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Under The Knife: Holliday finds there is a cost to playing tough

I talk about Tommy John surgery and other major procedures as abstracts, but we have to remember that these are people, not just names and stat lines. The rehabs aren't just dates on a calendar, but goals that people are working toward. There's work being done by people you never see, from physical therapists to scouts who monitor progress to make the hard decision on whether a player who's trying to come back should be brought back at all. It's a story that hasn't been told for a lot of reasons, but I'm excited that things have come together the way they have, even if I wish this player and his family didn't have to go through it. I'll keep you updated. For now, let's get to the injuries:

Holliday has been fighting through a series of maladies, much like the Cardinals have throughout the 2011 campaign. Holliday's recurrent quad strain, along with the current roster needs and construction, finally prompted the team to give him the DL time he'll need to heal up. The injury isn't significant in and of itself, but the concerns are over the recurrent nature of it and the fact that Holliday tends to beat himself up physically. It's that vaunted "football mentality", but in the scheme of things, anything he gained by toughing it out will likely be lost by the missed time.

Increasingly, the concept of the 7-day concussion DL has opened discussion on a shorter DL again. I've advocated the use of an inactive slot on the roster (travel with 26 or 27, only have 24 active. Only days on the active roster would count for service time, except for starters, which would even things out for the owners.) With the upcoming CBA expected to be relatively smooth, there's a chance for small changes like this to take hold.

It comes as no surprise that Matsuzaka is headed for Tommy John surgery. Granted, as I said above, I spent most of my Thursday discussing and watching the diagnosis process for this and it's seldom questionable. There are times when a team and/or a player want to try the rehab route, but the success rate for those is below 50 percent. Matsuzaka hasn't been what the Red Sox expected, but then again, they never allowed him to be Daisuke Matsuzaka. "I love you, now change" was the real plan as the Sox tried to turn their great Japanese pitcher into an American pitcher. They took away pitches, changed his routine, even had him in Arizona working out with Dustin Pedroia in the off-season. It all came with the best of intentions (and a big check), but Matsuzaka never took to it well. It's not just Matsuzaka either. Tim Lincecum famously has a clause that didn't allow the Giants to change his mechanics while some pitchers this season have told teams that they feel so strongly about their long toss program that they'd pass on moving to some teams.

Matsuzaka will have the surgery, spend the next year rehabbing, and will come back. The question now is will the Sox ask him to keep changing or will they try to salvage their big investment by letting him Turn Japanese. (Are reports that Hideki Okajima would rather be released than called up related? Yes.)

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Ignoring economic realities, I'm sure that GM Tony Reagins looks out at the mound and wonders what his team would be like if they still had Haren rather than Joe Saunders and some magic beans. That's a what if. The what if being if Haren had not had to limp off the field with back spasms that cropped up in the midst of his side session on Wednesday. Sources tell me that this is a new problem, so they're not exactly sure of the root cause. Back spasms are painful, but can linger or not. The Angels medical staff is full bore on this one and have good results with similar injuries, so there's hope. We should know more about how much time, if any, he'll miss sometime on Friday. Right now it's "completely unknown" whether he'll make his scheduled start this weekend.

I was talking to a scout this week who joked that all young players should have surgery immediately after signing. "Give the pitchers Tommy John and take the hamates out of every hitter," they said, mostly joking. The fact is that these two surgeries are a bit overblown and not to be done prophylactically. The easier thing, I think, would be to give hitters some sort of hand protection. Sandoval has come back well after his surgery and will start a rehab assignment on Friday. It shouldn't take him too long to get his swing back, but as with most wrist injuries, we can expect a bit of a power drop over the next six to eight weeks. Even without all of his power, the Giants will welcome him back with open arms as they try to find some offense anywhere they can.

If all it took was some rest, what was the rest of the drama with Hughes? After his "reset", Hughes has made solid progress. A simulated inning doesn't sound like much, but Hughes' work was actually more about the preparation, warmup, and cooldown as much as the work itself. Hughes passed "with flying colors", according to one source, and will now take the next step, which should be live batting practice, though that source said it would be another sim session. If Hughes makes it past that on Saturday, he would likely head out on a rehab assignment of two or three starts and then be ready to return. It's a rapid and near unexplained turnaround, which is why some with the Yankees are even more worried now that there's some good news. "They didn't know what was wrong and now they don't know if they fixed it," said an AL scout who's been monitoring the Yankees closely in anticipation of them hitting the trade market this summer. Hughes is an interesting case that bears close watch.

Another Twin? Yes, the Twins seem intent on having a Mets '09 kind of injury season, but this all has roots going back years. The Twins haven't seen reason to put much focus on injuries, injury management, or worse, prevention, over the last few years, going back to the tail end of the Terry Ryan administration. Kubel was placed on the DL after a sprain of his foot didn't recover sufficiently since the injury on Monday. The injury isn't considered severe, but along with several other roster moves, such as placing Jim Thome on the DL with his quad strain and shifting Joe Mauer to the 60-day DL, the team is trying to shake things up before what many think will be a sale of several players.

Suddenly, Jimenez is back. He got his first win, a complete game shutout, and showed a 98 mph fastball. The Rockies have to be happy, but don't get too excited. The thing about things coming from "out of nowhere" is that they often go right back there. Worse, with velocity, it can come from a lot of places and some of them aren't good. If a pitcher is an engine, there's a redline there. Either can go faster, but there's a cost. We don't know right now what Jimenez's redline is, though given his past velocity, this doesn't appear to be something unsustainable, if the base is fine. Jimenez has had this skill in the past, so the hope is that yes, he's back and not that "he reached down and got it."

Joe Mauer is headed to the 60-day DL, but I'm hearing that even the June 12 date that would be his first date possible to come off is in question. Mauer did catch three innings on Thursday in XST ... David Wright is starting the more active phase of his rehab from the vertebra fracture that put him on the DL. He should be back in games in the next two weeks, though the Mets do appear to be going at a bit slower pace than expected. "He's going to have to pass a physical at some point," said one scout who's been watching ... If Josh Johnson does well in his pen session on Friday, he'll be activated and start on Tuesday. He'll be watched closely and have some limits when he comes back, but he's been so good, you have to take the chance and activate him ... Shane Victorino will be activated on Friday and should go back to his full-time role quickly. The Phils will probably slow his running for the next week or so ... Barry Zito will make the first of three rehab starts on Monday. That puts him back with the Giants mid-month ... Rich Hill left his last outing with a forearm injury. The Red Sox saw something on the MRI and reports are that Hill is headed toward season-ending surgery. It's a tough break for a guy who took a long time getting back to the majors the first time around ... Matt Harrison has a blister and couldn't make his start. He's expected to be able to go next time his turn comes ... Brandon Webb's rehab appears to have been shut down. The next step, if there is one, is unknown at this stage ... This year's SABR convention is coming up early next month. I'll be there, leading what promises to be an amazing panel on sports medicine that will include Dr. Neal ElAttrache, Kevin Wilk and Ned Bergert. I hope to see some of you there.