Under the knife -- wrap

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If there's one thing I've learned in the seven years that I've been doing UTK, it's how much we don't know. Each time I learn something new and think that the game has figured something out, there comes new information that poses new questions. My job is to report the story as best I can based on the information I have, and because of that, I regularly make mistakes, but I am learning from them as well. I wish I could go back in time and retract saying that CC Sabathia was overused in 2003, or that Frankie Rodriguez's arm had to fall off at some point. (It still hasn't!) As I learn more, those mistakes become part of the process of learning itself. What we can't do is ignore the facts or the mistakes; to do either would slow the pace of our learning. Back in '04 when I wrote Saving The Pitcher, I listened to people who I trusted, experts like Tom House, Bill Thurston, Craig Yeager, Marty Kobernus, and others.

Two voices that I paid a great deal of attention to back then were Dr. Glenn Fleisig and Dr. Mike Marshall. Marshall, with his decades of research, his Cy Young Award, and armed with his intriguing concepts, made me think there might be a different way. When I questioned his motion, trying to adapt parts of it to my efforts, he accused me of "plagiarism for five-year-olds." (He might have noted that I gave him full credit for his work, but Marshall works in absolutes.) Fleisig, the biomechanist who's at the heart of the decades of research done at ASMI, has been gracious with his time and his research, and he has shared his frustrations. While I consider Glenn a friend, I always try to look at his work objectively, in the same way that he has to before publishing in the various scientific journals.

When Marshall sent one of his pitchers to ASMI to be studied, I expected there to be some interesting results, and were there ever! It was not what I expected at all. Marshall's motion as tested simply does not work. To summarize, Marshall's motion gets less velocity out of more force, meaning it is less efficient. I hope to write more about this in the near future, but the study is important enough that I want you to hear about it, see it, and be able to look at things for yourself.

Before you accuse Fleisig of bias, he's not alone in his findings. There is danger in trying to do things, and I always worry that what I thought I understood in '03 might turn out to be wrong, and that the unintended consequences might end up being the cause of injury to someone. The assessment of pitching mechanics has gone from something I approached as a curiosity five years ago to a field that is now a common read on the blogs. The thing is, even the experts and the so-called experts are learning that what we think we know may not be so.

Powered by never forgetting, on to the injuries:

It wasn't so much a surprise that Wagner had a setback as it was how much of a setback it was. He had a similar issue back in mid-August when his elbow swelled up whenever he went full out with his pitches. That's how this happened, but no one seems to understand how he went from claiming to have "no problem" with his UCL, to Tommy John surgery during the course of a normal rehab. It's my understanding that the imaging that showed the strained tendon did not show the damage to the UCL. (Also, it's important to note that some sources are calling this an MCL sprain. The MCL, or medial collateral ligament of the elbow, is more commonly called the ulnar collateral ligament to avoid confusion with the knee's MCL.) Wagner's agent, Bean Stringfellow, was quoted as saying that he was surprised that the rehab would take three weeks; a UCL tear would certainly involve more time and precaution. If as far back as August 5 the Mets were saying that there was no issue with the elbow, what happened here? Did doctors -- multiple doctors -- miss the diagnosis, or did they misread the images? Did Wagner's UCL just snap? (That's an uncommon occurrence.) If anyone knows, they're not talking, and Wagner is headed for surgery and is done not only for this season, but likely much of '09 as well.

(* The Injury Cost above adds in the 180 days he's likely to miss next season.)

Pujols might have Tommy John surgery. That's a known. It's the same known that's been in play since, what, '04? The Cardinals made a prescient move by shifting him to first base to protect that arm, and to protect the value of the bat that he holds with that arm. It's worked for several years now, and it's hard to say that it's not still working; he's hitting around .360 with no loss of power and a career-high EqA for a guy whose entire career has been a high. (As I typed this, he'd just hit a three-run bomb off of Ryan Dempster.) In addition to the elbow, Pujols has foot, back, leg, and knee issues of varying degrees, and he's still put up the numbers year after year. I may be being facetious when I ask 'what might this guy do when he's healthy?,' but it's also the scary truth. While it seems that we live in a world of uncertainty, Pujols is the one near-certainty. It's as if Usain Bolt has been running with a rock in his shoe all this time, Lance Armstrong was riding with nine gears instead of ten, and Mike Tyson was sane; what happens if "all-time great" wasn't their best possible outcome? Just as a pitcher who has bad mechanics and good results is hard to mess with, Pujols' swing is along the same lines, which is why the Cards are saying not so fast to Pujols shutting it down, having the surgery, and potentially missing a month or so next season. To be continued, as they say.

The White Sox are going to be without Konerko for a while, though I can't be more specific than that. Early reports were that it was a mild strain of his MCL and that he'd be back in a matter of days. Later reports have him out indefinitely, though there's some overlap there; "indefinitely" and "day to day" aren't mutually exclusive. While it's easy to worry that this will drag on, the White Sox have a great record of getting people back on the field, and more importantly, keeping them out there. I'd anticipate Konerko missing time perhaps through the weekend, but not much longer. The key will be whether the sprain is affected by his high-torque swing, and if he can safely run the bases.

