Under The Knife: Should no-hitters spur talk of PED use for pitchers?

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Matt Cain's perfect game was awesome, but we're seeing what Joe Sheehan calls a no-hitter cluster. Over the last three years, there have been 16 no-hitters, including five perfect games. The balance seems to have tipped over the same period, from the high octane offensive environment of the '90s and early '00s to the pitching dominant times of today.

Some readers claimed there needed to be more "steroid testing." I'd suggest that the amount of no-hitters is at least as extreme as the amount of home runs. And if you're going to make the negative case on hitters, ignoring that pitchers in the steroids era juiced as well, don't we then have to suspect pitchers now? If Jose Bautista has to answer a bunch of clown questions when he hits 50 homers, why doesn't Cain and Philip Humber? (And for that matter, has anyone asked Bryan LaHair where this power spike comes from?) I am certainly not suggesting that Cain, Humber, or any pitcher is doing something illegal. Far from it, especially with the effective testing program in place. I'm merely suggesting that if you step back and use a bit of common sense, you'll realize that baseball is a constant search for an advantage. The cycles tip to hitters sometimes (1930, 1997) and to pitchers sometimes (1968, 2012). Cain's perfect game was awesome, but so was Bautista's 50-homer season. Let's enjoy them both, and moreover, let those two have the credit for great performances.

Powered by a really great Fun. concert, on to the injuries:

This feels like the year of the recurrence. Tulowitzki was in the first game of his rehab stint when the groin strain showed up again. It's unclear yet just how serious the recurrence is, but early indications are that this could set Tulowitzki back significantly. The Rockies had hoped he'd only need a couple games at nearby Colorado Springs (AAA), but this will likely push a return out to the end of the month. It's a bad sign that it happened on a run to first (though some sources suggest that it happened on the swing rather than on the run itself). It's usually more taxing on the adductors to move laterally rather than a simple linear motion. The ERD is tentative with the possibility that a more significant strain and the calendar could keep him out past July 10.

There's an odd side result to Tommy John surgery that I termed the "honeymoon effect." Looking at the data, it seemed like pitchers who had their ligament reconstructed had a five-year period in which there would be no further problem with the elbow. There were shoulder and other injuries, but there seemed to be some sort of protective effect for the elbow. My original theory was that it's a new ligament, so maybe it took a certain amount of time to re-damage it. Later, I discovered that there's a process called "ligamentization," win which the transplanted tendon actually becomes a ligament over time. That process takes about five years. While we don't know that ligamentization and the honeymoon effect aren't coincidental, most surgeons I've spoken to on this seem to agree.

All of that is preface to the fact that Drabek had Tommy John surgery almost five years ago. On Wednesday, he felt something pop in his elbow and came out of the game. We have to hope it's not another ligament going, and the early signs are positive. Drabek told reporters that the elbow feels better and that he passed strength and stability tests. There are no scans scheduled, so all we can do is hope this was a flukish incident and that the close of the honeymoon means nothing for Drabek. Still, with this timing and the inexplicable record of keeping pitchers healthy in Toronto, it bears watching. Right now it looks as if Drabek will make his next start on schedule.

Norris left his Tuesday start with a sprained knee, but the sprain is minor enough that Norris was out getting his side work and some conditioning in by Wednesday. Norris described the pain as intermittent, something he felt every few pitches, rather than a traumatic event as it first appeared. He left after chasing a windblown pop-up, which forced some awkward movements, the kind that would be aggravated by the injury and any accompanying proprioreceptive issues. Norris' Sunday start remains in jeopardy, but missing out on a start at Texas on a hot summer day isn't the worst result for Norris owners. Best guess right now is that Norris will make the start, but will be shadowed.

"Rotationally restricted" is a pretty awesome turn of phrase by Bobby Valentine. He was describing the core injury to Youkilis, but "rotationally restricted" might be a better term to use in the future. Youkilis has what is variously described as a rib, intracostal, and oblique issue, but all of it comes down to the fact that it keeps Youkilis from rotating on a swing, which makes his complex swing impossible. With teams scouting him for an inevitable trade, even a minor injury is bad for the Sox's return. Youkilis got Wednesday off ahead of a scheduled off-day on Thursday, so the hope is that the rest will have him back for Friday. (I know GM Ben Cherington is saying that Youkilis is off the market, but the market is so tilted to sellers that the Sox likely will end up trading off Youkilis.)

