Under The Knife: Communication key to saving Johnson's year

The world didn't end this weekend, allowing baseball to continue. Interleague play continued and didn't appear to have changed their pattern of being just another game for teams, at least when it comes to injuries. There was some discussion about interleague games creating more injuries, and while it makes some sense, the facts don't match up. The lack of the DH, which could force some hitters onto the field, as well as different parks with which players aren't familiar have combined to raise concerns. But over more than a decade, with new players and nearly a full rotation around the various spots possible, there's just no evidence that the risk increases. While I agree with Tom Verducci and others that something needs to be done to make interleague more than just another game on the schedule, it's unlikely that any of those changes will change what ends up here in UTK.

Powered by the countdown to this year's Indianapolis 500, on to the injuries:

There's a lot of different directions to go with the news that Johnson is heading to the DL after pitching thus far with a sore shoulder. First, if it's been bothering him, maybe he needs to keep it sore, given his results. Johnson has been outstanding all season, perhaps despite the problem. One source suggests it was because of the problem, saying "maybe he got more efficient, knowing it got more sore as he threw more pitches."

But the data doesn't match up. If there was any effect, it was slight. More troubling is that Johnson hid the injury. If the ace pitcher, performing at the top of his game, can't go to the trainers and say "you know, my shoulder's a bit sore," then who can? The open dialogue between a player and a team's medical staff is a huge thing, one that can be lost all too easily due to a number of factors. This could have been worse, if Johnson's reticence had ended up causing a more significant injury. The injury itself is minor, a strain at the front of his shoulder causing some inflammation and discomfort. The Marlins should be able to get Johnson back at or near the minimum, though they'll surely be watching him closely and perhaps limiting his innings slightly.

It won't be May 15 that Utley returns, as I'd expected, but not far off. Utley's problem -- which is often described as patellar tendinitis by the media -- is under control, and now that he's hitting to the Phillies' expectations, he's been activated and will be in the lineup on Monday.

This is an issue of maintenance and control. Look for Utley to get some regular days off in the first month of his return, especially in common situations like day after night and where an off-day pairs up. Given the knowledge of the condition and his performance in rehab, I expect Utley to play at or near his normal level immediately in all phases of the game aside from on the bases, where he'll likely be under orders.

Yankees reliever Feliciano has had a crazy workload over the last couple years. Abusive? Well, that depends on how you define it, but Feliciano took the ball all those times. That leaves him where he's at now, reaching for anything that will help get him back on the mound. He's nearing the end of the rest period prescribed by Dr. James Andrews, but now he's trying platelet rich plasma (PRP) therapy. The therapy has had mixed results scientifically and in baseball, but there's an element of desperation for Feliciano here. It's unclear whether this was something initiated by Feliciano or the Yankees, who have previously used PRP, most notably in an attempt to get Xavier Nady back. A better comp is Alan Horne, an oft-injured pitcher that put off rotator cuff surgery last June and has not yet returned in any way despite using PRP.

The procedure is controversial, but is not in any way something that even ventures toward the "performance enhancing" side of things. Adding platelets, which help blood clot, is a far cry from adding red blood cells, as is done in "blood doping." (Blood doping can be done chemically, via drugs like EPO.) Blood doping is done for endurance athletes and likely would have no effect on baseball players, even starting pitchers. Baseball is a burst activity that tends toward the anaerobic, but PRP is not blood doping. It's controversial because of the mixed results and sparse science, not because of treading on some ethical line.

Feliciano is weeks away from throwing and a month or more away from a return, at best, so it will be very difficult to tell how, if at all, this helps. His return is still very questionable, with major shoulder surgery still very possible.

While Garza is downplaying the severity of his elbow issues, saying that he could pitch if this was October, there is some concern. Garza will have an examination and likely an MRI on Monday, which will determine if he makes his next start. Garza has been very healthy through his career, especially while at Tampa, so any problem is something new. Garza has been used heavily, mostly due to his effectiveness and the Rays' deep trips into October. There hasn't been much of a sign of trouble prior to this, which leads many to wonder about possible changes to his routine or just a buildup of "mileage" on his arm. One scout who called to ask me about Garza's situation mentioned one meme about the Rays: "Everyone wonders if they've got some magic formula that tells them when to deal a guy who's about to fall off a cliff." It's likely not that, but the Rays front office probably loves the concept.

The Indians are adjusting expectations for Sizemore as much as there's been a real change in his recovery from a bruised knee. Lonnie Soloff told the press that it's "not a foregone conclusion" that Sizemore would be ready to come off the DL when he's eligible on May 27, but sources tell me that it's still the most likely scenario. Sizemore is running and hitting, but he's not doing a lot, part of a very conservative rehab for a minor injury. His baseball activities are going to amp up a bit this week, with a mid-week decision point on the exact details. There's still a chance that the team would ask him to go on a quick rehab assignment to tune up his swing against live pitching.

