Will Carroll
Wednesday April 6th, 2011

Baseball continues to search for some sort of explanation regarding the uptick in oblique injuries. Digging through my injury database shows a steep trend up from just seven in 2005 to 22 in '09. As a numbers issue it's clear, but the "why" is powerfully murky.

Perhaps we should be looking to Texas, which hasn't had an oblique injury lead to the DL ... except that the DL isn't always the best indicator. The Rangers lost Alexi Ogando during last year's playoffs to an oblique strain and Tommy Hunter missed time in 2010 Spring Training to an oblique strain. Those are accidents of timing and show the problems of data that we're dealing with on the outside.

Failing an answer from baseball, I looked to research. A 2010 study from Stanford involving the Giants team doctor showed some interesting results for a small set of pitchers. Their results showed that guided injections had players returning in just over a month (30.7 days.) That's not significantly faster than what the database shows for non-injected pitchers (32.6 days, though it's likely those three pitchers in the Stanford study are also included in my data set.) We know that an injection of this type was used on Casey Blake this spring, so we'll have to monitor his results. In addition to cortisone injections, some team physicians I've spoken with about this issue are considering the use of platelet-rich plasma (PRP) injections. Teams don't seem to know how to prevent these injuries, giving doctors plenty of chances to fix it from their end. It's a situation I'll continue to monitor. For now, let's get to the injuries:

If oblique strains seem viral this spring, appendectomies are now catching a bit. Dunn felt that pain in the lower right quadrant of his abdomen and headed in for surgery. Like Matt Holliday, it was a laproscopic procedure, meaning he could be back in a week to 10 days. The Sox are being a bit optimistic, saying he could be back in five. While Dunn doesn't have to play the field he does have to twist when swings the bat, which will be the worry. Look for him taking BP for an indication when he'll be back. Once the power returns, so will Dunn.

Yankees fans seem to be in a bit of a panic over Hughes' first start, with the focus on his velocity. Hughes was at 89 and as high as 91 during his first stint this season, something that seems to concern new pitching coach Larry Rothschild. Hughes said he'd rather be pitching at 93, a 4 mph jump. That kind of jump isn't something that just happens without some mechanical or health change, but are either of those issues holding Hughes back? Trying to take as much of an apples-to-apples look as possible, I looked back at the start Hughes made against the Tigers on Aug. 19 of last season. In that start, Hughes was living at 91 and as high as 93. He had slightly more movement and a near-identical release point, so it's hard to say this is a mechanical issue. Instead, it appears that Hughes is either fatigued -- which is possible at this stage of the season -- or could have some sort of shoulder injury. Velocity doesn't magically appear and disappear. Now it's up to Hughes and Rothschild to find the solution. Until then, you have to be wary and watch the gun on Hughes.

You read that ERD right -- and I'm being a bit conservative. Sources told me on Tuesday that Holliday could be back in the Cards lineup as soon as Friday after having a laproscopic appendectomy last Friday. Coming back just a week after a surgery doesn't seem possible, but we've seen baseball players back in 12 days and football players back in 11, so this isn't that far out of line. I'm erring on the side of caution, like I think the Cardinals will do. If Holliday can go swing a bat without discomfort, he'll play this weekend if not Friday. That's going to be the real test, so batting practice this week will be a tell. If he's putting balls in the seats, he'll play quickly. Absent a setback, Holliday won't be going on the DL and should be back in your fantasy lineup as quickly as he's back in the Cards'. (One interesting fact: @jrmark asked, "is it rare for a 30-year-old to have appendicitis?" Since it's medical study day at UTK, I checked and the answer is no. According to this 1997 Norwegian study, the biggest age cohort is 13-40. That's a pretty broad range and it will skew lower, since it can only happen once, but it's hardly rare.)

Drew's abdominal strain is low on his abdomen, an uncomfortable area for any man, let alone one who makes his living twisting and bending the way an MLB shortstop has to with almost every activity. The injury is serious enough that he can't play through it, but not so serious that it can really be considered more than day-to-day. The willingness to play a man down and save days is a strength of this medical staff. Say, for instance, that Drew is ready to come back after seven days -- that saves eight games of his production. And given that his replacement is Willie Bloomquist, that's worth about a third of a win, assuming last year's values. That doesn't sound like much, but small things like that can add up. There's still no real ERD on this because it's truly day-to-day. Watch the lineups.

The Marlins are being very conservative with Stanton, who's on his second leg strain of the young season. They're leaving him on the active roster due to off-days and his ability to pinch hit. Sources tell me Stanton's power is not affected since he's "so strong in his upper body," but any good hitting coach will tell you power comes from the legs. Until Stanton is showing us power, I have to be at least a bit skeptical. The Marlins are being smart, making sure that Stanton's not going to reinjure himself in any manner, recurrence or cascade. His fantasy owners would be smart to be as patient.

