Under The Knife: Lincecum's collapse has taken all by surprise

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Tim Lincecum was supposed to be a clone. His father, Chris Lincecum, famously built his son's delivery in the image of his hero, Sandy Koufax. There's lots worse pitchers to be modeled after, but in the continuing quest to figure out "what's wrong with Tim Lincecum?" I think we need to go back to the source. Remember -- Sandy Koufax was out of baseball by the time he was 30.

It's impossible to do any kind of functional analysis, motion for motion, though the visual similarity is there. We know the outcome of Koufax's career -- an amazing peak, an early end, and a shredded elbow. In 2009, Dr. Frank Jobe told me that "if I'd invented UCL repair a decade earlier it would be called Sandy Koufax surgery." But is there much that can be learned by comparing the two?

My colleague in research, Dan Wade, took a look at this comparison, with Dan drawing up a couple charts at my request. In the first, we compared the WAR (wins above replacement) for each of Koufax and Lincecum age-for-age:

Obviously, Lincecum hasn't been 29 or 30 yet, so the end of Koufax's career is not shown above. There are some similarities, disguised a bit by the inability of WAR (or any stat) to adjust for the usage patterns of the two eras. Koufax was part of a four-man rotation for the majority of his career and made significantly more starts per season that Lincecum (or any modern pitcher.) Koufax even relieved a few times a year, something Lincecum did in college.

Because Koufax peaked late and Lincecum's peak came early, I asked Dan to "flip" the chart. The chart below takes Koufax's last five seasons in reverse chronological order, comparing them with the first five complete seasons of Lincecum's career:

It's a pitching Rorschach blot. Maybe there's something there, maybe there's not, but it's hard to draw any conclusions from this surface comparison. There was nothing anyone saw to indicate that this kind of epic statistical collapse was coming. The "worst" of the preseason projections called for Lincecum to go 12-10 with a 3.31 ERA.

In this era of medical advancements and new ideas, it's easy to believe that the candles that burn twice as bright can still burn just as long as the others, but that isn't necessarily the case. Lincecum isn't Koufax, that much is certain, but the next few seasons will go a long way toward determining how similar the two really are. Lincecum doesn't look like he's headed for the spectacular flameout that Koufax had (and even so, that would require him getting his stuff back.) He has the advantage of playing in an era where elbow injuries barely qualify as career threatening any more, but if there isn't anything structurally wrong with him, all the medical advancements in the world won't fix his issues. This problem is still one for the coaches at this point, not the doctors.

Powered by Andrea Pirlo's cheeky Panenka, on to the injuries:

So, for all of you that said that Howard was out for the season, get ready to eat some of the same crow I've been tasting for having said that Howard would be back in May. Howard is scheduled to begin a rehab assignment this week, though it's unclear where. The likeliest spot, at least to start, is Clearwater (A), where Howard has been working out at the team complex. As with most minor league rehabs, it will be very controlled, though Howard has been doing almost everything already, just not in game conditions. Simulations are only so accurate, but Howard will be playing with some limitations even after he returns to the Phillies. He'll be asked to not tax the leg too much, either in the field or running, but let's face it, it's his bat they need. Howard's one big question mark is whether there's any loss of power due to the loss of muscle in his calf. Coming back from an Achilles tear is tough, but possible. Coming back from the loss of actual muscle due to infection debridement, especially for a big power hitter, is uncharted territory. If there's any sign of power, even loud doubles, then Howard's a fantasy buy-low candidate. I don't expect the rehab assignment to be long, but there is a question about whether he can be back before the All Star break.

The setback experienced by Longoria on his rehab assignment turned out to be more than simple tightness. Longoria did re-injure the hamstring, though it's not a complete return to Step 1. Longoria will be shut down from all baseball activities until the end of the week. At that point, the Rays' medical staff will assess where he is and work with the field staff to determine the next step. It's highly unlikely that he would shift right back to a rehab assignment, but instead will likely need a week to 10 days of continued rehab. Longoria could be back in the minors at that point, putting his likely return right in the midst of the All Star break.

After being injury-free for the first two months, the Rangers seem to be regressing to the mean. I say seem to be because I'm not sure that principle holds in sports medicine. It implies that there's a true level, one that can't be changed or adjusted. Moreland injured his hamstring on Tuesday, but the team waited and watched until Friday. By that point, they knew that the hamstring was going to force a DL move.

The team will shift Mike Napoli to 1B on a more regular basis. Michael Young will also see some time there as he shifts around the IF/DH slots.

