Inside the 2014 Numbers of Each MLB Team’s Regular-Season Injury Impact

For the past 10 years, I've been keeping track of injuries in baseball. Using a proprietary database, the difference in how teams manage injuries has often led to insights. Some teams are good at keeping their players healthy; some aren't. Some teams take injuries seriously; some just shrug and say it's part of the game. Some are consistent; some aren't.

In 2014, there's some clear insights to be gained. There are only two ways to win in baseball: collect talent and keep it on the field. Only a few teams were able to do both or, in the absence of that ability, to work around it with depth, payroll or in some cases, dumb luck. 

Here are 10 insights and a chart to show you the difference in injuries we saw in 2014:

 

1. Who were the best teams at managing health in 2014?

The Milwaukee Brewers have been at the forefront of injury management for the past decade, establishing themselves as among the elite. A few years ago, a long-term analysis showed that they were neck-and-neck with the Chicago White Sox for best medical results over a decade. That hasn't changed.

In 2013, the Brewers were hit with a series of fluke hamstring strains. There was no pattern to it, and that usually points to bad luck, something that corrects. With a lot of work behind the scenes from both the medical staff and the strength and conditioning staff, that did correct. They were able to minimize the injuries they did have, such as Ryan Braun's lingering thumb issue. They lost less than $9 million in value, more than $1 million better than the second-place team, the New York Mets.

The Pittsburgh Pirates also deserve recognition for their management of injuries. They lost just over 400 days total this year, the best in the majors by over 100 days, but the injuries were to star players, which ended up costing them over $25 million in value. While the Pirates did get the Wild Card, the team's tough first half and key injuries appear to be the difference between winning the division and being forced to play that extra game.

 

2. What teams had the worst results this season?

One thing to note is that at the far end of the results, it doesn't necessarily mean that a team is "bad." A team like the Texas Rangers is a perfect example of this. The Rangers medical staff is normally in the upper third of teams when it comes to days and dollars lost, but in 2014, their luck didn't just turn, it abandoned them. 

The Rangers put up the single worst season recorded. While we only have about the past 10 years or so, there are estimates for seasons back into the '80s. The Rangers clear the previous record, put up by the 2007 Washington Nationals, by 10 percent. Lots more on the Rangers in the next answer.

Other teams on the low end of results are the Colorado Rockies, who lost $95 million in value, largely due to the loss of Troy Tulowitzki and Carlos Gonzalez for large parts of the season. Keith Dugger and his staff have never put up results this bad.

Another team at the low end is the San Diego Padres. The Padres have made residence in the bottom third for several years, with a three-year average of 27th of 30. With the team in transition, new GM A.J. Preller could find a lot of improvement by putting a focus on the medical side, as well as bringing in more talent.

 

3. How bad were things for the Rangers in 2014?

I'm out of superlatives. The Rangers lost over 2,000 days, which has never been done before. They lost 13 players for the season and another 13 for at least 100 days. On top of that, there was a significant amount of value lost. 

They lost starters and prospects. They lost nearly their entire rotation at one time or another. Very few players escaped the carnage, but there's no real pattern to the injuries either. Many were traumatic injuries, such as Prince Fielder's neck and Matt Harrison's back. Others were chronic, including a number of pitching arm injuries, both elbow and shoulder. Among regulars, only Elvis Andrus made it through the season unscathed.

Jurickson Profar is one of only two players ever to go on the DL with a teres major injury and the other, Clayton Kershaw, came back in a month and will take home a Cy Young. Meanwhile, Profar remains unable to throw without causing a re-injury to this point. It's been that kind of season.

On the upside, the sheer number of traumatic injuries and the likely comebacks for some of the chronic injuries should have the Rangers in a good position. This medical staff's results have been solid over the last five years, so just getting back to 2013's total should mean about three wins. Getting back to the top 10 could mean as many as 10 wins. If there's such a thing as luck balancing, the talented and deep Rangers could be challenging again quickly.

 

4. If one-year stats aren't very meaningful, what about three-year stats?

On the downside, I mentioned earlier that the Padres were one of the league's worst. On a three-year basis, they're the worst. Even with the Rangers putting up a record in 2014, the Padres still finished almost 700 days ahead of the Rangers. They've lost at least 1,500 days each season and 1,900 in 2012. 

On the upside, the Mariners have been quite solid, just ahead of the White Sox and Brewers. This is no surprise given that the Mariners took home the Martin-Monaghan Award for best medical staff last season. The Twins finished just behind these three despite a poor 2014. 

 

5. Just how big of a problem are injuries in MLB?

If you listen to Forbes' figures, you could buy 26 of 30 teams for just the injury tab this season. While the stat used for value is not the same as dollars, the MLB lost about $1.13 billion in value. Yes, that's billion with a B. That's just 2014. 

So what is this stat used? I call it injury cost, and it's a calculated value using Wins Above Replacement (WAR) and lost days. The salary structure of MLB depresses values for young players. The best example of this is Matt Harvey. Harvey missed the entire 2014 season while recovering from Tommy John surgery. In salary terms, he was just over $500,000, but it's obvious that he's more important to the Mets than just as dollars lost. 

By using the calculated value, there's a more even accounting of a player's true value. Harvey was missed by the Mets the same way hundreds of players were missed around the league. Overpaid or underpaid, injuries have a real cost and a value cost. Teams can insure their real losses, but on the field, the best way to insure against those losses is prevention.

 

6. What about that Tommy John "epidemic" we heard about at the start of the season?

The so-called epidemic turned out to be merely a cluster. After May, only three more MLB pitchers required Tommy John surgery, including one that was only on the 40-man roster (Matt Purke of the Washington Nationals.) The in-season numbers were relatively low, which points to throwing programs and spring training as the bigger problems.

That's not to diminish the issue; it still cost teams and players a significant amount, but the front-loading of injuries is not a new thing or even a baseball thing. The same pattern is seen in both the NFL and the NHL. The NFL sees over half of its total injuries by Week 2! 

This points to some possible causes and cures. While elbow ligament injuries do tend to be chronic (building up rather than one traumatic event), it doesn't appear to be a single-season injury. Few of the pitchers over the past few years have seen high innings or in-game pitch counts. The insidious damage is long term, but few can sight when it begins. Bronson Arroyo fought an elbow sprain before finally giving into surgery, but he's been among the most durable starters in baseball for a decade. Inevitable or did something change?

With one-third of pitchers in the game sporting the triangular scar on their elbow and numbers in the minor league increasing, there's still a lot to be done to reduce this. If nothing else, the so-called epidemic may have forced some action by MLB. They established a new group to research what they can do to reduce the problem, including Dr. James Andrews and Dr. Glenn Fleisig on the panel.

 

7. Do injuries and wins correlate?

So you're asking if injuries matter? Yes and no. There are plenty of teams this year, including the Dodgers and Nationals, that finished in the lower half of results and made it to the playoffs. Teams like the Mariners and Brewers missed the playoffs despite great injury results.

Instead, they can be a small factor in-season but seem to be a forward indicator. Four of the 10 healthiest teams from last season are in the playoffs this season, but it's not enough to just be good for one season. While a team like the Royals had a drop-off from their Martin-Monaghan Award a couple of seasons ago in 2013, they were back near the top again in 2014. Consistently establishing a team at the top is good practice.

To overcome injuries or to accept risk the way that the Dodgers and Yankees have done for years, you'd better have payrolls like them, at or near the top of the game. 

 

8. What teams made the biggest improvements or declines in 2014?

The Pittsburgh Pirates made a huge jump, going from 23rd to first overall in days lost, a difference of almost 1,000 days. The Pirates had one of the best days lost numbers ever four years ago, but they have since changed medical staffs and seen their results all over the place. 

The Brewers went from 22nd to second in days lost, fixing the fluke problem with the hamstring strains from 2013 and keeping the rest of their players on the field. The Yankees were in the top 10 in days for the first time in a decade despite significant value lost. Without CC Sabathia and Masahito Tanaka's injuries, the Yanks could have challenged for first (in both senses).

On the downside, perennial top staff Diamondbacks went downhill again, largely due to arm injuries. The Diamondbacks lost several of their pitchers for the year, dropping them from 14th in 2013 to 27th. From the opening of the season, the Diamondbacks were locked in no better than 20th just on arm injuries.

The Rockies had a major drop, going from eighth to 26th, losing a ton of value as well along the way. A concerning number of injuries for the Astros dropped them from third to 23rd. Remember that injuries tend to be a forward indicator, but it could be that, like the Pirates and Brewers, the Astros' flukish injuries could balance out and give them a boost in 2015. 

 

9. Looking through the data, is there anything you'd tell teams?

It's long been known that not all players have equal value. Given the choice of keeping a star healthy or a bench guy, the decision is easy, though it goes against the instincts of most athletic trainers. However, the decisions should be made on a less elitist level. In 2013, it was clear that outfielders should, for the most part, get very little attention. They're simply replaceable.

In almost every case, outfielders' extended losses were able to be covered easily by a fourth or fifth outfielder without a significant drop-off. Even on a pure value level, only two of the 25 most costly injuries were to outfielders. (Bryce Harper makes sense, but Nori Aoki? That surprised me, though he's certainly helped the Royals go deep into the playoffs.) 

 

10. What is the MLB doing about this?

Sadly, very little. MLB loses billions each and every year in terms of value lost, but they barely put millions into research to prevent them. The billionaire owners wouldn't stand for these kinds of losses in their businesses, but seem to mostly shrug their shoulders and send their best players back to Dr. James Andrews or Dr. Neal ElAttrache. 

While MLB's recognition of some of the problems of the game has picked up, with the aforementioned "arm injury" committee, spending on a significant level hasn't happened. MLB subsidizes almost no research and is behind other sports in terms of pure sports science. They will institute a new tracking system next year that will give a flood of data, but it could take years before any team learns how to make use of the data.

It would be very easy for MLB to fix this, and I can make it very palatable. MLB and its 30 teams should put together the "Selig Institute for Baseball Research." Each team puts in a certain amount, let's say $1 million each to establish it and then $100,000 a year every year thereafter. It's nothing in terms of what they spend or lose, but it could make a huge difference.

All findings at the SIBR would be made available to each of the 30 teams and to the public, so as to make sure that the best research is available to all levels of baseball. A focus on player safety, player health and game improvements is a nice mission and would be a nice legacy for the commissioner to go out on. 

 

Significant contributions to this article were made by Tyler Brooke and Kameron Casey.

Will Carroll is the Lead Writer for Sports Medicine at Bleacher Report. He also hosts B/R Afternoon Drive on B/R Radio on Sirius XM. Tune in weekdays from 3-6pm Eastern on Sirius 93 or XM 208. 

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How Giancarlo Stanton’s Horrific HBP Will Impact the Star Slugger’s Future

There are few things in sports more scary than watching a player, especially a star like Giancarlo Stanton, fall to the ground. An errant (and clearly unintentional) pitch from Mike Fiers tailed directly into Stanton's face, leaving the slugger on the ground until an ambulance came to take him away.

Joe Frisaro of MLB.com has the details in this tweet:

If this video (warning: graphic) is too much for you, this may be all you need to know: There was enough blood that the grounds crew had to come out and work on the batter's box once he was removed.

Stanton was immediately taken to an area hospital, cared for by both the Miami Marlins' medical staff and the Milwaukee Brewers' doctors, per a team source I spoke with moments after the incident. It is common practice in MLB to have the home team's doctors care for both teams' players, especially in situations like this. Team doctors do not normally travel with the club. 

The response was lightning fast. Marlins athletic trainer (AT) Mike Kozak made it to Stanton in nine seconds. Keep in mind that I can't tell where Kozak started from. Athletic trainers are often at the end of the bench working with players and react to crowd sounds or calls from the manager or umpires before going out on the field.

Head AT Sean Cunningham took just 18 seconds to join Kozak in attending to Stanton.

Stanton had been on the ground only 49 seconds before Brewers head AT Dan Wright was seen checking with his Marlins counterparts and calling for the cart. At the 2:20 mark, Dr. Bill Raasch made it onto the field. Dr. Raasch is one of the top orthopedists in the country, so Stanton was a bit lucky that he was at the ballpark tonight. (Team doctors often rotate, depending on their schedules.) 

Stanton was quickly transferred from the cart to an ambulance and taken to an area hospital. While I am not sure which hospital Stanton was taken to, Dr. Raasch practices out of Froedtert Hospital, which is about five miles from Miller Park. My guess is Stanton would be taken there in case he needed immediate surgery.

Fixating the bones around his eye would be the immediate concern if needed, though there was no mention of surgery in the initial reports, such as the one above from beat writer Frisaro.

The bigger issue for Stanton or any hitter is his eyesight. Players do get hit in the face, from Jason Heyward last season to Andre Dawson in one of the worst hit-by-pitch situations I've ever seen. Heyward still wears a flap to protect his face, though he has come back from a fractured orbital with no real issue.

The best-case scenario was sitting in the Brewers dugout Thursday evening. Jean Segura was hit by an errant bat in a similar location to Stanton earlier this season. He needed several stitches but did not have any fractures. He also avoided a concussion, returning to the lineup in just days. 

A worst-case scenario would be one like what Juan Encarnacion suffered in 2007. Encarnacion's injury ranks among the most gruesome in any sport. A foul ball hit Encarnacion while in the on-deck circle, creating what is called a blowout fracture. Despite surgery to put things back in place, Encarnacion's vision was 20/400 in the affected eye, which is legally blind in many states. He was never able to play baseball again.

Doctors will use several imaging techniques, including X-ray and CT scan, to check for damage to Stanton's orbital. While it will be clear in the case of a blowout that the orbital has lost integrity, a lesser fracture can be just as serious and often requires surgery to fixate. Keeping the eye in place is key here. In addition, any swelling must be controlled to prevent damage to the eye itself and to the optic nerve.

Besides the orbital bone, doctors will check the zygomatic arch with both X-ray and CT. This area is to the side of the head, nearer the ear and connected to the cheekbone. This is a very weak area and one that can be very difficult to reconstruct. 

In addition to fracture and eye issues, it is very likely that Stanton was concussed. While it is a secondary problem to the other possible issues, a concussion is a serious condition and must be treated. It is very likely that Stanton will be placed into MLB's concussion protocol and will need to pass the needed steps before returning to play. 

Stanton, on top of all that, has a facial laceration. This is a fancy word for a big cut, suffered when the ball struck him. Given the amount of blood, it's a safe assumption that Stanton will have stitches to close the wound and likely some swelling. If Stanton had managed to avoid both fractures and concussion, the stitches alone would have prevented an immediate return to play.

Oddly, the location of the laceration could be a positive sign. According to the The Associated Press, Stanton was "bleeding heavily from his mouth." If the ball struck him lower on the face, his eye may have been spared some damage. The fact that there's dental (teeth) damage is another indication that the impact may have been away from Stanton's eyes.

With only weeks left in the season, it is hard to imagine that Stanton will return to the Marlins lineup if there are any issues, as Mike Redmond told the AP after the game. Given his current numbers, he is a clear favorite for MVP. Even if this closes out his season, he should get heavy consideration alongside Clayton Kershaw, Andrew McCutchen and the player who was nearest him when he was felled, Jonathan Lucroy.

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Masahiro Tanaka’s Elbow Presents Unique Risk Regardless of 2014 or 2015 Return

"Shut him down!"

With each pitch that Masahiro Tanaka throws, the cries from fans echo fainter. When it would have been simpler to let their ace wait and watch as Derek Jeter's last season faded away rather than burned out, the New York Yankees didn't go the easy way. They went the smart way.

Instead of shutting him down, the Yankees sent Tanaka all the way across the country to have his elbow examined. It was a bit of a fluke that Dr. Chris Ahmad, the Yankees team physician and one of the top doctors in baseball, was at a convention of orthopedists. Tanaka was not only checked by his own doctor, but by a few more of the best in the business. 

All agreed that the small tear, said to be around a 10 percent tear, did not need surgery. The standard is that a 25 to 33 percent tear is in a grey area, but anything above that normally will need a reconstruction (Tommy John surgery). With the small tear, the consensus was that Tanaka had a good chance of rehabbing through the injury and pitching again in 2014. 

