Under The Knife: Roster expansion gives teams flexibility down stretch

Powered by email -- seriously, hit the button up there if you have an injury question -- on to the injuries:

The Dodgers have help coming in Josh Beckett, but would that trade have been made if the Dodgers didn't know that Chad Billingsley was headed to the DL? We'll never know, but the recurrence of elbow pain and inflammation for Billingsley had to be some motivation. The Dodgers gave Billingsley a minimum stay, which included the All Star break due to the same issue, and he came back well. Very well, in fact, dealing up two great performances on his return. There's clearly a problem, with his last start where the real pain is evident. The hope is that they can do the same thing -- rest two weeks, pitch for a month, which would put them into the playoffs. Billingsley is going to be a risk, so they'll have to build some confidence in his ability to hold up before they put him on a playoff roster. Of course, they have to get there first, so expect Billingsley to be out as little as possible.

Ben Sheets did what I worried he would do -- he wore down. Sheets showed that there's still talent in his arm during his first five starts with the Braves. There's just not durability. The fact that baseball can't come up with better ways to utilize the things Sheets can do without exposing him to things he shouldn't isn't his fault. This is the same sort of thing that's putting a focus on Stephen Strasburg. Without data to truly monitor the fatigue levels of pitchers, we're left guessing, grasping at proxies like pitch counts and innings. We're left managing them based on roles and needs, not capabilities. Five innings for a win and five days rest is leading to fifty percent of pitchers ending up on the DL and better than ten percent of pitchers ending up with a big scar on their elbow. Sheets' shoulder issue isn't serious, but in the grand scheme of things, the Braves are down one pitcher they'd hoped could help them down the stretch as they try to avoid the shadow of last September.

The Yankees have slipped a bit in the standings, making it easy for some to point at the pitching injuries. I'm hardly one to diminish injury's effects on the game, but in this case, minor injuries are being used as creative ways to find rest for pitchers that have been worked pretty hard. CC Sabathia came back, pitched well, and Ivan Nova replaced him on the DL. Nova, who many forget is as young as he is (25), has a more serious issue, with significant inflammation in his cuff. The Yankees are hoping that rest does him as much good as it did Sabathia, but it's going to be more than the minimum. With just over a month left and playoff planning in place, getting Nova back for the playoffs is more the focus. The team will want to see a start or two, which would mean Nova would need to be back -- with no rehab starts -- by Sept. 20. That's going to be a tight fit. Andy Pettitte will probably be on a mound later this week with a return shortly behind. The Yankees are hoping to have one playoff pitcher between the two.

Jose Bautista's return didn't last long. He was off the DL for barely a day before going right back on it. There had been signs that hard swings were causing him problems, with setbacks during his rehab process, but no one, including the Jays, expected this big of an issue. Bautista is headed to Cleveland to be checked out by the same doctor that has dealt with Kevin Youkilis and others who have had similar issues. The expectation is that whether Bautista needs surgery or not, he's likely to be shut down for the remainder of the season. Bautista is resisting this a bit, so I'm holding off on the DFS designation. The Jays will let Bautista come back for a "confidence cameo" only if he's 100 percent, but it's more important that he's ready next April, not this September.

The Red Sox lost a lot in their recent fire sale, but now it looks like they're about to bench one more superstar. David Ortiz is continuing to have trouble with his Achilles, needing painkilling injections to be able to go out and perform baseball activities. Even so, he's having a lot of tenderness afterwards, indications that the inflammation may be symptom rather than cause. Ortiz is basically in the same position that Ryan Howard was at this time last season. Howard played through the injury, using painkillers and anti-inflammatories as well as other modalities, in order to help his team reach the playoffs. We know how that ended -- and so does Ortiz. Whether the Red Sox plan to re-sign Ortiz or not doesn't change how they will handle him. Medical decisions from the team's side seldom hinge on those factors, though players see it differently. They'll often push to be on the field in contract years or if they're taking shots in the press. Ortiz's situation has to be viewed in a team context as well. I'm not going to the DFS yet, but we might have seen the last game in a Red Sox uniform for Ortiz, who's truly a franchise icon.

There's not much left in Lance Berkman's knees. He knows he's facing life-long issues in the future, or at least knee replacement. He had such a good year and so little issue with the knees in '11 that few expected such a nasty recurrence, but it only takes one bad step, one bad twist, or one bad hit to put things on the wrong foot, no pun intended. Since I first saw Berkman at Rice, the guy has been one of the purest hitters and that ability is still there. He'll try to fight through the pain and help the Cardinals push towards the playoffs, giving himself one more chance to play in October. Does it surprise you that someone who's been as good as Berkman for so long is short of 2,000 hits? It surprised me. Berkman should start a rehab assignment later this week.

Joey Votto will begin his rehab assignment later this week. It will likely be a very short one ... Albert Pujols is out through at least Tuesday. Odds are he'll be back, but the Angels seem to do a better job of reining him in than they did in St. Louis ... Mark Teixeira left Monday's game with a calf injury. It was called a strain, even though he had fouled a ball off his calf (which would usually be a bruise.) He'll have an MRI, but looks to miss at least a few days ... Miguel Cabrera will be back in the lineup this week. His ankle sprain was painful, but minor ... David Freese escaped any serious injury after being hit in the wrist by a pitch. He'll be back in the lineup once the pain and swelling are gone ... The Braves will rest Chipper Jones until the soreness in his side subsides, but you know how this song goes ... Yes, it's looking more and more possible that Dylan Bundy could come up this season to bolster the O's. He's certainly not tired and it would tweak the nearby Nats to have Bundy pitching while Stephen Strasburg is shut down ... Good news on Gavin Floyd's elbow. It's a flexor strain, which isn't good, but it could have been a lot worse. No word on when or even if he'll be back despite the fact that the White Sox haven't put him on the DL yet ... Mike Napoli is a bit behind where he expected to be. He's unlikely to be ready this weekend ... Rookie Mike Olt is playing through plantar fasciitis, which is very painful and tends to linger. Watch to make sure he keeps his platoon position in coming days. The roster expansion would give the Rangers room to rest him ... Roberto Hernandez sprained his ankle and left Monday's game. He's questionable for his next start. Missing a start against the Rangers isn't a bad idea anyways ... Kyle Gibson made a start for Rochester (AAA), his first after Tommy John surgery last year. He'll pitch in the AFL and could contend for a starting spot in the Twins rotation next season. Consider him a sleeper ... Wondering why Cleveland committed to Manny Acta early? He's at the top of managerial search lists in both Boston and Houston. Terry Francona isn't going to be a candidate for either -- Boston for obvious reasons, Houston because he wouldn't want to replace close friend Brad Mills. That leaves Dave Martinez as the top name for both ball clubs.