Under The Knife: Early-career limits paying dividends for Reds' Bailey

It's been an amazing year. As I close out the 10th regular season that I've done this column, I can only hope that everyone who read the column this year, whether a first-time reader or a long-time medhead, learned something new. My goal is to tell the story of baseball through the lens of sports medicine. As I hear more and more people talk about the sorts of things that I've been pushing -- injury prevention, biomechanics, preventive equipment -- I realize that while it often feels like I'm yelling into a hurricane, some of it is heard. The more and bigger voices that take up this cause, who realize there are things that can be done to reduce injuries and keep these special athletes on the field, the better the game will be. If baseball won't do it, if teams won't do it, then it's up to us as fans to push for it. It's our game in ways and together, we can make a difference.

This column could not occur without a number of people. Most cannot be named, since they are confidential sources, but they know I appreciate them. I have to thank Dan Wade for his invaluable assistance both as a researcher, a sounding board and a friend. The team that hires him will be getting a valuable asset. I also want to thank Jim Rome, Trace Longo, Jayne Walker, Ralph Reiff, Scott McCauley, Joel Henard, John DiTullio, Cory Schwartz, Dan Benjamin, Meredith Wills, Ted Price and Cindy Blue, who made this season special.

So for the last time this season, and powered by what should be an amazing October, on to the injuries:

I've been as hard on Bailey as I have on any pitcher. There was not only a huge gap between his potential and his performance for years, but I didn't see the potential many did. He's a very solid SP4 and that is not an insult. (Joe Sheehan called him an SP2, which I think is overrating him.) On Friday, Bailey was as on as he'll ever be, no-hitting the Pirates with great stuff and a great plan. No-hitters are singular events, and I don't have to point to Phil Humber to remind you that they really mean nothing in the grand scheme. For Bailey, what's far more important is how he's been used recently. In 16 of his last 20 starts, he's gone over 100 pitches. He also hasn't gone more than 120 pitches. Previously in his career, like many young pitchers, he'd been a bit babied. That kept him more or less healthy through the injury nexus, and yes, almost all of that was under Dusty Baker. Bailey's career path brings to mind that of Josh Beckett, who had minor injuries that kept him from racking up huge innings totals. Bailey's been loosed now and seems to be thriving under the higher, but not high, workload. It's too early to say for sure, but maybe there's something to learn from Dusty and Homer about pitching.

The Yankees got quite a scare on Friday when Cano took a ball off his hand. I'll table the discussion about why a star like Cano doesn't have protection that would have made this a non-issue, focusing instead on why even minor injuries are devastating at this time of the season. There's just no time for the medical staff to do anything or to allow the natural process of healing to work. That leads to desperate measures, which have to be balanced with the long-term interest and value of that player. Cano showed no issue with the hand on Saturday and Sunday, playing both days. Two doubles on Sunday showed that his power wasn't altered by the injury, so Cano and the Yankees got very, very lucky.

The Yankees will get Teixeira back on Monday as they make the final push to win the AL East. With the Orioles tied heading into the last week, the schedule would seem to lean toward the Yanks, but we all know that giving the Red Sox the chance to spoil things for their rivals make this anything but easy. Teixeira passed his last tests on Sunday, and while he's not at 100 percent and will be asked not to go too hard when running the bases, the Yankees need whatever they can get from him. There's a recurrence risk, but given the stakes involved, it's a necessary evil. The team is also watching Nova closely. While the Yankees plan on him starting on Tuesday, several scouts that have seen Nova in the second half of the season say they are worried an injury is underlying his struggles. His innings totals don't point to a fatigue problem, but a DL stint has held those down slightly and show that his shoulder, for whatever reason, isn't holding up as he would hope. Tuesday could be make or break, quite literally.