Ahmad and the Yankees agreed to rest Tanaka for several weeks and then set him up on a conservative rehab throwing program. They also used an injection of platelet-rich plasma on Tanaka's elbow.

This standard but still poorly understood procedure uses a patient's own blood to help stimulate healing. The early discomfort that Tanaka reported in his elbow may well have been his body's reaction to this procedure. That Tanaka made rapid progress after the first two weeks of pure rest matches this.

It will probably be a good trivia question someday, but Tanaka owes a small debt to another Japanese pitcher if he recovers well. Takashi Saito was the first MLB pitcher to undergo PRP for an elbow injury. His injury and recovery went very well.

Tanaka had no problems at all through the various phases of the rehab throwing program. Most pitchers with more significant sprains will fail at these early stages, such as how Matt Moore did in his first throwing session. As he extended out and then progressed to a mound, Tanaka had no issues. 

Tanaka's next step is to throw a simulated game. He'll do that Thursday, on the road in Detroit, according to MLB.com. This will test his ability to recover between innings and should elicit any lingering pain or inflammation from the elbow. 

The Yankees may not have been working blind. Though the team has refused to confirm, sources tell me that they have used a portable ultrasound to check the ligament throughout the process. (I detailed this device near the bottom of this B/R article.) By actually looking at the ligament and monitoring its progress through the process, the Yankees were able to make educated decisions at each step.

Compare this to what the Washington Nationals have done with Stephen Strasburg and other pitchers. Several seasons back, the Nats shut down their ace near the end of the season as he passed 150 innings pitched. Strasburg was coming back from Tommy John surgery and should have been at his strongest.

While I'm not advocating throwing him if fatigued, the Nats essentially picked a random number to stop him at. Worse, the shutdown did nothing to reduce the risk of future injury for Strasburg.

While Strasburg has been healthy, and it is hoped he continues to be healthy, there's no direct causation to the shutdown. Most pitchers in the four- to five-year period after surgery remain healthy and have no issues. The Nats did similar things with Jordan Zimmermann and recently with Lucas Giolito, the top pitching prospect in the minors.

Tanaka will remain risky once he returns. The ligament is functional, but not as strong as it was, even when completely healed. A ligament is like the rest of the body and heals in an involved manner. Over time, the ligament will get stronger until it is almost back to normal.

Adam Wainwright pitched several top-notch years in a similar situation. Eventually the ligament did give out, though it's unclear if it was directly related to the original injury.

In fact, Wainwright brings up the biggest risk for Tanaka. If the definition of insanity is doing the same thing and expecting a different result, pitching with the same injurious mechanics and expecting different results is pure insanity. Tanaka's mechanics certainly look odd and appear to have significant timing issues.

That said, he's been exceptionally successful and durable with those mechanics prior to this injury. Add in that Larry Rothschild, the Yankees pitching coach, is not known as a tinkerer, and it's unlikely that Tanaka will make any significant changes during the rehab process. 

Tanaka has shown a high levels of skill and integrity. His apology for his injury to fans is certainly one of the more unique things that I can remember happening after a player went on the DL. At no stage has Tanaka shown that he wasn't willing to do whatever it took to get back. His stoic exterior has disguised any pain, but it has also disguised how hard he's worked in rehab. 

One thing to keep in mind is that Tanaka's results are unusual and very individual. The low-grade sprain gave the medical staff something to work with. A significant sprain is still going to lead to surgery, but it's a reminder that there's progress being made.

Along with the years of work they've put in on Michael Pineda, the Yankees medical staff certainly appears to have a win. While Tanaka is not back yet and could have a setback with any pitch, things certainly look very positive for a September return. He's risky, but the return could be exceptionally valuable as they sit just a few games out of the second wild-card spot. 

Shut him down? No. But with every pitch Tanaka throws from now until the end of the season, even if one of them ends in injury, the Yankees are telling those that called for a shut down to simply shut up.

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How Troy Tulowitzki’s Hip Problems Compare to Those That Derailed A-Rod

According to Patrick Saunders of The Denver Post, Colorado Rockies shortstop Troy Tulowitzki will have hip surgery on Friday, ending his 2014 season. He will come up short on plate appearances and will not be eligible to win the batting title, handing the lead over to teammate Justin Morneau.

With outfielder Carlos Gonzalez also likely to be shut down due to injury, per Saunders, the question shifts to the future for Tulowitzki and the Rockies. 

Tulowitzki is expected to have a procedure done to fix the torn labrum in his left hip. This labrum is similar to the one in the shoulder that is often a problem for pitchers. The shoulder (or glenoid) labrum and the hip (or ace tabular) labrum are both thin discs of cartilage that function to cushion and stabilize the ball-and-socket joint. 

When the ball (head of the femur, in Tulowitzki's case) grinds or even impacts the socket, the labrum can get caught in between, damaging the cartilaginous structure. Until recently, this was impossible to diagnose. It usually presented as groin pain and was treated as a strain. Given Tulowitzki's previous problems with sports hernia, he may have had two problems presenting the same way.

The recovery is often cited as between four and six months, but there is a wide variance in the recovery time. Some rehab protocols, such as this one from UW Health, indicate a return as soon as eight weeks. Since most players have the surgery at the end of the season or during the offseason, it's tough to get a true read on returns. A player could be ready to go in February, but with no games until April, two months is often tacked onto the recovery if measured between games. 

The surgery has been very successful, especially in baseball. Dr. Marc Philippon from The Steadman Clinic in Vail, Colorado, pioneered the procedure and has been the go-to surgeon for athletes. Philippon's best-known case is Alex Rodriguez, who had the procedure done on both hips at different times.

While others, such as Philadelphia Phillies second baseman Chase Utley, might be more physically comparable, Rodriguez is often used as a point of comparison. While Rodriguez did have the procedure twice, the surgeries were actually performed differently.

In his first surgery in 2009, Rodriguez had only part of the surgery done. The area was cleaned up, but the labrum itself was not repaired in an attempt to get him on the field quicker. It worked and has held up. He never had that revised.

In 2013, Rodriguez was obviously having issues on the field; it was later revealed that he was fighting through the hip injury that required extensive surgery. He was able to play, but the Biogenesis scandal took him off the field. Physically, however, he has shown no problems.

A source I spoke with indicated that he believed Rodriguez would not be hampered by the hip now if he were able to play. Rodriguez is expected to return in 2015. 

Tulowitzki is facing an extended period of rehab after surgery, but the signs are all positive. He has come back from similar surgery in the same area without issue. If successful, Tulowitzki should be back on the field for spring training. We will have to watch to see if it costs him any lateral range, but most doctors and athletic trainers I spoke with believe that Tulowitzki will come back near 100 percent.

"I'm looking forward to getting back and playing the game I love," Tulowitzki said Wednesday, via Thomas Harding of MLB.com. "I will do everything I can to perform at a high level for the rest of my career. This should answer a lot of the leg issues I have had in my past."

Given that Tulowitzki has put up MVP-caliber numbers while dealing with a chronic injury, I'm very positive on his successful return. Who knows? Maybe he can be better once his legs are completely healthy, which has to scare some pitchers out there.

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Under the Knife: MLB Injury Analysis on Machado, Verlander, DeGrom and More

There are a lot of debates in baseball. It's what drives the sport, I think. It's the same for injuries. How much comes down to luck and how much is preventable? How much is workload and how much is genetics? With injuries to major stars like Justin Verlander, Manny Machado and Andrew McCutchen, injuries are once again deciding pennant races and creating new debates.

The downside here is a lack of data that allows anyone to create a debate. Just as any upside brings cries of "he must be on steroids," it seems that any downside brings the cries of "he must be hurt." Without being able to know what the athletic trainers and doctors are seeing (or without me calling my sources!) observers are left guessing, often wrongly.

The easy solution would be for teams to give more information. There's no advantage in holding it. Helping fans understand what's going on behind the scenes would make them feel more included. People read this column for the kinds of things that the team should be telling them. It's a huge opportunity for a team confident enough to be open.

Until then, we'll have plenty to talk about here, so let's look around the league... 

 

Manny Machado 

It looked bad. In fact, it looked as if Machado had injured his other knee in a similar fashion to the knee that cost him the end of last season. Dr. David Chao tweeted that he thought the mechanism matched another sprain, one that could be devastating to Machado and the Baltimore Orioles' playoff hopes. Instead, the minor sprain may not even push Machado to the disabled list. 

There are a couple details beyond the mechanism of injury that are key. First, we don't yet know the full extent of the injury. Machado was scheduled to have imaging done on Tuesday afternoon, but there were positive signs Monday night. The team called the injury a sprain, indicating it felt there was some level of ligament damage but seemed a bit optimistic, as noted by MLB.com's Brittany Ghiroli.

Most importantly, people seem to have forgotten that last year's surgery was done to "lock in" the knee and make sure that he didn't have more recurrences. There was some debate as to whether the surgery was necessary, but Machado eventually decided that letting Dr. Neal ElAttrache fix the knee was the best decision for the long term. Once he came back, Machado has had no issues with that knee. 

There's likely an element of genetics here. Machado has two knees, so it's likely that the problem he had in one is also present in the other. It could be more or less serious and certainly hadn't presented itself as an issue until this one awkward swing, but it does seem to be there.

Now the question is about specifics. What ligament is sprained and how long will he be out? The Orioles didn't give that info, but the reaction is telling. That he's not immediately on the DL indicates that it's a low-grade sprain and that perhaps the knee's stability isn't compromised.

Details should emerge over the next few days, but the key is whether Machado can function in the field and at bat. Watch to see when Orioles head athletic trainer Richie Bancells allows him to try that. If it's this weekend, it's a major positive. If the knee isn't as stable as originally thought, the DL will remain a possibility. 

 

Justin Verlander

"That explains a lot." One quote from a source summed up a lot of the reaction to Verlander's injury, but I think it's oversimplifying. A lot of times, when a star player has a substandard performance, the easy assumption is "he must be hurt." The problem is that there's seldom any evidence. 

Yes, Verlander has had a poor season, but until he left Monday's game just an inning in, there was no real sign that he had problems with his arm. Now, a sore shoulder pushed him out of the game and perhaps to the DL

An MRI showed "normal wear and tear" and some inflammation, but no major damage, according to AT Kevin Rand, by way of MLB.com's Jason Beck. The wording here is key. Pitchers with the experience of Verlander's are likely to have some issues inside the shoulder, but they are normally asymptomatic.

It's been speculated by many doctors, including James Andrews, that most pitchers have labrum, rotator cuff and ligament damage, but that they either don't know it or adjust.

That's the case with Verlander, but with a lot of money left on his deal, Tigers fans and front office types are going to be wondering whether that wear and tear is finally affecting his function. It's likely the case, which puts Verlander back on the Roger Clemens path.

I've thought for the last year-and-a-half that Verlander was transitioning from power pitcher to pitcher, just as Clemens did in the middle of his career. We'll see whether Verlander can complete that transition in the offseason.

For now, Verlander and Rand will have to focus on function. Getting the inflammation out is relatively easy with therapy and medication. How his shoulder responds after will be easy to see with velocity and command. It looks like Verlander will miss at least one start, but the team will hold off on a DL move until it sees whether he can make his next side session. 

The Tigers are in trouble, according to B/R's Scott Miller, with a real chance of missing the playoffs despite the David Price trade. Price and Max Scherzer should be enough for most teams, but adding in injuries and ineffectiveness in the bullpen makes keeping up with the streaking Royals an issue.

Kevin Rand is going to have to get these situations under control if he and the rest of the Tigers are going to have a shot at a ring for owner Mike Ilitch

 

Tyler Skaggs

Add another name to this year's long roll of Tommy John pitchers. The Los Angeles Angels have lost Tyler Skaggs for the rest of the season and likely the bulk of 2015 as he recovers from impending elbow reconstruction. Seeing a young pitcher break down isn't unusual, but there's some background on this that does make it worth looking at.

Skaggs came over to the Angels this season from the Arizona Diamondbacks, a team that's traded away several pitchers over the last few seasons. At one point, Skaggs was just one of the young pitchers drafted in by the D-backs. Trevor Bauer, Jarrod Parker, Patrick Corbin and Skaggs were all set up to be the "rotation of the future", but injuries set aside some while general manager Kevin Towers sent some away.

Three of those are now rehabbing from Tommy John surgery, with Parker having his second while with Oakland. Only Bauer, a long-toss aficionado, has avoided the issue, despite the fact that Arizona has been excellent at keeping its players healthy over the last decade while under the care of Ken Crenshaw

So we have multiple young pitchers with different organizations and workouts, but three of four have lost at least a season to elbow issues. This is the problem that baseball faces all over, but in this collection, we have an opportunity to find out if there's any solid causation.

MLB is just beginning to study the problem, but for the Diamondbacks, figuring out any solution or change sooner rather than later could be key to turning the organization's fortunes around.

 

Jacob deGrom

The answer to every pitching injury is not "shut him down!" It seems that fans have let the pendulum swing too far, just as teams have done with pitch counts, inning limits and other strategies that haven't worked to reduce injuries over the last decade. 

Remember, the question should be asked with each and every pitching injury as to what caused the injury in the first place. Too many times, teams are merely treating symptoms caused by the underlying problem, which is often mechanical or structural. Without answering those, the result is likely to be the same when the pitcher is stressed again. 

Jacob deGrom has been a revelation for the New York Mets this season, but as a young pitcher on the edge of a career high in innings and pitching at the major league level for the first time, it's not surprising that the stress on his arm would also be at an all-time high. 

DeGrom was smart enough to tell the team, and the early diagnosis, according to Kristie Ackert of the New York Daily News, is that he's dealing with minor tendinitis in his rotator cuff. DeGrom's self-reporting is unusual in a culture that denies injuries and avoids early treatment in order to not appear weak.

While DeGrom will miss the next few weeks, he'll likely return. The Mets will watch him closely as they work to make sure his shoulder is healthy both now and for the upcoming years, when he may well slot behind Matt Harvey and Rafael Montero, who will replace DeGrom in the rotation for now.  

 

Gerrit Cole 

Sometimes, rehab assignments are tough to read. A few years back, A.J. Burnett came down to Indianapolis to throw a rehab game. If all went well, he was expected to head back to the Pirates. His outing was terrible in terms of results. His velocity was fine, but he got knocked around. He hit his pitch count, grabbed his bag and headed out.

For him, it was a success. He showed he was healthy, got his work in and headed back. Flat out, he didn't care about the result.

I don't think that's exactly the case with Gerrit Cole, but it might not be far off. What we see from the outside are results, while what Cole may be doing is simply getting in his work and adjusting some things that the Pirates aren't going to advertise. One of those things seems to be experimenting with his velocity and likely his effort level. 

In his last rehab start, Cole was dominant. In the start before, he got knocked around a bit, but in the fourth inning, dropped his velocity. Cole said he did it on purpose, but no one seemed to know what the purpose was. I believe, having spoken with a few pitching coaches around the league, that Cole is trying to dial down the effort in his delivery to protect his shoulder.

Power pitchers, such as Justin Verlander, often lose some velocity as their career progresses. They have to adjust on the fly to become pitchers rather than just reaching back for that fastball when they need it. If Cole is making that adjustment now, it could be read in a number of ways, but there's no sign he's lost velocity.

We'll have to see over his next few starts for the Pirates if this was an experiment or an adjustment, and if he can stay healthy with either. 

 

Dan Jennings 

Dan Jennings took a very scary liner off his head. He was clearly concussed, but the 101-mph liner could have done much worse. He was hospitalized for tests, but rejoined the Marlins on Monday. He won't make it back at the seven-day minimum, but the concussion DL has no maximum.

We'll see whether or not he wears any sort of protection, but it's another chance for MLB to step up and put more dollars into developing a usable protective hat for pitchers.

 

Andrew McCutchen

The Pirates waited on Andrew McCutchen, hoping that his rib fracture would improve in terms of pain and function without placing him on the DL. Despite some progress, the Pirates made a retro move on Monday.

With the move sliding back to August 3, he could be back as soon as this weekend if he continues making progress. It's at least a sign that McCutchen isn't going to have major problems once he returns. 

 

Masahiro Tanaka

Masahiro Tanaka is making nice progress through his rehab throwing program, as noted by Brendan Kuty of NJ.com. He's been able to go out to 90 feet without any pain or inflammation after the sessions.

