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Tuesday, February 16, 2010
Updated: February 17, 11:26 AM ET
Injuries: 10 players to watch this spring

By Stephania Bell

Every year there is a handful of players whose biggest story of the season is not their home runs or hitting, nor their strikeouts or sliders, nor even their base stealing or walks. The story is in a stat that no player wants to acknowledge … days on the disabled list.

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In some instances there is no major incident, no clear defining injury moment, just weeks of frustration while watching teammates from afar. Just ask Arizona Diamondbacks ace Brandon Webb about that feeling. Webb never really got started in 2009 before his season ended prematurely. Now the question for fantasy owners is, will he be able to deliver this year?

For some teams, it is as if the whole roster has been bitten by an injury bug. You didn't have to be a New York Mets fan, or even have a single Mets player on your fantasy roster last year, to know the injury woes facing that group. As just one small measure of how overwhelming the Mets' injury concerns were, and still are heading into this season, there was a choice to make as to who would make the cut for this column. As it is, Mets comprise roughly one-third of our not-so-desirable top-10 list. The question for fantasy owners now becomes, is there some value to be had amongst this infamous group?

To help get you ready for a healthy 2010 fantasy baseball season, let's take a look at 10 of the most intriguing injury stories heading into spring training. To be sure, these stories will evolve, so stay tuned for updates as the season approaches. Of course there are a number of other injury nuggets lurking amongst team rosters, along with others yet to crop up once spring training kicks into gear. So yes, we will be watching.

The Mets not only saw a high percentage of their players succumb to injury last season, they saw their highest-profile and most valuable players' seasons end prematurely as a result. The Mets notch the top three spots on our list with major injuries to an outfielder, an infielder and an ace pitcher.

Carlos Beltran, OF, New York Mets: We start with Beltran not only because of the significance of his injury, but because it became the first news story for the Mets in 2010. Just when the Mets were looking to put the injury headlines in the rearview mirror, they resurfaced front and center in mid-January with the news of Beltran's knee surgery in Vail, Colo.

Beltran's surgery came as somewhat of a surprise -- apparently to the Mets' organization as well, based on the response from management -- although the injury had been ongoing since June. To recap, Beltran sustained a bone bruise last year that caused such pain that he essentially became nonfunctional for the remainder of the season (after being shut down in June, Beltran did return for some playing time in September but clearly was not 100 percent recovered). Beltran underwent surgery in January which was performed by Dr. Robert Steadman, leading many to suspect that he had undergone a microfracture procedure (since Steadman was a pioneer of the technique). The Mets have indicated that the procedure was not a microfracture but rather a "cleanup" of Beltran's bothersome knee which, according to AP news reports, showed evidence of progressing osteoarthritis on MRI. The timetable for Beltran to return to baseball activities after surgery has ranged from eight to 12 weeks, either of which still results in a delayed start to his 2010 season. As of this writing, the New York Post has reported that Beltran is currently undergoing rehabilitation in his native Puerto Rico but the Mets expect him to head to spring training when other position players report (Feb. 23). That should not be interpreted as an indication that Beltran will be able to fully participate, but rather as a sign that he will simply be joining his teammates. Beltran's timetable likely will not have him seeing any game action before the middle of May and there will be no incentive to rush.

While Beltran is hoping for a successful return, this much is known: His knee is not normal. By virtue of the procedure that he recently underwent, regardless of how extensive the cleanup was, we know that the surface of his knee joint is no longer pristine. That doesn't mean he can't get renewed life out of his knees and go on to be productive, but it does raise the risk of problems in the future. Fantasy owners should be guarded in their approach to a player like Beltran and recognize that his activity may not ramp up until most fantasy drafts have passed.

Jose Reyes
Jose Reyes was limited to just 36 games and 11 stolen bases in 2009.
Jose Reyes, SS, New York Mets: As much as we want to believe that a relatively young player like Reyes has put his injury woes of 2009 behind him, his injury history just won't let us. For one thing, Reyes may be young at 28 but his hamstrings -- and their history of giving him trouble -- seem much older. Reyes and his chronic leg injuries are of particular concern since he is a speed guy. In other words, his special value is largely dependent on the health of his lower half.

