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Under The Knife: All-Star break may deliver good news for Dodgers

Dario Franchitti doesn't just drive the last 20 laps. Peyton Manning doesn't just play the fourth. LeBron James doesn't just play in the fourth quarter. OK, maybe the last one is stretching the analogy, but over and over, managers are leaving their best pitchers in the pen in the toughest situations. I won't go all Joe Sheehan on you here, but watching Mike Adams (a good pitcher) go up against Kevin Youkilis in extras Thursday made me throw up my hands. We're seeing more and more good use of stats, and yet with wins on the line -- real wins, the ones that count in the standings -- managers aren't going to their best pitchers. Managers who ignore stats do it, as do managers who micro-manage splits and small sample matchups do it. (As I write this, Jonathan Papelbon just blew a save, so even a save situation isn't perfect usage!)

I've long been a proponent of this kind of strategy as espoused by "Tom Tango." I've had discussions with four different GMs about doing this, but none have yet tried it. In fact, over the last 20 years, the only changes in how pitchers are used is a diminishing use of closers and the occasional short-term experiment with four-man or six-man rotations.

What's interesting is that while field staffs say it's about "comfort" and "role," there's some underlying information that might indicate that's not actually the case. I'm going to show you some of the work that Dan Wade has been doing in the background over the last couple months and it's going to shock you. Pitchers aren't tipping pitches, but injuries, and they're doing it in a way that belies the way that managers believe they should be used. One particular stat underlying performance has unfurled a new red flag that predicts injuries unlike anything else I've seen. Fantasy players can use it before teams, who are always slow to adapt.

The Dodgers are going to let Kemp show that his hamstring isn't going to be an issue. His rehab has been a bit slow, but there are some signs that Kemp is ready to make his next step. His first two games have shown no problems, this time. It's clear now that he came back too quickly and re-injured the strain, but it appears that it didn't set him back to square one. He's been healing up, and this rehab assignment is the last step. The Dodgers clearly would rather have him wait past the All-Star break, but if he can do it, you have to give him points for wanting to play. Kemp is good for baseball and he'll help himself with marketing and endorsements.

The Dodgers did finally push Ethier to the DL with a retro move. He wasn't making much progress and with the All-Star break, he'll only miss a couple more games. He'll be eligible to return right after, but he'll have to show that the oblique is completely healed. The Dodgers medical staff (a new one this year) has shown a trend toward being conservative, especially in light of Kemp's visible setback. Ethier should be fine shortly after the break, if not immediately.

So now we know the setbacks Carpenter had weren't really setbacks; they were symptoms. Carpenter's shoulder isn't the problem as much as the structures that help the shoulder function. Thoracic outlet syndrome isn't good for anyone, but it can be fixed. Pitchers are susceptible because of the repetitive motion, just like swimmers and (ironically) carpenters, who regularly swing hammers above their heads. Carpenter dealt with a similar (if not identical) situation and was able to make it this far without surgery. It only took one throwing session after he visited Dallas before Carpenter changed his mind and decided to have surgery. I had forgotten last week that Carpenter signed an extension, reducing his salary this year but putting him under contract to the Cards in 2013. There's no reason to think he won't be ready to pitch by next spring or that this rehab will go any differently than the myriad others he's done.

The news isn't quite as bad on Garcia, but he's not going to be the immediate answer. If Garcia's not back in early August as planned, the Cards are going to face some tough decisions about Lance Lynn, who will run into workload concerns around the 150-inning mark. Garcia had a side session, but it was "light, a touch session" according to observers. The hope is that he'll make his next session, sometime this weekend. He'll need to progress pretty fast to get to a rehab assignment around July 20 and then show stamina in two or three starts in order to make the target. Given Garcia's recurrent elbow issues and the lack of knowledge about how much force his elbow is taking, he becomes a huge risk in the short-term and beyond.

It wasn't a week ago that I questioned how the shift of Cashner back to the rotation would work. That answer came quickly -- poorly. Cashner throws the ball really, really hard. He was clocked as high as 101 mph on the Padres broadcast, but the latissimus dorsi didn't hold up. We've seen more of this type of strain in the last few years. The simple reason seems to be that pitchers are throwing harder -- clearly the case with Cashner -- and also that the shoulder and elbow are protected. If those aren't the weak links, the lat often is. The Padres don't think this will be a long-term problem, that the injury is a lot less severe than how it looked. Like Roy Halladay, Cashner could miss a month, maybe a bit more, and his role remains an open question at this stage.

