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Under The Knife: Baseball slow to understand benefits of prevention


After considering the many injuries already this season, I tweeted out that American sports teams needed to focus more on prevention. Some of the top European clubs, such as Real Madrid, spend up to 80 percent of their time on injury prevention. That being the case, there's room for improvement in American sports.

The reaction on Twitter was twofold: 1) Detail what you think should be done; and 2) Injuries are "part of the game."

On the first, I declined to put forth a bunch of ideas for what teams could do because ... well, I'm not the guy you'd want to listen to. I have ideas, sure, but the hard working doctors, trainers and other medical professionals deserve my respect. Let's start with something simple -- hand injuries are clearly preventable, for the most part. They're usually traumatic, either getting hit with a pitch or injured sliding, like Kurt Suzuki on Wednesday. A protective glove could help with either, so let's say outfitting every player with this type of protection would reduce injuries by 50 percent, which is conservative. That's a reduction of five hand fractures. It doesn't sound like much, but that would be a savings of around $2 million, which would be enough to buy about 50,000 pairs of gloves. That would be more than enough for MLB to pass them down to the minors, colleges, RBI, or even just fund research with the savings -- which might be the best idea.

It's the second that bothers me. There's no way that all injuries can be prevented, but this is a goal of reduction, not elimination. Too many think that all injuries are random. This is like weight loss, one pound at a time, rather than surgery. As my friend Luke Kasdan put it, this is a problem that could save millions at a cost of pennies on the dollar. With apologies to Jonah Keri, this is far more than just two percent of a billion-dollar issue.

There were 501 DL stints last year and something simple would lop off 1 percent of them. There's always going to be the general trauma, but those only amounted to 20 percent of injuries last season. We can do better and sticking our heads in the sand is not going to get us there.

On to the injuries:

Rivera has been shagging balls in the outfield for his entire career. While we can discuss whether or not it's a good thing for any pitcher to do, it's hard to fault the practice after one time among thousands becomes a problem. He could have done something similar jogging poles, working out on a treadmill, or just stepping off a sidewalk wrong. The video of Rivera going down, grabbing his knee, and seeing the positioning of his affected-side foot was painful to watch. Joe Girardi announced after the game on Thursday that Rivera has torn his ACL. He'll need to have it repaired once the swelling reduces. Rivera is done for 2012 and given his age, this could end his career. In the short term, David Robertson and Rafael Soriano will pick up the save chances, but the longer term is the bigger concern.

There's something of the offseason in Braun's Achilles issue. While the haters will hate no matter what, Braun's not immune. He has wanted to go out and not only help his team back to the postseason, but prove he's the same player he was before the disputed PED test. (Has Braun passed his drug tests this year? Yes.) Right now, he's dealing with a sore and inflamed Achilles tendon. It's enough to be problematic, but not enough to keep him out of the lineup. Both Braun and the medical staff are cautious, so at the slightest sign of an issue, he was pulled. An off-day on Thursday helped and it's likely that he'll be back in the lineup on Friday. This isn't going to go away just yet, so be on the lookout for Braun's availability if you're in daily or weekly move leagues.

The Brewers got the worst news possible regarding Gamel. They were already struggling to replace Prince Fielder when one twist cost them Fielder's best available replacement for the rest of the year. Gamel tore his ACL on a play in the field and will need to have it replaced, an 8-12 month process. Gamel did stay in the game just after the play, which some are questioning. It's very difficult to do a full field assessment in baseball. Unlike football, play doesn't stop indefinitely. When he came into the dugout and a full suite of manual tests were done, he was out quickly and headed for imaging. This is a traumatic injury and one that's going to test the Brewers' depth and GM Doug Melvin's creativity.

There's more to Beckett's injury than a simple missed start may cure. While Beckett does have a sore lat, the Sox called up Aaron Cook, who had to be up or his opt-out would kick in. The lat is worrisome for Beckett, since it's an unusual injury and one that recalls the initial diagnosis for Clay Buchholz last season. It is expected that Beckett will be back in the rotation shortly, but this bears watching. Lat strains tend to be kinetic chain issues, with Ben Sheets being the prototypical example of this injury. Beckett went deep into his last start, so using this circumstance to buy him some extra rest is more proof that Mike Reinold is managing things well.

