Under The Knife: Baseball can learn a lot from English soccer franchises

Fourth is the new first.

That was the slogan on last year's Manchester City T-shirt. Fourth place means entry into the UEFA Champions League, the highest level of European soccer. City came in fifth last season, losing a duel to Tottenham Hotspur, a team with connections to the Oakland Athletics. In 2011, City is locked into fourth and headed to Europe next season. While the team is rumored to be after several high-ticket transfers to bolster the team, they're also bolstering a medical and research staff that's already among the best in England. The club posted nine new jobs, including some titled "Head of Medical and Sports Science" and "Elite Development Squad." It's an impressive listing, demanding top credentials and experience.

Contrast this to baseball, which might as a sport be spending as much on research and sports medicine as Man City is about to on new hires. While Man City tries to catch up to some of the elite clubs on the pitch, they're also trying to leapfrog them off the pitch, spending Euros from their uber-rich ownership to establish themselves alongside AC Milan, FC Barcelona and Real Madrid as sports science elites. I wonder if John Henry, owner of the Red Sox and of Liverpool FC, will take note. Maybe Stan Kroenke, the new owner of Arsenal and of the St. Louis Rams, or Randy Lerner, owner of Aston Villa and the Cleveland Browns, will bring this kind of scientific approach to the NFL. In an age where nearly a third of teams have a payroll of over $100m, why does no American team have a sports science budget over $1m?

Powered by HeyTell, on to the injuries:

The hard part of pitching and pitching injuries is understanding that it's a holistic process. If you're a coach at any level and want to see something amazing, have your pitchers take their shoes off and throw. The toes -- something we never see at upper levels -- do different things in different pitchers. Some go up, some curl down, some slide off to the side, some go up on toes like a ballerina. It's utterly astounding the first time you see it and one of those hidden sides of baseball that's barely been investigated. Once you realize it's a holistic but multifactorial process, things like what's happening with Aardsma make more sense. When one problem occurs, like a hip injury, the body adjusts and in doing so, might put something else at risk, like an elbow ligament. I started calling these "cascade injuries" after a term from networking science. Aardsma's Grade 2 sprain of his UCL often, but not always, leads to Tommy John surgery. He'll see Dr. Lewis Yocum at Kerlan-Jobe for the final decision. Either way, he's going to have an extensive rehab and leaves Brandon League with the closer's role for the foreseeable future. I'm not ready to drop the season-ending tag on this injury; I'll wait for Dr. Yocum's opinion.

Here's my funny John Farrell story. A couple years ago, Dr. Glenn Fleisig of ASMI were standing in the lobby at the Winter Meetings, talking pitching, when Farrell, then the pitching coach of the Red Sox, walked by. Glenn introduced us, flubbing my name as "Will Ferrell." Farrell laughed and said "I get that all the time too. Wish I had his paycheck." Very true, though John's doing all right as the manager of the Jays. His decision to pull Morrow early was criticized by some, but to me, it's a smart way of managing a starter. Managers of yore (and by yore, I mean the sixties and seventies) had a very quick hook, taking a pitcher out early when he didn't have his good stuff. It's common sense, and paired with an ability to bring them back on shorter rest, it's good management. We'll see whether Farrell and the Jays do the second part, but I think taking a look back to what worked for 100 years in baseball, then testing it with today's scientific methodology, is the best way to make the game better.

The White Sox get Peavy back on the mound Wednesday. It wasn't the path the expected, but the timing is not far off what they had hoped for when he first tore his lat last season. The single setback was the cuff strain, something that I'm told by a trusted biomechanist was to be expected, as the cuff and lat can "work together" in some pitchers. I wish we knew more about this or rather had better data. The White Sox were one of the first teams to make use of biomechanical data, but despite their success on the field, they're another team that's essentially abandoned that tool. Peavy appeared to have no problems in his last start with control or stamina, so he should be full go on Wednesday, though I doubt the team will take him much above the 90-pitch mark.