One of the keys to dealing Kevin Youkilis was that Middlebrooks was expected to be more durable. A hamstring strain can happen to anyone, but the clear lesson here is that age isn't a good proxy for injury risk. Young players get hurt more than older players, but heal quicker on average for similar injuries. There's a balance that has to be found and one the Sox just haven't this season, for a number of clear reasons. The Sox will make a choice on Middlebrooks, but the call-up of Mauro Gomez is a tip. With the All-Star break coming up and some retro days available, the DL is likely.

Down on the farm, Ellsbury and Crawford have shifted up to Portland (AA). Ellsbury was out of the lineup on Thursday, though there was no explanation given at deadline. Ellsbury hasn't played back to back games in the field, so he's going to have to show that skill before he's back. Crawford is doing well, aside from fouling a ball off his knee. He's still on track to make it back to the Sox after the break and could be ready now if needed. The elbow remains a problem and it will be interesting to see how it's managed. The ideal would be to have him rest more at home or to have him DH some, but the Sox roster lacks that kind of flexibility.

The Angels looked at the calendar and pushed Haren to the DL. He'll miss fewer games because of the All-Star break and they'll be able to go with a reliever (Kevin Jepsen) instead of a starter (for now.) Haren's velocity has been off because he's simply not able to bend his back, causing him to leave pitches up. It doesn't take a PitchF/X guru to see that he was making changes in his delivery, and that's dangerous. Mild back strains clear up, but the mechanical changes can create a cascade effect that's much tougher to work on. Haren should be fine in both the short- and long-term, but he's going to need to work hard on maintenance to be able to stay at this level.

People continue to suggest that the Nats will take the ball from Strasburg at the 160-inning mark. This despite GM Mike Rizzo saying there's nothing to that number. At 93 innings in 16 starts, one possibility is that Strasburg has a hard per-game limit, well under his current six-inning mark. Skipping him just once and limiting him to five innings no matter what would leave him at a relatively comfortable 173. Then Rizzo and his staff can figure out what to do with the playoffs. One interesting suggestion I heard from an NL scout was that Drew Storen, who's about to head out on a rehab assignment, get stretched out and finish the season as a tandem with Strasburg. Storen was a starter in high school, so this isn't too crazy an idea. In the playoffs, the same scout suggested that the Strasburg-Storen tandem could be slotted as the 4 starter in the NL rounds of the playoffs, limiting them to just one start plus "kitchen sink" availability in Game 7. "The World Series is a whole different matter," he laughed. I've heard worse plans. We still have no idea what the Nats plan is or how fluid it may be.

Yet again, a pitcher left after being hit by a comebacker. Brian Duensing took one off his ankle. Word is just a bruise, with the All-Star break coming at a perfect time. It would be a good time for equipment managers to buy some shinguards too ... Late word that Dustin Pedroia will go to the DL with his thumb issue. Keep your eye on this -- it could be just timing to get him some extra rest with the break, or he could be tapping out ... Giancarlo Stanton's minor knee inflammation is likely the same minor meniscal tear that bothered him earlier this season. The Marlins have been fine maintaining it so far, but there could be more issues like this ... Roy Halladay will throw a pen session this weekend, then head out on a rehab assignment late next week. He could have as few as one start, with his stamina really the only issue here. ... Chase Utley played a day-after-night game and showed no issues with his arthritic knees. Good sign ... Jonathan Lucroy is doing well and should begin his rehab assignment next week, putting him on schedule to be back on July 20 or so. The hand fracture has healed up as expected ... Max Scherzer will make his Sunday start, but watch for him to be on a very short leash with the break coming up ... Johnny Venters hits the DL with what the Braves are calling "elbow impingement." He's dealt with this before, so while it's worrisome, it's more a maintenance issue ... Dee Gordon dislocated his thumb on a slide. An MRI showed a severe sprain that will need surgery. He'll miss six weeks ... Vernon Wells is playing catch. His recovery from thumb surgery is going very, very slowly, but that's less to do with his thumb and more to do with the Angels roster. There's no place for Wells to go absent an injury and he's impossible to trade ... Todd Coffey will have Tommy John surgery, but not for a tendon ... Jesus Montero had a "mild concussion" after taking a foul ball off his mask. He'll be observed, but shouldn't miss much time ... Anyone getting the feeling that Rick Peterson is working out really well for the Orioles? They'll have to watch out for a couple other teams that will be looking at him this offseason.

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