I watched the Opening Day game at the Trop to see what the new turf looked like. For some reason, the turf looks terrible on TV. That's relatively meaningless, but I've wondered in the past if there's some mental block for players. I've stood on that turf, and in prior years, it wasn't very soft. The new turf looks the same, but I'm told it's slightly softer. It might not be enough for Damon, their new LF, who is already having some knee soreness due to the turf. They may need to sub him out during homestands, maybe swapping him and Manny Ramirez, which would be a big defensive hit. The more likely beneficiary would be Felipe Lopez, who would take 2B while Ben Zobrist shifted to LF. This is definitely worth watching for Damon, but be aware of opposing who have knee or foot issues, such as Carlos Quentin and Grady Sizemore, who'll have trips to the Trop in the next two months.

He's not jogging. GM Ruben Amaro made that clear after a Ken Rosenthal report on Tuesday hinted that Utley would be doing just that -- jogging -- soon. In denying the report, Amaro did give clues as to what's going on behind the scenes. The whispers are starting to add up, and I think there was something to what was reported. "There is no timetable," Amaro said, but there is a "progression." Those are words that we'll often hear from physical therapists. Instead of thinking in terms of days or weeks, we'll have to think in terms of activities and milestones, as well as Utley's physical responses. Utley has been taking grounders, so the jogging is the next one, followed by running and then hitting. It could move fast ... or slow. It's similar in ways to what we saw with Carlos Beltran last season, and it wouldn't surprise me to see some sort of bracing happen here. I'm not saying that Utley will be out as long as Beltran was, but I do think we can learn from comparisons.

Fantasy owners who jumped after Jon Rauch haven't been rewarded. Through the first three games, they hadn't needed a closer and Rauch barely saw the field. That said, a game like Tuesday's highlighted the weakness in John Farrell's current bullpen as he had to go six deep to get the extra inning win. After Jo-Jo Reyes didn't last four innings, Farrell mixed and matched pretty well, but adding Francisco and Dotel should strengthen them by pushing good pitchers forward. I wonder if it would have changed the mix of long and short relievers, but that's a problem for another day. Francisco is close to heading out on a rehab assignment now that the minor leagues are starting up. It's expected to be quick and focused, though it's likely that he'll do it in the low minors and start. Low, because it's not that warm in Syracuse or New Hampshire right now. Starting, because they want to make sure he gets his one inning and gets his treatments. The Jays still have Dotel in Florida and he won't join the team until next week. Even then, its unclear now whether he'll also head on a more advanced rehab, but it looks like they think he can slot back in since his arm is unaffected.

Cashner hasn't followed the normal path to the majors. The Cubs drafted him out of college, where he'd been used as a closer. They converted him to a starter, a bizarro path to the normal one, but it worked. The Cubs thought all along that Cashner had the arm and the potential stamina to succeed as a starter and by taking a rotation slot this spring, they were proven right in one sense. But after he left his first start with a sore shoulder, they left the other big question wide open: Can Cashner stay healthy as a starter? Since Cashner was pitching well, we have to assume that it was serious enough for him to signal to the trainers. There's no word yet on the specifics or the severity. The Cubs are also already dealing with Pena missing time. His injured thumb is a mild sprain, one that should take a matter of days before it's comfortable again. Pena's issue is gripping and holding the bat at this point, and given past hand problems, the Cubs are smart to be fairly conservative with him. The Cubs have an off-day Thursday, so if they hold him out on Wednesday, they're buying him time to heal up.

Aroldis Chapman "only" threw 101 on Sunday in his first appearance for the Reds. One interesting fact got back to me though: He's got less movement on harder pitches. This is confirmed by PitchFX and it's something hitters are picking up. Whether they can do anything with it remains to be seen ... Ubaldo Jimenez will have a side session Wednesday. If that goes well, he'll start Friday. If the cuticle is still a problem, he could be pushed back a day or skipped altogether this turn ... Word is that Grady Sizemore will start out his rehab stint with Double-A Akron, so that he can be closer to the Indians medical staff ... Brian Wilson will be activated before Wednesday's game, according to Bruce Bochy. His beard, however, avoided the DL altogether and has two saves. One puppy, one damsel ... Joel Zumaya is headed to Birmingham to meet with Dr. James Andrews. He's being examined before he'll be cleared to start throwing again ... The M's are going to bring Franklin Gutierrez back very slowly, starting with some innings in minor league games later this week ... Corey Hart should start a rehab assignment this weekend. It's expected to be relatively short ... Shaun Marcum said his shoulder didn't bother him in his first start. The velocity seems to agree, though it's very tough to tell anything from one start ... The new IFP -- that's SI Inside Fantasy Podcast -- should be up today. Be sure to listen in for tips from Eric Mack and myself either on iTunes or in the SI Inside Fantasy Podcast archive.

Follow Will Carroll on Twitter (@injuryexpert). He is a member of the BBWAA and PFWA.

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