Under The Knife: Nicasio injury shows need for progress not over

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I know that fantasy sports are a bit of an escape for most of us, even more than sports can be. Injecting reality into that dulls the rush we get from drafting the best sleeper, from making the best trade, or watching your hot prospect explode on the scene. Sometimes I have to be that buzzkill. This weekend was one of the scariest, as we came all too close to having a death on the field. I'll tell you more about Juan Nicasio below, but when we deal with an injury referred to in medical texts as "often fatal," it's time to take a look at advancing the safety of the game.

I'm of the opinion that something is better that nothing, yet hitters avoid the "gazoo" helmets that protect them, but "look goofy." Pitchers refuse a small shin guard, one of which would have kept Roy Halladay, the most durable of modern pitchers, from having a broken leg from a comebacker a couple years back. I've long thought that a small insert of hard plastic and perhaps a bit of foam could be put inside the pitcher's hat while pitching, giving him some extra protection. It wouldn't help in all situations, but I know that pro pitchers wouldn't go for the pitching helmets that we're starting to see in youth leagues.

At some point, some pitcher is going to decide that he's going to wear it and it will save him a major injury. He'll win, despite the padding, and another pitcher will say that Halladay or Lincecum or Strasburg or Taillon is a guy they'll emulate. We'll look back the way our ancestors did at gloves, chest protectors and batting helmets, wondering how they ever played without them. Powered by that hope, on to the injuries:

There is no easy way to discuss what happened to Nicasio. In ways, it is beyond belief. Nicasio was hit with a comebacker in such a way that he fractured the highest vertebrae, the one just under the skull called C1. A fracture of this type is called a Jefferson's fracture, after the doctor that first described this. The typical Jefferson's fracture is caused by an axial load or, in rare cases, a severe rotation of the head. With the hit of the ball and Nicasio's fall onto his face, it didn't appear that there was the proper loading necessary to create this. There's the chance that Nicasio had a congenital defect that was exacerbated by the comebacker and that he had been "on the edge" for a while. We'll really never know. Dr. Neel Anand called the injury "extremely unusual." He agreed that it may have been the rotation, saying, "It is possible that he was hit hard on the right side or under the chin, both of which can create a serious whiplash-type of movement to the neck and create the fracture as the head whips back into hyperextension." The whip is hard to see on the video, but we don't have the best angle.

The fracture was such that he needed spinal fusion. The usual procedure involves locking together the top three vertebrae with plates and screws, which will limit his flexion and rotation in the long term, but makes the area stable enough to hold the head up and keep any damage from the spinal cord. Full credit has to go to the Rockies medical staff that quickly recognized the severity of the situation, braced Nicasio, and got him to the hospital quickly and without further damage. Watch the video and you'll see trainer Keith Duggar get to Nicasio in just seven seconds. It's a huge positive that there was apparently no spinal cord problem and that Nicasio has full sensation and motion in his limbs, though watching the tape, it appears that he was trying to figure that out at some points, making almost a throwing motion which could indicate he was having some issue in his hands or that the pitching motion was the most natural motion for him and it just came to mind when asked to move his hands. While the best case scenario is that Nicasio is ready to pitch next year, this is one of those situations where hoping that Nicasio has a normal life should come first with any further baseball a big bonus if it does happen. We came very close to losing a pitcher, closer than anyone outside the Rockies medical staff might realize.

I was making calls on Sunday afternoon when the buzzing started. My Early Warning System started picking up that something was going on with Reyes. I jumped on Twitter between the time that Reyes was pulled from the game and the time that the Mets announced to the press box that Reyes had been removed due to a "stiff" left hamstring. That's the one that's given him problems, so even a minor problem has to be taken seriously by the Mets medical staff. Literally seconds after Reyes was pulled, people started pounding Twitter, asking for an explanation. While I love Twitter, it's things like this that remind me of Bill James' "public utility" statement he made years back. There's simply no way that even the most dialed-in beat writer could have known the severity at the time. I've seen the same sort of thing, with people not just asking, but demanding to know what an injury was for an NFL player ... while the player was still down on the field. Watching the panic, the speculation and the misinformation run over the next seven minutes was a lesson in the positives and negatives of a real-time media. Reyes' hamstrings require a level of caution beyond normal, so pulling him was the smart, conservative play. How long Reyes will be out, if at all, will be determined over the next 24 hours. ESPN's Adam Rubin reported that Reyes will have an MRI. Reyes' normal hamstring routine and maintenance will amp up a bit in hopes that this is just a minor speedbump.

