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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