A few more of these sessions and he's likely to get up on a mound or half-mound. That could happen as soon as this weekend. While Tanaka is still on track for a September return, there are a lot of steps between now and then, more if the Yankees insist on building his stamina up. 

 

Michael Pineda

The Yankees are shifting Michael Pineda's next start from a rehab outing to a key game against Baltimore. Pineda has done well in his rehab starts, but he's not stretched out. That means he'll likely go a short outing and will be shadowed.

Remember, stuff hasn't been Pineda's issue, but recovery has. How Pineda reacts between starts will be more telling than anything he does against the Orioles. Don't be fooled by strikeouts or velocity, no matter how positive.

 

Wil Myers

Wil Myers is very close to a return. The Rays could use his bat and to see what they can expect from him next year. It's been a tough second year in the majors for Myers, with both injuries and adjustments. He can still crush a mistake, but the Rays are hoping that he can become a more complete hitter while staying healthy.

He still has a ton of potential, but seeing the power back after a wrist injury is a good sign for the present.

 

Troy Tulowitzki

After previous groin issues, Troy Tulowitzki's problems remain, but it may be more serious than previously thought. The Rockies are sending their shortstop to Marc Philippon in Vail, Colorado, who specializes in athletes' hips.

Philippon has surgically repaired the hips of several MLB players, including Chase Utley and Alex Rodriguez. If Tulowitzki does need surgery, he could return for the start of next season, though it could complicate the idea of a trade—unless a team already has a comfort level with the doctor and rehab. Like the Yankees?

 

Brett Anderson 

Brett Anderson is sidelined by yet another injury. This time, it's a serious back problem that could lead to surgery. Anderson consulted with multiple surgeons about his bulging disk and is now headed for surgery on Thursday, according to MLB.com's Thomas Harding. If so, that would not only end his 2014 season, but it could put the start of his 2015 season in jeopardy.

He's injury prone, but Anderson's never shown, despite those injuries, that he's lost any talent along the way. Some team will take a chance on him if the Rockies elect to pass on his option. Anderson and his agent would be smart to align him with a team that has experience rehabbing pitchers from this kind of procedure, like the White Sox or Rangers.

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Under the Knife: MLB Injury Analysis on McCutchen, Tanaka, Lee and More

A.J. Preller is the new general manager of the San Diego Padres. He's a great pick in my opinion. He's the consummate scout with the ability to find and manage international signings in the new limited environment, as well as a snappy dresser.

Preller obviously has the scouting background but also has a scouting mandate in his new position as well. The Padres were focused on people with similar backgrounds, with Billy Eppler and Mike Hazen the other finalists for the position. The Padres are obviously looking to build through the draft, which Preller should be well set up to do. 

However, the Padres should focus on one other area, one that could pay more immediate results. The team has some of the worst team health results around. Only the Yankees are worse over the last three years at keeping their players on the field. The Padres have lost over 4,000 days to the disabled list, something they can't absorb the same way the Yankees accept. (Data is from my proprietary Injury Database.)

Finding and developing players can take years to pay off. Even with top Preller finds like Jorge Alfaro and Nomar Mazara making it to Double-A more quickly than many expected, it's still a timeline that is tough to sell to a fanbase. Fixing team health can be done quickly. We've seen several massive turnarounds with renewed focus around the league.

Preller is bound to surround himself with some very smart people. He should definitely make sure he has the same with the medical staff. He's seen this year that bad luck and injuries can combine to tear down a talented team quickly in Texas. It's the easiest and cheapest path to improvement the Padres have. I'm sure Preller doesn't need my advice, but he knows how to find me if he wants more suggestions. For now, let's look at the injuries around the league...

 

Andrew McCutchen

It's impossible to say that Andrew McCutchen's avulsion fracture is a direct result of the pitch that hit him in roughly the same area. Then again, if you see a guy in a ski mask standing outside a stereo store that's just been robbed holding a bunch of boxes, you might want to check on him. 

But that's about assigning blame, as many are doing including this insightful look by Joe Starkey. I can look at an injury and wonder, but when I asked how an avulsion fracture might have happened, things get pretty technical but seem to circle back to the hit. One team physician told me "the avulsion is easy to explain. He twisted too hard, but that normally doesn't happen. Normally the muscle or cartilage gives, but if the back was in spasm at same time he swung, well, that's a bidirectional pull that might just create the avulsive force."

This kind of injury has a standard recovery of four to six weeks, but the Pirates are holding McCutchen off the DL so far. They're waiting to see how his body reacts to the injury and treatment. If they can keep him functional and the pain manageable, there's little chance he could do significant damage. "The bone is already pulled, but it's hardly the only point of contact like you would see with a ligament," said the team physician.

There's little harm in wait-and-watch for the Pirates. Maybe McCutchen comes back and they save 10 days he could have been stuck on the DL. Maybe they're just waiting for Starling Marte to return from his rehab assignment. A retro DL move is in place if needed, so McCutchen's immediate future remains unclear. 

 

Masahiro Tanaka

Playing catch doesn't seem like much, but for Masahiro Tanaka, it was huge. Tanaka made it through two throwing sessions and will now start to amp things up carefully but not slowly. The Yankees have outlined a rehab throwing program that could have him on a mound as soon as next week, according to the New York Post.

This accelerated timetable is still cautious. Any pain or problem with recovery will send Tanaka back, perhaps to a shutdown or even surgery. There's always going to be a risk that his healing UCL will snap, but as baseball pitchers have shown us this year, they're all at risk. 

The Yankees could be creative here. Instead of sending Tanaka down to rehab, why not let him go three or four innings and shadow him with a long man or a returning player like Michael Pineda? Using another starter would be tough because both have normal routines they like to use, but utilizing all their assets as they push toward the end of the season is key if the Yankees want to get into the playoffs.

(Quick note on another Yankees pitcher: CC Sabathia had his knee surgery on Wednesday, and things went well. Dr. Neal ElAttrache found a bone spur inside his knee that hadn't shown up on images. That was removed, he got some cleanup and injections and will start his rehab immediately. It's a very positive report.) 

 

Cliff Lee

The Phillies didn't trade Cliff Lee before the deadline and just after it? Well, they won't be dealing him in the waiver window either. Lee's flexor tendon has been re-damaged, and while this is a similar location, the early indications are that it's not in the exact same spot. It's not clear because as of Wednesday, Lee still hadn't had an MRI, per the Philly Inquirer.

Part of the reason is the team clearly thinks Lee is done for the season. However, it's important to do the normal rehab up to a point, if only to have some clarity about Lee's future. If he needs surgery, it would behoove everyone to do that as quickly as is possible. If he needs rehab ahead of any major decision, that needs to start quickly as well.

A re-strain of the area, regardless of specific location, certainly points to a problem. Lee has a lot of mileage on his arm, and something is breaking down that one area. The Phillies would be smart to have Lee's biomechanics checked once he's back to throwing to see if something could be pinpointed, but the team has done very little with this in the past. 

 

Matt Garza

The Brewers don't have a big margin for error in the NL Central. While many are surprised the Brewers were ever in first at all, the team is holding on largely because of its pitching. They've gone three deep with Matt Garza, Kyle Lohse and the homegrown Yovani Gallardo, while filling in the back with a variety. 

Garza's oblique strain is mild but just enough to hold him out for a start or two. Because of the uncertainty, the team elected to DL him, call up a replacement and hope that having him healthy for the stretch run will counteract the loss of three starts. 

The team's Big Three has been very healthy this year, as has the rest of the team for the most part. A run of hamstring injuries and the loss of its big bats last year was a fluke, letting the team get back to contention at the same time it gets back to health. That's not a coincidence. 

Garza does have a history of injuries over the past few seasons, including an oblique strain last year. Garza's experience with it helped here. He got the injury checked early, which should keep it from being as serious as he dealt with last year. 

 

Edwin Encarnacion

Edwin Encarnacion is nearly running again. A setback late last month not only cost Encarnacion time in getting back, it's made it necessary for him to head on a rehab assignment. The Jays are hoping it's short, says Shi Davidi, but he's got some hurdles to get past before that happens.

Encarnacion's quad strain has grabbed again on a couple occasions despite it being described as a mild strain. That indicates the problem is in a difficult or weak location. This kind of injury can be very recurrent, and unless the team is willing to simply say "don't run," Encarnacion will need to have the leg healthy. Even at first base, several of the motions require quad involvement, so even an Encarnacion-in-statue mode would be risky.

The Jays have a split personality with team health. They've got terrible results with pitchers but great results with position players. That gives Encarnacion some hope. If he can get back this week, watch for signs that his swing hasn't been affected. Any sign of power—line drives, gap doubles, light tower homers—would be a big positive. 

 

Torii Hunter

Torii Hunter got lucky when a pitch off his hand left him with nothing more than a painful bruise. It's just another situation where an existing technology—a padded glove, like this one—could have prevented an injury. I don't understand why players, especially players who have broken bones in their hand, don't wear them. If I were an owner or GM, I'd put incentives in contracts for players who would wear state-of-the-art protection against them ending up on the DL. 

 

Michael Wacha

Tanaka wasn't the only one whose game of catch was significant. Michael Wacha is back throwing a ball after time off to let his shoulder heal up from a stress reaction. That's a positive, according to MLB.com, but he'll need to make it through several more steps in his rehab-throwing program before the Cards know if or when they'll get him back. They've been creative with use this season, but with new depth, they could be even more creative with Wacha. 

 

Gerrit Cole

Gerrit Cole's latest rehab start was a mixed bag. He showed good velocity and got to his pitch count, but he got knocked around some (10 hits) and lost velocity. He'll need to show more in his next time out, which is one more start than the Pirates initially planned for him. The team will be watching closely, hoping that Cole can get back and supplement its NL Central chase down the stretch. 

 

Allen Craig

Allen Craig's time as an active Red Sox player was brief, but suggestions that his foot has been the reason for his disappointing season strike me as reductive. The Cardinals staff is topnotch, and the team uses extensive video analysis. I have to think one of those two would have detected something, even if Craig wasn't telling them. We'll see if the Sox can get him on track for next year, but being healthy can't do anything but help. 

 

Joe Mauer

The weirdest thing about Joe Mauer and his rehab is that it's almost a non-story. He DH'd in Cedar Rapids (A) and seemed fine, but Mauer at 31 has become a forgotten player it seems. The Twins have four more big-dollar seasons of their hometown hero, but at this stage, he's closer to becoming Ryan Howard than Harmon Killebrew. The move to first hasn't helped, so the Twins had better figure out what will or suffer the small-market consequences. 

 

Andrelton Simmons

The Braves are hoping their defensive wizard, Andrelton Simmons, can avoid the DL after spraining his ankle. David O'Brien notes that the early signs aren't positive, but the team will wait on a decision. This is one situation where playing a man down might really help things, but it would go against the pattern of Fredi Gonzalez. 

 

Ryan Zimmerman

Ryan Zimmerman has a Grade 3 strain of his hamstring, but the Nats insist that the six-week time frame they're giving is real. A near rupture of the hamstring will normally keep a player out for months, so what's the story? Much of the speculation I've heard—and let's be clear, I haven't been able to confirm this—is that Zimmerman's injury is to the semitendonosis.

This muscle's tendon is often used in elbow and knee reconstructions so the body can work without it. The idea is that essentially Zimmerman did a "self surgery," but that once he recovers from the trauma, he could function. We'll see in a couple weeks if he's able to get back out and run. It's unclear what the Nats will get if he does come back, but the possibility they get something remains plausible.

 

George Springer

Another setback for the Astros? Yes, George Springer was close to a return after playing in Quad Cities (A), but the quad appears to have been reinjured while legging out a double. It's tough for players to play "smart" in rehabs. They shouldn't go all out, just get their work in and heal up, but that's not how most are wired. Evan Drellich has the details, but don't expect Springer back for a while as he restarts the process. 

I'll be in Texas next week for a great event. Not only is it great to be on stage with Don Welke and Jon Daniels, both taking questions, we'll be raising money for Richard Durrett's family. If you're near Arlington, come see us on Wednesday. I'll also be doing an event with The Scoop on Thursday in the area. I love getting out and meeting readers and new friends, so hopefully you'll see more of these in the near future.

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Under the Knife: MLB Injury Analysis on Tulowitzki, Tanaka, Harvey and More

The trade deadline is always an exciting time around baseball, but if you look closely, team health feeds the deadline. Teams are replacing players they expected to have. They're buying expensive pitchers to soak up innings that young pitchers can't handle. They're valuing prospects not just on talent, but risk. 

Front-office types will be burning up the phone. Scouts will be watching and reporting. Medical staffs will be called in to check files and physicals will be taken. With everything that is measured in baseball now, they're still left guessing in many situations about injuries, risk and value. 

Again, we have an asymmetrical situation. Some teams will have more information or analyze it more accurately. Some teams will miss something or ignore an element they shouldn't have. A trade will succeed or fail based on an injury. Go ahead—look at some of the deals from a few years back and tell me how many injuries you see.

There's no area in baseball untouched by sports science and sports medicine, but too many teams leave those areas underserved and underfunded. The injuries of tomorrow might have been noted today, but from out here, we'll probably be left to guess. Maybe the trades that weren't made were successes because an injury acquisition was avoided. 

It will be hours before we know who moves at the deadline. It will be years before we know whether the deals worked, or maybe a couple months, when a team moves into October. For now, let's look around the league at the injuries this week...

 

Troy Tulowitzki

Needles. Groin. You never want to hear those two words in the same sentence. Troy Tulowitzki—yes, with a T—got to experience dry needling this week in hopes of avoiding another groin surgery. Tulowitzki was checking in with his surgeon and, while surgery isn't happening yet, it's still on the table.

Dry needling is a relatively new technique that's not far off from acupuncture, though it doesn't use the same principles. Essentially, it's just stimulating an area. You may not want to check out this video if you're squeamish, but it does show things clearly.

Tulowitzki's groin is problematic, chronic to a point and certainly makes it difficult for the trade that whispers have him pushing for. It's more likely that he'll have to wait until the offseason for a move.

In the meantime, he'd like to get back on the field to show that he's healthy enough to trade for. We won't get much of a chance until mid-August, if then, but look for any signs of physical activity, even jogging, to get a sense of which direction this is going.

 

Masahiro Tanaka

Masahiro Tanaka reported last week that he was still having some pain in his elbow. This week, things are getting better every day. What changed? Well, nothing.

Tanaka had a PRP (platelet rich plasma) injection into his elbow. That injection is designed to inflame the area slightly and accelerate the healing process. Several doctors have told me that soreness in the first week after the injection is very common, especially if the injury is still in the acute phase. 

If Tanaka's progress really is progress, and if the PRP is helping even in a small way, it's a huge, massive win for the Yankees. Timing is almost irrelevant here since, if he does need Tommy John surgery, he'll miss all of 2015.

He could go all the way into December or January and not truly affect a 2016 return, so there's no rush, though certainly if he shows that he can come back and pitch, the Yankees would love to have him back.

We should get more indication in the next 10 days. Tanaka will likely play catch around that point and it will be very telling. Matt Moore couldn't make it past that easy stage and headed for surgery, which isn't uncommon. While we still don't know which way it will go with Tanaka, we're getting closer. 

 

Edwin Encarnacion

The Blue Jays don't have the best record of team health, but they're actually very good at keeping their position players healthy. It's a bit surprising that Edwin Encarnacion has taken as long as he has coming back from what was said to be a mild quad strain. The absence is going to force a rehab assignment now, pushing his return back at least a few more days.

Sources tell me that the setback he experienced a few days ago wasn't any re-strain of the muscle, but was merely some excessive soreness. Because of the location of the injury, low near the tendon, the Jays elected to back off a little, add some therapy and see how it went. So far, so good.

Encarnacion isn't a speed player, but injuries like this can throw off a player's hitting base. Joey Votto is an extreme example, but watch to make sure that Encarnacion is hitting well, not missing and showing some signs of power when he does go out on his rehab assignment.

If it happens this weekend, as is possible, he could be back by next week. 

