Under The Knife: Surgery may spell the end to Posey's catching days

Plays at the plate are baseball's equivalent of running across the middle in football. Many of the hits are bone crushing and memorable, and when people get hurt, the peanut gallery screams: "Of course he got hurt, someone always gets hurt on that play!" This view suffers from what is known as the Von Restorff effect: Plays that are abnormal are more easily recalled than those that are unremarkable. The vast majority of crossing route or plays at the plate come and go with no injury, which makes them largely unremarkable. The plays we remember easily are the ones where trainers were called onto the field, the replay was shown dozens of times during the delay, and teammates huddle nervously.

Since 2005, there have been approximately 10 catchers who have gone on the disabled list directly because of collisions at home plate, just under two a year, with an average of 38 days lost. Catchers do take an inordinate amount of abuse, but they're under greater threat from taking a foul ball off their exposed hand or getting hit on a hitter's backswing than they are of getting injured when they're bowled over by a runner.

Obviously, Buster Posey will be out much longer than a catcher who breaks his hand on a foul ball, but his injury is an aberration, and the long-term damage caused by taking repeated balls of the mask is likely to be more substantial, if less replayable. Careers like Mike Matheny's ended because of an accumulation of small hits, not one big one.

Powered by Mona, on to the injuries:

It's not news that Posey is done for the season. It is news that he might be done as catcher. While the Giants won't acknowledge the possibility, and while Posey is insisting he'll be back at catcher, the procedure done makes it difficult for many to think he'll be able to do so effectively.

In essence, Posey had the worst high ankle sprain possible. "Ignore the fractured fibula," said one orthopedic surgeon who works on high profile athletes. "It's the syndesmosis that is going to be very, very tough on him."

Most think that Posey will be able to come back and be able to run and hit, but the burden of crouching is where it gets a bit confusing. "Watch a catcher's ankles during a game," said one NL athletic trainer. "They're always involved. They're never north-and-south." That burden on a repaired syndesmosis might be asking too much. Posey will still be an athlete, so it's the specific demands of catching that will tax him, not the normal "baseball activities" he would see at any other position. I expect the Giants will give him every opportunity to catch, but I'm not confident that it will work out.

Nathan's return to the DL in the first year back from Tommy John isn't unusual. It's a case of there being setbacks along the recovery process. There are as many situations where the process leads to different results as injuries, but there are almost always changes for which to account. Sometimes the changes are good -- a player is healthy and rested, shows better velocity and solid control. Sometimes they're bad -- a player comes back and alters his mechanics, consciously or unconsciously, and a cascade injury arises as the weak link in the kinetic chain is moved rather than removed by the surgery and rehab. So while it is not surprising that Nathan had some issues after coming back, but lumping him into a large bucket without any context or precision doesn't advance the discussion. Nathan's inflammation is minor and is as much an excuse to work on some of the issues that have come up as it is a worrisome injury. He should be back a bit over the minimum.

The Twins saw Liriano throw Monday and didn't see enough to keep from sending him to the DL. I'd been told over the weekend that Liriano would have to be "perfect, pristine" to avoid the stint -- he wasn't. Liriano said that he didn't feel right, making it easy on the Twins to make the move and bring up Anthony Slama. Liriano was given extra rest in two of his three starts following his no-hitter, but we've seen time and time again that there's a stress beyond the simple pitch count of a no-no. Liriano's shoulder has been an issue for him for a couple years, but this season, his effectiveness (aside from one game) has been missing. The team believes it's just inflammation and that he'll only miss another start or two, but if that's the case, why haven't they done this prior to now?

"It's shoulder-related," said Dave Pruemer, the Twins assistant athletic trainer, when asked about Mauer's slow start in XST. Mauer has been limited to DH in his first few outings. It's hard to call them games due to the controlled nature, but baseball doesn't have a synonym for scrimmages. It's easy to say, though that he's not throwing, outside of drills, playing catch and the rehab process. So why has the shoulder now become a tipping point, instead of the legs, the back, or the holistic mess that he'd become before the viral infection? It's hard to say that Mauer would have had this problem previously. Like a pitcher, a catcher with bad legs or a bad back might be throwing "all arm" and end up with a cascade injury, but outside of a pretty serious labrum tear in his throwing arm, Mauer has had plenty of time to heal up. If it had been a shoulder problem all along, wouldn't it have made itself evident in some way? Would he be playing long toss and making throws to second if it was the primary issue? I'm utterly baffled by this, and it does not reflect well on the Twins. Mauer should have been back by now given the information we had, but this is new, and even adding a week to 10 days to the ERD may not be enough.

Soriano had been having something of a rebound campaign, largely because he had been healthy. A quad strain suffered on a grounder, though, has pushed him to the DL. The Cubs had to make this move quickly, given that they're crushed by an injury stack at OF. Soriano's strain won't keep him out much beyond the minimum, but the bigger concern is that this is a return to the pattern that has haunted much of Soriano's Cubs tenure. At his age and with his skill set, the legs serve as something of a leading indicator. Soriano's a walking red flag at this stage in his career, but it's not the walking part of that which worries me. It's the running.

