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Under The Knife: Pence finds health elixir still eluding Utley, Howard

I've talked about pitch counts for a week now and I know you want me to be done with it. Then again, I've been talking about pitch counts for a decade. Reader Mason Stark e-mailed with a point that I thought was worth touching on, however. "I think I understand the different points you're making here, but I do think it's a mixed message when in one article you use the pitch count as evidence of potential abuse, and then in the next article you make a statement that suggests pitch counts are completely irrelevant," Mason said. He's right and I want to be very, very clear. If Little League and even high school pitchers had trained coaches and athletic trainers looking out for them each and every start, I'd say that we should disregard pitch counts there. (In fact, I think velocity loss is a better measure, but it's never caught on.) In the absence of something better, though, pitch counts are a measure of defense against ridiculous usage. At upper levels, pitch counts lose their value because we have more and more data that we can use to make good decisions. We need more data, more education, more parents asking questions and demanding answers. This problem isn't going to be solved overnight, but I'm going to keep standing on this soapbox until the problem's fixed, or at least until I see some progress. Like I said, I've been saying this same thing for a decade ... and it's my biggest failure that I'm still saying it. I always wonder if I'd said it more clearly then, would I be saying now "on to the injuries"?:

Bottom line, Utley isn't coming back soon. Utley met with the team, but elected to stay in Arizona where he continues to rehab his damaged knees. There's no clear timeline, but I'm reminded of last year. When he came back, he came back in a hurry, and then once back, played like the Utley of old. That could happen again, though I'm less certain of it and a whole lot less certain of the timeline.

Howard saw a specialist and was told it will be one more week before he's cleared for full activity. It's mobility that's the last step, yet that's the smallest part of his game. He's doing everything but that in his work now, and if you think anything but the slightest sign that he can field will prompt the Phillies to activate Howard, you're crazy. He's already swinging a bat, but not hitting, according to GM Ruben Amaro. I'll admit I don't understand the difference here. I don't expect the team to waste many at-bats on the minors with him. Getting Howard back before the All-Star Game would be a win for the Phillies and their medical staff.

The last thing the Phillies needed was another injury, especially to Pence, who's become the centerpiece of their offense in the absence of ... well, everyone else. Pence injured himself on an attempted catch against the Giants and said that the adrenaline of the moment kept him from realizing he'd hurt himself. It's hard to believe the trainers wouldn't have noticed the play and asked him, but it's also believable that he'd say "nope, I'm fine" when they did. (Indeed, Pence credited the medical staff when asked about it later.) The shoulder was sore the next day and Pence had a precautionary MRI. It must have been nothing, since he was back in the lineup on Tuesday. Was it one of those magical healings? Was Tim Tebow seen in Arizona? The thing to note here is how fast things can change. While some want to fault me for saying that the Phillies were worried on Tuesday morning, things change, sometimes for the better.

Pineda had a contrast MRI on Tuesday, and while the results are not known, the Yankees are sending him over to Dr. David Altchek. Altchek might be better known for his docking technique used in Tommy John surgery, but his hospital (Hospital for Special Surgery) has been at the forefront of research into shoulder injuries, especially what Dr. Steve O'Brien has taken to calling the biceps-labrum complex. No, it's not a good sign that Pineda is heading for a second opinion, and as we found out late Wednesday afternoon, it wasn't. The Yankees announced Pineda has a torn labrum. A surgery is scheduled for next week, but Pineda's recovery is expected to last a year.

A scout told me on Monday night that he noticed Lincecum occasionally wincing and making some gesture toward his side. I didn't always get the best angles via the replay and couldn't completely see what he was talking about, but it's certainly worth noting. Lincecum had his best outing of the year, but he's hardly back to peak form. As I told the guys from Rotoanalysis on their podcast, I think Lincecum is one of those pitching savants, able to make adjustments on the fly that other pitchers never consider. His velocity loss seems to be a matter of adjusting to stamina concerns and his pitching has stayed effective for the most part. I think he's moving in the right direction, though it's worth watching him very closely.

Pelfrey's injury came out of nowhere. He had a couple decent starts, including an eight-inning outing last time out. Unfortunately, his elbow swelled up afterward and tests showed a partially torn UCL. Remember, the Mets team doc is the Altcheck, so if he's advised surgery (and that's unclear), it's unlikely that another doctor is going to have a different opinion. The degree of sprain is unknown, but if this goes surgical, the timeline becomes that of every Tommy John patient -- out for the season, return in 9-12 months. I'm leaving the TBD up there for now until we get a solid diagnosis.

Bay seems to know what his injury isn't, but even after X-rays, there's some question about what it is. An MRI showed a fracture of the non-displaced variety. That pushed him to the DL, but it shouldn't keep him out much longer than the minimum. I don't think running into a wall and breaking something tells us much about Bay or anyone. The human body breaks when it runs into hard objects like a wall or the ground, whether it's a guy with an injury history or not. I just wonder if some team might extend the warning track and tell it's players "hey, we don't want to see you running into the wall. Give up the double, throw it in, and let's keep you in the game." I'm sure that there's a way to take the WPA of the play and equate it with the lost value of a player on the DL. It's hard to tell an athlete to ease up, but it's not hard to make the case as to why they should.

Chris Narveson will have season-ending surgery to repair a partially torn rotator cuff ... Stephen Drew is running the bases, the last test before the Dbacks send him for a rehab assignment ... Daisuke Matsuzaka gave up a couple homers in his first rehab outing, but made his pitches and showed a solid fastball, according to reports. His next start will be Saturday at Portland (AA) ... Hideki Matsui may sign with the Rays as a backup option for the injury-prone Luke Scott ... Adrian Beltre was back in the lineup for the Rangers after a good MRI on his hamstring ... Dr. Lewis Yocum told Sergio Santos that there's no structural issue in his shoulder. The Jays will shut their closer down for a minimum of four weeks and as Pineda has shown us, it might be longer ... One scout that saw Chipper Jones over the weekend said "He can barely make it up the line. He's going to have to hang it up soon." Jones was out of the lineup Monday, but back in there, running poorly, on Tuesday ... The Braves have sent down Jair Jurrjens in a stunner of a move. Jurrjens is still struggling to repeat his motion due to knee issues ... Felipe Paulino will make a rehab start on Wednesday for Omaha (AAA). The Royals could use the help ... Zach Britton is back on a mound, but there's still no solid timeline for his return to the Orioles ... Kerry Wood is making some progress after a cortisone injection. He'll throw off a mound sometime later this week ... Ronny Cedeno slept wrong and exacerbated an intracostal strain. I mean, that's really sleeping wrong.

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