Under The Knife: Loss of depth squeezes hopes of Braves, Red Sox

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I've done more than a thousand Under The Knife columns in the last decade. As another season closes with today's column, I'm reminded of both how far things have come and how far we have left to go. This column started because of curiosity about how sports medicine fit into the landscape of baseball and fantasy baseball. I sent an e-mail to three friends, asking whether the kind of information I could find and explain about injuries would be valuable. It has since grown into a column at one of the biggest sports publications around.

The incidence of injuries aren't down, but we're making progress. High pitch counts are a thing of the past, though it could be argued that baseball has allowed the pendulum to swing too far toward protectionism while not understanding the true problem, fatigue. Teams still don't do basic research, haven't added to medical staffs to remove the man-hour bottleneck, and we've seen the rise of oblique, lat, and hip labrum injuries over the last few years. There's more to be done over the next decade than we've even dreamed of doing this last one, but every time you read this column, we're chipping away a bit at the entrenched position of baseball.

Injuries are part of the game, but they don't have to be as big a part of the game as they are now. Baseball has lost billions of dollars and thousands of days to injuries, but the owners haven't gotten it yet. Want the next Moneyball style advantage? Here it is. I'll keep working until they do.

This column wouldn't exist without the assistance of others. Each and every column should have credits at the end, but I do want to take this occasion to thank many of them. First, to Dan Wade, who's been on the back end doing research and is likely to be the next one of my assistants to move into a front office position. Thanks to all my sources and advisors, most of whom can't be named here. I also want to mention a few names -- they know why they're here: Trace Longo, Cory Schwartz, Matt Swartz, Eric Seidman, Joe Sheehan, Rick Peterson, Joel Henard, Jenn Sterger, and my wife, Barbara. Powered by the people behind the scenes, on to the injuries:

The Red Sox are getting all the attention, but the Braves are stumbling almost as badly and largely for the same reason. Their strength was their rotation and its apparent depth, but injuries wiped out that depth and a couple of ineffective starters beyond that crushed this team. It's possible to call it overuse, or at least a suboptimal usage pattern, in both the rotation and the bullpen, but it goes beyond that. Hanson couldn't complete his weekend pen session and now looks doubtful if the Braves make it into the playoffs. Small rotator cuff tears are big problems, especially for young pitchers. The Braves are going to have to be careful with their young ace.

Their one steady performer has been Hudson, who left his last start with cramps and dehydration. He'll be ready to make his last start, but won't be in position to make another start until Sunday at the earliest, which will limit his NLDS exposure. A one-game playoff would be a "kitchen sink" game to be sure, but Brandon Beachy is the likely starter, leaving Mike Minor and Derek Lowe to go in Games 1 and 2. The Braves are also concerned about Jones' knee, which is acting up again. He'll fight through as the medical staff tries to manage the swelling, but he's likely to need at least minor surgery after the season.

The Sox have struggled since before Youkilis left the lineup, but as we close in on what might be known someday as the Last Night of the Red Sox Dynasty, we have to wonder if it's symbol might be here. Youkilis was almost traded to the A's for Billy Beane (a much better return than what the White Sox appear to be getting for Ozzie Guillen), but instead became both a cultural icon and a heck of a player. His positional flexibility allowed Terry Francona a lot of maneuverability. I've always been obsessed with the idea of the "roster expander" -- a player who can play multiple positions, essentially allowing a team more than 25 options on the roster -- and Youkilis is one of the best. His hip flexor strain is painful, but it's the sports hernia that continues to be the real problem. Youkilis simply can't make athletic movement, or even walk up stairs, without significant pain. The Sox haven't had an emergency so bad that they've turned to him, which tells you a lot. Youkilis will be back next season, after surgery to fix the hernia, and should return to normal.

The Cardinals spent most of their unlikely playoff chase without Holliday in their lineup, but he came back from his finger injury on Saturday. Normally a finger injury will affect grip, leading to less power and more strikeouts. Neither has been much of an issue for Holliday, as he has seemed to be focused more on contact and comfort. It's reasonable to say that he's been tentative at the plate, making me wonder if Holliday is risking that finger and perhaps offseason surgery for another chance at October.

