Under The Knife: Mets' medical staff key to surprising season

It's not actually the halfway point, but the All-Star Game serves as the unofficial version for baseball, giving rise to all sorts of "what to expect in the second half" articles, as well as looks back at the first half.

I'm doing the latter, since I've heard a couple people refer to 2011 as the "Year of the Injury." The fact is that injuries aren't up significantly when you look at simple numbers. The perception is there because -- and this is subjective -- that higher profile players such as Albert Pujols, Derek Jeter and Alex Rodriguez have spent time on the DL. People notice when the best players on the best teams are missing time. We miss Pujols, but barely notice Wilson Betemit.

It's hard sometimes to take our emotions and biases out of baseball since we're all so passionate about our players and our teams. To get at the facts, we have to take that step back and question how we're looking at it. Without it, there's no improving.

One of the questions I posed last week on the Medical Panel at SABR41(full audio available at the link) was why we're not reducing time on the DL or at least the number of injuries. The raw days lost is inflated by surgical recovery; players that are rehabbing now were sent home years ago, their careers over. Baseball can still do better, especially at the lower levels, where noted therapist Kevin Wilk gave a scary stat, that 50-60 percent of youth pitchers will have an injury. With numbers like that, we have to go from hoping we can do better to making tangible steps. I guess my part is here, upping awareness and giving a forum to the best in sports medicine. Powered by Spotify, on to the injuries:

The expected trades have started, but for the Mets, it's health that's going to be the key to their fate this season. They've done an utterly amazing job with Carlos Beltran, allowing him to play, helping them on the field and raising his value to a point where it's unlikely the Mets will get just a salary dump out of a deal. They're doing well in rehab as well. Wright's return has taken a bit longer than initially expected, but that's not on the Mets staff or on Wright. He's just at the long end of this based on some setbacks in the process that aren't out of the ordinary. Wright should begin rehab games over the weekend. Once he shows that he's not hurting himself and that his swing is ready, he'll be up. That could be very quickly, according to some sources, though I'll play it safe and keep the ERD out another 10 days. Reyes made the trip to Phoenix over the break, hanging out with his NL teammates (and maybe sizing up future teammates, if some reports are to be believed.) His hamstring is doing well, leaving running full speed his final test. Most believe this will go well and that Reyes will be activated on July 18, the minimum. It will be an interesting decision whether or not to activate Reyes for weekly leagues. He's unlikely to push the hamstring too much, which could hold down his steals, but he's playing too well to bench in most formats.

Beckett went to warm up at the All-Star Game and realized that his knee injury was more of an issue than he'd thought. I'll give him some credit for going and trying, but it was smart to not risk anything. Beckett's had issues with cascade injuries in the past and isn't far removed from that terrible outing where he completely lost his release point. Given the injuries that have gravely tested Boston's pitching depth, Beckett's availability is vital. If he's forced to miss even a start, it's find someone on the depth chart who makes the start. The Sox are the kind of team that could go with a creative solution, like a bullpen game, a couple tandems of long relievers, or something similar. At this point, it looks like Beckett is going to try to go on Sunday. He'll have a shadow, and if there are any sign of problems, they'll push his start back.

Rodriguez had his knee surgery last weekend, in Miami. Like most surgeries, it was "successful." That basically means doctors did what was expected and the patient woke up at the end. The hard part is the rehab and seeing how his body adapts to the procedure. There was a bit of confusion last week about my connection between his past hip issues and his current knee problem. I'm not saying that it will happen, but that it easily could become a cascade issue and that the need for caution could extend his rehab past the best case scenario. We'll get early indications on the timeline by when Rodriguez starts running, or even jogging. That should be at about the 10-day mark, so going long there is going to mean he's very likely to go long on most steps. The ERD above is the most likely scenario I can put together, but it would probably best be expressed as a range in this case.

So, Mr. Hughes, you're just now realizing that the hamstring strain that took you out as a rookie might have led to mechanical changes? Cue my theme song. Hughes is doing a bit of magic, talking about a change in his breaking ball to avoid discussion of ... well, everything else. Mark Hale of the New York Post did a nice job breaking through the fog and getting to the concept that Hughes' shoulder injury might be a long-form cascade injury, something that took time to break down due to the subtlety of the changes. Hughes' shoulder issues could well be the result of additional arm effort rather than a more balanced, "push with the legs" trip through the kinetic chain. We'll just have to wait and watch when it comes to the "power curve" and Hughes' ability to recover and stay in the rotation.