Many are familiar with the saga of Reyes in the 2009 season. It began when Reyes strained his right calf in mid-May and missed a few games as a result. In early June he tore his right hamstring, which would prove to be the beginning of his 2009 demise. After several setbacks during rehab and varied courses of treatment, Reyes finally went under the knife in October to address scar tissue in the hamstring tendon. As of early February, Reyes appeared optimistic about his progress. He told Newsday that he was "happy" to be running sprints and, above all, running without pain in his leg.

So is this injury really behind him? Perhaps. In the short term. But it is hard to imagine that Reyes is completely free of any issues with his hamstring. Consider that Reyes has had troubles with his hamstrings since his minor league days. As a sprinter and base stealer, he places more explosive and more frequent demands on his hamstrings than a power hitter, for instance. Recurring injury to a particular muscle group coupled with high demand is not a great combination. While the surgery may benefit Reyes, especially in the immediate future in that it may have cleaned up some scar tissue and increased blood flow to the area, it does not change the fact that his baseline hamstring tissue is likely compromised. Part of the reason for the success of Tommy John surgery is that the ligament is being completely replaced by a structure from another part of the body; it is entirely new tissue. No such thing happened with the hamstring.

Let's frame it this way: While Reyes could get off to a great start with fresh legs, it would not be a surprise to see him miss time again this year. Another thing we know is that when Reyes does travel to the disabled list, his history suggests that he does so for an extended period. And as one of my colleagues who works in the majors reminds me, "The biggest predictor for going on the DL this year is time spent on the DL last year." Hmmm. Sage words for fantasy owners to bear in mind come draft day.

Johan Santana, SP, New York Mets: Santana underwent surgery on Sept. 1 to remove bone chips from his left (throwing) elbow. At the time, it seemed like the final blow to an already ailing Mets lineup and as is always the case when a pitcher goes under the knife, left many concerned about what the ultimate outcome would be.

The good news was that Santana did not emerge from surgery with a reconstructed ligament, just a cleaned-up elbow after removal of some extra bone growth, a common side effect of throwing. In January, Santana returned to the mound during a Mets minicamp and seemed thrilled with how he was progressing. According to AP reports, Santana is pleased with his mechanics and is having no pain in the elbow. At this point, all bodes well for Santana to be ready to start the season and there is every reason to be optimistic.

Well, almost every reason. The concern with the particular procedure that Santana underwent is not in the procedure itself, but in what it could mean as far as the big picture of Santana's elbow health. The presence of bone spurs can be suggestive of instability within the elbow. The spurs themselves form in response to stress within the joint. They can become painful and limit motion. They can also fragment and form chips or loose bodies. Removing the spurs or chips can help reduce pain and restore motion. There is some speculation, though, that spurs provide additional stability, and that once removed, the increased motion in the elbow could place additional strain on the all-important ulnar collateral (Tommy John) ligament.

St. Louis Cardinals ace Chris Carpenter had bone spurs removed in 2007, only to end up having Tommy John surgery a few months later. While Carpenter is not an isolated case, there are numerous other pitchers who have gone on to pitch successfully after bone spur/chip removal. Santana himself underwent a similar elbow surgery in 2003 and followed it up with a strong season the subsequent year. The Mets are clearly hoping that Santana repeats that pattern, but there is no denying that his throwing arm has added six years of wear and tear since then. From a fantasy perspective, it's a matter of risk versus reward. Santana may well deliver a Cy Young performance in 2010, but until that actually happens, there is some justifiable concern as to how he'll hold up during the season.

Brandon Webb
This was a rare sight last season: Brandon Webb throwing a pitch for the Diamondbacks.
Brandon Webb, SP, Arizona Diamondbacks: There might be no throwing arm more scrutinized during spring training than that of this Diamondbacks ace. Webb had one start for the Diamondbacks in 2009 and then spent the remainder of the season sidelined with a shoulder ailment. Even after surgery there has not been much light shed on exactly why Webb's shoulder issue was so debilitating, since there was not much to fix according to various postoperative reports. It's worth noting, however, that despite the fact that there were no reported major labral or rotator cuff tears, any pitcher's shoulder is bound to have damaged tissue within the joint as a result of the strain of repeated overhead throwing. Even minor tissue damage, when strategically placed, can cause enough discomfort to render the shoulder unable to perform.

