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Under The Knife: Slow approach may work well for Latos, Morneau


There are more oblique injuries this spring than one would expect. I don't like saying that injuries are just "part of the game," though it's clear that traumatic injuries are unpredictable. I also don't like guessing, so I went to the leading expert in this area, Mark Verstegen of Athletes Performance Institute. Mark and his team have done more to emphasize the importance of the core than anyone, so I asked him: What's the deal with all these oblique injuries?

"Obviously this is a huge question with a lot of variables. So as I list these off, they are in no particular order but more in areas of consideration. First, we are understanding more about these types of injuries, and as a result, have better diagnostics to see these types of injuries. It's the same as you always see more of something when you are looking for it. With that said, the core is the hub of the wheel. Baseball players have to transfer energy from their feet through their midsection to deliver their skill of hitting, throwing or reacting. If there is a link in the chain that is kinked, this disrupts that energy transfer creating stress at the kink and the link in the chain breaking. If the kink becomes the core, the stress ends up then creating these kinds of injuries. The kink in the chain can result from a multitude of things and influenced through asymmetries, from left to right, and rotationally in left and right diagonals and upper vs lower.

"The asymmetries themselves can be caused from a variety of things, such as lifestyle [daily demands, postures, always rotating more to one side then the other, etc]. These injuries can also be impacted by result of accumulation. This can come in many forms. There is the accumulation of a rigorous training/playing schedule, one sided sports creating asymmetries, then that same schedule without proper recovery such as rest, sleep, nutrition, all lead to breakdown and microtrauma that adds up over time (days, week, years), putting a multiplier on the situation. At the end of the day the better the athletes' systems to account for all of these things the better and the less likelihood for these injuries."

That's a lot of information, but there are several things we can take away. While fans can't see or measure the asymmetries, we have to hope that the medical staffs and strength and conditioning staffs can. This is a medical situation where large samples don't help us, since it happens on an individual-by-individual basis and it's harder for teams to control what players are doing in the offseason, especially with higher-dollar athletes. For those who head off to places like API or St Vincent's Sports Performance in the offseason, they're getting good advice, but what about the hundreds that don't? I expect we'll be able to look back in 10 years and see that oblique injuries were misunderstood and that they won't be as big a part of the injury landscape then.

Powered by another amazing run by the Butler Bulldogs, on to the injuries:

News came this weekend that Latos was having shoulder problems. Initial reports were bad but anecdotal. Stories circulated that Latos "couldn't button his shirt", which certainly doesn't sound good, but isn't very instructive. By Saturday evening, sources were telling me that this was bursitis, later confirmed by the Padres. By Sunday, Latos had made some progress, but things still look as if he'll miss his first start. There's some debate as to whether missing that start would be reason to push him to the DL. My initial sources seemed to think that the Padres would err on the side of caution, knowing that Latos was pushed hard last season and that he's firmly in the red zone of the Verducci Effect. Word late Sunday is that the Padres will wait until the last minute to make the decision on the DL. There's little reason to rush it, since the schedule makes a fifth starter unnecessary for the first couple turns. In the long term, this isn't serious, but should serve as a reminder of just how risky young pitchers are, no matter how cautious teams are with them. This episode wouldn't shift Latos too far down most draft boards and perhaps not at all in keeper leagues.

The Reds have some real issues with their rotation heading into the season. While they do have some depth, losing two starters is tough on any team. Three is nearly impossible to overcome -- and is a good rule of thumb. Check any team's SP8 and you'll see why. Bailey has been shut down with another instance of shoulder impingement. Basically, the muscles and tendons inside Bailey's shoulder don't have enough room to move, either because of structure or inflammation. It can be as simple as clearing up the inflammation or as technical as changing his mechanics to open things up. It's the recurrence that's the real worry. Bailey's had this before and been able to come back, but the fact that it wasn't corrected tells us that it could come back again unless something changes. Recurrences tend to be cumulative as well, since there's likely some fraying or scarring going on. In the extreme, there could be a surgery, likely a Mumford procedure where the collarbone is shaved down to create space. Several pitchers, such as Trevor Hoffman, have had that kind of procedure and come back. I'm not suggesting that Bailey will need surgery yet, but just to illustrate the "worst case."

