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Under The Knife: Mets staying in contention thanks to medical staff

The Mets are contenders at the All-Star break. While that soaks in, let's focus on one big reason why. The Mets rotation is made up of two post-surgical shoulders, a knuckler who requires regular injections of Toradol to be functional, and two pitchers who haven't exactly been injury-free through their young careers.

Trainer Rey Ramirez and his staff have caught more than their fair share of flak since an inexplicable 2008 season that has to be some sort of record for dollars lost to the DL and for bad luck. They've been better every year, despite a lot of accepted risk and injury-prone players like Jose Reyes, Carlos Beltran and Jason Bay. Remember, Sandy Alderson and Paul DePodesta have had a chance to look at every inch of this operation. They made a lot of changes, but they changed nothing -- not one thing -- about the medical staff. I talk a lot about results here, because that's what we can measure and quantify in terms of on-field results. It hardly tells the whole story. Some teams like the Yankees accept a ton of risk, knowing that one injury hardly wrecks their depth. Every team's medical staff is among the best of the best, even when they've had a year like what the Mets and Ramirez had a few years back. Whether this team wins this year or not, the work of Ramirez and his staff should remind us all that we should always look deeper than wins, losses, and dollars.

Powered by Apple's new Podcasts app, on to the injuries:

It's no secret that Zimmerman has been struggling this season, fighting off a chronic shoulder injury. The difference is that Zimmerman's team is finally heading into the second half of a season in contention. That changes the context and the care. Instead of thinking that they can get him through for a while and shut him down early, the Nats medical staff has to think a bit longer term. Zimmerman had an injection into his AC joint, indicating that there was inflammation and impingement. The term "cortisone" has gotten to be a generic, so it's unclear if this was the classic corticosteroid and topical anesthetic shot that we're used to seeing or a newer injection like Toradol. Cortisone, itself, is acidic and can, over time and extended use, actually destroy the tissues that it's trying to help. It's a classic "short-term good, long-term bad" situation that has to be balanced by the player and the physician. If the treatment works, look for more pull hitting and a bit more power as the key.

In Tuesday's game at Lehigh Valley, Utley went 2-for-4 with a homer, playing all nine innings and making a couple plays in the field. He didn't have any noticeable issues, though his range and speed were never really tested in this game. Josh Whetzel, the voice of the Rochester Red Wings, called the homer "towering" and added that Utley looked "spry," even making a couple of good charges on the ball. If there is any worry, it's that Utley had two strikeouts. Whetzel said one of them was a tough call, but the other was a chase up, so it may be a bit of a positive -- perhaps Utley is still off on recognition. Utley is expected back in the Phillies lineup on Wednesday, and if Tuesday is any indication, fantasy players want to put him right back in the lineup. Utley is sure to get occasional days off to keep the knees fresh, but last year's return didn't come with as many off days as expected.

Bob Elliott, the Hall of Famer writer from Toronto, has a lot of facts and figures in his latest article, but I do have questions about why Morrow will miss two months with an oblique strain. I don't doubt that someone gave Elliott that number, but like the "12 to 18 months" he quotes for Tommy John surgery, it's a bit conservative. I said just after the injury that Morrow would miss roughly a month and I haven't heard anything to change this. The Jays weren't even sure they were going to need the DL, so for this to have changed significantly either indicates a setback of some sort, which usually doesn't happen this early in a rehab, or that the Jays are taking their time, knowing that Morrow's workload could be an issue. Keeping Morrow under 190 innings is going to be something of a step back for him, though nothing in his development has gone to book. I'm moving the ERD back, but only slightly until I'm able to figure out more on the situation.

It was a bit of a surprise when Bobby Valentine told the media that Ellsbury was ready to start a rehab assignment soon. In fact, it was easy to side with the cynics that called this a misdirection play by the manager after an unpopular trade and another batch of bad news that seems to be hanging over this team. Ellsbury could start his rehab assignment at Ft. Myers (A) on Friday, but he will be limited to DH for a bit. Throwing seems to be the biggest issue for Ellsbury at this stage. A swap with Crawford would be unlikely since Crawford is barely ahead of Ellsbury in his rehab from an elbow injury. Ellsbury isn't likely to shift David Ortiz out of the DH slot either, which means he'll need to be nearer 100 percent than perhaps needed if the roster was a bit more flexible in Boston. Crawford is also at Ft. Myers, also DHing, so we can assume he'll either move up or at least out to the field later this week. Late Tuesday, that's exactly what the Red Sox announced -- that Crawford will shift to the field when Ellsbury starts.

