Under The Knife: Kemp's athletic gifts effort make for injury risks

On Monday, my research colleague, Dan Wade, described a new study that showed little correlation between pitch count and performance. Let's stick another fork in pitch counts; this time with a study led by Dr. Glenn Fleisig of ASMI, from 2007. This study showed that there's not much of an effect on pitching mechanics based on pitch counts. Using motion capture data, the researchers were able to show that pitchers didn't significantly change their mechanics or increase the joint loads as the pitch counts got higher, to as much as 135 pitches. The most notable conclusion from this is that torso tilt might be a significant measure of fatigue. It's not something that can be tracked by PitchFX, but there are systems that could do it. One team uses a simple camera to track mechanics -- it's mounted on the back wall and takes a picture with each pitch, remotely triggered. They can overlay the picture on the computer and see mechanical changes. This camera is actually looking for tips, but could be used to track tilt or other measures of fatigue.

While this is another nail in the coffin for context-independent pitch counts at the professional levels, counts still offer a good-enough measure of workload for lower levels, up to and including high school. Earl Weaver said that "the batters will tell me when the pitcher is done," and this is now being objectively shown to be the right tack. Pitch counts without context don't give us enough information about what we're actually trying to measure, which is fatigue. Managers should no longer be falling back on "100" as a magic number. Whether it's one pitch or 150, the batters will let them know. Instead of counting pitches, we should be looking for direct measures of fatigue that will give predictive input to pitching decisions by the manager and pitching coach.

No studies like these have been done with major league players. The reasons are relatively simple. First, it's difficult to do studies on million-dollar players being asked to perform in season. Second, there's a great amount of resistance from the MLBPA. Even on seemingly simple studies, the union has resisted the inclusion of even data from 40-man roster players. I'm seldom one to call the union obstructionist, but in this case, their position needs to change and change quickly.

Powered by Brett Lawrie's helmet, on to the injuries:

Kemp isn't going to catch Cal Ripken, but his consecutive games streak does tell us something about Kemp. He's durable, heals quickly and generally doesn't have to go "max effort," taxing the muscles and joints. He's one heck of an athlete and that reserve of talent keeps him from having to work too hard. This isn't meant, though it's occasionally seen as a lack of effort. He's just so good that things come naturally and easily. The same things happen to engines as they do ballplayers. The closer to 100 percent they run, the quicker they break down. Kemp's hamstring strain is serious enough that it's not going to be a only a week. They'll use the time to make sure he's fully healed from this Grade I+ strain. He should be fine once he returns. In the meantime, the Dodgers will use Bobby Abreu and Jerry Sands.

The Yankees kept Robertson's oblique strain quiet for a couple days. Some say they were just giving Robertson some cover while others suggest that the Yankees were checking the market for relievers. It's an odd situation for Robertson, who was kind of hung out and made to look like he'd lost his job quickly. The oblique strain is on the left side, but both sides are involved in the pitching motion, so one is not "better" than another. He'll miss roughly four weeks.

Corey Wade will get some more action in later innings with Rafael Soriano getting the save chances. It' seems as if Joe Girardi is reading LI charts.

The worst case scenario was also the most likely scenario once Duffy was diagnosed with "medial elbow pain." That's where the ulnar collateral ligament is located. The testing done by Nick Kenney and his staff likely pinpointed that there was a deficit and tenderness on palpation. Much has been made of his previous elbow pain and that the Royals elected not to do an MRI at that point.

I wanted to get an expert opinion on this and went to Dr. Orr Limpisvasti, one of the top orthos at Kerlan-Jobe Clinic in Los Angeles. I asked him when he orders an MRI on an athlete? "MRIs help diagnose many conditions that are not clearly apparent using other diagnostic means (history, examination, plain radiographs, ultrasounds, etc. ...)," said Dr. Limpivasti. "In joint pathology, the following conditions often require MRI scans: soft-tissue conditions (meniscus, articular cartilage, tendon, ligament, labrum, etc.), bone contusions, stress fractures, loose bodies and many more. It is simply a better study for many injuries in sports medicine.

