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Under the Knife: Brewers may have to get cautious with Braun

There's some pretty amazing studies being done that are very relevant to baseball and baseball injuries. Whether it's the study that shows a series of exercises that significantly reduce the effects of shoulder impingement or a Boston University study on non-surgical fixes for the dreaded SLAP tear of the labrum, there's interesting work being done out there. The problem is that "out there" seldom tends to make it "in here," to the world of baseball. I spoke with ten athletic trainers, team physicians, and one AHP and not one was aware of either study. Given the time that these members of the medical staff have dealing with their team, not to mention outside practices in the case of team physicians, it's not surprising. Conferences like ASMI's Injuries in Baseball Course help, but did you know only two teams get their medical staffs together to try to get on the same page and make steps forward during the off-season? (It probably wouldn't surprise you that those two are among the top five in five-year rankings for injury results.) In the realm of small changes that could be done immediately and at low cost, there's a big one. Powered by Ravi Coltrane, on to the injuries:

Watching an athlete writhing in pain is difficult. Watch next time it happens. Don't look away. In that brief instant when something bad happens, you'll see teammates react. You'll see the opposition react. You'll see the athletic trainers come running, often from both sides. You'll see the umpires ignore the play and help as they can. You'll see a doctor pop out of the dugout; that man or woman was often in the stands, but they can get where they need to be quickly. Players' careers, perhaps their lives, have been saved by what's been set up. So when it's something as simple as a groin strain, it's no less painful, but hardly something that can't be dealt with. Ryan Braun looked to be in significant pain with his injury, another cascade issue on his right leg, but the Brewers' medical staff was ready. Quick treatment may help him be back as soon as this weekend. The worry here is that the trouble has traveled. Braun's running out of things in his right leg to injure, so they're going to have to get to the root cause or give Braun more time to rest and recuperate. A Zack Greinke trade might be that sign. Fantasy players are going to have to be wary that Braun could end up losing playing time, perhaps significant playing time. For now, though, he's expected back in the lineup on Friday.

David Ortiz's injury isn't as bad as it could have been, but it's not good. The Sox pushed him to the DL after a second MRI and second opinion showed that Ortiz's Achilles wasn't torn, but that there was significant damage. Reports that there were no ruptures or tears are ... well, mostly correct. A rupture is a complete tear but a strain is a small tear. There is a strain here, towards where the Achilles connects to the heel. This is an important point - the calf contracts, raising the heel by using the pulley of the Achilles tendon. (Try it at home. I'll wait.) Sources tell me that this was close to being an avulsion, where the bone is pulled away. In ways, it's good since it tells you how strong that thick tendon is in Ortiz's case, but the pain and swelling in his heel could indicate a problem at that junction. How Ortiz's body heals will determine how this goes and there's not much the medical staff can do at this stage. The walking boot will be the big tell. As long as it's on, he's at least a week out and the longer this goes, the worse it is for the return. The Sox did get some good news on Wednesday, as Andrew Bailey had a good bullpen session. He's not quite ready for a rehab assignment, but that should come in the next ten days. It shouldn't be a long one if he shows command of his pitches. He could be in the closer role for the playoff push, though there's rumblings that he might not be handed the position back without "earning it" from Valentine.

It didn't start out easy for Drew Storen, but he made it look that way. For his first pitch in 2012, he got to face David Wright, who already had two homers in the game. Wright and the other two batters Storen faced didn't get anything done, letting him burn through an inning of non-save situation work. The Nats aren't going to just hand him the closer role, but an outing like this is going to make it tougher to say he's not the best option. Storen showed no problems with the elbow, either on or off the mound, during his recovery and rehab. While the Nats won't test him with back-to-backs quickly, there's no reason to think there's any further issues inside his pitching elbow right now. If he's available in your league, grab him now. Stunningly, he's available in almost half of leagues right now. The news keeps getting better for the Nats, with Jayson Werth starting a rehab assignment in nearby Potomac (A) on Friday. Werth's wrist has had a normal - not fast, not slow - rehab and he's shown no issues along the way. If that sounds a lot like the process that Storen went through, you're right. This is getting to be the Nats' medical M.O., slow and methodical. That same tack might lead Werth to spend more time in the minors than you'd expect. Some have suggested he could spend two weeks finding his swing since he's been out since early May. His results could shift that, as Werth knows, so look for him to try and show both power and bat control quickly. At best, he'll be back a bit before August 1st, but I'll leave the ERD there for now.

It's good to know that Mike Rizzo has made a decision when it comes to Stephen Strasburg. It's a bit worse to hear Rizzo explain what he doesn't have. He doesn't have a magic number. He doesn't have a plan that he can articulate. He doesn't seem to have any sort of scientific backing on when or even whether Strasburg should be shut down. He doesn't have a plan for making the timing better for this, something like extending Strasburg's rest so that he could make the same amount of starts (if that's a definite) but go deeper into the Nats' playoff push. There's not even a creative usage being discussed. No, Strasburg will be shut down, period, and he won't be available for the playoffs. While their heart is in the right place on this, nothing else is with this. I think we'll look back on this in a decade as the tipping point where the pitch limits went too far, hand in hand with the rejection of evidence.

The surprising thing isn't that Carlos Beltran needs some time off to rest his aching knees. The surprising thing is that he hasn't needed time off before this, or perhaps it's even more surprising that he needs rest at all. Not many people gave him much of a chance a few years back, myself included. Beltran did everything he could to avoid microfracture surgery and was worked hard by the Mets medical staff. When he did return, with bulky braces protecting his knees from further damage, many didn't think he could keep it up. He did, through a trade and a free-agent signing, well enough to head to an All-Star game and keep a team in a playoff hunt despite being considered the replacement for Albert Pujols. Rey Ramirez doesn't get the credit since Beltran has moved on, but Beltran sure does. It's his knees, his results, and if he needs some days off here and there, well, that's a lot more than we expected.

Trevor Bauer was sent back to Reno (AAA) after another rough outing. His control has been the big issue. I have an interview with long-toss guru Alan Jaeger over on The Nickel if you're interested in hearing more about this topic ... Cameron Maybin's wrist injury isn't making much progress. The Padres will rest him through the weekend before making any decision on the DL ... Mitch Moreland is expected to start a rehab assignment on Monday, which could put him back in Arlington by the end of the week ... Brett Gardner's latest MRIs have gone out to Jim Andrews and Tim Kremchek. Late word is that he'll have surgery, though it's unclear what the surgery will be or where it will be done at this time ... Brett Anderson will start his rehab assignment at Stockton (A) on Saturday. He'll likely stay below 50 pitches in this first outing, which puts him on track for a late August return, about right on schedule for Tommy John survivors ... Chris Ianetta is throwing well enough that Mike Scioscia is satisfied. Yeah, it's something like that. Ianetta will head out on a rehab assignment this weekend or early next week at worst ... Jon Rauch has had his knees drained twice recently. That's not a good sign for him or the Mets ... Not to tease, but I've got a story coming up in a couple weeks about what it's like to undergo surgery at Jim Andrews' facility in Gulf Breeze, from the inside.

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