Webb underwent a "cleanup" procedure on his right shoulder in August to address some frayed tissue around the labrum after several failed attempts at conservative rehabilitation. The delay to surgery, for those who might be wondering why it was not undertaken sooner, is not only reasonable, it is actually standard practice in this type of scenario. Surgery on a pitcher's throwing arm is always a last resort, particularly in the absence of any obvious pathology, because any postsurgical recovery is going to be extensive, whether major repairs are involved or not. The benefit for Webb is that the strengthening programs he undertook when trying to rehab the shoulder no doubt have helped in the recovery process following surgery. Nonetheless, the timetable is a progressive one based on small increments of success.

As Webb himself pointed out to The Arizona Republic in early February after a flat-ground throwing session, "It's something that, not all of a sudden am I going to be 100 percent. It's going to be a gradual thing still. Today was really good. I feel like I'm building up every day. I haven't really thrown for a whole year. Even if somebody didn't have surgery, if you lay off for a whole year it's going to take a little bit to get your arm strength back and stuff."

Very true. Expect the Diamondbacks to be cautious with his return, given the long layoff and the nature of his injury. That said, if Webb recovers without incident, it will bode well for his health for the season. Spring training will be very helpful in gauging how Webb's shoulder will fare. Fantasy owners should consider that from a health perspective, the absence of setbacks along Webb's path is more important than a targeted start on Opening Day.

Josh Hamilton, OF, Texas Rangers: Hamilton has faced a litany of soft tissue (muscle, tendon, ligament) injuries, not only last year but chronically. In 2009, he underwent surgery to address a sports hernia. The good news there is that once repaired, it should no longer be a concern and he has had plenty of time to recover.

The more problematic issue for Hamilton in 2009 was the disability associated with a pinched nerve in his lower back. He has been undergoing an offseason conditioning program designed to help better protect him against recurrence of symptoms. The Dallas Morning News reported in November that Hamilton opted to stay in Texas during the offseason to work specifically with Rangers strength and conditioning coach Jose Vazquez. Hamilton has a known pars defect in his spine, a vertebral anomaly which in and of itself is not a big deal, but it does make it more critical to train the deep abdominal stabilizing muscles to help avoid back pain. The symptoms Hamilton experienced last season (pain in his low back and radiating into his leg) could certainly recur and it's worth noting that this was not his first episode.

Although there is no definitive direct link between Hamilton's past drug use and his struggles to stay healthy, it is reasonable to expect that his tissues may have been further compromised to some degree as a result. Hamilton certainly dealt with injuries prior to his drug suspension, but the added toll on his physical well-being may be part of his big picture.

The Rangers obviously wanted to bring Hamilton back, but the fact that his is a one year, incentive-laden deal is telling. The likely position move from center to left field may well help Hamilton's body, particularly if he can avoid crashing into walls, but expect him to still be at risk for some sort of soft tissue ailment this year.

Ben Sheets, SP, Oakland Athletics: Sheets and his agent went shopping for a team in 2009 … and found no takers. Apparently no one was interested in paying him a year's salary to rehabilitate an elbow that would require surgery to repair a torn flexor tendon.

A teamless Sheets ultimately went under the knife in February of last year and began the process of working his way back to the mound. And the shopping continued. After he flirted with several teams, most of which sent scouts out to watch him throw this January, the A's ultimately proved to be the buyer, committing to only one year but at the fairly hefty price tag of $10 million.

The concern is not so much in the recovery of this particular injury. Overuse of the flexor-pronator (the muscle group on the front side of the forearm that controls downward wrist motion and some forearm rotation) is not uncommon in pitchers and failure (or partial failure) of the tendon (which anchors that muscle group to the bone at the inner aspect of the elbow) is not unusual. Athletes are often able to return to throwing within four to five months after surgery, with a full recovery expected ranging anywhere from six to 10 months. Andy Pettitte returned following a similar procedure in 2004 and he's still producing. The issue is whether the flexor tendon tear is an isolated injury or whether there is other structural damage present which, even if insignificant now, could manifest itself in the future. Where is a crystal ball when you need one?