 

Brandon Morrow

Brandon Morrow is closer to a return, but he won't be back as a starter. Instead, the oft-injured Jay will work out of the pen. It's not the worst idea, but my question is whether he'll be used to the best extent, assuming that the organization isn't doing it because they don't think he can stay healthy as a starter.

The job descriptions are telling: starter, reliever, closer, lefty specialist. But shouldn't it just be pitcher? Bo Porter, manager of the Astros, barked earlier this season that he didn't care about roles, just that his pitchers get outs. Easy to say when the pen didn't really have any standouts and the team isn't winning. Porter hasn't really had much in the way of innovative pen usage either.

Morrow, assuming everything is normal with his finger when he does return, is clearly not a one-inning guy. He's gone multiple innings, even complete games in the past. A finger injury shouldn't change that.

If John Gibbons and the Jays can't figure out how to leverage a player like this, using him as a long man, a swing starter or a shadow to keep the workload down on Marcus Stroman, then I just don't think anyone will buck the book.

Managers will say they don't manage to a stat, but with the pen usage of modern baseball, it's worse than that. They clearly manage to the save, leaving their best arm sitting in key situations. They won't use the eighth-inning guy in the seventh, despite the leverage. They're often lost in extra innings and nearly unwilling to use a quick hook. 

Morrow's situation isn't unique, but it is as clear an opportunity as I've seen for a creative, thoughtful usage of an asset. The Jays consider themselves contenders and need to maximize every possibility. Not using an asset like Morrow to his fullest reasonable extent is simply poor management. 

 

Ryan Zimmerman

A Grade III hamstring strain is about as bad as it gets. In most cases, it's a rupture—a complete tearing of the muscle. It can be used when the tearing is bad enough that any load will damage it further, where the structural integrity is damaged. It can often be surgical, though it depends on which of the muscles and the location of the tearing.

In other words, this is bad for Ryan Zimmerman, if you believe Bill Ladson's report (and I do.) Already plagued by shoulder problems, Zimmerman now has a significant leg problem to add to it. He's already not the fastest player, but dropping more speed might make playing the outfield even tougher. 

It's extremely unlikely that Zimmerman will make it back this season from a severe strain like this. It's not impossible, especially if he does a Kirk Gibson and hobbles up as a pinch hitter when rosters expand. The Nats are sticking to their eight-week timeframe, so while in most leagues, I'd say drop Zimmerman now, deeper leagues might want to wait just a bit.

 

Mythbusting

If you follow the trade deadline closely today, you'll likely hear someone say that a player can't be dealt if they are on the disabled list. That's untrue. Any player, no matter their injury status, can be traded. As in most cases, a player has to be accepted, meaning they "pass" the physical. 

A "pass" doesn't mean that a player is injury-free. It's essentially saying that they're willing to sign, or in this case, transfer, the contract as written. The acquiring team is also taking responsibility for the player, incurring any further medical costs. That's a big deal, but not insurmountable in the right situation. Some have even suggested it could be a market inefficiency. 

Justin Masterson is just the latest example. He's on the DL now, expected to be activated on Friday for his start, though the Cardinals (assuming his knee and the rest of him pass the physical) may change that schedule. John Mozeliak knew he could make a deal for a DL player and is counting on his medical staff to make it work. Now you know. 

 

Matt Harvey

Matt Harvey has been cleared to throw from a mound starting Friday. It's another step in the deliberate process the Mets are taking with his rehab.

Don't expect huge things from these early sessions. They're not about velocity or stuff, just merely getting in the work and stepping forward. There's still a chance Harvey gets a late-season cameo, even with the Mets being as conservative with this as they have been.

We'll definitely see Harvey in games this year, probably in Brooklyn not Queens. 

 

Wil Myers

Need to sneak another bat onto your fantasy roster? Wil Myers is getting ready to start a rehab assignment in the near future and should be back for Tampa in mid-August.

He didn't hit well before his injury, something of a sophomore slump, but he still has talent. The Rays are playing well right now and getting Myers and Jeremy Hellickson function as deadline acquisitions.

If Myers hits quickly and well, he's a big boost, but don't expect power to be instant after a wrist fracture. Look for any signs its coming, like hard-hit balls and gappers. 

 

Michael Bourn

Michael Bourn is a speed player. He has a chronically bad hamstring. Surgery didn't cure this, as it often doesn't. The advantage is that Lonnie Soloff is charged with getting him back out there and Soloff has experience. He first got noticed for his work with Ken Griffey Jr.

Bourn's a much different player than Junior, and if the speed isn't there, he'll have to adjust.

The Indians would settle for seeing him on the field right now. Bourn is closer, taking batting practice, but there's still no date for a rehab assignment, according to the Cleveland Plain Dealer. He's at the long end of the three-to-four-week estimates, but the Indians will want to see him not only play, but recover, so don't expect him back too soon.

 

Derek Holland

Derek Holland is coming back from knee surgery that has cost him the season so far and, with the paucity of success of microfracture in baseball, he's going to have to beat the odds as well.

It was a good first step for him in Frisco (AA) where he got in two innings of work. He didn't have great control (two BB) but he did dominate with four strikeouts. He'll step up the stamina next time out and should use most of the 30 days of his rehab before a possible return to Arlington.

 

C.J. Wilson

C.J. Wilson made it through his Monday rehab start, going 81 pitches over five innings for Arkansas (AA). He didn't have any apparent trouble with his ankle or the hip that he now says was the real issue.

His stamina is already up there, so it should be a normal start for him Saturday. Watch to see if his feet are moving well, especially the back leg where Wilson says the real problem was.

 

Starling Marte 

The Pirates were involved in a lot of trade rumors this week, including some about Jon Lester. To get Lester, they'd need to have a package of prospects, and Marte could be the kind of game-ready, under-control player who would fit in nicely in Boston.

Of course, the Pirates would rather keep him alongside Andrew McCutchen and Gregory Polanco, but sacrifices are sometimes made to long-term plans, even when it's Neal Huntington at the helm.

Marte is still having some issues with his concussion, according to the Pittsburgh Post-Gazette, wavering with symptoms. This isn't uncommon at all, and the Pirates are monitoring him closely. He won't be off the concussion DL when eligible, but there's no way to say just how long he'll be out. There's no sign this will be extended, but concussions follow no pattern. 

 

Gerrit Cole 

Gerrit Cole looked great in his first rehab start, done at Indianapolis (AAA). He'll have one more start, this coming Saturday at Indy's Victory Field.

If he can show the same kind of stuff and have no setbacks with his strained lat, he'll be back in Pittsburgh for his next outing. The velocity was back for sure and Cole seemed to be focused on the attack, which is a positive.

No one seems too worried about a lat strain here after his shoulder injury, but it isn't a great pattern. Sources tell me the Pirates want to keep Cole healthy and focus on some changes in the offseason that they think will help.

 

Mark Appel

Wondering why the Astros sent Mark Appel to Corpus Christi (AA) despite a poor run in Lancaster (A)? The answer isn't entitlement, but system. A source tells me that the Astros have a system called Kinatrax installed in Corpus Christi, though I could not confirm this. Given some of the statements that came out about additional tools, this makes some sense now. 

Kinatrax is a multi-camera markerless biomechanics system that can show many things that could be used to analyze Appel beyond the results. (Corpus Christi also has a Trackman system installed, but those are pretty widespread. They're pretty easy to spot as well, with a flat radar panel installed directly behind the plate.)

A couple teams, including the Mets, have been testing this kind of system, but the results are unknown. We'll see how the Astros use it. With someone like Brent Strom running the pitching program, it could be a big weapon. I wonder if there were any mentions of this system in the Ground Control leaks.

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Under the Knife: MLB Injury Analysis on Tulowitzki, Teixeira, Wacha and More

Brady Aiken will go down as one of the most intriguing draft stories in the history of the MLB, no matter how it goes. Like most draft picks, it will be years before we know whether the Houston Astros missed out on a top talent (or three) or whether they dodged a bullet.

Aiken's physical cost him an agreed-upon $6.5 million as he elected to walk away. That's confidence or folly, and no one knows which.

The reason, however, is known. Aiken was found in the physical to have a smaller-than-normal UCL. That's the ligament that would be replaced in Tommy John surgery.

Many compared Aiken's situation to that of R.A. Dickey, who lost a bonus when he was discovered to have no UCL at all. The situation is different; it's not apples to apples, it's apples to no apples.

Aiken's "small" ligament is still functional, and that's the key point here. While it is demonstrably smaller than expected, it's not demonstrably weaker. The fact that it handles 97 mph stuff tells us that either Aiken is exceptionally efficient or the small ligament is stronger than it's size would indicate. 

Aiken was checked by three doctors, including Dr. James Andrews, who cleared him to pitch. However, the Astros' doctor (or doctors, more likely) indicated that the ligament was an issue.

Now, let's be clear—it is not known whether the Astros "failed" Aiken, and it's frankly semantics. They used the adverse finding to try to get a discount above what they had already negotiated, and Aiken walked.

That's a risk for both.

Are there tests that would check the strength of the ligament? Not really. I spoke with several doctors, including one that examined Aiken, and none seemed confident in any extant test. More than one of them suggested a biomechanical evaluation, but it seems that neither the Astros nor Aiken wanted that. Aiken's camp was already perturbed about leaks from the Astros about his physical. 

Aiken has some decisions, but this one will be an interesting one to follow. Maybe Aiken is another Gerrit Cole who goes to college, matures and succeeds. Maybe he'll be back in the draft next year. It's unlikely that he'll be a free agent, but we do know he won't be an Astro. Everything else is unknown, but very, very intriguing, in many ways, including medically.

There are plenty of major leaguers with injuries this week, so let's look around the league...

 

Garrett Richards

Jerry DiPoto told the media that the L.A. Angels weren't going to put any specific restrictions on Garrett Richards this year, as noted by Alden Gonzalez MLB.com. Part of the reason is that he doesn't have "a violent delivery." I'm not disagreeing with DiPoto here, but the fact is, he doesn't know.

The Angels aren't a team that does much with biomechanics, so he's guessing based on looks. DiPoto certainly knows pitching and has people around him that know as much, so it's a very educated guess but nonetheless a guess. He could be right, he could be wrong, and he could be gambling with Richards' arm.

I'm not advocating for an innings restriction or a shutdown here, but I'm advocating not guessing. Without biomechanical data, the Angels could measure Richards' fatigue in a number of ways. If they're doing that, awesome, but all my sources indicate that like most teams, they're not. 

Richards is facing a major innings increase if he continues at this pace, but there's no other evidence of fatigue that's noticeable. The Mariners saw 98 last time out, so his fastball isn't tired. Until Richards gets north of 180 innings, he's not in dangerous territory, and at age 26, he's not the type that's most at risk either.

 

Troy Tulowitzki

Another season, another injury for Troy Tulowitzki. "Tulo" stayed healthy enough to play opposite his hero, Derek Jeter, in last week's All-Star Game, but he quickly ran into more problems, literally. Tulowitzki was placed on the disabled list by the Colorado Rockies on Tuesday due to a strained hip flexor, noted by Cody Ulm of MLB.com.

The injury, suffered last Saturday, is just the latest in a string of injuries that have kept Tulowitzki off the field. When on it, he's great as all his numbers show. The downside is that these recurrent leg injuries indicate some sort of movement problem that isn't being corrected.

I asked Lenny Macrina of Champions Physical Therapy in Boston, one of the top sports PTs around, about this, and he agreed:

He most likely has some form of hip or lumbopelvic dysfunction with imbalances in ROM or core strength leading to his recurrent hip-flexor strains. If he doesn't stabilize well through his pelvis and has a dysfunctional movement pattern, then he will over-stress and overuse the surrounding musculature leading to injury.

What Macrina is saying is that Tulowitzki keeps having the symptoms fixed but not the problem. Without that, he'll continue to have similar, related issues. It's a very difficult fix, especially given his on-field success. The injury doesn't really affect his trade possibilities, since all the sources I've spoken with over the last two weeks have indicated that Tulowitzki was essentially untouchable. 

His return to the lineup will be conservative, especially if the Rockies fade further without Tulowitzki in the lineup.

It's going to be a very interesting offseason in Denver. 

 

George Springer

The Astros have plenty of other problems, but few of them are as important as keeping George Springer healthy. Springer has been solid for the Astros since coming up, putting up great power numbers but missing a lot of balls. The floor on Springer is pretty high, but to keep that floor stable, he'll need a solid base.

That base is the problem. Springer is having lower-body issues, if you listen to the Astros' hockey-like statements. The real problem is not dissimilar to what Joey Votto is going through. Springer has a problem in his lower quad, near the knee. This kind of soreness is often akin to "jumper's knee" but really prevents a player from getting a solid base.

Springer still has plenty of power, but even more than Votto, it's key to the Astros' future to keep this from becoming a chronic problem. Not only could it sap power, but it could hurt his range and his speed.

The Astros can afford to be very conservative with Springer, and they'd be right to do so. While he's a nice Rookie of the Year candidate, they'd rather he be on the field healthy next year than take home a trophy this year.

 

Michael Wacha

The Cardinals got some good news on Michael Wacha. Not great news, but good. Wacha had an MRI on his shoulder, and things look like they're healing up on his scapula. The stress reaction is less stressed, and Wacha is a bit closer to throwing.

At this point, he's still got a couple weeks of healing, and even then, this is the kind of problem that could quickly recur. Aside from letting it heal up, there's not much the St. Louis med staff can really do here. The root cause is likely throwing, and it's not like Wacha can stop doing that. 

This type of injury has been recurrent in the small number of pitchers that have had similar injuries. The plus for Wacha is how quickly they caught it, so there's hope there. What we don't know is how much hope. Once Wacha starts throwing, every day of pain-free and injury-free throwing is a major plus.

I feel pretty positive about it, but since it's nearly impossible to make significant changes, there's just no way to have Wacha be anything but risky. Risk is fine if it's matched with reward, and Wacha has the kind of upside to make buying all the Maalox worth it. 

 

Mark Teixeira

"Injury prone" is a word that is thrown around too easily. It's not even the right term for Mark Teixeira. Usually a durable player, Teixeira has actually followed a nasty pattern that I hadn't seen coming. I call it the "Iron Man" effect, after Cal Ripken. Once a very durable player starts to have physical problems, things can get out of hand quickly. Ripken is one example, as is Johnny Damon. 

Teixeira hasn't been as durable as those two, but he's been above average. He was a 162-game guy a couple times and a 150-game guy otherwise, until he wasn't. Expecting him to come back to those levels now, after wrist, back and other minor problems, is folly. 

His latest issue is a minor lat strain, which is not related to his other back problems, at least not directly. The Yankees are going to try to let him have a few days off to heal up. They think he can avoid the DL, but the option is open. Joe Girardi normally doesn't like to play short, so that's a positive sign.

The downside here is that it's one more piece of maintenance work that the New York med staff has to do day to day as it tries to keep the entire team healthy. Adding in a player like Chase Headley and his back maintenance really taxes the staff even more.

If the trainers can hold this team together with the equivalent of duct tape and get it to the playoffs, that will be a feat.

 

CC Sabathia

CC Sabathia will have his surgery on Wednesday, and all is expected to go to plan in Los Angeles. Dr. Neal ElAttrache is doing the surgery and seems confident, as does Sabathia, that he can be back next year.

It will be tough to track this until the spring, but if Sabathia is doing normal, daily activities this offseason, that's a very good sign.

What's less clear is whether Sabathia needs to lose weight.

Weight on its own is not the best indicator of stress on the knee. It's much more biomechanical, which is something we just can't know until after the surgery and the healing. We simply won't know until January, just ahead of spring training.

 

Michael Pineda

The Yankees are getting some positive signs from Michael Pineda. In what some called a last chance, Pineda has made progress, though he's still having issues with his shoulder.

He'll throw two batting-practice sessions this week to gauge how much pain and inflammation he has. If they can get him through that, he'll head out on a very short rehab assignment. He won't get up to full stamina on the rehab assignment but can help a short staff with even four or five innings. He'll build up on the fly, if possible.

Pineda's issue has been between-start recovery, so the Yankees appear to be a bit desperate to get any kind of value out of him.

 

Yasiel Puig

It's not easy for players to switch to wearing a padded glove. Troy Renck, the longtime Denver beat writer, and I had a discussion about it, and it's as much about mental comfort as physical. Players get very comfortable with certain things, in a lucky-sock kind of way. Even when it's in their best interest, as a padded glove would be, it's hard for someone to change.