If the Cardinals chase down a playoff spot, it will be without Furcal. He has a strained hamstring that will keep him out "several days" and could keep him off the NLDS roster. (Remember -- the 9/30 designation means that a player will not return for the regular season, which ends on 9/29. It does not mean that a player will be ready for the playoffs.)

The Yankees are getting rested in the last week, infuriating some Red Sox fans along the way. But there's a difference between well rested and healthy. The Yankees will have a playoff rotation that starts with CC Sabathia, but it won't have Hughes. His return on Monday was limited, but successful. The Yankees hope Hughes can be a part of a playoff bullpen, essentially backing up A.J. Burnett in what should be considered a tandem. Hughes is scheduled to pitch a couple innings on Wednesday, giving the Yankees a chance to see how his arm recovers in this role. I'm told he will not be used in back to back games, so his usage will be planned. The Yankees have known for a while that they'd be without Cervelli, but the fact that he's still having concussion symptoms has the team concerned beyond the playoffs. Cervelli will work in the offseason with specialists, but there has been talk that Cervelli will consider walking away from the game if there's no improvement.

Another nasty comebacker came screaming at a valuable pitcher on Saturday. This time, it was Hernandez taking a sharp liner off his forearm. X-rays showed no fracture, but the team protected the arm anyway and will keep an eye on it before he heads off into the offseason. Over on the football side of things, I tested a substance used in flak jackets by a company called Unequal Technology. It's light, flexible Kevlar composite could easily be sewed into sleeves or undershirts to help protect pitchers from just this kind of issue without limiting or restricting them in any way. Its' time that this type of protection was used by players or even mandated by teams. Hernandez's season is done, but Saturday was his last scheduled start anyway.

The Phillies got Pence back on the field on Sunday, using their lead to give him a few games off. The team has worked on his patellar tendinitis, figuring out both what aggravates it and what he best responds to, over the last few weeks. The three-day break allowed them to make sure they have a real baseline and have controlled the inflammation as best they can. The time frame suggests that they may have used an injection or other anti-inflammatory as part of that, but there's no confirmation of that. The medical staff should be able to handle this through the playoffs. Hopefully, an offseason of rest will help Pence get over the worst of it. There's some question as to whether a shortened offseason will hurt, but I'm sure both Pence and the team would be glad to find out if they come away with another ring. Beyond Pence, the Phillies are sending a lot of players to the Instructional League to keep them in game shape, showing just how worried they are about some of their players. Oddly, Domonic Brown doesn't appear to be one of them. Many people think Brown will be trade bait this offseason, especially if the Phillies need to renovate their bullpen.

It's no surprise that Stephen Strasburg will be on an innings limit next year. While Mike Rizzo won't say what that limit is, his 123 innings in '10 make it reasonable that he could throw 180 or so in '12. Tommy John surgery, it appears, doesn't seem to "cost" a player a year of development. If you treat it as if the player would have played that year, with a normal 30-inning increase, they can come back with another 30-inning increase the following season as well without getting into Verducci Effect territory ... Justin Upton isn't having any concussion symptoms, but the D'backs held him out until Tuesday just to be sure ... Grady Sizemore is headed back to Dr. Richard Steadman to see if he'll need microfracture surgery on the other knee this offseason ... Mark Trumbo's season ended with a stress fracture in his foot, ironic since it started due to Kendrys Morales' similar issues ... Ervin Santana was scratched Tuesday due to an organizational decision. He and Jered Weaver are done for the season ... Carlos Guillen won't be back before the ALCS, and even that's a major question ... Brian Wilson has been shut down for the season and could still face elbow surgery this offseason ... The Twins put Joe Mauer and Justin Morneau on the DL for procedural reasons that relate to monitoring their offseason programs ... I signed off last year with a Jay-Z lyric, not knowing if this column would ever come back. Instead, this has been the best year ever, so one last thank you to you for allowing me to reintroduce myself.