Under The Knife: Back strains taking heavy toll on 2012 season

Dan Wade has been digging through the Injury Database and found something intriguing regarding an injury we're seeing more of this season. Here's his report:

"If it seems as though a certain injury seems to pop up some seasons far more frequently than in others, they do. In some cases, better diagnostic tools or a more refined test will turn a general injury like "dead arm" into a more specific one like a strained shoulder capsule or the like. Other times, without a singular cause, a certain injury will pop up far more often than in past seasons. Early in the year, it appeared as though ACL tears were going to be 2012's mysterious injury spike, but aside from the well-known examples in April and May, there haven't been many more. Back strains may not have beset quite as many well-known players, though Jered Weaver and Roy Halladay both missed multiple starts because of theirs, but there have still been 15 other players who have gone on the disabled list because of a strained back.

"The 17 DL stints due to back strains this season are more than double last year's total of eight, and the highest number of back strains since 2007 by similarly large margins. On average, a back strain costs a player 45 days, and while this season's average is down to just 40 days, that will likely rise as the seven players who are still recovering from their back strains take time to come back. Players like 41-year-olds Jim Thome and Miguel Batista do little to shake the theory that back injuries, in general, and strains, specifically, are an old man's injury, but the median age is down to just 29 with players like Austin Romine and Brent Morel missing extended stretches at 22 and 23 years old, respectively.

"It's highly unlikely that this represents any sort of trend, but it will be worth watching to see if these injuries pop up again next year or if this is a random influx of bad backs in baseball."

I spoke with several members of MLB medical staffs who collectively had no explanation for the increase in strains. Without measures of rotational torque, it's going to be impossible to figure out whether there's been a mechanical change, but we'll be watching. I'm working on something that may vastly increase the amount of data we have coming in as well as getting additional minds working on the output. It's an exciting time.

Powered by Homeland, on to the injuries:

Cabrera tested positive for synthetic testosterone. The positive test came in July, was not appealed, but that's about all that's standard about this so far. This exclusive from the New York Daily News breaks down a pretty amazing story, and reveals that former federal investigator Jeff Novitzky is working closely with MLB.

Cabrera has given up his source, meaning we could see more suspensions. Cabrera's positive test shows that the testing program is working, though it has opened baseball up to more charges that it's not doing enough or that people are circumventing the process. Perhaps MLB should spend a few million in order to do CIR tests on every sample, but the cost and time required is high enough to be a valid argument against. My real question is why Cabrera felt the need to use a banned substance and how long was he doing it? If this was a long-term use, one that stayed below the testing protocol, and helped Cabrera emerge, it's going to force yet more changes to the MLB drug policy. One that I would suggest is that suspensions require complete cooperation in regards to dates of usage and helping law enforcement. I would also advocate that negative tests be public, with the dates listed on their official bios.

There's a lot of controversy with the Red Sox, so any confusion around Crawford's elbow is just another brick in that wall. Crawford has played all season with a damaged UCL, making Tommy John surgery always a possibility, if not a likelihood. Crawford was helped by both an early season PRP injection and by regular maintenance, which involved painkillers and anti-inflammatories. Reports came out in recent days, first by Peter Abraham, that Crawford was going to ask to have the surgery now. Later reports have Crawford meeting with doctors on Monday to discuss the options. It takes a position player about six to eight months to come back from Tommy John surgery. The reduced time frame is due to less repetition and fine control needed. If Crawford has the surgery now, he would be back by April in most cases. If he waits until the season is done, he could miss April. We'll get some indications of what the Red Sox are thinking about Crawford's place on next year's team by this decision. The fact that it's all playing out in the press again tells us just how bad the atmosphere is in Boston.

The Sox are taking the long view with Ortiz. His strained Achilles is painful and swollen, so the painkilling injections -- not cortisone, as some reports have alleged -- aren't going to be the answer. The Sox medical staff knows that cortisone has been the center of speculation as to why Ryan Howard had his Achilles let go. Ortiz and Howard are obviously similar in style and physique, so Ryan is being used as something of a template. The Sox shut Ortiz down for five days and will slowly get him back up to speed. This plan likely keeps him out until at least Sept. 1. Roster expansion will help the Sox with flexibility, allowing them to swap out Ortiz for a runner more often. From a fantasy perspective, Ortiz's value is likely to decline due to decreased opportunities and reduced run scoring. From a team perspective, it's unclear how Ortiz would respond to this, as it might further shakeup a tumultuous clubhouse with Ortiz the next to leave.