Maybe Yasiel Puig will consider it after taking a hard fastball off his hand. He got away with nothing more than a bruise, but it could have been worse.

Without changing gloves, next time might be.

 

Josh Beckett

Josh Beckett isn't healthy, but the hope is that the hip impingement has been helped enough by a cortisone shot that he can be effective. The Dodgers will have to watch this one closely, but Beckett isn't your normal pitcher at this stage. He understands the risks and is hoping to push for one more chance at a ring. Watch to see if he's able to get full extension or is shortening his stride or follow-through.

If he does start well, there's also the question of keeping him healthy between starts, so Stan Conte's going to have some long nights.

 

Michael Cuddyer

The Rockies lost Tulowitzki for a while, but that doesn't appear to change the timeframe for Michael Cuddyer. The latest MRI on his injured shoulder showed some progress, so he'll amp up his work and build towards a mid-August return.

The team may not want to trade him, as it's said, but he could be a nice waiver-trade guy for a contender who needs a bat. He could always re-sign with the Rockies if they want him that badly. That kind of "boomerang deals" happen all the time. 

 

Joey Votto

Dr. Tim Kremchek was on WLW with Lance McAlister on Tuesday and discussed Joey Votto. Kremchek said that Votto was doing well, but that while he wanted to be on the field, they had to keep a long-term horizon for his quad issue. Kremchek acknowledged that the Reds are going to have to stay in the race to get Votto back for September.

The bigger question now is whether Votto's situation can be kept from going chronic. At this stage, he couldn't even DH, and the Reds don't even have that option.

 

Late Scratches: Both Manny Machado (Orioles) and Pedro Alvarez (Pirates) left Tuesday's games with what are thought to be minor injuries. Keep your eye on both of these key players for playoff contenders.

You can follow me on Twitter (@injuryexpert) for updates.

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Can Yankees’ CC Sabathia Still Be an Impact Pitcher After Latest Surgery?

There's seldom good news when a player is ruled out for the rest of the season. For CC Sabathia and the New York Yankees, there's actually very good news in the announcement that he'll miss the remainder of the 2014 season due to impending knee surgery, as noted by Bryan Hoch of MLB.com.

Sabathia has been out since mid-May with knee problems. He made a rehab start and had a setback. Instead of heading back to Dr. James Andrews, Sabathia checked in with several surgeons, leading many to expect Sabathia to have microfracture surgery. Instead, the Yankees announced that Sabathia will have an articular cartilage debridement, which is a cleanup and smoothing. This type of procedure is far less problematic than microfracture

Sabathia saw several surgeons, but when it was announced he was seeing doctors that did not specialize in microfracture, such as Dr. Dick Steadman, who pioneered the procedure, there was some hope. After seeing Yankees team physician Dr. Chris Ahmad and Rangers physician Dr. Keith Meister, Sabathia chose to go with Dr. Neal ElAttrache

All are qualified surgeons, but ElAttrache has a great track record with knees. One of ElAttrache's best known cases is not in baseball, but the return of Tom Brady after an ACL reconstruction is one of the best results we've seen. ElAttrache also put Zack Greinke's collarbone back together aggressively, getting him back on the mound quickly, and repaired Kobe Bryant's ruptured Achilles.

The normal recovery period for this type of surgery is varied. In some situations, a player could return in as little as two months, but the Yankees realize that Sabathia's size and the internal damage in his knee are significant enough that rushing him back for this season would be counterproductive. Instead, they'll focus on getting him ready for next season, much as they did with Derek Jeter late in 2013.

"Because we're in July, I think he'll come into spring training, in theory, ready to go," Yankees general manager Brian Cashman said via Hoch of MLB.com. "Given the number of things that have gone on, we'll have to be careful with him nonetheless."

The rehab for this type of operation is relatively straightforward. Sabathia will have around eight weeks of normal therapy as they focus on making sure the knee heals up well after the procedure. There will likely be a focus on making sure his secondary stabilizers are strong and that his pitching mechanics will not put an undue stress on the repaired portion of the knee. 

Past that, the Yankees will focus on maintenance. Making sure Sabathia doesn't have problems between starts or at least making sure the problems are manageable will be key. Overall conditioning is not likely to be a major concern, but if any specific mechanical changes are needed, the Yankees want to give Sabathia plenty of time to adjust.

The fact that Sabathia has avoided microfracture is a major positive. While the procedure has been used for nearly 20 years in helping certain knee issues, it still has a very low percentage of success in baseball. There's really no explanation for that, but the fact remains that there are few successes. Avoiding the procedure, at least for now, gives the Yankees one less thing to worry about heading into 2015. 

The best comparable situation in baseball is not a pitcher. Instead, it's Chase Utley, the Philadelphia Phillies second baseman who had two straight years of problems with damage inside his knees. The Phillies struggled to get Utley back to function, unable to find a maintenance program that would keep him on the field without significant swelling.

It took some time, but Utley has been very solid since coming back. Utley faces a different situation than Sabathia. He has less specific demands on his knees, but he has to play every day in the field. Sabathia will have the normal off time between starts, so some swelling wouldn't be devastating, though it would indicate that there are further issues.

While the Yankees can't count on having Sabathia back for 2014, they certainly have to feel better about the chance of having him take his turns in 2015. If they can get Sabathia at the top of the rotation alongside Masahiro Tanaka (who is still hoping to avoid Tommy John surgery, per Howie Kussoy of the New York Post) and keep them both healthy, they'll be a far better team.

To do so, New York's medical staff will have to overcome a lot of challenges and show better results with maintenance than it has in the past. As Mike Axisa of RiverAveBlues suggests, Cashman and the Yankees should take a hard look at their plan for 2015.

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Meet the 10 Super Surgeons Tasked with Putting MLB’s Broken Arms Back Together

This is the All-Star team of sports medicine. After consultation with people around the world of baseball and sports medicine, I've compiled a list of 10 "Super Surgeons."

This is my version of this kind of list, and I believe it remains important. The fact is that while these 10 physicians are stars in the sports medicine world, they are largely unknown to sports fans. While we all worry about the epidemic of arm injuries in baseball, it's ironic that we know so little about the men who attempt to heal those same injuries.

While many would recognize the name Dr. James Andrews, few know how he got to where he is. Did you know his athletic background is not in baseball or football, but track and field? (He was a pole vaulter.) Do most super surgeons come from the same background or top medical schools? Not at all. 

Their stories are as individual as the athletes they help. Most played sports and came to love them, but topped out and found a new way to keep their passion for competition alive after medical school. (That's a pretty good plan B, after all.) All are exceptionally qualified and passionate about their profession. They are athletes and most are younger than expected. 

While it will surprise no one that Dr. Andrews remains at No. 1 this year, there is always the question of who the "next Dr. Andrews" will be. If anything, this list reminds us that sports medicine is in good hands for years to come.

If Dr. Andrews retires in the next few years, there may be a reshuffling of who goes where from what teams and agents, but the quality of care should remain constant, largely because of a focus on education and research, fueled by Dr. Andrews and Dr. Frank Jobe, who passed away earlier this year.

A significant portion of the doctors on this list were trained by one of those two doctors or those whom they trained.

Sadly, Dr. Jobe is not the only loss. Dr. Lewis Yocum, who was on both previous lists, passed away in 2013, though his work lives on. This list, as you will see, tends to trend down to the next generation and even beyond, which means that sports medicine is in very good hands.

This list is hardly comprehensive, as there are far more than 10 worthy physicians out there. Teams around baseball (and other sports, since there is a massive crossover) have hard-working and well-qualified medical teams. If I wanted, I could go 20 or 30 deep with this list, but I've always thought the simple top 10 worked best.

For now, let's meet this 2014 class of Super Surgeons.

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For Masahiro Tanaka, Injury Is About His Mechanics, Not His Splitter

Masahiro Tanaka may have been a high-priced addition to the New York Yankees last offseason, but he's been an invaluable pitcher through the first half of the season. With CC Sabathia out for this season with knee problems and losing several others to injury, Tanaka has carried the team on his unhittable splitter. Now, his arm has come up sore and perhaps broken under the load.

The Yankees' team physician reviewed the images and examined Tanaka in Seattle on Thursday, finding a small sprain of the UCL, as noted by Sweeny Murty of WFAN. My sources tell me that the tear is very small, under 10 percent, which is below the normal threshold for surgery, which is somewhere between 25 and 33 percent. Tanaka also had some small osteophytes in his elbow, which is common.

No sprain is good, but this is far from the worst case. Tanaka will have a PRP (platelet rich plasma) injection and rest for a time before starting a rehab throwing program.

If the tear does not heal or gets worse, Tanaka would be a candidate for Tommy John surgery. The UCL does often repair itself from small tears, so catching this early can be considered a positive. He is definitely going to be high risk for the near future and will have to be handled carefully. One option the team will have is to do regular checks on the area, either with MRIs or with diagnostic ultrasounds. 

There is no clear timeline for his return. The Yankees are likely to be conservative, but without Tanaka and CC Sabathia, the Yankees pitching is very thin.

Tanaka himself will likely drive the return date based on milestones in the rehab process. As he passes certain milestones, such as long toss and throwing from a mound, responding without setbacks, he'll be allowed to push forward. He could miss as little as 15 days, but it is more likely that this could go four to six weeks. 

One of the major questions was why Tanaka was sent to Seattle rather than back to New York. Dr. Chris Ahmad, the Yankees' team physician, was in Seattle to attend the annual AOSSM convention. Dr. Ahmad is a board member and has made major presentations in the past, such as performing a shoulder labrum repair live for attendees at last year's meeting. (He was live; the shoulder was not, as you can see in the attached picture.)

Rather than wait or sending Tanaka to another surgeon, it was simpler to send Tanaka to Seattle. Many of the other top surgeons in sports are present at this conference, so if a second opinion is requested, it could likely be handled quickly.

One of the main questions that will be asked about Tanaka's arm injury is whether changes to his workouts and frequency of outings caused problems. It is well-known that Japanese pitchers throw less often, usually once a week, and have extensive between-start routines. They also tend to throw more pitches. 

Daisuke Matsuzaka had difficulty adjusting to the American style and injured his elbow, with many blaming the changes for his problems. Yu Darvish has been more successful, but the Rangers have eliminated several of the pitches he featured in Japan, though he will occasionally bring them out in situations. Tanaka has a more limited repertoire, being far more reliant on his dominant splitter both in Japan and in his time with the Yankees.

Japanese workouts are often as inexplicable as their musical tastes. (That band, Momoiro Clover Z, is Tanaka's favorite.) Pitchers will regularly throw in the bullpen in between innings and will often go to the pen for work after they are removed from starts, especially in unsuccessful starts. 

Tanaka did, like many pitchers, have an extensive workload in Japan when he was young. He was pitching for Rakuten at the age of 18 after a celebrated high school career.

While Japanese pitchers make less starts, they tend to throw more pitches. Tanaka wasn't injury-free in Japan, having a couple episodes of shoulder fatigue that cost him starts, especially in 2009 and 2010. He came back well after these problems and was dominant in 2013. 

Research that I did with Nate Silver in 2004 showed that pitchers under the age of 24 were more likely to be injured, so this is a bit worrisome, though the Yankees surely understood this when they purchased him. 

Another question that the Yankees and Tanaka are going to have to determine is how damaging his splitter is. The pitch has long been thought to have a higher cost than other pitches, but the entire idea of pitch cost has largely been reduced by current research.

Chris O'Leary, a top researcher, does a good job debunking this theory in this thread. I asked him what he thought about Tanaka's splitter and overall. He told me:

"Some will point to Tanaka's use of the splitter as a red flag. However, I've yet to see convincing evidence of a correlation between arm problems and the splitter. If you look at Tanaka's mechanics, you can see evidence of the timing problem that you tend to see in high pitching elbow guys and that eventually overloads the elbow and the shoulder."

As stated earlier, Tanaka used the same pitch repertoire in Japan for years without injury, so it's difficult to say that this should have suddenly become a problem unless it's one of wear-down. That means there's no easy answer as to why he has suddenly hit the disabled list.

It's not Tanaka's pitches. It's not that he's Japanese. Instead, it's as simple as it is for so many other pitchers: poor mechanics. It appears that he is just another injured pitcher on the long list we have of those in 2014. As dominant as he has shown he can be, he and the Yankees will have to figure out how to keep him healthy enough to use it.

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Molina, Phillips Have Similar Thumb Injury, Could Be out Rest of Season

The St. Louis Cardinals are trying to chase down the Milwaukee Brewers, but they'll now have to do so without one of their top offensive players, lost to a torn ligament in his thumb.

The Cincinnati Reds are trying to chase down the Milwaukee Brewers, but they'll now have to do so without one of their top offensive players, lost to a torn ligament in his thumb.

Whoa. Deja vu.

There's some irony in the fact that two players who went face to face in a particularly nasty brawl a couple seasons ago, Yadier Molina and Brandon Phillips, are now headed to the disabled list and possibly surgery with near-identical injuries. The two stars are both likely to miss between eight and 12 weeks after spraining their thumbs.

These are similar injuries to what Bryce Harper and Josh Hamilton had earlier this season, with the good news being both came back well after surgery to reattach the ligament.

While the Cardinals and Reds have not yet confirmed that the injuries were to the ulnar collateral ligament (thumb) in their respective players, the mechanism of injury certainly suggests it for both. The UCL is also the most often injured ligament in that part of the hand. 

Note: The UCL in the thumb is not the same as the UCL in the elbow, which is replaced in Tommy John surgery. "Ulnar collateral" is a medical description of the bone and function. These two different ligaments are on opposite ends of the same bone, hence the similar name.

For Molina, Bernie Miklasz of the St. Louis Post Dispatch broke the news:

Molina injured his thumb in a very unusual way. Like Harper, he injured his thumb on a slide into third, but he slid feet first. As this MLB.com video shows, he injured his thumb as it slid behind him.

It's unclear at what point it extended. The normal mechanism for this type of injury is that the thumb is pulled back, toward the wrist. Cardinals manager Mike Matheny, a former catcher, noted that Molina's thumb has been beat up by catching, but it's unclear if it was weakened previously and this slide was the final straw.

"When I felt it, right away I knew there was something wrong with it," Molina said via Jenifer Langosch of MLB.com. "That's the way I always slide. This time, my thumb got stuck in the dirt, and you saw what happened. Mentally, I'm so frustrated. You play hard, and for something to happen like that, it's bad."

For Phillips, Ken Rosenthal of Fox Sports did the honors:

Phillips' mechanism was far more normal. This MLB.com video shows that his thumb was pulled back as he tried to make a diving stop on a ball. It's a play he's likely made hundreds of times in his baseball career, but getting the thumb into just the wrong position caused the injury.

Neither the Reds nor the Cardinals have confirmed that their injured players will need surgery. Rosenthal is reporting that Phillips will have surgery tomorrow. It is common in these cases. The UCL can be easily reattached or stitched back together as necessary, and the healing tends to be very simple. The patient is braced for a few weeks and can work back to swinging a bat in as little as a month.

The success rate is very high for this kind of surgery.

If surgery is needed, both are likely to consult with Dr. Thomas Graham in Cleveland. Graham has become the first call for most players who have any sort of thumb injury. He did the surgery on Harper earlier this year. Dr. Steven Shin did the surgery for Hamilton and is one of the Kerlan-Jobe doctors who often gets the first call on the West Coast.

Molina may have a slightly harder time with this. The demands of catching take more of a toll on the thumb, though it is his right (throwing) hand rather than his catching hand, which would be much more difficult to come back from. (Molina does have a special material inside his glove that dissipates force already, so it would be difficult to cushion him more if it were necessary.) 

A 12-week loss would put both players very near the end of the season. Since both are in contention now, it's unlikely they would be shut down unless their teams fell completely out of the chase.

On the upside, both Harper and Hamilton returned ahead of that mark and have had no real problems once they returned. 

These sprains are a tough break for both NL Central contenders. In races so tight, almost anything can be a difference-maker. More often than not, it's team health. Losing Phillips (1.1 WAR) and Molina (1.7 WAR) could be that difference. 