Sheets has had plenty of time to recover from this particular surgery in advance of the 2010 season. The big question is not only how healthy Sheets' elbow is, but how the rest of his oft-injured frame is faring. Remember Sheets has made several visits to the disabled list during his career and some of the injuries he has faced are potentially chronic. He has dealt with bulging disks in his back, hamstring strains and tendinitis in his throwing shoulder, along with inner ear problems that resulted in dizziness. After a great start in 2008, his elbow failed him late in the season.

His performance for the scouts this winter was enough to at least convince the A's that his extended time off has not overly impacted his mechanics and that he does appear on track to start the season. There is every reason to believe he will start strong based on his current progress, and the time off may have afforded the rest of his body a much-needed break. Unfortunately, there is no true way of knowing how long his health will hold up. The A's seem to be taking a calculated risk by investing for only one year, maybe less if the goal is simply for him to make it to the trading deadline. Fantasy owners should keep that in mind.

Alfonso Soriano
Alfonso Soriano batted a career-worst .241 last season and missed 45 games.
Alfonso Soriano, OF, Chicago Cubs: Soriano requires a different spin in this discussion since he is not coming off a single major injury, but rather he is trying to overcome the reputation of being on the downturn as a result of his accumulated injuries.

For the past three years, Soriano has just not lived up to fantasy baseball expectations, yet each year those expectations have continued to be lofty … until now. Entering the 2010 season, it is certainly clear that Soriano has become a risky prospect, dropping in our rankings from a preseason rank of 16 in 2009 to his current preseason rank of 138. Soriano's numbers in 2009 were the worst of his career and the culmination of a progressive decline in home runs and stolen bases.

One reason Soriano hasn't been able to put up winning numbers is simply because he has missed so much time. Injuries, it seems, are at the heart of Soriano's recent downfall. While he hasn't suffered anything catastrophic along the lines of an ACL or a UCL (ulnar collateral ligament, aka Tommy John ligament) tear, the cumulative toll of Soriano's ailments may be catching up with him.

Since his storied 2006 season, Soriano has suffered multiple injuries, especially to his wheels, which spells problems for a speedster. In 2007, he strained his left hamstring and right quad, the latter of which forced him to end his season prematurely. Still not running well when the season started in 2008, Soriano went on to tear his right calf muscle. Despite performing well enough to be selected to the 2008 All-Star Game, Soriano was unable to participate in that game because of a fractured bone in his hand. By the time that season was over, he had missed more than 50 games due to injury.

Hoping for a fresh start in 2009, Soriano arrived at spring training saying he felt better physically than in years past. Unfortunately, his April collision with an outfield wall led to knee problems that persisted throughout the season until he ultimately underwent arthroscopic surgery in September.

So what is a fantasy owner to expect in 2010? It's a great question without a clear answer. Soriano's age (34) and his recent injury history are not an ideal combination when it comes to projecting his future health. While being hit by a pitch seems more like a bit of bad luck sprinkled in the mix (which is how he broke his hand), Soriano's leg injuries seem to be largely a sign of progressive breakdown. Speed players in baseball are the finesse players of their sport and although they are potentially more elite in their running and speed skills, they may also be more prone to injury, especially in the muscle strain department. Soft tissue injuries such as muscle strains can certainly impact a speed player like Soriano, not only when they first occur, but potentially long term as well. Formation of excess scar tissue post-injury, lack of flexibility, decreased strength and power, and compensations by other muscle groups are all possible consequences of such injury. These outcomes can ultimately prevent a player from achieving his full performance potential, particularly in the areas of speed and power. That failure to perform can manifest as a simple drop-off in physical performance, a mental hesitation to trust in one's body that translates to less aggressive play, or, ultimately, further injury as a result of placing demands on the body that exceed physical capacity. These are the same challenges facing the aforementioned Reyes, who has dealt with chronic hamstring injuries of his own.

This year, Soriano will be coming off the arthroscopic knee procedure and a subsequent rehab program designed to promote his all-around strength, hopefully preventing a repeat of previous seasons. While there is no reason to think Soriano couldn't have the type of bounce-back season a player dreams about, there is no means of guaranteeing that he will.

Chad Qualls, RP, Arizona Diamondbacks: Along with their starting ace Brandon Webb, whom I discussed earlier in this column, the Diamondbacks are counting on the return of their closer Qualls this spring. Qualls suffered a slightly less common injury for a pitcher, soft tissue damage that resulted from a dislocated left kneecap. In a bit of a freak play, Qualls deflected a line drive in the final moments of an August game, then fell awkwardly, dislocating his patella or kneecap.