Another day, another phour Phillies in the UTK. Utley shifted to a "real" rehab assignment after success in XST. He didn't play in the field, going 1-4 as a DH, because the team wasn't quite ready for him to go back-to-back days in the field. The key there is that it was the team, not Utley, who feels he's ready now physically, just needing to get a bit of work in before he's prepared for his return. The focus for many remains on his patellar tendinitis, but sources tell me that was a secondary problem all along. Utley could shift his rehab to a higher level this weekend if things go well in the field, which has him on track for a return to Philly next week. Oswalt might replace Utley in Clearwater, as he appears to be ticketed for a rehab assignment at a low-level affiliate on Thursday or Friday. Oswalt's back is problematic in the sense that rest and treatment hasn't moved things much. The issue here is one of communication, as sources tell me Oswalt can't give much guidance on what is working and what isn't. "He points and makes faces," said the source. Oswalt thinks he can pitch through the issue, while the Phillies medical staff isn't sure he's not making it worse by pitching through it.

Contreras has progressed to throwing in the bullpen and could start a rehab assignment next week. He's not thought to be that far away, since his splitter is already working, but the Phils still have some questions about his usage patterns, something they'll try to test during the rehab. How he performs -- or rather, recovers after performing - will determine the role he comes back to. Finally, Blanton came off the DL and started, but he came up more sore afterwards than expected. His next start is in some doubt, though the team will watch him closely over the next few days to see if they can get the elbow back to a usable state.

A lot of times, rehabs are boring. Boring, tedious, and monotonous, so I don't talk about them much. I did an article on rehabs for the Football Outsiders Almanac 2010, and man, I've never had to work so hard to get through an article, mimicing the rehab process. For the last several weeks, Hamilton has been rehabbing, staying in shape, and just waiting for the healing process to take hold in his fractured arm. He's finally making visible progress, with discussion of him taking batting practice this weekend. The team isn't ready to give him the nod just yet, likely waiting on images to tell them that he's not at risk of a setback. Hamilton's progress is slightly slower than expected, which slides his ERD back towards the end of the month. The Rangers don't mind, as they want a healthy Hamilton more than they want a quick return.

Barabasi's book Linked was key to my development of injury coverage. His newest book, Bursts, could end up being as important, explaining several things like the seemingly viral nature of some injuries. Writers like Barabasi, Taleb, and Groopman have formed significant portions of my injury education and they deserve the credit ... No surprises for the Mets as both Chris Young (torn shoulder capsule) and Jenrry Mejia (sprained elbow) got confirmations. Mejia is headed for elbow reconstruction while Young is at a career crossroads ... The Angels put Vernon Wells on the DL with a significant groin strain. The team won't call up Mike Trout despite what Mike Scioscia considers "depth issues" ... Ike Davis left Tuesday's game with a strained calf. No word yet on the severity ... Rafael Soriano heads for an MRI after elbow soreness held him out Tuesday ... Andrew Bailey is making progress and could be out on a rehab assignment early next week ... JJ Hardy was activated from the DL and celebrated by going 4-5 with a HR. Needless to say, he seems healthy ... Trevor Plouffe has a mild hamstring strain, but might have to go to the DL due to the roster cramping that the Twins have had lately ... Adam Lind is out until the weekend with back spasms. Watch this one closely before putting him back in the lineup, since back issues have a tendency to be all over the place and sap bat speed ... Watch Mets scouts closely over the next couple weeks. The team is prepping in case they decide to trade Jose Reyes, a decision that will only be made after taking on minority partners in the Mets ... Carlos Beltran got a day off Monday, after playing 21 straight games. With his knee issues, that's an impressive win for the Mets medical staff ... One of my best moments in the many I've been lucky to have since doing this was being on the stage of the Hi-Tone Cafe, talking baseball. The Hi-Tone is one of Memphis' historic clubs, hosting hundreds of acts, from Elvis Presley (the building was The King's dojo) to Elvis Costello. Memphis is one of many places that need our help right now, so keep them in your thoughts.