"The clinical scenario truly dictates the necessity for an MRI. In sports medicine, educating the athlete thoroughly on the diagnosis, prognosis, natural history and treatment options often requires an MRI scan. Often it depends upon how involved the patient, family and, possibly agent are involved in the nuances of treatment and decision-making. MRIs can also assist in this process beyond the pure structural diagnosis."

In other words, it depends entirely on the situation. An MRI is a tool, but not always the most appropriate tool. Be aware that the medical professionals who treat and diagnose athletes have a lot of tools in their toolbox before they start ordering up MRIs. In this case, the MRI only confirmed what they knew -- Duffy will have Tommy John surgery and miss the rest of the season.

I often talk about simple solutions reducing injuries. How simple? Two injuries in baseball could have been prevented by a $30 piece of equipment. Just the loss of Niemann costs the Rays about $680,000 in his salary, plus that of his replacement, medical costs and more. Comebackers are an all-too common occurrence, and nothing is done to protect pitchers. (Better defensive positioning isn't a solution because studies have shown the ball comes back too fast to react in all situations.) An entire staff could be outfitted for a couple hundred bucks. I'm not just faulting teams here; the players aren't rushing out to buy them for themselves either, even after injuries. Roy Halladay, who had his leg broken by a similar hit a few years back, continues to pitch without protection (and admittedly, without problems.) Niemann's fractured fibula will cost him about six weeks, but he should be able to return normally.

The Yankees had a similar situation. Nova took a comebacker off his ankle, but was able to continue. On a later fielding play, he seemed to roll his ankle and has a sprain. His next start is in doubt, but for now he's day-to-day. It's time for players to stop resisting protection or for teams to start demanding it.

A sharp foul that comes at the dugout is a scary thing that can be very serious, but normally, it just scatters players, spills drinks and makes for some laughs after everyone comes out OK. We used to call balls like this "ugly finders." The worst case scenario is something like what happened to Juan Encarnacion a couple years ago. Tulowitzki just got a nasty bruise on his lower leg. He really had no chance to react. This happens so infrequently that I'm hard pressed to say that something should be changed. He was back in the lineup Tuesday night for a late game. He shouldn't have more issue than a bruise that matches his uniform.

Eliezer Alfonzo had his drug suspension lifted after 48 games. While many are pointing to the "Braun technicality," the Ramirez reduction is in play here as well. MLB's decision to fire Shyam Das is connected ... Jose Valverde left Tuesday's game with back stiffness. Watch this one closely to see if he'll need more than a bit of rest ... Adam Jones ended Monday's game grabbing at his leg after running to first. He was back in the lineup on Tuesday, but it bears watching ... Stephen Drew played nine innings at XST. His next step will be Reno (AAA), which could come this weekend ... Chris Young will head to Reno to continue his rehab. He should be back with the D'backs soon, perhaps even this weekend ... As I anticipated in Monday's UTK, the Rays used a retro move to place Desmond Jennings on the DL with his sprained knee ... Freddie Freeman had some blurry vision. The team thinks it was his contacts rather than a lingering issue. He was out of the lineup on Tuesday, so keep an "eye" on this. Sorry, had to say it ... Jon Jay heads back to the DL with a shoulder issue. The wall wins, man ... The Nats think Mike Morse could be back in early June now. We'll need to see some progress from him on baseball activities soon to make that happen ... Sandy Leon was placed on the 60-day DL after a high ankle sprain sidelined him. The 60-day is a roster thing, not a real indication of severity ... Looks like Brandon Inge will avoid the DL, but miss a couple more games as his strained groin heals up ... Congrats to SI for bringing on one of the good ones. Jay Jaffe will be joining SI.com to do the same kind of amazing "blog" as Zach Lowe, Stu Hackel and Chris Burke. I'm excited for my friend Jay.