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Under the Knife: MLB Injury Analysis on Encarnacion, Sabathia, Votto and More

I feel a bit more optimistic about injuries than I have in a while. I showed you the Motus Sleeve last week, but that's hardly the only new thing coming into baseball to try to help in the battle. I might have been a bit early calling 2014 the "Year of the Sensor," but things like the Sleeve and the new MLB Statcast (which really needs a catchier name) are going to revolutionize things.

But they won't do it all at once. The PITCHf/x system was introduced to baseball a couple of years ago, and it took a while before anyone really understood how to analyze the mountains of data coming out of it. Now, that system is changing, and the flood of data just keeps coming. Perhaps the next thing baseball needs after sensors is a big filter, but it's more likely that the "Big Data" solutions will be the first try. 

Bloggers, if you want your next chance to move to the front office, start prepping to parse sensor data. The first to get to interesting solutions will be the next Josh Kalk or the next Dan Fox. Overall, it's going to be very good for baseball, especially if this round of data helps us figure out how to stay healthier. We're not there yet, so let's look around the league...

 

Edwin Encarnacion

The Toronto Blue Jays aren't telling us much about the quad strain for Edwin Encarnacion, but they are giving us enough to understand what's going on. With Encarnacion on the DL and the Jays saying he'll miss two to four weeks, noted here by the National Post,  the likelihood is that he has a Grade II strain. The timeline fits.

The only thing that really doesn't fit is that Encarnacion said that he felt a pop. That's a very vague thing, but when it's meaningful, it usually indicates either a tendon or ligament coming loose. A full-on muscle tear (rupture) is usually so painful that the descriptions are more like "searing" than "pop." With minimal swelling, it looks like Encarnacion felt something but that he avoided the worst.

About that swelling: It's another sign. Early indications were that Encarnacion would need to wait until Monday or even later to have an MRI. Instead, they were able to do it early on Sunday, indicating that the swelling wasn't a problem or was easily controlled. 

All in all, there are more positives than negatives. Encarnacion is on the DL, but even that will be minimized by the All-Star break. The question now is whether Encarnacion can come back quickly enough to avoid a rehab stint and more lost time. Don't think that the home run chase won't enter into the timeline, either; it will. 

 

Joey Votto

Joey Votto heads back to the DL with what CBS Sports tells us the Reds are calling a "distal quad strain." This isn't a lie, but it's one of those terms that sounds informative but isn't. Distal is simply a direction. Closer to the body is proximal; farther from the body is distal. The knee is more distal than the hip, so the Reds are merely saying that Votto has an injury nearer the knee.

However, this is a clue. Also at the distal end of the quadriceps are a number of tendons. An injury to a tendon is a strain, the same term as an injury to a muscle. However, tendon strains tend to be more inflammatory (tendonitis) and can become chronic (tendonosis). A tendon strain usually indicates a traumatic injury, which we know isn't the case.

We also know that Votto is dealing with a situation that the Reds once said "couldn't get worse." That sounds like a manageable condition, something like a patellar tendonitis. We may not know what it is specifically, but there are clues.

More concerning is the functional issue. Votto hasn't been playing well, and during his series of knee surgeries a few seasons ago, he struggled to get back to normal function even after the knee was cleared. This seems precisely to that pattern, indicating that maybe this is much more about Votto's function than any significant setback physically.

There's no question he's on the DL and will be into at least mid-July. Everything past that is a relative unknown. Given what we do know and all we don't, Votto is suddenly very risky.

 

CC Sabathia

As Bob Dylan once sang, "things have changed." At this time last week, things looked pretty positive for CC Sabathia and the Yankees. He was heading toward another rehab start, and the team was mapping out how he'd fit back into the rotation. Then Wednesday, Sabathia's knees had swollen back up and he was shut down, with Mark Feinsand filling in the details.

Sabathia was scheduled to visit Dr. Andrews with initial reports signaling that would come on Monday. As yet, there have been no announcements, but no news isn't good news when it comes to this. It could be that Sabathia's knees are still too swollen to do a good exam and set of images. If so, that would be a huge negative.

Dr. Andrews isn't a microfracture guy, but it's easy enough to refer Sabathia to someonethat is, if that's the case. One source I have told me that Sabathia's agents consulted with Dr. Brian Cole, a White Sox doctor who has performed some advanced knee procedures, including a meniscus transplant on a minor leaguer. While Jose Martinez hasn't moved up much, he wasn't much of a prospect to begin with, and he hasn't had issues with his knees. 

Could Sabathia be heading toward being the first major leaguer to try it? That's unclear. Athletes seldom want to be the first or even early test cases. Tommy John's situation was unusual, but with the lack of success with microfracture in baseball, Sabathia may be forced to make a similar choice. At this point, it's safe to drop Sabathia in all formats, including keeper leagues. We won't know enough until spring training to make him a good lock.

 

Jaime Garcia

I'll ignore the drama here on Jaime Garcia as much as I can and focus on the physical. After coming back from shoulder surgery and struggling to stay healthy, Garcia developed symptoms of Thoracic Outlet Syndrome. We're still learning about this condition, which is truly a repetitive stress injury. While you may know it as the injury that sidelined Chris Carpenter, it's often seen in actual carpenters. (Wonder why? Think about hammers.)

While TOS is little understood, one of the patterns that's developing is that there's two clear types of conditions that are both called TOS. Garcia is dealing with the type that impinges the nerves rather than the vascular system. Neither is good, but there seems to be a bit better return rate with nerve impingement, though given Garcia's other issues, it's tough to take this in isolation.

The drama with the communication and the frustration of GM John Mozeliak (noted by MLB.com) is interesting in ways, but probably won't have much of a bearing on this. Garcia is staying in St. Louis for surgery, a bit of a surprise given that this is relatively specialized and the likelihood that Garcia's Cardinal career is effectively over. That the Cards medical staff got anything out of him from his previous shoulder problems shouldn't be diminished by this last problem.

 

Brady Aiken

Since the news broke yesterday that Brady Aiken, the overall No. 1 pick in this year's draft, hadn't passed the Astros' physical, not much has changed, but the fact that Aiken isn't taking a reported $5 million tells us that there's some question. Either way, Aiken's not likely to head to UCLA this fall.

The question is really more one of risk. If a third of pitchers will end up with Tommy John surgery, there's plenty of pitchers signing without the discount that will lose a year. The Astros are smart enough to know this, and even the possibility of having two early picks in next year's draft isn't worth the headaches of losing a 1-1. 

Aiken (and all draftees) have until July 18th to sign, and this one might take that long. This is less about the elbow now and more a simple negotiation. While I'll be interested to see how they handle Aiken once he signed, I do think what we know about Tommy John surgery means that the risk is very limited.

 

Jeremy Hellickson

Jeremy Hellickson is back in the Rays rotation after missing the first half of the season while rehabbing from shoulder surgery. The Tampa Bay Times gave some nice notes on how the return was managed well, if conservatively, which is nothing new for the Rays. Hellickson's first start back on Tuesday night went well, though he didn't go very deep. There's little doubt he'll expand on that over the next few starts.

If he's solidly back in the rotation as expected, he will either solidify the Rays as they try to surge back into contention or anchor the rotation once David Price is gone. Either way, he's key to the Rays. This is probably your last chance to pick him up, though he's only owned in seven percent of Yahoo! leagues.

 

Gerrit Cole

Gerrit Cole came back from a shoulder issue and ended up right back on the DL. That's never good, but Cole's new problem isn't directly related to the old one. Instead, the lat strain is likely a compensation issue. Even a minute change, inside or outside, can create new problems up and down the kinetic chain. With as much force as Cole is generating on every pitch, this is an even bigger risk.

The interesting thing here is that this is a perfect test case for the Motus Sleeve, which we know is being tested by the Pirates. Using the Sleeve during his rehab would put the Pirates and Cole in a better position to succeed. Right now, it's a nearly singular advantage.

 

Jered Weaver

Jered Weaver left his Monday start with tightness in his lower back. Weaver has had minor issues in the past , but it never became much more serious. The Angels will give him a couple days of treatment to see how he responds and with the All-Star break coming, don't be surprised if they bump his next scheduled start back to give him even more rest, as the Los Angeles Times notes is being considered. Matt Shoemaker, who came in when Weaver left Monday, would be the most likely to take that spot start. 

 

Justin Masterson

Justin Masterson hits the DL with a knee injury that the Indians haven't given a lot of specifics on, as noted by Cleveland.com. It sounds like meniscus or maybe articular cartilage, but it's the effects that have been the problem.

Masterson has been bad for a couple weeks, and now, perhaps it was just adjustments to a sore knee. You could maybe wonder why Masterson pitched through it, but there are reasons to try up to a point. This one passed it, and we'll see if they can get him back to right.

Power sinker guys like Masterson haven't been durable, but he's more than a one-pitch guy. He's worth taking a chance on if someone bails out on him.

 

Michael Bourn

Another hamstring injury for Michael Bourn shows just how tough it is for a speed player to come back from a significant hamstring injury. Bourn has been able to get back on the field, but not stay there. The Indians are going to have to figure out how to keep him healthy, which is going to start with some rest. Lonnie Soloff is one of the best at dealing with precisely this injury—he worked with Ken Griffey Jr. in Cincinnati—so there's hope. What there may not be is time or speed. 

 

Ricky Nolasco

Ricky Nolasco has been pitching since spring training with a sore elbow. Tests showed it to be a flexor strain, which shouldn't be that big a deal. What is a big deal is that Ron Gardenhire basically came out and told everyone that he liked that Nolasco hid the injury. Mike Berardino let Gardenhire's words speak for themselves here. Comparing an injury to a broken bat? I don't even know what that means, but I'm not sure Gardenhire does, either.

Trust between players and a medical staff is key, and the longtime Twins manager essentially stuck a knife in his ATs. The macho culture of sports tends to feed on itself, but the old-school Gardenhire is proving that with a young and rebuilding team, it might be time for the team to say school's out.

 

Bronson Arroyo

There's no odometer on a pitchers's arm. Bronson Arroyo was one of the most durable pitchers in all of baseball, so when he went to Arizona this year, the thought was that he'd be a stable base for some of their young pitchers (at least the ones they hadn't traded away). Instead, he's headed for Tommy John surgery

My question is whether there's a proximate cause. Did Arroyo simply wear out his arm over time and the D'backs bought at the wrong point (and did Cincinnati know something?) or did something change?

There's no real answer here, and Arroyo's not the most introspective of pitchers, so we probably won't know. That lack of data capture is one of the reasons we haven't seen a real change in the injury rate. If nothing else, we need to at least ask why.

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Brady Aiken’s Injury Doesn’t Ruin Pitcher’s Huge Upside

It seems like quite the roller coaster, going from the No. 1 overall pick in the 2014 MLB draft to being told that your pitching elbow didn't pass the team's physical. That's what Brady Aiken is facing, according to Jon Heyman of CBSSports.com. The lefty from San Diego with the All-American looks may have an all-too-common elbow issue and could be facing Tommy John surgery in the near future.

Beyond the shocking headline and the $1.5 million difference between what Aiken was going to get and what the Houston Astros want to pay him now—which is admittedly quite the difference—this isn't that worrisome. Tommy John surgery simply doesn't scare teams the way it once did, and in many situations it barely moves the needle. If anything, the Astros may see the physical issue as a way to save money more than a reason to be particularly concerned about Aiken.

One indication is the reported $5 million offer. Under the current collective bargaining agreement, the Astros could offer Aiken (or player that does not pass the physical) as little as 40 percent of the original bonus, per Ken Rosenthal of Fox Sports. That would be $2.6 million or almost half of what the Astros actually have offered. The agreed to $6.5 million is under the slot value, so some reports have the needed offer higher, at 40 percent of the $7.9 million slot.

Confused? Don't be, because at either value, it's clear that the Astros came in knowing they could get a good young pitcher at a below-slot value, once again appearing to go cheap in the draft. With both previous No. 1 picks, Carlos Correa and Mark Appel, the Astros signed them well below their slot value. They were able to use the extra money to sign other players, so it's not a purely cheap strategy.

Aiken did have a heavy usage pattern in the last two seasons. He pitched two full seasons at Cathedral Catholic in San Diego, as well as playing for the Under-18 National Team and participating in several showcase events. This isn't uncommon, but there wasn't much of an offseason for Aiken leading up to the draft either.

For what it's worth, Aiken's personal trainer is refuting reports, as noted here in the Houston Chronicle. It should also be noted that Paul Flores is not a certified athletic trainer as he was initially identified in the Chronicle article. It was corrected. While Flores could speak to Aiken's physical conditioning, there is no note in his bio of medical training. As with the Chronicle, both the Astros and Aiken's agency refused comment on the issue.

One scout I spoke with gave me his report on Aiken, done early in the scouting process:

"He has a distinct 'back and uphill' motion. That indicates a soft core. Easily correctable, but it will change the timing. We normally see this with adolescent pitchers who are growing into their bodies. I would be curious to know more about his conditioning and overall strength levels. The Hamels comp is pretty solid, but Hamels doesn’t have any of these flaws and didn’t as a HS senior."

The comparison to Cole Hamels is an easy one. Any good lefty from Southern California is going to get that, but in this case, it's not a bad one given their similar motions.

The "back and uphill" motion is not necessarily a negative. Work done by Alan Jaeger, a top pitching consultant, points to this type of move, seen in the picture of Hamels here, as something of a positive. The front shoulder is slightly higher than the back shoulder, though they level out at release. There haven't been biomechanical studies to prove this move is good or bad, but it is common and shows no correlation to elbow injuries.

However, two teams that I spoke with said that they had concerns about Aiken. "We didn't red-flag him," said one scouting official from the AL, "because we knew he wasn't getting to us. If he had, the workload he had in high school and showcases was a bit worrisome. Maybe he'd have passed, but we'd have checked."

Another scout, who watched Aiken closely heading into this year's draft, had another concern. "There were a lot of stories about the kid being a workhorse, but he's skinny and developing. I don't know how all his crossfit [stuff] fits into baseball. It's too new and our strength guys don't like it for our major leaguers. Did he hurt himself pitching or playing with ropes?"

The Astros are in good position to make a sound medical judgment. Dr. Thomas Mehlhoff is an orthopedist for Houston and has become one of the few surgeons that teams trust to do Tommy John surgery. It is unlikely that the Astros would have ignored Mehlhoff's opinion in this process, though it is not known officially whether Mehlhoff is involved. 

If Aiken does have a compromised ulnar collateral ligament, he would hardly be the first or even the best pitcher in this situation. Lucas Giolito, another hard-throwing Southern California kid, was a top pick of the Washington Nationals a couple of seasons back. Baseball Prospectus recently ranked Giolito as the top pitching prospect in the game.

Giolito's mechanics were very questionable. (Giolito's father, Rick, heartily disagrees with my assessment.) Giolito almost immediately tore his UCL and headed for surgery. He's back and dominating Single-A as expected, so the loss of a year of development doesn't seem that bad compared to his upside if he can stay healthy.

Several pitchers over the past few years have followed a similar pattern. One pitcher that was watched closely this year was Bryce Montes De Oca. The Kansas fireballer missed his junior year after spraining his elbow and having Tommy John surgery. He came back very well in his senior year, and while he was used judiciously, his fastball tempted many teams. He ended up going in the 14th round to the Chicago White Sox, largely because of high bonus demands rather than the injury.

All this comes from the experience of the Los Angeles Angels. Former scouting director Eddie Bane, now a special assistant with the Boston Red Sox, thought enough of a high schooler who was facing Tommy John surgery to take him in the 14th round for about $700,000. Bane believed that Dr. Lewis Yocum, then the Angels' team physician, could get Nick Adenhart back on the mound. The Angels ended up with a great young pitcher who was tragically killed before he could reach his full promise, but the gamble definitely paid off for the team.

Compare this to Mark Appel, a right-hander who just a year ago was the consensus best pitcher in the draft. He had almost no injury concerns coming out of Stanford and got regular comparisons to Mike Mussina. He's had trouble adjusting to the Astros development system and dealt with thumb injuries in his first full season, so there's never a guarantee.