Quentin underwent a procedure on his wrist called an open reduction with internal fixation, or ORIF. That procedure, which put the broken bone back in place and set it there with a small screw, went well, and it's possible but not probable that he could return for the playoffs. If he does, Quentin and the Sox will have to thank skateboarders all over the world; there have been great advances in the treatment of broken wrists over the past decade, due in part to the increase of such injuries that one physical therapist credits to kids trying to replicate the moves of Tony Hawk. (If that Injury Cost seems low to you on Quentin, remember that those were calculated based on projections before the season that expected him to be a platoon player with 11 home runs. Before you go knocking PECOTA, Rotowire had him projected about the same with 9 homers, and BaseballHQ had him with 12. The most aggressive projection for him, ZIPS, had him hitting 15.)

It surprised me when I discovered that the White Sox have shifted, if not to an out-and-out four-man rotation, to a five-day rotation, where their four starters are taking their regular turns every fifth, and the fifth starter in the rotation gets skipped as often as the schedule permits. I paused, thought about it, and realized that this shouldn't have surprised me at all; Kenny Williams isn't afraid of trying new things or of doing things his own way. We haven't always been supportive of his methods or his choices, but the results speak for themselves, both positively and negatively. The same could be said for Ozzie Guillen, or for Don Cooper. They've also set an apparent lower pitch limit, with none of the four starters going more than 110 pitches. I say apparent, because aside from Javier Vazquez, none of the other four have gone over that number more than once all season. If the White Sox get to the playoffs, these are the kinds of moves as far as pitcher handling that deserve far more notice than Williams and Guillen and Cooper have received, but that doesn't make this kind of management any less smart.

The Cubs think that Zambrano will be back later this weekend, though Hurricane Ike pushed back his scheduled Saturday start. All anyone should care about once he takes the mound is if he can get back up to his normal arm slot. If not, it will mean that the rotator cuff tendonitis is causing problems that will continue to cascade. I'm not saying that they couldn't use Zambrano, only that they have to be both careful and smart in how they do so. Zambrano showed a predictable pattern between returning from the DL last time to the beginning of this most recent hiatus. We can safely predict that a similar occurrence will take place in roughly the same time period, and probably a bit sooner. The Cubs need to be very careful in how they bring him back, since doing so too soon might position him to run out of gas in the midst of the NLCS or World Series. With the playoff spot all but locked up, the conservative course would be a much smarter path here. It would also be in line with what they're doing with Harden, who slotted back into the rotation this week after missing a start. The rest did him good, just as it would for any pitcher at this stage of the season. More worrisome is the continued absence of Gaudin, who was acquired to take some of the bullpen workload off of Carlos Marmol and Kerry Wood. He's served that purpose so far, but his lingering back issues have kept him out for all of September, and threaten to end his season. The Cubs pitching is systematically breaking down under the workload, and while this isn't the same as the post-'03 overwork failure, it is an inability to keep the staff healthy through a combination of events, and there's no curse involved in it.

I haven't said much about Kendrick since he went back on the DL at the end of August, and I'm not alone. Kendrick hasn't had an update on Rotowire since Aug. 29, or on Rotoworld since September 5, when Mike Scioscia said that Kendrick was making progress. We can see how useful that tidbit of information was, since Kendrick is still out. There's no real change as the Angels second baseman rehabs what is becoming a chronic hamstring issue, and until he's ready, the Angels can afford to be conservative with him now that they have the division wrapped up. He is expected back for the playoffs, though I can't give a solid return date. His DXL has him returning sometime next week, but that looks iffy. There's no new information here, but perhaps this will keep some readers from asking every day. I am watching, and when I have something, I'll let you know.

To paraphrase the great LL Cool J, don't call it a setback. Carpenter was unavailable on Tuesday, and unsure about his availability on Wednesday, but this sort of thing is what was expected. While the Cardinals said they would use him at closer, they also said they would do so when he's available. He won't do back-to-back games, and I'm not sure that they'll put him in any true closer situations. It seems as if they'd like to use him in less stressful spots, where he can start an inning, have a few runs worth of cushion, and regain some confidence while saving the pen a bit. This is smart usage, and while it's not going to add up to that much work for Carpenter, it will be enough for the team to just have him around even after the Cards are eliminated.

Mark Ellis is done for the season, and likely headed for surgery, as he has a torn labrum in his throwing shoulder. Bad timing for the injury-prone free agent to be. ... Randy Johnson is scheduled to throw Saturday. He missed his last start with shoulder stiffness, and his back is being monitored closely. ... Troy Percival left Thursday's game with back stiffness; back and hamstring problems often go together. ... Troy Glaus is expected to return this weekend after some shoulder pain, but Rick Ankiel will probably be shut down very soon. ... Melvin Mora returned to the lineup after straining his hamstring in front of a crowd of Baseball Prospectus readers a few weeks ago. ... The O's also got George Sherrill back; he's going to be used "judiciously." ... Gabe Kapler tore his lat. It's about all that you can't see in this picture. He's going to try and return, but even pinch hitting seems unlikely. ... Tom Gorzelanny is done for the year. He appears to have injured his finger in similar fashion to the way in which Adam Wainwright was sidelined earlier this season. ... Todd Helton's coming back this season, but I'm still not sure why.