Bailey's likely to miss a month as the Reds rest the shoulder, get him some treatment and then dial him back up to a starter's load. I think it will take closer to six weeks to get him back.

The news on Arroyo wasn't good, but it could have been worse. Arroyo has been sick for a couple weeks, though he was pitching through it. The diagnosis of mononucleosis isn't going to change that, surprisingly. Arroyo's stamina will be affected, and it wouldn't surprise me if they have to shadow him, likely with Sam LeCure. LeCure is in the five slot for now, but the schedule means he won't get many starts and will likely be used as a reliever during the first week of the season. Since mono can linger for weeks, or even months, the Reds will have to watch him closely. Arroyo can breathe a sigh of relief that he doesn't have Valley Fever, a fungal infection native to the Phoenix area. It cost Conor Jackson a year of rest and recovery.

Finally, the Reds are getting toward the end of the time Cueto was scheduled to be shut down. His forearm has made progress, per sources, but it's impossible to tell whether he'll have any sort of recurrence once he resumes throwing. In the best case, Cueto will need a couple weeks to dial it back up, perhaps needing a minor league start or two before returning to the Reds rotation. That will cost Cueto at least two, maybe three starts and that's only if he comes back on a relatively aggressive schedule. I'll have a lot more on these Friday, since I'll be in Cincinnati for Opening Day. I'm sure Dusty Baker is looking forward to a lot of questions about his pitching staff!

The Twins announced that Nathan wouldn't be the "sole" closer for the first month, but don't be too fooled by this. This isn't a change. The Twins have long said that Nathan would be used carefully, if not cautiously. What this isn't is a signal of any sort of setback, that Nathan won't get the lion's share of the available save opportunities, or that it significantly alters Nathan's value (or adds to Matt Capps' value). Dan Wade dug into the data and found out that a team's closer only got saves on three consecutive days 18 times last season. None of those were by Billy Wagner, the perfect comp for Nathan. If Nathan comes up with 37 saves like Wagner did last season, I don't think anyone who drafted him will be disappointed. I know Twins fans won't be. I moved Nathan up on my draft board and would advise you doing so as well.

The Twins got even more good news with Morneau. The problem this spring has been "in his head" according to multiple sources, but they didn't mean it was post-concussive symptoms. Morneau had to get his confidence back after a long battle with those symptoms, and it appears that the Twins' slow, steady plan has accomplished that. Several sources think Jim Thome was kept as much for his influence on Morneau as he was for his pursuit of 600 homers at Target Field. Morneau will meet with some of the specialists he consulted with to get the final "clearance" to play, though that's really just a formality. My hope is that Morneau will wear a two-flap helmet that will stay on when he's running the bases. It might not have prevented this concussion, but it's the best available protection. Most players choose comfort over protection. Just watch how easily the helmets come off as they walk back to the dugout. You'll note there's no ERD for Morneau, because all indications are that he'll be in the Opening Day lineup.

The Phillies have enough issues with Brad Lidge (see below in Quick Cuts) and Chase Utley. They don't need yet another guy clogging up the training room, but that's what they have with Polanco. He's always been a high maintenance guy, and I don't mean that in a bad way. He just always seems to be banged up and is one of those guys who the medical staff has to factor in high on their time management charts. Polanco isn't responding well to the first round of treatment on his elbow and may need a cortisone injection to help free it up. Polanco will need it Monday or Tuesday to be ready for Opening Day. Polanco isn't expected to miss much time, if any, at this stage, but a tight elbow could affect him both in the field and at the plate. The Phillies seem to be happy with the course of this, but keep an eye on Polanco in these last few spring games.

The Astros might get a new owner shortly after Opening Day, but they'll need a new 2B before then. Barmes broke his fifth metacarpal, the bone on the outside of the hand away from the thumb and below the pinkie. I guess Jeff Bagwell didn't recommend wearing the kind of pad on his hand that he wore during his late career, after several similar issues. Barmes will miss at least a month with this, but once he's back, this tends not to have too many lingering issues. Broken bones heal, and unlike wrist injuries, broken hands tend to be binary -- once they're functional, they're fully functional. The Astros don't have a fantasy-relevant backup, so they'll be watching the waiver wire closely over the next couple days.