On the pitching side, even the good news has an asterisk. Beckett threw a side session on Monday and came out of it saying he felt good, but there's no decision yet on when or how he'll slot back into the rotation. The team is currently juggling things to deal with new and returning players, so while Beckett could be back on Friday, it remains to be seen whether that will happen. Regardless, sources tell me that Beckett will be on a strict, "surprisingly low" pitch limit in his first start back. I couldn't get more info on where the "surprisingly low" mark was set, but fantasy players might want to let Beckett's first start go. The Sox also announced that Buchholz was suffering from erosive esophagitis, a common and controllable situation. He should be out only the minimum.

The good news is that Avila doesn't have a so-called "structural problem" in his knee. The downside is that he has an advanced case of tendinitis in the knee. (The downside for me? Having to go through another discussion of "tendinitis" vs. "tendonitis" with nitpickers.) Actually, Avila's case is severe enough to verge on tendinosis. Tendinosis is the more chronic version and can require surgery if there's enough deterioration in the fibers. It can be managed, but Avila's not likely to hold at the catcher position very long dealing with something like this. The Tigers have dealt with this before, with Victor Martinez, so expect a similar plan.

Byrd was busted for the use of a defined PED, in violation of the joint drug agreement. That's the standard part, but there are three interesting notes on top of the basics. First and most notably, Byrd was a client of Victor Conte, who ran BALCO. Conte has been focused more on boxing and working with VADA (Voluntary Anti-Doping Agency), which conducts tests in boxing and MMA. Byrd went out of his way on Monday to clear Conte of any complicity. It seems like those going after Conte were quick on the trigger, certainly something we see too much of in this Twitter-fed attention economy. Second, Byrd tested positive for tamoxifen. Tamoxifen is a drug approved for use in chemotherapy for breast cancer. It is a powerful anti-estrogenic and is normally used as part of a "stack" to counteract some of the side effects of steroids. That Byrd was willing to take this, a drug with some severe side effects of its own, and that he wasn't positive for anything else bears questioning. Finally, Byrd's suspension begins immediately despite the fact that he is currently a free agent. It appears that suspensions are now measured in terms of days, rather than games, though I can't find when this change took place. It could be in response to the oft-ignored reduction in the second suspension for Manny Ramirez. This is all without discussing that Byrd failed to get any performance enhancement from this so-called performance enhancer.

It looks like Matt Kemp is out not only through the All-Star break, but for the All-Star Game and perhaps beyond. His hamstring is still problematic and we may not see him back before August ... Jose Valverde was available to pitch on Monday, but there wasn't a save situation. I'd like to see Jim Leyland give him an inning regardless over the next couple days, but he'll likely just come in when the stat says so ... Chris Carpenter had what he termed a setback, but it seems minor at this point ... Many are reporting Nelson Reimold's surgery as a discectomy, which is true, but the more important piece of the surgery is the spinal fusion. This is very similar to what Peyton Manning had done and has a similar six-month recovery period. It's also the downside case for Carpenter .... Matt Harrison expects to make his next scheduled start, but Colby Lewis heads to the DL with tendinitis in his pitching elbow. Scott Feldman takes his Thursday start, but Martin Perez was called up and could factor in to the suddenly thin rotation ... Dan Hudson left the mound early, walking off with an apparent elbow injury. Pat Corbin is the likely replacement ... An interesting take on Tim Lincecum from someone with a unique POV ... Jeremy Hellickson made it through his bullpen and is expected to start on Saturday for the Rays ... Publicly, the Jays aren't too worried about Henderson Alvarez and the elbow issue he had this week. Privately, they're looking at all their rotation options while trying to maintain both depth and leverage. That includes scattering scouts and signing Jamie Moyer ... Jose Altuve took BP on Monday, but did not play. He should return from a mild hamstring strain soon ... The folks at Rawlings might have a commercial on their hands. Marco Scutaro took a Stephen Strasburgfastball to the head and walked away. Scutaro will be monitored per the MLB concussion policy ... Bud Norris will return to the Astros rotation on Thursday. He had no issues with his minor knee sprain during his short rehab ... Justin Maxwell did everything he could, but couldn't avoid surgery on his ankle. He'll have the chips removed and will miss a month or so ... Brian Schneider will miss a couple weeks with a high ankle sprain ... Travis Hafner will begin a rehab assignment on Wednesday, starting at Norfolk (AAA) ... Remember, Stephen Drew is scheduled to be activated on Wednesday. He'll take the starting SS slot back, but will get regular days off in the first few weeks ... So the Rockies are going to try and split pitching coach duties after Bob Apodaca resigned? That won't work well, especially in the midst of a desperate four-man experiment.

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