Gonzalez has a bone bruise. This may seem like an injury we're seeing more of, with Gonzalez, Ike Davis and Delmon Young all recent examples. It's actually something that doctors are actually seeing for the first time. Bone bruises aren't seen on X-rays, most MRIs, or even when doctors look around with their arthroscopes. Instead, advances in imaging technology have led to something called a 3 Tesla MRI, which is simply a more powerful magnet that gives more accurate images. Now that doctors can see the actual problem, it can be treated.

Gonzalez's wrist issue was exacerbated by his play, a move to make him a defensive replacement last weekend that wiped out a possible retro DL move. The Rockies have not said what bone is bruised. As with Pujols, the anatomy matters. If Gonzalez has bruised the larger bones of the forearm, it's easier to heal up. If it's one of the small bones of the wrist (hamate, scaphoid, etc.), it's going to be longer and have a greater effect on his power. I'm working to find out, but for now, we'll have to guess. The more likely injury is to the arm, which would have a minimal impact once he gets past the acute pain and swelling. He had a cortisone injection just before the break, but a DL stint is still very possible.

Young pitchers break. It's a sad fact of baseball. We remember the Nolan Ryans, the Bob Gibsons, the Bob Fellers, because they were the exceptions. They held up and had long careers, but as far back as Cy Young, there are pitchers that worried about overuse. Christy Mathewson wrote a book in which the biggest piece of advice was to save the best pitches for the best hitters and biggest situations. Research done by Nate Silver and myself showed a huge issue with young pitchers below the age-25 season, the same high-risk pitchers that Tom Verducci watches for innings increases. Guess how old Anderson and Ross are? (A: 23 and 24, respectively.) Relying on young pitchers is a risky proposition, and that the A's rotation is full of them more than doubles-down on that risk.

Anderson got the worst of it, blowing out his elbow and making good on the things I worried about this spring. He'll miss the rest of this season and a portion of 2012 as he recovers. About the only thing that makes this any different from any other Tommy John story is that it's clear that Anderson did not have a complete tear (rupture) of his UCL. The platelet rich plasma effort and rehab recommendation of Dr. James Andrews indicates that this was on the edge. In the end, it wasn't working and the ligament was replaced. The news is a bit better for Ross. His problem is just an oblique strain, or it was until he came up with some shoulder soreness. It's a classic cascade injury -- one problem leading to another through unconscious mechanical changes or compensation -- and he'll be shut down for a week.

Victorino is headed to see one of the area's top hand doctors, though it's not clear why. It could be to get cleared or it could be to see why he's still having problems. Victorino sounded positive when he sat in with Chris Berman during the Home Run Derby, but he dodged specifics. Sources are conflicted, but it's my belief that he's going for clearance and will amp up the baseball activities this weekend. A rehab assignment would come shortly after that, though it's not going to take much to have him back with the team absent a setback. Thumb injuries do tend to linger, so watch to see if Victorino's contact rates drop or his K rates rise.

Jose Bautista left Thursday night's game after injuring his ankle on a slide. No word at deadline about the severity, so watch this closely ... Ike Davis had a cortisone shot in his ankle and will rest for another three weeks as the medical staff works with him to avoid surgery ... Despite all they do to keep the All-Star exhibition safe for players, anything can happen. Miguel Cabrera mildly strained his oblique during the game, and the Tigers will watch him closely before getting him back into the lineup ... It's this kind of story that's going to keep my job interesting for the next decade ... Ryan Madson did well during an inning of rehab work at Clearwater (A) and will be with the team Friday ... Jose Tabata is playing in Bradenton (A), but his results were a bit mixed. He may need a couple more days on rehab before returning. The plan is to have him back for the over-.500 Pirates this weekend ... Denard Span has been cleared ... John Danks will throw once more in the minors, with the Sox looking for more stamina. If things go well, he'll be back for the Royals series ... Scott Baker threw this week and if all goes well, he'll be back in the Twins rotation for Monday's doubleheader ... Luke Scott is going to need another cortisone shot in his shoulder, a sign that he's unlikely to be ready to come off the DL early next week ... Justin Duchscherer still isn't throwing and there's a chance that if he can't get anywhere by August 1, the O's will throw in the towel on this experiment ... Thanks for all the feedback on the Next Gen GMs article from Wednesday. See you next week, when UTK hits the road, starting in Toronto on Thursday.