The White Sox seem to be slow-playing Peavy a bit. After his rotator cuff tendinitis was initially discovered, the team got very conservative, saying that they didn't expect him back until May. Peavy wasn't completely shut down however, though they did keep him from throwing while the treatment and (likely) medication got a chance to work. Peavy's return to the mound on Saturday doesn't mean he won't be on the DL to start the season, but it was very positive. Peavy not only threw off a mound, he was able to spin the ball a bit and even worked from the stretch. Word from Sox camp is that Peavy had "normal soreness" on Sunday. Peavy's ERD moves up slightly, though the possibility remains that the Sox will pull the reins on his return, keeping that May 1 date in place.

I play in a surprisingly small number of leagues. I used to play in as many as eight, including experts leagues, but I found I was spending more time on my leagues and less on yours. I still play in one long-term league, one I've played in since 1984 that still includes several high school and college friends. We use a little-used but great scoring system called Mann-Malin. It's so obscure I can't even find a good link to explain it. I also play in an online league set up by a friend of mine who has a better job than me. We had the draft for that league and I went in with Eric Mack's Top 300 list and the Bloomberg iPad app to assist me. With solid keepers -- Albert Pujols, Ryan Braun, Josh Hamilton, Evan Longoria, and Andrew McCutchen -- I was able to attack from the opening round. I seldom keep pitchers since there are so few consistent starters or relievers. Instead, I grab the best available players in the first few post-keeper rounds, then begin filling in. I naturally have a bias toward thin positions, and despite a disastrous Tout Wars strategy a couple years back, I still lean to spending more on pitchers than most. I resisted this year, grabbing Mike Stanton and Rickie Weeks with my first two picks.

I went pitching with my next three (Yovani Gallardo, Neftali Feliz, and Clay Buchholz.) I won't go through the whole draft, but I'm happy with the team. I feel like I got great values in Trevor Cahill (19th), Aroldis Chapman (20th), and Scott Rolen (injury prone, but at the 22d round, I'm fine with the risk.) I picked up Stephen Strasburg in the 24th as a future keeper as well. I hope you all have as much luck -- and fun! -- as I did with this draft.

Roy Oswalt is on track to make his scheduled first start for the Phillies on April 3. He's having no latent effects after being hit in the neck by a Manny Ramirez comebacker ... Andrew Cashner making the Cubs rotation is another point in favor of treating relievers like starters. Putting pitchers in roles is a new idea that simply isn't working ... C.J. Wilson left his weekend start with a hamstring issue. I'm told he pulled himself as a precaution, so watch to make sure he makes his throw day ... Comments from Frank Wren to the Atlanta Journal-Constitution make it sound like Jair Jurrjens could start the season on the DL. His oblique injury needs more testing than he can pass by Opening Day, though a final decision has not been made ...

Sources tell me that Carlos Beltran made it through playing the field "better than expected," but that he's laboring so much in the field that there's an ongoing debate as to whether the Mets would be better served putting him on the DL or playing him hard early, hoping to showcase him as a possible DH ... Andy Marte. Brandon Wood. Ryan Anderson. Do not rely on even the "can't-miss" prospects to get you anything in fantasy ... Brad Lidge is heading for an MRI. He was already going to the DL, but this new info means that Ryan Madson has to jump on most draft boards ... No one seems too worried about the toe injury that Matt Holliday has missed some time with. He's been dealing with it for much of the spring, though there's not much clarity about what the problem actually is coming from the Cards ... Adam LaRoche is going to try and play through a rotator cuff tear. I've got no faith in that happening well ... Get ready for SI Inside Fantasy, the new podcast, starting later this week. If you remember my old radio show or podcast, this is going to be much the same thing. Eric Mack and I will give you the best fantasy info, plus I'll have interviews with some of the most intriguing people around the game.