That development system, which is a modified tandem system, could help protect Aiken when he comes back. The team is conservative with its usage and workload patterns, so Aiken will have plenty of protection both before and potentially after surgery. 

Even if Aiken needs Tommy John surgery immediately, this is hardly a major problem for him or for the Astros. While the return rate from Tommy John surgery is not perfect, it's conservatively marked in studies at 85 percent. Aiken has a lot going for him physically and on talent, so this is likely to cost him money, not his baseball future.

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Under the Knife: MLB Injury Analysis on Harper, Wright, Bautista and More

Oven Mitts? That's what the Washington Nationals are using to protect both Bryce Harper and Ryan Zimmerman, essentially. With Harper coming back on Monday after missing eight weeks rehabbing from thumb surgery, it appears he's wearing the mitt to protect his hand on the bases, though nothing is known about why Zimmerman is also wearing it. Dan Steinberg has a good picture, but there's not enough of a look to tell what this is or why. 

A few weeks ago, Billy Hamilton wore something like this that was more of a sliding glove. He was asked to take it off by an umpire and I haven't seen it since, so I can't tell if this is similar. Harper and Josh Hamilton accentuate the risk of sliding, though Hamilton is more old school, reminding us that stealing bases like Rickey Henderson and Vince Coleman does come with a toll on the body.

If the new mitts or sliding gloves or Alex Torres' hat are a sign, it's that we are at least seeing a little safety innovation on the field. It may be a very early stage, but there are a few new things out there that with some iteration could make the game better. Losing one of the top stars for two months isn't good for the game. Perhaps the next commissioner will put together some sort of X Prize for safety, putting a bounty up for anyone who can put together something that can save the game millions. 

For now, we have plenty of injuries to look at as we continue on the record pace of pitcher and overall injuries. As we near the halfway point of the season, the injury stats are stark that this is perhaps the one area of the game where innovation and creativity could have a real impact. Are we at a tipping point? I can't tell, but I do feel more awareness. For now, let's look around the league...

 

Jose Bautista

Watching how the Toronto Blue Jays are managing Jose Bautista's hamstring injury is a master class. Bautista is going to be used carefully, with Anthony Gose acting as a caddy, to make sure that the All-Star outfielder doesn't have to overtax his hamstring while still providing power to the Jays, as noted by Yahoo Canada. This is taking a careful balance between the medical staff and the field staff, so it's worth tipping the cap to John Gibbons and George Poulos here.

Bautista is clearly not back to 100 percent and is barely running at more than a jog. That's smart, though difficult to pull off, as there have been some plays, especially on the bases, where Bautista's natural instincts have kicked in. Still, the Jays medical staff has escaped any setbacks, which allows it to at worst keep Bautista at a very functional level.

The team has clearly been aiming at the All-Star break as its goal. A couple extra days of rest could push the hamstring back to a near-normal state and allow it to use him more normally. There's going to be some risk of reinjury for a while, but Bautista has made it this far, which is a positive. The break and continued smart usage could mean nearly a full win for the Jays, one the medical staff should get credit for, especially if that's the difference between the playoffs and heading home.

 

David Wright

Bruised rotator cuff? That's a tough one to do. It's hard to bruise a muscle like that without having other associated damage, but maybe this diagnosis is a bit more complex than what it sounds like. Wright's internal workings aren't significantly damaged and certainly not strained or otherwise structurally unsound, but something's going on in there. 

A bruise isn't necessarily the simple traumatic lesion that we normally think of. Inside the body, it's an indication of some sort of damage, often chronic in nature. Again, that idea doesn't seem to be in play with Wright, but this is a bit of a stumper, even for the doctors and ATs I spoke with.

Wright is out until Friday, according to NJ.com, but even that is a bit of a moving target. There's a retro disabled list move there if they want it and with the All-Star Game coming up, he would miss less than most 15-day periods.

The Mets are in an odd position with the face of the franchise, and trying to figure out how much difference he makes in the lineup as they decide whether they're sellers is even more complicating. Stay away from Wright in your fantasy lineup until we know whether his shoulder will affect his swing and his power.

 

Hanley Ramirez

The Dodgers have two decisions coming up regarding Hanley Ramirez. They'll decide whether or not a strained calf will send him to the DL before Thursday's game, per the LA Times, and at some point in the near future, the front office will have to decide if it's really going to give him a long-term, big-dollar deal. Given his injury history informing both decisions, I'm not sure why it's tough for the Dodgers.

Ramirez's calf strain came immediately on his return from a shoulder problem. These kind of multi-system injuries are indicative of a full-system breakdown in some cases and conditioning issues in others. Did Ramirez simply slack on his conditioning and come back as a risk for the kind of leg injury he got? We can't know that from outside, but it's certainly been a pattern in his career.

The team is using him as a pinch hitter, so the retro move is gone, indicating that at least there's some hope that he won't need a DL stint this time. It's tough to say with Don Mattingly, who has regularly gone against the advice of his medical staff over his Dodger tenure, so there's that additional complication. I don't think Ramirez will go to the DL, but he's very risky over the next few days. Again, the All-Star break could be a big help for him, assuming he sticks around for treatment.

 

Evan Gattis

A bulging disc is never a good thing, but don't panic too much about Evan Gattis. Gattis is a big bear of a man and those muscles and core should help here. Gattis' issue is in the thoracic part of his spine, which is usually well supported. He'll get an epidural injection to try and reduce the inflammation, likely in a series of as many as three.

The concern is that the injections won't help with the inflammation or the pain and that Gattis will miss far more than the 15 days the Braves are hoping for. There's no good range on this. Players with injuries like this can be out from a matter of days to a full season or even longer. 

There's little we can learn from the outside until we see Gattis back doing baseball activities. A short layoff from those means he'll be back quickly, but if he misses much time beyond 10 days, he'll need to do more to get back, perhaps including a short rehab stint. Another complicating factor is whether or not he'll catch. The Braves can be flexible with that, so I don't believe it will delay a return, whenever that happens.

 

Yoenis Cespedes

Yoenis Cespedes has a laser rocket arm, but his legs seem a bit more human. He's skipped in and out of the A's lineup for the last week as he deals with a minor hamstring strain. Nick Paparesta and his staff have given the A's a big boost in terms of injury stats, but small tests like this don't show up in those and are just as important.

Keeping Cespedes in the lineup is more key for the A's than most teams. Power is lacking, especially with Josh Reddick out, and depth is at a premium for a team that simply doesn't have much of it. In places, they can replace a player and not lose much, but with a few of their players, there's simply too much of a talent gap. The training room is supposed to be an all-equal facility, but baseball shouldn't work that way. Not everyone is of equal value.

Cespedes was back in the lineup on Wednesday, noted by Susan Slusser of the San Francisco Chronicle, but watch to see if he can slow down a bit and give the legs a week of "rest." He doesn't seem the type that is aware enough to play at a safe level, so this is a very risky week. If he can make it to the All-Star break without a setback, that's a very positive sign and another plus for Paparesta.

 

Ground Control

The Astros have a system they use to handle all their data, including emails, that they cutely call Ground Control. This week, the contents of that system were hacked or leaked and published at Deadspin. The fallout around the league isn't the worst for the Astros, but losing scouting reports and some internal metrics could hurt whatever competitive advantage they think they have. 

What is worrisome is whether medical records are also included in the leaks. MLB uses a different injury tracking and medical record system across baseball, standardizing all of these reports and making them quickly accessible in trades. Talking to people with knowledge of the Ground Control system, there were significant parts of it that did have medical and performance information. If that leaked—and there's indication that parts of it did—it's more serious.

Systems like this are becoming the norm. I can remember seeing the first such system, the Indians' Diamond View, almost 10 years ago, and can hardly imagine what it looks like now. Security is a big concern, but don't expect that teams will develop a hacking department alongside their scouting department. The Astros will just need a new system now, called Damage Control.

 

CC Sabathia

The Yankees like what they see so far from CC Sabathia, enough that they're shifting him around during his rehab to line him up for the anticipated return, as noted by MLB.com. Sabathia has had no problems with his knee and is merely working on command and stamina through the series of starts. He's still on track to make it back to the Yankees right around the All-Star break, but there are some indications that it could come sooner rather than later even with the break. 

 

Michael Wacha

Michael Wacha has a very strange shoulder injury, but the key is not what it is, but why. The stress reaction in his shoulder blade was caught early, but there's still no clarity on what caused this. This is a perfect application for biomechanical analysis, but there's not going to be a "before picture" to work with.

Still, once Wacha does begin  to throw, understanding the forces acting on his shoulders would be important. It would also be good to know whether any changes that he made caused positive or negative consequences to his arm. Fixing his shoulder but putting more pressure on his elbow wouldn't be a good outcome. This is definitely going to be a huge test for the Cardinals medical staff when he does start throwing again, which should be around the six-week mark.

 

Derek Holland

Derek Holland is making some progress, but the Texas Rangers don't seem to be in a rush. Holland has missed the entire season after an offseason accident caused Holland to need significant knee surgery. Baseball has a terrible record getting players back after microfracture surgery, but Holland's area was very limited.

Holland is doing well in his sim games, building up some arm strength, but the Rangers won't start a rehab assignment for about another week. He's likely to do that in Frisco with rehab ace Carlos Olivas and could take the full 30 days possible before returning. Watch his control more than his stamina once he gets back in games. 

 

Carlos Gonzalez

Carlos Gonzalez is making nice progress after having a small benign tumor removed from his finger. He's hitting off a tee, but the key for Gonzalez is that losing the tumor regained a lot of movement in his finger immediately.

He'll need to make sure that his grip strength is back, but I talked with a scout who has watched Gonzalez closely for several years who explained to me that Gonzalez's swing doesn't put as much pressure on that finger as most. Look for him to amp up the swings and get to a rehab assignment in as little as 10 days. 

 

Nolan Arenado

While going 2-for-8 isn't inspiring, Nolan Arenado didn't have many problems besides getting hits on his rehab assignment. He was there to make sure that his finger would hold up and that his grip strength was fine.

On those counts, he's fine and could be back, but there is still some question about the amount of swing-and-miss. That could take a while longer as he knocks off rust and gets the grip strength and bat control back to normal levels. Don't expect him to be quite the contact hitter as normal, but when you start to see an uptick, make sure he's in your lineup. 

 

Taijuan Walker/James Paxton

Patience is hard in baseball, but sometimes it pays off. The Mariners have waited most of the season for two pitchers they hope to build around. James Paxton has made only a handful of starts, and his rehab has been stop and start. Taijuan Walker's situation started earlier but finally has progressed past a number of setbacks to put him in the major league rotation. His first start was solid, and his stuff was good despite nerves and the occasional mistake pitch. 

The Mariners deserve credit for focusing more on getting them back in the right way than just getting them back. They've been able to tread water all the way to a playoff slot and with both pitchers, they escape some of the innings limit questions they faced due to the injuries.

Fatigue is still going to have to be monitored, but it's easier to do so, even into October, given the later starts. The Mariners could go on quite the run as their rotation gets deep. 

 

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Key Questions, and Some Answers, About Stunning New Report on A-Rod PEDs

Alex Rodriguez was using testosterone. This is hardly news, having first been outed a few years ago and then again as part of the Biogenesis case. Instead, the fact that MLB sanctioned his use by granting him a therapeutic use exemption (TUE) in 2007 is a bit of a stunner to those of us that have been following MLB's continued chase to get performance enhancing drugs (PEDs) out of the game.

Major League Baseball was forced to comment after the excerpt was released, saying: 

The TUE process under the Joint Drug Program is comparable to the process under the World Anti-Doping Code. The standard for receiving a TUE for a medication listed as a performance-enhancing substance is stringent, with only a few such TUEs being issued each year by the IPA. MLB and the MLBPA annually review the TUE process to make sure it meets the most up-to-date standards for the issuance of TUEs.

That's hardly enlightening. We're left with a lot of anti-Rodriguez hysteria, but not a lot of answers as to what this means. Even all the acronyms will get confusing! There are more questions than answers on this, but let's take a look at some of the bigger ones raised by this report. 

 

What does it mean that Rodriguez was able to use testosterone legally?

Rodriguez was reportedly granted a therapeutic use exemption during the 2007 season, per Bob Nightengale of USA Today. Tim Elfrink, one of the Miami New Times writers that broke the Biogenesis case, published in an excerpt at SI.com that Rodriguez was given a TUE by MLB's independent program administrator (IPA), Dr. Bryan Smith. Rodriguez was also granted a TUE for Clomid, another banned substance, in 2008. 

It is unclear if Rodriguez requested or was granted a TUE for testosterone in 2008 or any other season, though MLB did discuss only the 2007 TUE at Rodriguez's grievance hearing for his most recent suspension. 

 

Why would MLB grant this type of waiver for anyone?

It is known that several players have been granted TUEs for a condition known as hypogonadism. In several of these cases, the player was a survivor of testicular cancer. Former Red Sox third baseman Mike Lowell has admitted use of several drugs, such as testosterone, as he was trying to have children after his cancer treatments. 

In cases such as this, the treatment is truly testosterone replacement (or TRT). A player would be brought back up to a normal level of testosterone for a man of his age and size. 

Other substances also require a waiver. The largest number of waivers are granted for drugs to control ADHD. These drugs are powerful stimulants, such as Adderall and Modafinil. MLB has a strict procedure for granting these waivers, and in almost all cases, they require the diagnosis to be made in childhood. 

The NFL, NBA, NCAA and Olympics all have similar procedures for waivers. Most are based on the World Anti-Doping Agency (WADA) standard, though MLB's procedure goes above and beyond the requirements of WADA. The NFL has never clarified its TUE procedures, but it is believed that an athlete only requires a prescription there without an IPA clearance. 

 

Why would MLB grant this type of waiver for Rodriguez?

This is the one I don't have an answer for. Rodriguez would have had to make a very compelling case to Dr. Smith in order to be granted the waiver, but I know from work I did at the time that MLB was very much against granting any waivers for TRT due to the level of scrutiny on the sport. The only known exceptions were for testicular cancer survivors. 

There were questions about whether Jason Giambi was granted any waivers for his treatment for a pituitary tumor in 2004, but neither Giambi nor MLB has ever commented on this. 

I cannot speak for Dr. Smith, but I cannot comprehend any circumstance where he would have granted this waiver aside from a clear medical necessity. Smith may have granted the Clomid exemption in order to take Rodriguez down from his TRT, but even this would be unusual. 

Dr. Smith was replaced as MLB's IPA in 2012, though I was told at the time that there were no performance issues. Dr. Smith was simply moving on with his career. MLB has not seen significant movement in the number of TUEs, which it reports every year, since Smith left. 

 

How does a TUE work in terms of testing and therapy?

A player with a TUE is still subject to MLB's drug testing procedure. Nothing is different and the collector and lab do not know about the waiver at any point. In fact, the test will show up as a positive for testosterone (or other waived drug) and will be reported to MLB just as any other positive would be.

At that point, MLB's IPA would match the player against an in-force waiver and stop the process if an exemption exists. This is not reported to teams or the player. However, teams do know that a player has a TUE because they are involved in the process of getting one approved.

One thing to note is that a TUE is made for therapeutic purposes. Players that test positive for dosings that are excessive to therapeutic use can be disciplined. For someone like Rodriguez, this means that he could use testosterone to return levels normal for a man of his age and size, but not to use massive anabolic doses to gain muscle mass.

 

Why would this waiver process be necessary at all in sports?

There are valid medical reasons that a banned substance would need to be used. Many asthmatics use drugs that are considered stimulants. Players with ADHD have a valid medical need for drugs that are banned. Propecia, a drug used to combat hair loss, is banned in international competition and has resulted in positive tests for players who failed to get exemptions. 

Drug policies are designed to stop the abuse of drugs in sports. TUEs are necessary in order to allow medical use of some of these drugs as necessary. In some cases, especially ADHD, MLB has required some players to attempt to switch to non-banned drugs such as Strattera in their therapy.

 

Why doesn't MLB publish the list of players that have received TUEs?

MLB is prohibited by HIPAA and other laws to violate a player's medical privacy. A player may elect to discuss his medical condition, but  the waiver that a player signs that allows a team to speak to the media and others about medical conditions specifically excludes the discussion of medications.

 

Is the waiver process abused or a failure?