Thumb injuries tend to affect bat control, creating swing-and-misses, so Bourn's 2-for-3 day with a walk and his 40th steal is is a big positive for Bourn and for the Braves. Bourn versus Yadier Molina might be one of the key matchups in the anticipated NL Wild Card game. The Braves are also taking the chance to rest McCann. His knees are sore and swollen, so don't expect him to play back-to-back games as they prepare for the playoffs. Once they get there, he is a bit risky depending on the schedule (and assuming they get past the Cardinals.) The Braves will have to consider this when they make out their LDS and LCS rosters, though they really don't have a realistic option behind McCann and David Ross.

In a tense doubleheader Sunday, the Rangers avoided complete disaster ... but it came with a price. Beltre, already dealing with a scar tissue problem in his stomach, injured his shoulder on a dive in the first game. He wasn't able to finish the second game, and several observers noted he seemed very uncomfortable at bat. Even if it's just a minor shoulder injury, with a set of perhaps must-win games in Oakland and only a couple days to heal up, it's not good by any stretch of the imagination. The Rangers would love to lock at least the division up to buy Beltre some rest, but it's not clear if he'll even be available yet.

Losing a set-up man doesn't seem like the worst thing that can happen, but as with Cano, even minor injuries get amplified at this point in the season. There's no time for what would have been a minor DL stint in June because now it is a season-ender. That said, Adams' problem is not minor. He'll need surgery for thoracic outlet syndrome, and while that has a good return rate, it's not clear if Adams will be able to safely and effectively pitch through it. Adams doesn't have what doctors consider "dangerous" symptoms and he is going to try and pitch, but he is going to take the rest of the week off. It's going to be difficult on the Rangers to trust Adams enough to put him on the playoff roster for at least the first round. A new split grip is helping Koji Uehara lately and could put him in position to take that role, which is a reminder of just how valuable Mike Maddux is to the franchise.

The Tigers would like to see Scherzer pitch at least a couple of competitive innings before heading to the playoffs. Part of the reason is to have some confidence in him, but the other part is to set the rotation. If Scherzer has to be covered just in case he is pulled early, the Tigers would want a guy behind him who is more likely to go deep into a game, saving the bullpen, or putting Scherzer ahead of a travel day. Scherzer is expected to pitch on Wednesday after getting in some side work without pain over the weekend. Fantasy players shouldn't start Scherzer as it's both risky and likely to be too short an outing to get the win or significant strikeouts. If Scherzer can't go, the Tigers may end up with Porcello as their SP4 rather than a long man. Porcello could be the shadow for Scherzer if Scherzer ends up as the SP2, though a dip in velocity has some worried that Porcello is fatigued. It makes things tougher on the Tigers as they set things up for what could be Jim Leyland's last stand. It's hard to imagine baseball without Leyland, Tony La Russa and Dusty Baker in a dugout, but we could be facing that next season.

Nice to see Brandon McCarthy can still be thoughtful. I hope that he finds a smart solution this offseason ... Brett Anderson will throw from a mound on Monday. A regular season start is out, but the A's are trying to be creative with how Anderson could come back, including a short stint in a Wild Card game ... David Freese returned Sunday from his ankle sprain. The Cards were conservative with him, so there shouldn't be any issue now ... Erick Aybar left Sunday night's game with a strained quad. He's day-to-day ... Ryan Howard ends his season with a broken toe. He dropped his warm-up bat - made of lead - onto his foot in the on-deck circle ... Jacoby Ellsbury surprised many by returning to play Saturday. Most thought he'd be shut down with his shoulder injury, but reports are that Ellsbury pushed for the return. It's also another indication that the Sox want to play spoiler this week ... Troy Tulowitzki played five innings in an instructional league game this weekend. He'll be evaluated Monday, but he's pushing to play in one game before the season ends ... Ricky Romero has a minor knee injury. He came out Saturday after three innings and may not pitch again this season ... The Mets aren't pushing to get Frank Francisco back, though reports of a serious UCL tear appear to have been erroneous ... Neil Walker has been shut down due to a herniated disk in his back. It has not been determined if he will need off-season surgery ...There's a rumor that Teddy is finally going to win in the Nats Presidents Race. Of course, if he does, Mike Rizzo and Davey Johnson will shut him down for the rest of the season.