The Mets are fading from contention, and with that, they're taking a look to the future. Santana is coming back from a lost season and a repaired shoulder, so what they've gotten from him is testament to the surgeon, the medical staff and Santana's will. Pushing that would be short-sighted, potentially taking away any gain. There's no word on when, or even if, the Mets will shut Santana down, but they're definitely considering it right now. It wouldn't surprise me if the Mets let Santana take them to roster expansion, or just beyond. Santana will likely close his season out at home, to maximize the effect. The Mets also have to be careful with Matt Harvey, who's already passed his career high for innings. Shutting him down at about 150 innings would make sense.

Votto had not one, but two knee surgeries in the space of a month. The Reds, in that same month, got a more comfortable lead over the Pirates despite missing an MVP candidate. Those two facts make it very simple -- the Reds can take their time getting Votto back. The hard part might be convincing Votto of that. He's taking grounders and doing light running, but the hope is more that he's able to catch the tail end of a minor league season for a couple games of rehab rather than rushing back to the lineup. The knee shouldn't be much of a problem once he is back, but even as "minor" as the second surgery was, it's still surgery. I don't expect Votto back before roster expansion, but Votto could push his way back ... and maybe already showing signs of that.

Maybe no one has noticed, since the Phillies are well out of contention, but the players who have returned have played well. Utley is hitting for a bit more power and showing patience, while losing a bit of speed and range. He's played regularly, which shows that after a certain point, the Phillies' medical staff has been been able to maintain Utley at a consistent level of health. The question now is whether they can keep him from missing the first month of the season as he has the last two. The same holds true for Howard. He's showing some power, but is still struggling with the loss of strength in his repaired calf. The Achilles repair has been fine, but it's going to take much longer to get over the effects of the debridement forced by infection. For all those who want to fault me for saying Howard would be back May 1, I'll fault them back for being too stupid to understand when something changes. No one -- not even Howard himself -- could have understood how big of an issue the infection would be. If analysis doesn't change when there's new information, it's not very good analysis.

Chipper Jones is going to need a day off here or there to keep his knees healthy. With the Braves in contention, Jones is looking to October as his real victory lap ... CC Sabathia had a good side session and will come off the DL at the minimum, as expected ... The Yankees may need to push Mark Teixeira to the DL, but they're hoping that they can get Alex Rodriguez back first. Teixeira's wrist is manageable, but it's nowhere near 100 percent ... Jose Bautista will start a rehab assignment on Monday. If his wrist holds up, it should be a very short stint ... Brett Lawrie started his rehab assignment on Saturday and could be back as soon as Tuesday ... Brett Anderson went 96 pitches in his rehab start, but Oakland is looking to have him make at least one more start. He's nearly out of rehab time and doesn't have much left to show, leaving the A's to make a roster move. He'll strengthen their rotation, or at least add depth ... The Pirates lose rookie Starling Marte to a strained oblique. They'll be cautious with his return ... Troy Tulowitzki isn't going to be shut down despite the Rockies record. He could start a rehab assignment by the weekend ... Michael Cuddyer came off the DL Thursday and was right back on it Sunday. Medical staffs never like that, even if Cuddyer did hit a homer in his first game back. He'll miss at least the next three weeks and could be shut down ... Carlos Ruiz is out of his walking boot, but the chance that he returns this season is declining. The Phillies are still working toward having him back in mid-September ... Rubby De La Rosa hasn't given up a run during his rehab stint. The Dodgers will get him back in the bullpen for September, just 13 months after Tommy John surgery ... Emilio Bonifacio is back for the Marlins. His thumb is still sore, but he can play. Fantasy owners desperate for steals have to take a look here ... John Lackey has almost nothing in common with Mariano Rivera, but like the Yankees closer, Lackey won't pitch this year either. He is making progress, pitching well in a side session observed by Sox brass.