Many, including those in Congress, have discussed whether the TUE process can be abused. It is often discussed in terms of the numbers of athletes that have been diagnosed with ADHD. In 2013, 119 TUEs were given with the vast majority being for ADHD drugs.

While some will argue that number is high, it is statistically in line for an all-male, active group. (Anecdotal studies of grade school athletics show the number nearer to 20-25 percent of participants.) Unless MLB is simply going to remove the waiver programs and force players to go off their medications, this seems to be about the standard level. 

Unfortunately, no other major sports publish their numbers, so it is impossible to compare. 

 

Could a player today get a similar waiver?

It is possible, though it is difficult to get any waiver. Players are put through a series of tests, not only by their own physicians, but by MLB approved physicians before being judged by the IPA. As seen above, MLB seems to have a very consistent number of TUEs for ADHD and other drugs. 

 

What would testosterone do for Rodriguez or other players?

Testosterone is the male androgenic hormone. It is what differentiates men from women on an endocrinological level. It is also the basis for all anabolic steroids. The body converts these steroids into some analog of testosterone in the body. All anabolic steroids are compared to testosterone, which is the "gold standard" of this class of drugs.

For baseball players, testosterone supplementation could give them greater muscle mass, better recovery and other positive effects. There are negative effects as well, but in TRT these are offset by the low doses and the use of other drugs such as Clomid. If held at strict TRT levels, Rodriguez and others would be at the same levels of testosterone in the body as a normal man.

In other words, the therapy should have been used to make Rodriguez have the same testosterone level as Derek Jeter, for example.

 

Is there a difference between the testosterone used here and similar prescription testosterone substances like Androgel and Axiron?

Remember the "Is It Low T?" ads you saw wall to wall during the last couple playoff telecasts? That's testosterone—and at a very similar level to what Rodriguez would have used. These are very popular prescription drugs used to help men with low testosterone levels.

While there is great controversy about not only the overuse but the marketing of these drugs, they are out there and widely used. For Androgel alone, sales were well over a billion dollars last year, making it the 35th-most used prescription drug in the U.S. and a big profit center for Abbott Labs. 

People may not like that Rodriguez used TRT, but if you looked around the average workplace in America, there's likely to be a number of people using Axiron, Ritalin or another drug that would require a TUE. Expecting more from athletes than the general population seems hypocritical. 

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The Sleeve That Could Save Baseball: Exclusive Look at New MLB Technology

In a conference room in Orlando, Florida, back in 2004, I sat across the table from Dr. James Andrews and Dr. Glenn Fleisig. I was attending their Injuries in Baseball conference and had the chance to interview both of them for my radio show.

I asked Dr. Andrews why he had founded the American Sports Medicine Institute, one that spent its time researching the very injuries that he fixed in his operating room across the street.

"I'd like to put myself out of business," he said. Fleisig laughed, but Andrews explained further. "There's too many of these arm injuries and it's worse with kids." Andrews talked for the next 10 minutes about pitch counts, research studies and the sheer number of surgeries he was doing on pitchers. 

As we know, those numbers didn't lessen in the intervening 10 years. In fact, they exploded. Tommy John surgeries alone have increased by 700 percent in that decade, with top surgeons like Dr. Tim Kremchek saying the percentage they see of youth pitchers needing the procedure is growing at an even faster rate.

What we've lacked is a real weapon in this fight. Now, thanks to the work of Joe Nolan, baseball finally could have that weapon. Nolan and his company, Motus, a well-known provider of biomechanical analysis from Florida, has created what they very simply call the Motus Pitcher Sleeve. It could be the Holy Grail of pitching.

Over the past two decades, biomechanics has made giant advances, including markerless technology and portable units (including those used by Motus), but baseball has remained resistant to the use. Most of this is the glacial pace of change in baseball, but it's also the natural instinct to push against a change that feels generational.

Pitching coaches who grew up in the game, doing the same drills that were taught to them by their pitching coach, who learned them from who knows where, simply aren't equipped to deal with a whole new flood of data. Giving them kinematics, kinetics, angles and newton-meters is like an old-school mechanic at the corner service station taking a look under the hood of a Tesla

Motus gave Bleacher Report an exclusive look at this new technology, pulling back the curtain on this new device. While it is still in prototype stage, Motus is hoping to have it consumer-ready by next year. However, they have several prototype units that they have in testing with pitchers at various levels. In fact, two MLB teams—the Baltimore Orioles and Pittsburgh Pirates—are currently testing the sleeve with their pitchers.

Motus Global is one of sports' premier biomechanical facilities. Headquartered in Long Island, Motus has an incredible facility on the grounds of the IMG Academy in Florida. For years, Motus has been doing full motion capture for major league teams. 

While they cannot give out the names of these teams, it is believed that there are five to 10 that use them at some level. However, the equipment is expensive and, while mobile, hardly accessible. Even at a reasonable cost for a test, there was a need for a new device that could be consumer-ready. I did some checking, and there's nothing like this in development at any of the major companies, though there has been some speculation that Apple's iWatch may have similar sensors.

Now the Motus Pitcher Sleeve is ready to be unveiled. Ben Hansen, Motus' vice president of technology, has led the development and explained the device in detail. 

The Sleeve, as I will refer to it, looks like a normal compression sleeve. It visually looks no different than the normal Nike or Evoshield sleeves worn by pitchers and other athletes. The only difference is a small sensor near the elbow that contains both accelerometers and gyroscopes similar to those found in modern smartphones and game controllers.

It's barely noticeable, as you can see in the above video and the picture below.

There's very little calibration that needs to be done. The athlete uses a smartphone app to put in his height and weight, and from there, the app can make some assumptions about the athlete's arm and body that have been validated from Motus' motion-capture database. 

In fact, the Sleeve is nearly as good as the motion capture. I asked Hansen to compare the Sleeve's data to motion capture.

"If the motion capture is a 10, then the Sleeve is almost a 10," he said. "It's already capturing at a higher rate (1,000 frames per second versus their current 500 fps for motion capture). It requires no setup, and when we compare various measures to the database we've built doing years of motion capture, it's very good."

Those measures alone will astound. The Sleeve can not only capture things like arm speed and release point, but it can calculate the angles of the elbow and shoulder. It can directly measure, in real time, the forces acting on the ulnar collateral ligament. 

This directly counteracts one of the main problems with motion capture. For all they're worth, motion-capture studies are done in a non-game setting. The player is forced to wear up to 50 markers and is usually required to wear a form-fitting suit. No matter how hard they try, it's impossible to pitch normally.

Game conditions and the adrenaline they generate have never been captured; the Sleeve has the ability to do that right out of the box. 

Where the Sleeve might do the most good is in capturing not just the pitches in-game, but practice and long toss as well. Hansen acknowledges that the long-toss mode is still very much in development, but knows how valuable it could be. One of the main worries that many have about long toss is that throwing more distance can put more forces on the arm and change the mechanics.

"This tells you immediately," Hansen explains. "It can warn you when the forces are up, in real time. Coaches can see if the pitcher is changing things in long toss." The teams that don't allow long toss (and yes, they do exist in MLB) will have a harder time maintaining that stance if the Sleeve gains wide usage."

One of the most interesting things the Sleeve can calculate is fatigue.

"It will give a measure of fatigue as well as efficiency. The easy thing to see is arm speed slowing down, but it also takes into account changes in mechanics like elbow angle, release point and others."

The app breaks this down simply and can give a coach or a parent a "red flag" that the pitcher is fatiguing, independent of any simple pitch count.

It's one thing for Motus to say its device is able to do these amazing things, but the testing so far backs them up. Even more important than that is that they have some big-time help in developing the app. One of the top names in the battle against pitching injuries is already on board.

"The only weapons we've had against arm injuries have been my lab and pitch counts," said Dr. Glenn Fleisig. Fleisig is the research director at the American Sports Medicine Institute (ASMI) in Birmingham. Alongside colleague Dr. Andrews, Fleisig developed the pitch-count rules used by Little League and wrote the recent statement on the Tommy John epidemic. He is also a member of the MLB committee looking into arm injuries.

Fleisig has long been the go-to guy on biomechanics, with MLB teams sending some of their pitchers to his Birmingham lab for a full motion-capture analysis. "[Motion capture] is still the gold standard but this sleeve is a great tool. It gives the results in a simple, focused way that coaches and parents can understand. It's a slick app!"

Fleisig sees every pitching gadget out there, but Motus came to him early and he was impressed. "This isn't a toy. This isn't a simple counter. This is a real tool. We've known, you and I, that not all pitchers are created equal. Billy might throw 80 mph and be low-stress, and Jimmy might throw 80 mph with high stress. We've known this, but now we get instant feedback from the Sleeve."

Measuring fatigue in-game and in workouts is also huge for Fleisig. "We can't individualize rules. We have to use safe averages when we talk about pitch counts or innings limits, especially at the youth level. Now, coaches will be able to see when those aren't giving a complete picture."

Fleisig, who is involved in the development of the Sleeve, acknowledges that it's not perfect.

"It's not as good as my lab, but it's very good. It gives results but might not tell you why those results are happening. I think one area it will be very good for is working with mechanical changes and seeing whether or not there's any result. I also think that it will open up some eyes and lead some to wanting a full biomechanical analysis."

With Fleisig and ASMI on board with this, the Sleeve has instant credibility beyond Motus' own testing, but there's another step that Motus has taken in testing. They've put the Sleeve, in beta form, on the arms of pitchers at several levels. Two MLB teams are testing it with their own pitchers, as are some other teams all the way down to the youth level.

I was able to speak with two Orioles officials inside the organization who have followed its use.

"We're not using it in games yet, but we really like the amount of data we get and it has exciting potential," said Kent Qualls, the Orioles' director of minor league operations, via phone. "We tried it some in the spring and we're hoping to get it into games in the instructional leagues this fall. We love the kind of data we get from ASMI's lab or from TrackMan, but this is another level. There's a lot of information but it will take some time to figure it out. We really want to get it into games."

One thing that's interesting is that the Orioles don't seem to trust the system entirely. I spoke with another Orioles official who spoke off record, telling me, "There's a disconnect between what we see with our eyes and what [the Sleeve] tells us. It seems to be a bit ahead of us on fatigue. I think that's on us. We'll see a guy and think, 'Is he getting tired?' and then wait for a clear sign, usually from the hitter. [The Sleeve] isn't emotional and doesn't care who's wearing it or how much he makes. I think it's better at it than a person, but it's going to be hard to let go."

The Pittsburgh Pirates are also testing the Sleeve, though they have been much closer to the vest with this than the Orioles. That's standard operating procedure for Neal Huntington's front office after his team was regularly attacked in the media for trying to change a team's culture early in the process. Now that they're winning, those attacks have been muted.

"Motus is great and got a lot of credibility from their work the last few seasons with Andrew McCutchen," said one Pirates official. "Cutch loves what they've shown him with his swing, and other guys follow, even the pitchers."

The Pirates know how important pitching injuries can be. "If this Sleeve was here last year and you tell me that it could have picked something up in [Jameson Taillon's] delivery? We would have to be stupid not to at least look into that."

Taillon, the team's top 22-year-old pitching prospect, was expected to be a big part of the team's rotation this year, but he was forced to have Tommy John surgery early this spring and will miss the season. With 23-year-old Gerrit Cole on the DL due to shoulder fatigue, the Pirates understand just how devastating pitching injuries can be.

The Pirates official refused to discuss—even off the record—how the team was deploying the Sleeve or what data it was using from the Sleeve. It was clear the Pirates are using it widely, and from the discussion I had, they seem as interested as the Orioles in using it in-game. There may be one or two other teams ready to test the Sleeve as well, but at this time, those teams are unknown.

Both teams did bring up a major issue with the Sleeve currently: It's not allowed in games.

However, there's really no reason it couldn't be. While MLB currently does not allow any wearable technology to be used in-game—and it would have to be approved by the rules committee, the Motus Sleeve is no different than a compression sleeve as used. It wouldn't distract a batter or give any real advantage that wasn't also available to the other team.

About the only issue is that Bluetooth LE, the technology used to connect the sensor to the smartphone, has a limited range. In most stadiums, a pitcher would be too far from the smartphone to transfer real time, but the sensor has enough memory to collect several innings of pitches and transfer those when it does get in range.

Mike Schneidler understands pitching and arm injuries. A former college pitcher with a couple scars on his own elbow, Schneidler now coaches Little League players on Long Island. When he first was given the chance to work with the Sleeve, all he could think was, "This could have saved me some pain."

Schneidler uses the Sleeve as part of a test, but he says that the kids already love it. "These kids are more in tune with the tech. They have Wii and Kinect and iPhones so you don't have to explain that part to them. They're also more in tune with injuries than you'd think. These are their heroes. Matt Harvey goes down, Jose Fernandez goes down and they're at practice talking about Tommy John surgery."

The kids don't seem to need any more adjustment to the Sleeve than pros. "They get it. They can see what they're doing on the app. You can't expect a 12-year-old to get the physics, but they can see the green and the red," Schneidler explains. He sees the use of the Sleeve as just another part of coaching. "I'm translating it into their terms. I do the same thing when we're learning bunt defense. I have to get them to get it. Same thing here."

While Schneidler is a former college pitcher and has some high-level knowledge, he doesn't think the Sleeve will require that. "A parent can understand it. They may not get all of it, but even if you just use a few things like arm speed and fatigue, [Motus] have done a good job at making it usable."

Schneidler can see a day when the Sleeve is used instead of pitch counts. "A pitch isn't a pitch," he said, echoing Fleisig's statement. "You get a little 11-year-old and he's going high effort on every pitch. Thirty pitches for him isn't like a bigger kid who's just up there playing catch. The [pitch count] rules are good, but they're not perfect. Every kid is different and [the Sleeve] tells you that."

Schneidler isn't yet testing the Sleeve in games. "There's enough pressure on these kids, but I don't see why it would change anything. A lot of them are already wearing Under Armour or something." He doesn't see any reason why it wouldn't work in games and looks forward to being able to do so. 

Just to check with someone who had not seen the device, I went to Dr. Tim Kremchek. Kremchek is not only the team physician for the Cincinnati Reds, but he has been very vocal in the battle against youth arm injuries. I showed him the video of the sleeve you saw above, and he was impressed.

"I think this has the potential to be huge! What we do know is that fatigue causes injury, fatigue causes a change in mechanics, which in turn causes increased stress and varus torque on the medial elbow. Knowing when these occur will greatly diminish injury to the elbow, and I believe the shoulder too."

I needed one more opinion.

"It sounds like science fiction," said Chris O'Leary, a biomechanical guru who has worked with several pro teams and is one of the best-known pitching mechanics writers. "But when you think about how far technology has come in five years, with phones and miniaturization, it shouldn't. It's inevitable."

So major league teams believe that the Sleeve is a game changer. Top doctors and biomechanists believe it is a game changer. Even coaches and pitchers who have been exposed to the Sleeve believe it is a game changer. The only question left is whether it will be adopted. 

Baseball largely rejected the use of biomechanical analysis because it didn't have the proper personnel to interpret and use the results. In cases where teams did use biomechanics—especially the current example of the Milwaukee Brewers—teams have seen significant reduction in injuries.

The Brewers are the only team in MLB to have no Tommy John surgeries at the major league level in the last five years. They're also the only team in that period to do biomechanical analysis on all of their pitchers. I don't believe that's a coincidence.

With the Motus Sleeve, cost certainly won't be the issue, and the ease of use of the smartphone app should help not only at the major league level, but also the parent who doesn't have a technical background.

Nolan says that the goal is to have the consumer version cost around $150, which is less than the cost of a single biomechanical evaluation. It's certainly less than the cost of a visit to the emergency room or Dr. Andrews' office.

Add in all the value of the Sleeve, the data it collects and the possibility that the data could be analyzed at a higher level, and there's endless possibilities. I asked Dr. Fleisig if he could see adding an in-app purchase someday where a parent could pay a fee to have him personally take a look at the pitcher's data. He laughed, but not dismissively.

"Maybe," he said.

The Motus Sleeve could be the biggest change for pitchers and pitching since Tommy John surgery. In fact, we may have the first real weapon in the battle to reduce the number of injuries and surgeries. This is more than a game changer; this is a game saver. 

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