Under The Knife: Teams likely to test Kershaw's pain tolerance
A couple years ago, I put Oklahoma City Thunder GM Sam Presti on a list of possible future baseball executives, saying that he was just that good. A big part of the success of the Thunder over the past couple years has been a commitment to reduce injuries and keep their players healthy. Dr. Donnie Strack and his staff have done amazing work, showing that even in a sport with as much running, jumping and hard contact as the modern NBA, injuries are not just random, that they can be reduced in a number of ways. Strack might have created one of the top sports medicine organizations in North America. If the Thunder go on to put a ring on their hand, more and more teams will be looking to Strack's creation. One organization to watch on this front is the Houston Astros, who are run by George Postolos, an executive with an NBA background. The Astros already have Sig Mejdal in place, so don't be surprised to see this team try to innovate medically as well, an asymmetric advantage they could get in place much quicker than rebuilding the minor league system and more cheaply than a run on the free agent market.
On to the injuries:
There's no such thing as a "little plantar fasciitis," no matter what Don Mattingly would have you believe. Anyone who's felt the pain knows. Anyone who's seen the careers derailed or ended by the malady understands. Hearing that Kershaw is dealing with the issue is exceptionally concerning. However, the results Kershaw is putting up belies the problem. The fact is that this only bothers him when he's running. The motion of pitching doesn't cause much stress to the fascia. It's his left, push, foot, so the stress is mostly lateral. A pitching coach I spoke with said Kershaw is one of the pitchers who really "pulls" his foot, so that there's not going to be a significant weight load. Unfortunately, we don't have really good data on that.
Teams will test him with bunts, or at least make him cover them. At the same time, the Dodgers will have to see whether or not Kershaw is compensating in any way, changing his mechanics and risking that magical left arm.
It's unusual for an owner to call out his own players in the media. But in calling out two of his star players, Ken Kendrick essentially called his own medical staff into question. The D'backs have been at the top of the injury stats since bringing Ken Crenshaw over from the Rays, where he was a Dick Martin Award winner. Up to Kendrick's outburst, there were no indications that Drew wasn't moving along at the proper pace given the severity of his injury and the demands of his position. Not surprisingly, Scott Boras fired back at Kendrick and once again, Boras appears to have the upper hand on an owner. Drew began his rehab at Reno (AAA) Thursday night, so the timing was odd.
Upton, another target of Kendrick, has no known injury issue since a minor thumb injury in mid-April, but Upton's performance thus far has led many to ask if there's something more than just a slump. Again, there's no evidence to suggest that, but Kendrick's statement and the proximity to Drew's situation are going to raise those questions once again.
Holland has been inconsistent at best this season, his performances on the mound as patchy as his "mustache." (Jay Jaffe looks on with scorn.) It turns out that underlying the shoulder fatigue is some sort of infection that has been an ongoing struggle. These kinds of issues, especially chronic intestinal issues, can take months to diagnose properly and even longer to find effective treatments. Adding in the need for top athletic performance at the same time is even more difficult. Beyond the Neftali Feliz injury, Holland's performance is one of the reasons that the Rangers added to their pitching depth with Roy Oswalt. Martin Perez is showing he still needs more time at Round Rock (AAA), so Holland's status is key to keeping the Rangers rotation strong 1 through 5. The Rangers have put Holland on the DL while they sort this out, but the stamina issue is likely to be an issue even when he gets back on the active roster. One solution would be to limit the length of his outings, perhaps pairing him with Scott Feldman. The pair is much more effective the first couple times through the order, so a modified tandem could be a solution, especially while the Rangers try to get him back to full health. For now, the Rangers will shift Alexi Ogando to the rotation and bring up Tanner Scheppers to take Ogando's short relief role. Ogando's stamina is also going to be a question, so backing him with Feldman isn't a bad idea either.
Don't freak out about the "fractured wrist" nomenclature here. What Konerko has is much more akin to a bone chip in his wrist, a floating piece of something that occasionally lodges itself in the wrong place. The Sox's medical staff have been able to adjust the piece of debris by using a simple variant of lavage. They inject a small solution of saline into the wrist to push the debris away from the irritating position. The technique was described, in humorous terms as "like that game at the fair where you aim at the clown's mouth with a water gun," but it's far more delicate than that. The irritation is minimal in this approach, but it's also a temporary solution. Konerko has undergone this procedure previously and he may have to have it again, but it appears that for now, it's a nice midpoint between pain and surgical intervention that would cost him weeks.