The Rangers didn't want Moreland to injure himself, but it's clear that the front office was ready for precisely this kind of scenario. With Napoli shifting to 1B, there's some question as to whether he'll do more than spot in at catcher down the stretch now. Keeping Napoli healthy is key and just another thing the team has thought through. Moreland shouldn't have much of an issue returning, though he's been cited as perhaps the weakest link on a very strong team. He won't likely lose his position, but he could see his role shrink if the team works well in this configuration.

Paulino is the fourth Royals pitcher to head out for Tommy John surgery. This is for a Royals team that last year was rated as the top medical staff given their results in both one- and multi-year timeframes? I got back together with Jeff Stotts of Rotowire, who co-presented the Dick Martin Award with me last year, the one that went to Nick Kenney and the Royals medical staff. I wanted a third pair of eyes (with Dan Wade) to look for any indication that the Royals' rankings were a fluke. It's not there. While young pitchers like Paulino and Danny Duffy are risky, it's hard to have seen this level coming on. The worry is that while some of this is "luck," the result of those seemingly random traumatic injuries, some of it might be the residue of overuse. The Royals were never going to be a good team, but a raft of injuries are making them into a really bad one.

The original word out of Boston was that Buchholz missed his Sunday start due to illness. That's never good, but illnesses happen, especially in the close confines of a clubhouse. The surprise came when he was placed on the DL, a big indication that this was more serious than the normal gastrointestinal issues. Turns out one of his symptoms is bleeding, so yes, it's much more serious. Buchholz will be treated and this isn't expected to be a long-term or life-altering issue. He'll be out past the All Star break, with Aaron Cook taking his roster and rotation spot.

The Red Sox finalized a trade with the White Sox, after things started moving fast on Friday according to Fox's Jon Morosi. Morosi is correct in that the key to the deal was the medical records, but multiple sources tell me that the talks, as of Saturday, had not progressed to the point where those had been examined by the White Sox's medical staff. Chicago has one of the top medical staffs in the game but relying on Herm Schneider to keep Youkilis healthy is a big risk given his varied and sundry injuries. The records were not thought to show any real new information, though one of the keys, I'm told, was how much maintenance Youkilis required. Medical records in MLB can be quite extensive, and while there can be much variation, even routine maintenance is usually noted.

Chase Utley is expected back on Wednesday. He'll have one last game at Lehigh Valley (AAA) Tuesday with Ryne Sandberg looking on, then over to Philly. ... Andrew Bailey had a minor setback in his rehab. It's not an issue with his surgically repaired thumb, but instead an arm issue. That's not good and it could push him back well past the All-Star break ... Carl Crawford started his rehab at Ft. Myers (A) on Saturday. That sets his clock for a July 14 return, at the latest ... Aroldis Chapman denies any issue with his lower back. This despite giving up some serious bombs and blowing three of five save chances. Is it regression to the mean or is Chapman's back really a problem? This one bears watching ... Jose Altuve left Sunday's game with a strained hamstring. He'll be re-evaluated, but will miss Monday's game at the least ... Joe Mauer was back this weekend for the Twins. He caught both Saturday and Sunday despite a planned game at 1B on Sunday. No word on why that changed, though it was always a bit questionable while playing at an NL park ... Joe Saunders hits the DL with a strained shoulder. His rotation slot will be taken by Trevor Bauer, who is a must pick-up in any format where he's available ... Matt Joyce will miss at least three weeks with a strained oblique ... Chris Iannetta is making progress, but he's at least a week away from a rehab assignment. The Angels don't seem in any rush ... Emilio Bonifacio is hitting off a tee this week. The Marlins think he'll ramp up his baseball activities quickly. Hitting is the only real issue since he's been able to do almost everything else during his rehab from thumb surgery ... Brandon McCarthy is headed back to the DL after his shoulder failed to recover between starts, again ... Matt Capps is heading for an MRI and likely to the DL after a setback with his shoulder. Glen Perkins will hold on to the closer job for now, though Jared Burton got the save on Sunday ... Nolan Reimold will have surgery on his neck. He's likely done for the season but should return normally next spring ... Jerry Layne took a nasty knock to the head on a bizarre play Friday night. He was removed, as per the concussion guidelines, after being treated on the field by both Twins and Reds medical staff. Layne will be allowed to return once symptoms have gone and he's passed the same baseline tests as a player ... Casey Affleck as Josh Hamilton? I don't see it, but Affleck did have a nice turn in Gone Baby Gone ...