The kneecap almost always dislocates laterally or toward the outside of the knee. This strains the structures on the inner aspect of the knee that help anchor the kneecap in its normal resting position in the groove of the femur (thighbone). If the strain is great enough, those soft tissue structures -- including the patellofemoral ligament, so named for anchoring the patella to the femur -- can tear, rendering the kneecap less stable overall than before. Surgery involves repairing the ligament to tighten up the soft tissue anchor on the medial (inner) side of the knee. Recovery usually requires three to four months and involves regaining range of motion in the knee and strength of the supporting muscles. The rehab program in many ways mimics the types of activities one would do following an ACL reconstruction, although the progression is typically faster.

The good news is that once healed, this is not likely to present any recurring problems. Qualls has been progressing well, throwing several bullpen sessions as of mid-February. Qualls indicated that he expects to be ready to start the season and that his arm may even be ahead of schedule as a result of his rehab program, according to The Arizona Republic.

He still has some hurdles to cross in spring training, but so far he is inspiring confidence that he will be ready to go by Opening Day.

Scott Sizemore, 2B, Detroit Tigers: Sizemore is unique amongst this group, as he will be a newcomer to the majors this spring. Sizemore, who has been developing in the Tigers' minor league organization, will not only be making his major league debut this spring, he'll be doing it coming off a serious ankle injury that required surgery.

While playing Arizona Fall League ball in October, Sizemore got the worst of it while trying to complete a double-play relay and ended up with a fractured left fibula (the skinny outer lower leg bone that makes up the outer aspect of the ankle joint). The fracture required insertion of hardware to stabilize the break, followed by a brief period of immobilization for healing. Gradually, Sizemore was introduced to range-of-motion activities and strengthening for the ankle, followed by removal of the hardware in mid-January (often done once the bone has healed adequately and the fixating pins are no longer necessary). The follow-up steps include progressive strengthening and impact conditioning, along with agility maneuvers designed to restore the normal function of the ankle.

The success of Sizemore's surgery and rehab are reflected in the Tigers' continued confidence that he will be their second baseman this spring. At the time of his hardware removal, Sizemore told that he could hit and take grounders, adding "I can swing 100 percent now." Sizemore headed to Florida in advance of his teammates to continue his progressive workouts and all appears on track for him to be ready to participate in spring training.

The good news with this injury is that once healed, the bone itself should not present a future problem. Perhaps the most challenging aspect of making a full recovery is gaining full mobility in the ankle following a period of immobilization. Movement at the ankle is necessary not in just the up-and-down direction, but multidirectionally to allow the agility required to jump laterally when fielding a ball or to pivot and turn on the foot. Sizemore's youth and health (he did break the hamate bone in his left wrist in 2008 and returned strong) help him here. There will be much to watch with Sizemore in spring training, but it does not appear that the injury will be something to hold him back.

Erik Bedard, SP, Seattle Mariners: It's not surprising that Bedard is on the injury watch list; it's more surprising that the Mariners decided to invest in another year after the past two ended with surgery. Since leaving Baltimore and heading west, Bedard has struggled with a variety of injuries to his back, hip and most recently (and perhaps most worrisome), his left (throwing) shoulder.

Entering this spring, Bedard is coming off August surgery to repair a labral tear. Normal, uneventful rehab requires four to six months just to resume throwing, with a gradual buildup toward return to competitive play. Mathematically, that puts Bedard into May or June before he can contribute, and that's barring any setbacks. The Mariners seem confident that Bedard will prove to be of value later in the season, but his history makes him a risky prospect for fantasy owners everywhere. If ever there was a player to take a "wait-and-see" approach on, Bedard is the one.

Keep in mind that injuries do have a way of happening on their own time frame, despite our best efforts to prepare you. So check back frequently as we will update this section as injury news develops leading up to Opening Day!

Stephania Bell is a physical therapist who is a Board Certified Orthopedic Clinical Specialist and a Certified Strength and Conditioning Specialist. She is a clinician, author and teacher with extensive experience in the area of orthopedic manual therapy and sports medicine.