Hamstrings are touchy things. The balance between function and dysfunction is frighteningly close, the tolerances like tweaking the engine of a Ferrari, even when the player doesn't run much like one. Avila is the latest player to re-injury a slight strain. It's a tough balance, especially when the player is likely pushing to be out on the field. Avila's disappointing season has mirrored that of the Tigers and going on the DL isn't going to help pull either out of that spin. Avila is not a speed player, but the hamstrings are key for function in his throwing motion and in comfort. You try squatting for a couple hours and see how your hamstrings feel. As with Matt Kemp, the re-injury part of this will force the team to be a bit more conservative, make him pass more functional tests, which means he's likely not back closer to a month.
Garcia missed a start with an elbow issue, then got torched when he got back on the mound. Now, he has a shoulder issue. The Cardinals have been vague about all of these, but indications are that the elbow issue was minor and had cleared up enough to get him on the mound. Now the question is whether or not that led to the kind of compensatory changes that lead to a cascade injury. Shoulder injuries after an elbow injury is a bad pattern, the kind of following down the kinetic chain that can go horribly wrong. Let's assume -- and be clear that no one, including the Cardinals, knows -- that Garcia was putting as much force into his pitches as normal. He was driving, using his hips and core to create the force necessary for a major league caliber fastball. The kind of advanced analysis that can be used to assess this doesn't give any clear picture, leaving the Cards to worry about what's actually going on there, working backward from symptoms.
I guess this is good news on RoyHalladay, but the fact that the doctors are addressing the labrum and rotator cuff at all is a bit strange ... Ryan Howard went 2-4 in a simulated game in Clearwater. He played at DH, so there's little to read into here. There's still no solid timeline for his return ... Freddy Galvis appears to have done something to his lower back on a swing. The team is already thin, but there's no indication that Chase Utley is even close to filling in while Galvis heads to the DL ... Want more, Phillies fans? Placido Polanco will miss a couple games with a nasty cut on his finger as well as a sore wrist. He says he won't need the DL ... Mariano Rivera is walking without a limp. Even so, he's about to have ACL reconstruction. The clot that delayed things has cleared up and in the meantime, Rivera has been working hard on 'prehab'. He's still expected to miss the season ... Evan Longoria wants to push his hamstring, but the Rays are traditionally conservative with rehabs. We'll see who wins this battle ... Austin Jackson is hitting without pain. That means he should go out on a rehab assignment soon. It's likely to be short, so leave some room on your roster for him. Late reports make it possible he could be back by Saturday ... Freddie Freeman injured his finger in a novel manner. He was hit by a Jose Reyes throw while on the bases. It's a bruise, not a break ... Daisuke Matsuzaka will get the start this weekend with Daniel Bard heading down to Pawtucket (AAA). Matsuzaka's rehab starts have been mixed, but this does indicate the neck/shoulder problem he's dealt with isn't that serious ... Geovany Soto will not begin his rehab as expected this weekend. His knee needs more time ... LaTroy Hawkins threw an inning at Salt Lake (AAA) and is expected to throw one more on Thursday. He should be back in the Angels pen by the weekend ... Jason Bay is due to be off the DL, but will stay on until his flu clears up. This is why DL days is a tough measure of any injury. So many things can alter the length ... Drew Stubbs remains out for the Reds with a strained oblique. He's day to day, but there's no clear path to a return ... Eric Stults isn't much of a fantasy factor, but he is a data point given his strained lat. It's not a common injury in pitchers, so the more we learn across baseball, the better. The downside is there is little to no sharing of this data ... Felipe Paulino left his start in the first inning with a strained groin ... Zack Greinke is 15-0 at Miller Park. At what point do the Brewers think about altering their rotation to just start him at home? There has to be a way to maximize his home starts. If you have ideas, e-mail me and I'll put the best one in Monday's UTK.
