dealing with hip pain over the last week. Oswalt, who left Saturday's game with what the team referred to as a groin strain, skipped his bullpen sessions this week to allow the hip to rest. Oswalt, who has faced groin injuries in the past, had indicated that this pain felt deeper in the hip itself and did not feel muscular, always a flag raiser in a pitcher where labral tears and degenerative arthritis can become serious matters (for example, Jason Isringhausen had surgery on his hip prior to the 2007 season). For the time being it appears that Oswalt escaped something more serious as he managed to throw for six innings Thursday, but it was a rough outing nonetheless (five runs, 11 hits). We will keep an eye on Oswalt to see if this is something that crops up again.
And in the good news department
Rafael Furcal, SS, Dodgers: Furcal has been testing his back in every possible way (fielding drills, running, batting practice) and has survived them all without incident. This has prompted optimism that he could return to the lineup for the Dodgers' series against the Cardinals this weekend. According to the Los Angeles Times, Furcal said he would resume his position straightaway if healthy enough, with no minor league stint as an interim measure. The suggestion has been all along that Furcal would return this week if everything went as planned, so expect to see him at some point during this series.
Doug Davis, P, Arizona Diamondbacks: Welcome back Doug!! Now that Davis has tackled his thyroid cancer head-on and beaten that, he will face the Braves Friday as he returns to the Diamondbacks' rotation. After several rehab starts, Davis is looking and feeling well, and will no doubt provide inspiration to everyone around him.
Be sure to check back throughout the Memorial Day weekend as we update these and other injuries. In the meantime, enjoy good weather and good health, and may all your fantasy players stay active on your roster and avoid the DL!