The Mets took another hit as Murphy appears to have a much more serious injury than Reyes. Murphy appeared to injure his knee, and Terry Collins reported after the game that Murphy was saying "get me off the field" repeatedly, an indication of just how much pain he was in. Murphy was sent for an MRI (likely getting there about the time Reyes was getting out), but video showed the knee buckle hard. Murphy tore his right medial collateral ligament (MCL) in 2010, an injury that cost him most of the year, so his knees may have some sort of proclivity for this. Someday, instead of an MRI, teams will take a DNA sample after they draft a player and know this kind of info, but for now, we're guessing and hoping that it's not as bad as it looked. (Late word is that Murphy has a Grade II tear of his MCL. He's done for the season though the injury will not require surgery.)

Beltre was making progress, though slowly, coming back from his hamstring strain. On Saturday, he became an object lesson in why rehabs are often slow and conservative. Beltre re-injured his hamstring, a severe setback that one source described shortly after the problem as a "restart" of the rehab process. The Rangers sent Beltre for an MRI and announced that he'd be out another three weeks. It wasn't clear from the announcement whether his return date would be three weeks out or whether the rehab process would take another three weeks. Given the results of the MRI indicate a restart, it would seem to be on the long end of that, putting Beltre back right around the start of September. Michael Young has been a more than adequate offensive replacement during Beltre's absence. The Rangers can't expect that to continue, but production of any sort buys the Rangers some time in what has become a surprisingly tight AL West race.

Jurrjens started the year on the DL and is headed back now. In between, he would have been a Cy Young candidate in most years, given 12 wins and a solid ERA. (His SIERA of 4.03 shows that he's been pitching a bit lucky.) Jurrjens hits the DL with what is being called a right knee strain, though the Braves seem to be focused on strength around the knee more than the joint's function and structure. It is the same knee that he had surgery on late last season, which has to be seen as a negative. The details on this injury seem a bit vague, so we'll have to take the Braves' word on this one. They think it just needs to "calm down" and that he'll miss the minimum. What it seems like is that the repaired knee is a bit fatigued and there's a deficit of some sort, perhaps even just an imbalance between his legs. Given his decline in the second half, fatigue seems the likeliest explanation, with this probably an early catch of an issue. Mike Minor will make the two starts the Braves think Jurrjens will miss.

The drama around Rodriguez never seems to cease, but the gambling issue isn't affecting his rehab from knee surgery. Rodriguez is at the Yankees complex in Tampa, amping up his baseball activities, including taking batting practice over the weekend. He could begin a rehab assignment by the end of the week, which would put him on the low end of the expected timetable for return. That return will depend on how long he needs to get his swing back and how well he can move in the field. The Yankees don't tend to require long rehab assignments, but seem to let more experienced players self-direct to some extent. They focus on objective measures of strength and the like prior to turning them loose at the end of the process. The best example of this is how the Yankees dealt with Derek Jeter. So far, things have gone well for Rodriguez. I'd expect the Yankees to be conservative, but not too conservative, as long as he continues his steady progress toward a return.

Once upon a time, I had what we half-jokingly called the "Daily Mark Prior Update," as Prior was coming back from his initial shoulder injury. Cubs fans (and fantasy followers) wanted to know every detail, the way some people seem to want to know about Lindsay Lohan or whoever it is on Jersey Shore. (Never watched, thanks.) Strasburg is nearing that, though there's also a side order of panic. "He's being rushed back" some claim, not noticing that it's been nearly a full year since his surgery or that Jordan Zimmermann, brought back on the same schedule by the same team is doing just fine.

Strasburg had his first rehab start on Sunday after Tommy John surgery 11 months ago and looked as good as any Nats fan could have hoped for on Sunday. He went 31 pitches in 1 2/3 innings, striking out four. More impressive was his velocity. My source at the stadium said 96, though I saw reports of 97 and 98 in other venues. I'd say he's not rushed and that stamina is the issue between him and a return to the Nationals in early September. Then again, he looked good enough that I wouldn't waste too much on the minors, the way the Nats did in 2010. He's not rushed. He's close to being ready.

