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Under The Knife: Strasburg plan little better than educated guess

You would think that everything that could be said about Stephen Strasburg had been said (or written, like this great Jayson Stark article) but after the discovery of the "no more than 180 innings plan," reported first by Jeff Passan, we need to look around to see if this makes sense.

Strasburg is a year post-surgery at this stage, which makes him very similar to Jarrod Parker, now with the A's. Parker is pitching more innings than Strasburg, doesn't have the same in-game innings limit, and is the same age. Matt Moore is also facing an innings increase higher than Strasburg and is a year younger, though he has no scars on his elbow. The A's and Rays wouldn't speak on the record, but both teams are clearly trusting their medical staffs, monitoring the players closely and seem comfortable with where they are now.

Parker is the best comp, but we can look to the not-too-distant past for other comps. Jaime Garcia came back from elbow reconstruction and went 163 innings the next season. He's had some injury problems since. The same could be said for Josh Johnson, though he had a much lower innings total due to timing, going only 87 innings in his first season back. Francisco Liriano and Edinson Volquez could be included in this conversation as well. All in all, lowered innings totals don't automatically equal health, and similar pitchers have gone more innings without apparent issue. Without the benefit of data, the Nats (and the rest of these teams) are guessing. That's not good enough.

Powered by Bob Ryan, who's career at the Boston Globe is unbelievably inspiring to so many, on to the injuries:

Going on the DL with an elbow issue sounds ominous. For the Yankees and their ace, Sabathia, it's really not that bad. Since coming off the DL at the All-Star break due to a groin strain, Sabathia has gone at least six innings in each of his outings. Some are suggesting his elbow issues are a cascade from that groin strain, but the Yankees believe they're more interrelated than causative. Fact is, Sabathia is just sore, not injured, and that getting him some extra rest is the best course of action. There's no discussion of surgery or extended absences. This is more or less wear and tear. In the shortest of terms, Sabathia will be back at or near the minimum, with the length determined by his recovery, the Yankees record and the pitchers that fill in the gaps.

In the longer term, this is a worry for the Yankees. He's got four more expensive years on his deal, and at 32, will fall under the 200-inning mark for the first time in a long time. Pitchers that get above 190 innings tend to stay there until they don't, but once they break under it, there's some bias to staying down there. The comps are worrisome -- Sabathia is at the same age as Tim Hudson when he needed elbow surgery and when Ron Guidry was nearing the end of his amazing run. A more interesting comp is Roger Clemens, who learned the splitter at this stage in his career and went on to dominate for another decade. Sabathia could be valuable as a 180-inning guy, but that's not what they paid for. Look for Sabathia to have these kinds of small breakdowns and for the Yankees to work hard on maintenance to try and prevent bigger breakdowns. Another thing you'll surely hear in coming days and more in the offseason is for Sabathia to buckle down on conditioning. Yes, he's a big man, but he's more athletic than he's given credit for by most. He's much more Charles Barkley of the Dream Team than Charles Barkley of today.

The differences between the 2012 Reds and the '10 Reds aren't that significant. There are some different faces -- Mat Latos perhaps being the biggest difference maker -- but this team is as much an evolution of that division-winning squad as a rebuild. That means that the team is older on top of being an injury-prone squad.

Votto had been making progress, but at some point -- likely during sliding drills -- he re-injured his knee. Dr. Tim Kremchek did a pretty interesting thing, going back in the existing (but healing) scope ports to pull out another piece of cartilage. This isn't a complete setback, but it's certainly not a positive. The key will be how Votto's knee responds, with the seven days some have quoted being very aggressive. Once again, we'll need to see Votto running and sliding, so I'm looking for this to be at least two weeks and perhaps longer.

The Reds are also dealing with Rolen's maintenance issues. Rolen has been pretty bad this season, though better than his abysmal '11. His back and shoulder issues have kept him from being productive in more than just bursts, so the Reds need to figure out how to time those bursts. He's not a strict platoon player at this stage, but the team needs to help Dusty Baker deploy Rolen in a way that will maximize his availability and impact.

Given the early success of Manny Machado, who replaced a bad 3B share in Baltimore, the Reds might think about giving minor-league speedster Billy Hamilton a similar look. Hamilton is a SS at this stage, like Machado, but would immediately give the Reds a leadoff guy. Rolen could take on the tougher pitchers and let Hamilton get some confidence against 4/5 guys or groundball pitchers. Creativity could help here, if the Reds are willing to get outside the box. Rolen could be on the DL if he can't play by Monday, which would open up even more room to be creative.