Remember Perez? The Royals gave him the big contract and thought they had their catcher of the future before a relatively minor knee surgery cost him half the season. This was a conscious decision, to repair the meniscus rather than simply removing it. It's long-term thinking that should pay off, but given the problems in Kansas City, it's unclear who will be doing that thinking. Medical decisions tend to carry over, so Perez's impending return should help a bit. Perez started his rehab last week and has had no issues, making many think he'll be up for next week, but the Royals seem to be willing to go the full 20 days if need be. It's unknown what their benchmarks are, but Perez is hitting well, catching full games, going back to back -- pretty much everything. Given the results, I don't think the Royals will be able to hold him back that long, so he could be back sometime late next week. If you liked him before the knee surgery, there's nothing in this that should change your mind. I don't love Perez as a fantasy player, but he's a solid option as a backup or fill-in.

I don't normally cover minor leaguers, but Rizzo is a hot pickup in many fantasy leagues. The 20 homers he has hit, even in an inflated PCL, have Cubs fans and power-seekers drooling a bit. As I said in this week's Fantasy Roundtable, I'm lukewarm at best on Rizzo and my opinion is cooler after a minor injury. Rizzo slid into a solid fence making a catch and was immediately pulled from the game. The mechanism is a tough one to judge, but sources say that the testing is much more precautionary than able to confirm an injury. The downside here is that Rizzo is confirming himself as a bit injury-prone, putting the knee, even if minor, close on the heels of a wrist issue that cost him a week. He's had these kind of nagging injuries throughout his minor league stops. There's no reason to think that will stop with a call-up. (Note: there's no ERD for Rizzo because he's not missing major league games.)

Some teams are desperate for pitching. How desperate? Enough to take a look at Sheets, who's been out of baseball for a while and was a big, expensive disappointment the last couple seasons he was playing. Sheets' injuries sapped his ace-level stuff until he was at best an innings eater. Sheets' elbow, shoulder and back simply gave out, leaving him a shell. With Johan Santana proving that pitchers can come back given modern surgical techniques, Sheets seems to be ready to try to return. He pitched for several teams, including the Phillies and Yankees. We'll see whether he can make it back in what would have to be one of the more intriguing comebacks in a while. He'd need an extensive run-up, probably longer than Roy Oswalt's, if he is signed, so I'm not putting an ERD on this one.

Chase Utley showed with his bat that he's going to need a longer rehab, actually getting booed in his first rehab game. Charlie Manuel said that he didn't expect Utley back until July ... What is it about celebrations? Aubrey Huff bruised his knee and may end up on the DL after getting injured after Cain's perfect game ... Evan Longoria will start what could be a short rehab assignment this weekend. If you own him, keep a slot open for him if you're in a weekly league ... The Rays put Luke Scott on the DL. Hideki Matsui will pick up some more plate appearances ... Another recurrence? Yoenis Cespedes was pulled Wednesday after returning to the lineup. His hamstring didn't get the memo and he's likely heading to the DL ... Brandon McCarthy is going to go from MRI tube to pitcher's mound quickly. He'll start Saturday after an MRI showed his shoulder was relatively clean, but it can't inspire much confidence ... Stephen Drew's triple at Reno was nice to see, but he's still not playing in back to back games and still has issues with lateral movement. We'll see how that goes this weekend as he's supposed to play in all three games. He's not ready just yet, Mr. Kendrick ... Ian Stewart heads to the DL with a wrist problem. The big worry is that there's nerve damage. He'll see a specialist about that, but there's the potential to miss significant time ... Charlie Morton will be having Tommy John surgery. He's done for the season ... Jeff Novitzky is doing the legal equivalent of doctor shopping. After a huge government investigation came up with nothing on Lance Armstrong, he found a willing ear in USADA. Hundreds of millions of dollars have been spent between BALCO, the Mitchell Report, and now the Clemens trial, all without much of an effect or even results. The FDA is actually refusing to give an accounting of how much it spent on its failed investigation of Armstrong, which Novitzky then took to USADA. When is it enough, Jeff? ... I'll be in Texas on a project for the next couple weeks. If you're in the Austin area this weekend, I'll be stopping in at Round Rock (AAA) with Ted Price to record The Nickel. Stop by and say hi.