Word out of Atlanta is that the concern about Heyward is less about how serious his shoulder problem is, but how serious it isn't. Essentially, Heyward has some inflammation in the rotator cuff that is entrapping a nerve, creating some problems downstream from the impingement. The effect on Heyward is essentially the same as a stinger. It's not a serious injury, but for Heyward, it's affecting him more than many think it should. Remember, this is an organization that is used to seeing its players follow the example of Chipper Jones, and play through things. Heyward is playing, but his request to see Dr. Lewis Yocum appears to have set things off track a bit as far as the Braves are concerned. Heyward could find himself on the DL, as well as a spot in the doghouse. It's not only shortsighted, it's the wrong kind of leadership.

The Angels are ready to send Kazmir on a rehab assignment. Kazmir hasn't been with the team during much of his DL stint, leaving many to wonder what exactly he's been doing in rehab. Kazmir was allowed to work with "people he was comfortable with" near his Houston home, but sources tell me that mostly consisted of "staying in shape, a bit of throwing." He shifted back to XST over the last couple weeks, returning to Anaheim to get observed over the weekend before heading out to Salt Lake City. Kazmir is being treated as something of a lost cause by the Angels at this stage. "They're out of ideas," one scout who saw Kazmir earlier this season told me, "so he either finds something and they can offload him or cut him." The third scenario is that the Angels hang on to him and try to shift him to a lefty reliever. That's a tougher shift given Kazmir's injury history and warm up, but at this stage, any value would be a bonus.

The Yankees are watching Hughes closely, having him checked and re-checked as he continues to progress through his throwing program. The conservative pace of his rehab will continue, even as he progresses forward. The biggest worry is, of course, a re-emergence of his symptoms, but that's also, in a way, what this program is designed to find. There's a bit of isolation with this, making sure that each individual component is tested, imaged and observed along the way. It's difficult since the shoulder is both a collection of parts and an holistic entity. So far, things have gone well, but there's been no sign of a problem, which means that either it's vanished magically or that it will be back at some point in the future, as Hughes gets closer to game conditions. His progress to the mound is likely to be his biggest test.

Andre Ethier escaped serious injury after smashing into the wall. He could miss some time if he remains sore ... David Wright is headed West to have his back checked by Dr. Robert Watkins, one of the best in the biz. We should get a bit more clarity on Wright's timeline after this exam ... Marlon Byrd was hospitalized after getting hit in the face by a pitch. Facial fractures are as bad as they sound. He'll go on the DL ... Brian Roberts won't make it back in just seven days from his concussion. He's still having symptoms and is being monitored by specialists ... Joe Mauer has begun running and doing some light catching drills at the Twins complex ... Josh Beckett is on track to make his next start. He left his last one with a sore neck ... Aroldis Chapman will start a rehab assignment Monday. The Reds think the problem was mechanical and that he'll be back for good on May 31. We'll see ... Clearwater has star power, something the Phillies probably aren't thrilled about. With Chase Utley leaving, the Threshers get Brad Lidge in for a rehab assignment. This does put him well ahead of the published return, but on track with a normal timeframe ... Pedro Alvarez went on the DL with his strained quad. He'll get a chance to get some minor league swings before returning, which should help his production as well ... Howie Kendrick had a cortisone injection in his sore hamstring. He should be back by Tuesday ... Marco Scutaro still isn't swinging a bat, meaning he won't be back from his oblique strain for at least a week ... Manny Parra is headed to see Dr. Yocum for a second opinion on his shoulder. He'll be shut down indefinitely pending the findings, a big negative considering his injury history ... Carlos Quentin missed the weekend with a sore knee. Sources say the issue is bothersome, but not serious, but that the team wasn't willing to risk him playing. Quentin's plantar fasciitis history figures in here ... Indians pitcher Alex White is out six to eight weeks with a strained finger. There's a chance that due to his status, this will end his season ... Nate McLouth left Sunday's game with an injury to his side. Early speculation is that it could be an oblique strain ... Adam LaRoche's shoulder issues are a problem for the Nats, as is his lack of production ... If you watched Bernard Hopkins win a light heavyweight title at age 46, you might wonder why the muscular Jean Pascal was raising questions about Hopkins and PEDs. It wasn't size, strength, or even endurance that beat Pascal. It was skill ... Are we at a point with Jose Bautista where he's become a player you'd pay to go see? I know that many will still throw the steroids canard out there, but I'll be addressing that very soon.