I think I freaked out some Indians fans when I tweeted that the Rockies cutting Amezaga affected the Indians more than it did the Rockies. The issue is that Amezaga is coming back from microfracture surgery and has been something of a stalking horse for me since he was slightly ahead on the timeline from Grady Sizemore. Amezaga wasn't able to play well enough to hold his job, but it's hard to put any of that on the knee. Amezaga was a player on the edge for a long time, a AAAA guy who could be a bench/utility guy but not much more. He wasn't Sizemore before the surgery ... and this is the lesson. Surgery is never a cure-all and seldom does anything more than get a player back to level. The best case scenario is getting back where you were with nothing lost aside from time. Amezaga's level wasn't that high, while Sizemore and someone like Bartolo Colon did have the things they had before and after surgery.

Buchholz says he's been dealing with a stiff lower back all year. It's one thing to believe someone when he says that, but another to rely on it. I'm sure Buchholz has been dealing with some level of back problem; many people do, whether or not they're a star pitcher. The issue is how it affects Buchholz and whether or not a small problem can create a bigger one. Any issue, no matter how small, can cause a change in the fine mechanics that a pitcher has to have. Moving anything can create poor results, like a loss of control or velocity; or worse, it can change the forces on the structures of the kinetic chain, leading to more severe injuries. While Buchholz will have a couple extra days off, the lack of depth in the rotation right now (and some issues with a "healthy" Jon Lester) make it tougher on the Sox to be conservative. While this problem is minor according to all sources and reports, it bears watching closely.

The Reds started the year with eight real starters. It was depth that most teams only dream of, but by June 1, that depth is gone. Leaving out Aroldis Chapman, the Reds have now lost Edinson Volquez to wildness, Homer Bailey to a severe shoulder injury and Sam LeCure is on the DL with a strained forearm. Their best "healthy" pitcher is Bronson Arroyo, who is fighting mono as well as hitters. Some of it is bad luck, as with Arroyo, but is the rest just luck or is there something within the organization that gives us clues? No, I'm not heading after Dusty Baker here, but I think we're seeing what I call "luck balancing."

A baseball season might seem like a long time, but we've often seen teams swing from year to year. The Mets had a horrendous, historically bad 2009, but came back to a more reasonable level in '10. It's as if a medical staff was a hitter who's true talent level makes him a .270 hitter. A couple extra hits and he's at .300, a few less and he's .250. These aren't swings that would confuse us. It's less understandable when it's a medical staff, when rosters turn over, and the cycle of injury and rehab get involved. The Reds were a bit "lucky" last year, though many rushed to credit new head trainer Paul Lessard, and this may just be the other side of the scale.

It didn't take long to find a comparable for Posey. Quintero's collision at the plate was eerily similar, as were the results. Quintero was in an odd, splayed, Tony Pena-kind of position when he was hit at the plate. Like Posey, he was forced around the rotated ankle and stressed the ligaments to their breaking point. Unlike Posey, he didn't have a fracture or a complete tear of any of the ligaments. Quintero has a mix of Grade I and II sprains, which means he could be back as soon as the minimum. Sources tell me the Astros are downplaying this a little, perhaps because they're scouring AAA for another catcher and don't want to be held to ransom. The Astros didn't have a strong catching situation to begin with, but injuries to Quintero and Jason Castro have left it razor thin. I'm being a bit more conservative on this than the team is letting on, but even coming back in a month is a positive result, given how bad it could have been.

The Marlins are downplaying the severity of Hanley Ramirez's back injury, but behind the scenes, many are happy to have some explanation as to why he's not hitting ... Ike Davis took batting practice over the weekend, but it did not go well. He's back in a boot and will be shut down for at least two weeks, meaning he may not be back until July 1 ... Matt Holliday was out of the lineup Tuesday with a recurrence of his quad strain. It's lingering and being a real matchup problem for Tony La Russa ... Tsuyoshi Nishioka is playing in XST and will shift to the minors in a couple days. He should be back with the Twins in about a week, but there's some question about where he slots in once he returns. Watch to see where he's positioned as well as how his swing comes back ... Corey Hart missed a couple games last weekend with the flu, then had to come out of Monday's game with symptoms. He'll be fine once he gets past this ... Kenley Jansen throws hard. So does Aroldis Chapman and Neftali Feliz. What else do they all have in common? Shoulder inflammation. Jansen hits the DL with the malady while baseball men try and figure out why. (Hint: recovery time) ... It's wrong, but every time I see Tony Campana, I hear Pacino's Scarface voice in my head. If he's still available in your league and you need steals, go ... Brandon Webb is topping out at 85, but he was "hittable" in his first rehab outing. Not only is the velocity not back, he's apparently lost some of the sink that made him dominant. He doesn't have much longer to find his stuff ... Jason Castro was shifted to the 60-day DL, another indication that he's not coming back this season ... Joe Sheehan is raising money to fight cancer, which should be even more of an issue for baseball with the sad news about Gary Carter. (LINK) You should already subscribe to Joe's newsletter, but if you don't, here's your chance to do a bit of good while doing yourself a solid as well. He's donating six dollars for every subscriber he has, so let's make Joe write a big check.