Everything's going according to plan for the Phillies. They're winning their division and are well set up for the stretch run and playoffs. They were almost completely healthy with Roy Oswalt coming back on Saturday, but now Polanco is out for at least the next several games and potentially longer. Polanco has spent the last couple seasons fighting small but lingering issues like this latest hip injury. Polanco has gone from a back injury to a hip injury in short order, making some wonder about the connection. It could be a simple cascade -- an injury that happens when things change to try and protect the other injury -- or it could be some sort of inter-related condition that refers the pain, which means that the pain is away from the actual injury. There's been a lot of speculation about a acetabular labrum tear, but there's no evidence supporting that yet and it wouldn't explain the back issues. We'll have to wait for Monday's MRI and hope that it gives enough info to assess how long Polanco will be out.

Dusty Baker likes "his guys." He's a manager with a style, not unlike Tony La Russa, that requires both manager and player to be on the same page, one with an "us against them" mentality. Baker backs "his guys" to the utmost, which is both an admirable quality and one that can hurt his team when he takes it too far. Early in the season, it was clear that Heisey was one of Dusty's guys, so much so that there were some press box jokes about Darren Baker being jealous. Heisey has been a solid fourth outfielder, but with Jonny Gomes sent to Washington, Heisey had a chance to establish himself in left. Instead, he strained his oblique and hits the DL. It's telling that Baker still doesn't seem to trust Yonder Alonso in left (or understand that putting him there when he has a groundball pitcher like Johnny Cueto (53 percent) on the mound would be a smart move.) Heisey will miss at least three weeks, but even beyond the normal hard-to-read oblique strain, a lot depends on how his replacements, especially Alonso, play in his absence.

The Reds also are watching Phillips after a collision with Drew Stubbs resulted in what looked to be a very painful sprain. Some initially compared it to the collision that Ike Davis had, resulting in his ankle problem, but replays show it was a simple roll. That doesn't make it less painful, but it does make it a short-term problem. Phillips was unavailable on Sunday, but the team seems to think he'll be back as early as Monday, though it wouldn't surprise me if this extended a couple more days. The DL doesn't seem to be any danger and in weekly leagues, I'd have Phillips in the lineup unless you have a strong backup.

Hanley Ramirez missed the weekend, but Jack McKeon says he'll be available for the upcoming series against St. Louis ... Tim Lincecum was hit by a bat that got loose of Chase Utley's grip. Lincecum was walking without a limp after the game according to the beat reports ... Bob Uecker gave a nice shout out to the medical staff of the Brewers after Corey Hart was hit on the back of his hand. Hart's X-rays came back negative and he'll come back once the pain and swelling is gone ... Shin-Soo Choo was back in Cleveland getting a final check before heading on a rehab assignment. He's scheduled to be at Lake County (A) on Monday if all goes well ... Dee Gordon was out with a bruised shoulder on Sunday, but it sounds as if he'll be back quickly ... J.J. Hardy is expected back Monday after missing the weekend with a vague ankle issue I'm told is a bruise. We'll have to watch this one given his injury history ... J.D. Drew hit off a tee on Friday and the Sox seem impressed by the results. Terry Francona said Drew felt like he wasn't far off ... Justin Smoak could be back as soon as Tuesday. He's been out with a thumb injury ... Chase Headley will see a hand specialist on Monday. Any fracture will cost him over a month, which might push the Padres to shut him down for the season ... Friend of UTK Mike Wilner is reporting that Cesar Izturis has a groin strain ... Ryan Spilborghs hits the DL with plantar fasciitis. That has a tendency to linger ... Brad Hawpe was on the DL with a finger injury already, but he's also had an elbow injury. Turns out that was the more serious as he had Tommy John surgery on Friday. He's done for the year, but could be ready late in spring training. Position players take less time to recover than pitchers for obvious reasons ... If you don't believe players would wear something like a pitcher's helmet, you'll never believe what they tried with Dave Parker back in the 1970s. I guess Parker was too big to make fun of!