Catchers take a lot of abuse, whether it comes in the form of collisions or foul tips, or just the physical demands of squatting and throwing for hours on end. A guy like Napoli, who can play 1B adequately and has the bat for DH, gives options to his manager. Napoli has caught a bit more this season than he did in '11 and is on pace to catch as much as he did in '09, when he didn't play 1B at all. But the wear is showing, as a quad strain pushed him to the DL. The Rangers like what they've seen from new acquisition Geovany Soto and without much depth there (Luis Martinez will be the backup), Soto will get the chance to make his case for returning in '12. Napoli shouldn't miss much more than the minimum, though the Rangers will focus as much on keeping him healthy for October as they do making sure he's back quickly.

The Red Sox have to be feeling snakebit at this stage of the season. Injuries have been as big a factor as anything, but the uptake of Bobby Valentine's message hasn't helped. Middlebrooks has been a symbol for all sides. His presence and promise helped push Kevin Youkilis out, while Valentine's sarcasm directed at Middlebrooks was another dividing point for the club. We'll see what Middlebrooks' absence does,after a HBP fractured his wrist. Middlebrooks will miss at least a month, with six weeks being a more likely period. That makes it possible that with just a couple weeks left in the season at that point, Middlebrooks would be shut down. The Sox aren't completely out of it, despite the reactions of their fan base.

Getting Ortiz back would help as well, but Ortiz had something of a setback this weekend. He had been pushing for a weekend return, but running and time seemed to act on his painful Achilles. The painkiller injection that Ortiz had was always going to wear off, but the hope was that he could make enough progress otherwise that the pain wouldn't completely return. It didn't, but it's also not where Ortiz or the Sox are comfortable. Some sources within the Sox organization say that they are worried about the chance that Ortiz would follow the pattern of Ryan Howard, coming back only to injure the Achilles more severely. "[The Sox] would get killed in the press," my source told me, "and right now anything that gives the press a hammer is out of the question." Until Ortiz can run pain free on back-to-back days, he'll stay on the DL. There's no clear path for when that will happen, so I'm switching his expected return to a TBD for now.

Brandon Inge dislocated his shoulder, stayed in the game after the swelling reduced, and then had the game-winning hit. That pretty much sums up the last couple seasons for Inge, who will have an MRI and could need a DL stint despite the hit ... Tommy Hanson went 78 pitches in five innings for Gwinnett (AAA). His next start will come for the Braves, though it's not exactly clear how they'll slot him back into the rotation ... Carl Crawford left Sunday's game with pain in his surgically repaired wrist. If he needs a DL stint, there's a chance the Sox would decide that it's a good time for him to have Tommy John surgery, though that's an outside shot right now ... Huston Street hits the DL with a minor calf strain. He should be back near the minimum ... Jordan Walden started a rehab assignment this weekend. It could be very short, with the possibility of him rejoining the Angels by mid-week ... Kevin Youkilis is dealing with multiple sore parts. The elbow/forearm is the most problematic, but he thinks he could be back early this week ... Jason Kipnis is hoping to get back in the lineup early this week. He's missed the last few games with a neck strain ... Denard Span left Sunday with a shoulder issue. X-rays were negative. Keep an eye on this situation to see how much time Span will miss ... Trevor Plouffe didn't play well in his rehab assignment, but his thumb held up. The Twins could activate him as soon as Monday ... Todd Helton had successful hip surgery on Friday. He should be ready in plenty of time for spring training ... Logan Morrison is likely done for the season, but the way his knees have been handled appears to be one of the things that the Marlins will deal with this offseason. Jeffrey Loria is, I'm told, talking to people outside baseball circles about setting up a more progressive medical and conditioning program ... The Jays don't think Colby Rasmus will need a DL stint after straining his groin Friday. That said, they're not sure when he'll be back either ... Dillon Gee is done for the season after shoulder surgery, but he should be fine for spring training. It could have been much worse ... Willie Bloomquist hits the DL with a strained back. Stephen Drew will have to take more time, though the D'backs still won't push things ... Emilio Bonifacio will start a rehab assignment Wednesday and should be back about a week after that ... It's not just the Olympics, but it is sad. It's clear that testing programs can't do one of the things they promised -- return trust.

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