Youkilis is breaking down. We've established that and there are more details in Wednesday's UTK if you'd like to go back and revisit it. He is on the DL with a back sprain -- yes, sprain. The problem is the sacroiliac joint, located between the spine and the pelvis. This is the same type of injury that Joe Mauer has dealt with, so it can be managed, but it's painful and tends to be chronic. While the Sox are hoping that rest and rehab will get Youkilis back at the minimum, it's hard to see just 15 days changing things. If Will Middlebrook plays well, I expect the Sox to give Youkilis more time in hopes of really minimizing the recurrence risk. The ERD reflects the conservative approach.

The Rays are already dealing with Evan Longoria's absence, so losing Upton for any period of time could be bad. The quad strain isn't that serious and he's expected back as early as Friday, but the pattern of injury is much more worrisome. His earlier back injury was traumatic, and while there's no direct correlation here, Upton's had a hard time staying healthy his entire career. (The same sort of small injuries seem to happen with his brother, as well, so a genetic component has to be considered.) Another complicating factor is the turf he deals with at home. While it's as advanced as possible, it's not grass and will be harder on many structures. In the short term, Upton's going to need to be watched; in the longer term, this pattern of injury is going to have to concern any team that's coming in on him in the free agent market.

Sandoval left Wednesday's game with what looked like a wrist injury. This isn't the same wrist that Sandoval had surgery on last year to remove the hamate bone, but that's not necessarily a positive. Indeed, it turns out the injury is to the opposite (left) hamate and will necessitate the same type of procedure and same timeline. That it's not his throwing hand is a bit of a red herring. Throwing comes quicker than hitting because of the forces and function involved, so don't be fooled by that. There's no proximal cause; Sandoval was at bat when the injury occurred and was clearly in pain, so we have to assume it was a pure trauma. We do have the perfect comparable here. It took Sandoval 45 days last year. He injured it on April 30, freakishly close to this year's time frame. If we add a couple days to his return last year, I think the ERD of June 15 will be very close.

Ryan Zimmerman will have a hitting session on Friday. If all goes well with his shoulder, he'll be back for the Nats on Tuesday ... Chris Young is also doing more hitting, but there's still no firm timetable for a return ... Cliff Lee has a good bullpen session. If his schedule session on Saturday goes well, he'll likely be activated next week ... Kurt Suzuki got lucky. His hit on the hand resulted in just a bruise and he'll miss minimal time, if any ... Brett Gardner had a mild setback. He won't be hitting until at least next week ... The Yankees told the media that Mark Teixeira has been dealing with a bronchial infection for much of the season. That can't help, though Teixeira is a notorious slow starter anyway ... Coco Crisp seems headed for the DL. His ear infection will be checked on Thursday, but reports seem to be leaning to the retro move ... Cory Luebke went to the DL as a "precaution", but the question is what caused the inflammation in his elbow. Unless the Padres fix that, he'll end up back in this situation ... Doug Fister made a good rehab start on Wednesday and felt fine on Thursday. He's likely to be back in the Tigers rotation on Monday or Tuesday ... Eric Chavez was placed on the Schwartz List (7-day DL) for concussion. Interesting part is that it was a non-contact concussion, created by the contra-coup, whiplash effect. Chavez will be monitored and subject to MLB concussion return-to-play rules ... Zach Britton will throw a sim game on Saturday. If that goes well, he'll head to XST. Things look good post-PRP for him ... Tsuyioshi Wada will have Tommy John surgery. The hope is he can be throwing in spring training next year, giving him a year on his deal to help the Orioles ... Mark Prior signed with the Red Sox. Really ... Crossed another one off the radio bucket list after doing radio with Steve Czaban yesterday. Dan Patrick, Bob & Tom, and Fresh Air should be reminded that I'm available.


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