Under The Knife: Strasburg offers reminder that heat is a threat

Tom Verducci's annual list of pitchers with worrisome workloads has been attacked by some, but the results this year are unquestionable. The sheer number of pitcher injuries are up slightly, but it's a vicious cycle. When a pitcher goes down, the likely replacement is seldom as good, usually younger, almost always less durable. A team that has injuries seldom gets less risky, leading to the kind of "death spiral" that can swallow a team. People like Bill Petti continue to look for warning signs and teams are doing things that are far more advanced, but we still don't have anything in the way of results. Whether it's a statistical measure of an observable result, like the PitchF/X results Petti uses, a derived stat, or even something like a continual monitoring of the UCL by ultrasound, there's work being done. Speaking of ultrasound, you've probably seen ads for Sonosite, one of many makers of ultrasound imagine. These types of devices cost between $20,000-$40,0000 -- not cheap -- but compared to the cost of injuries or the salaries of players, it's nothing. Yet I can count the number of baseball teams that use this technology on both hands with fingers left over. At some point, a team is going to get a massive advantage for a minimal investment. I have no idea who that will be, but the chance is available to every team, big and small market.

Powered by 12Society, on to the injuries:

If you listened to The Nickel. this week or have read me in this or my football space over the past few years, you know how passionately I feel about heat illness. This is something that's killing people across the country and can be cured -- utterly and absolutely eradicated -- for a cost that's not beyond any program. Add in an ATC at every practice or at least on site and we'd never have to talk about the issue again. Strasburg succumbed to 104-degree heat, which is hardly normal. He showed all the signs of heat illness and was removed and cooled, then given three bags of saline solution via IV. That tells you just how dehydrated he was, so the move was absolutely proper thing to do, both short and long term. Strasburg is too valuable to risk. At that level of dehydration, his muscles were at risk on an aside from the more pressing heat illness. On top of protecting him, this holds his workload down. Many, including Verducci in his article linked above, believe that Strasburg will be shut down in September. I'm very curious to see how this is handled and how it's sold to the public. For me, I want to hear some explanation of why. Whether it's science or random, I'd like to have some idea that the Nats went into this season with a plan for their star. Strasburg should make his next start without issue.

Well, there goes the argument that a comebacker hits a pitcher infrequently enough to excuse the lack of protective gear. Days after Andy Pettitte was lost for two months, Hellickson took a nasty liner off his shin from the bat of Prince Fielder. Just the idea hurts, and Hellickson is lucky that his leg is still attached, let alone not fractured. It's a matter of inches, fractions, geometry, physics and dumb luck -- all things that could be made irrelevant by a cheap, unobtrusive piece of equipment. Hellickson was removed from the game, but should make his next start. If there's any sign of limp or favoring the leg, they'll push him back. Hellickson was just coming off the DL, so if there's any positive here it's that he looked fine up until he took the hit.

The Rays got some more good news when Price made his scheduled work on Sunday. His back didn't appear to be any issue, according to both reports and sources, so he's expected to make his next start. Price has responded well to similar issues in the past, so he's a safe start in all formats.

"Fine." "Progressing." These are the kinds of things you want to hear from your child's first grade teacher, not a contender's 1B. Votto isn't going to offer a comprehensive diagnosis of what's going on with the knee. His description of what's going on and John Fay's observations indicate a minor meniscus tear at worst. It's something that the Reds will try to manage. Down the line, the worst case is that he misses 2-4 weeks after minor surgery. Timing is big here -- missing a couple weeks in August is bad, but once September is looming, there's no way they can shift to Plan B. I don't expect this to be a major issue for Votto. Once he's back on the field, which will happen early this week, look to see if he's driving the ball or if the knee is making him adjust at the plate. The Reds were also without Rolen over the weekend. It's almost funny, but it was good news that Rolen was having back spasms. The big worry with Rolen is another issue with his shoulder, so back spasms are manageable. Keeping these two healthy will go a long way in getting Cincinnati into October.

The Pirates got lucky. The player I've been touting for two years as the best CF in the game -- though Matt Kemp sure made me look a bit silly last season -- came very close to a terrible, perhaps season-ending wrist injury. The diving catch looked a lot like the play that sidelined Jayson Werth. McCutchen came away with just a mild sprain. He wanted to play on Sunday, but was not allowed. He's expected to be in the lineup in the next couple days, but as with any wrist injury, look to see if he's swinging and missing more and if he's showing power. Something as simple as pulling the ball hard is a positive sign, so don't worry about 0-fers unless they come with a couple Ks. McCutchen has been very healthy and even his minor injuries tend to have him back quickly and back in form.

Carpenter's recent rehab work has been back and forth, up and down. He went to Dallas to see a specialist, started up his rehab again, and then let everyone know that he has thoracic outlet syndrome. This is a condition that has caused problems for a lot of pitchers, with Kenny Rogers and Jeremy Bonderman numbering among the well-known ones. This does not always require surgery, so Carpenter's desire to try to pitch through it is possible. It's worrisome that he wasn't diagnosed before this, but it's possible that this is an addition to the previous diagnosis. Carpenter may be tipping that this is his last year and he's going to make one more run at it. One possibility is that Carpenter does what one scout termed the "reverse Wainwright." Carpenter could have issues with stamina and shift to the bullpen, the reverse of what Adam Wainwright did. There are no guarantees that would be any better. Carpenter is the height of risk, but the possibility of having an ace-level pitcher like him back in any capacity is worth it to the Cards as they chase the Reds. It appears that Carpenter has decided it's worth it to try as well. He's still on track for a rehab assignment after the All-Star break.

If you're sensing a theme today, it's "Will repeating himself." I'm willing to do that, over and over, on issues like protective batting gloves and other gear because it's just so simple. Chisenhall might not have been helped by the type of gloves that are on the market today, but if the ball hits an inch lower and we're talking about him trotting to first and back to his position for the next six weeks. Chisenhall is actually a bit lucky, at least relatively speaking. The pitch hit him above the anatomical wrist and broke the ulna, one of the two bones of the lower arm. Derrek Lee is an example of someone who had this and came back, as there tends to be quicker healing and little or no loss of power. It is going to take a while for Chisenhall, but maybe with a longer, "gauntlet" style glove, it didn't have to happen at all.

Evan Longoria is starting up with the baseball activities again. That means he's running more, not that he's ready for a rehab assignment ... Grady Sizemore hasn't re-started his running program. He's closing in on a point where the Indians will have to say it didn't work out and cut bait. Sizemore's bound to get a couple more chances elsewhere ... Travis Hafner was supposed to play in two games this weekend for Columbus. He played on Saturday, going 0-3. Sunday's game was postponed, so we'll have to wait and see what the Indians do. He could be activated anyway ... Raul Ibanez got popped in the mouth by a foul. He was in the dugout, so it's bad luck. He'll be fine and will join the team in Tampa after having cleared the protocols ... In a bit of a surprise, Ben Sheets signed a minor league deal with the Braves. They appear to have depth, so I'm curious why Sheets decided to go there, since I'm told he had multiple offers ... Henderson Alvarez gave the Jays some pitching good news. He looked great in his first start since leaving with elbow pain. Don't forget about this, but be hopeful ... Ian Stewart's wrist isn't responding to treatment. He's likely headed for surgery, which won't help the Cubs aside from racing the Astros to the bottom ... Apparently the Spanish system hasn't been figured out just yet. Amazing run by Spain in the Euros.