Under the Knife: JJ's mysterious injury; Jeter, Hamels to return soon

It's amazing how far things have come over the last decade. Dr. Rany Jazayerliand Keith Woolner, now the Manager of Baseball Analytics for the Cleveland Indians, developed a metric called Pitcher Abuse Points (PAP.) At the time, they had plenty of 130, 140, even the occasional 150-pitch outing to discuss. It's long been thought that super high counts - 150 and above - were normal during the '40s and '50s, but we remember the outliers. Nolan Ryan, Juan Marichal, and Bob Feller did have some games that were crazy, but overall, research has shown that pitchers threw about the same number of pitches as today. Pitchers were just more efficient. They didn't get as many strikeouts, which racks up the number of pitches, and they didn't fear the home run. All you have to do is look at shortstops of then and today. We "went crazy" because Ozzie Smith never hit homers, aside from that big one against the Dodgers. Phil Rizzuto hit as many homers in his career (38) as some shortstops do in a year now. Pitchers simply can't cruise, throwing their pitch and letting the defense do the work, the way that was in place since Christy Mathewson advocated the practice in his book,Pitching In A Pinch. (Isn't it amazing that something like this is available on Kindle?)

Going through historical numbers, pitch counts have dropped significantly, even at the extremes. In the 1950's, the highest outing was Herm Wehmeier, who went 203 pitches in 1957 ... and was out of baseball the next year. In the 1960's, the highest was Stan Williams, with 207, thought Sandy Koufax had two outings of 205 and 193. In the 1970's, it was down to 164, a record shared by Dan Warthen and Woodie Fryman. Showing up twice in that decade's top five was Steve Rogers, with 162 and 158 pitch outings in 1975 that came back to back. He lost his next three decisions and had a terrible '76 season. The 1980's didn't show much change, with Orel Hershiser going 169 pitches during his amazing streak in '89. Al Leiter's 163 pitch outing has often been cited by him as what broke him down. In the 1990's, aside from Tim Wakefield, David Cone had the highest count with a game of 166. Roger Clemens also got into the 160's twice, once before steroids and once after, for those of you wondering about that effect. Finally, in the 2000's, the high is 150 by Ron Villone, with Randy Johnson and Livan Hernandez showing up multiple times above 140. Across the decades, we see two things -- a pitcher has to be good to get that many pitches and there's often an effect of those high count games, often leading to injury or ineffectiveness, just as Woolner and Jazayerli proved in their research.

All that leads us to Wednesday's 132-pitch outing by Chris Carpenter. People reacted strongly to this "high count," filling my in-box with inquires. Carpenter's 36, has a history of arm problems, and is the ace of the Cardinals with Adam Wainwright rehabbing. He's also in front of a bullpen that's in flux, to put it kindly, which likely influenced Tony LaRussa to let his starter go a bit longer. It would be Macchiavellian to say that Carpenter is the guy you'd leave out there, over younger arms like Jaime Garcia or even Kyle Lohse, but La Russa has been accused of a lot worse than being Macchiavellian. This is simply a confluence of circumstances and a manager who understands that one high-count outing isn't a death sentence. I wish more manager would manage by a true measure of fatigue rather than by a number. PAP, as a stat, is essentially worthless now because it highlighted an issue so strongly that few pitchers ever get the chance to get to those high counts.

Going to see Dr. Andrews isn't always a bad thing. Andrews doesn't greet pitchers at the door to his facilities wearing a hood and holding a scythe, as some fans seem to think. Josh Johnson saw Andrews, underwent a series of tests, and left with the positive-sounding diagnosis of "nothing structurally wrong," according to his agent. The problem is that while it's good that Johnson doesn't have something wrong with the structure, there's still that pesky strain to deal with. Since the end of last season, Johnson has been dealing with the effects of some sort of muscular or capsular issue at the back of his shoulder. Even the full offseason didn't help, as Johnson said it's been sore since spring training. Johnson's heavy workload in the two years since he returned from elbow reconstruction are both positive and negative. The Marlins have to figure out how to heal the issue and to keep it from recurring under a normal workload. Johnson is out until August, with some undertones about this ending his season, especially if the Marlins continue to implode.

Derek Jeter passed all tests and will now take a couple rehab games to get his swing tuned up for his upcoming milestone. Jeter is expected to return to the Yankees as they head to Cleveland on the 4th, giving him three games on the road before returning to the Bronx for four with the Rays. Jeter's certainly capable of getting six hits in three games, but if Jeter were to sit one of those games as he 'eases back' into the lineup, no one but the cynics would complain much. Jeter's running appeared to go without issue, so it has to be expected that when he returns, it will be as starter and likely as the leadoff man once again.

Comebackers are just plain scary, whether you're a fan watching or the pitcher seeing that thing you just hurled coming right back at you. Cole Hamels couldn't get his glove on the ball rocketed back by Adrian Gonzalez. It could have been worse, as Hamels has a nice bruise to remember it by, but no fractures on his non-throwing hand. He'll be monitored over the next couple days, but injuries of this type normally don't cost any time. Since Hamels came out early, there's a chance the Phillies could bring him back on shorter rest, but with the All Star break coming up, the value isn't really there outside of trying to push Hamels towards 20 wins.

The Cubs had been hoping that they'd at least get some offers on Carlos Zambrano. Despite his no-trade clause and apparent desire to stay in Chicago, many think that the slow pitching market and the chance to move to a contender would change Zambrano's mind. I'm not so sure, but it will be harder to trade him if this back injury is anything other than very minor. Zambrano left his start on Thursday early, in clear discomfort. He'll have an MRI on his lower back as they attempt to find the root cause. He has had issues with his back previously and come back quickly, so the Cubs are cautiously optimistic. If you're scratching for pitching, this might be a time to get Big Z very cheap on the hopes that he's dealt to a contender, though you will be taking the risk that the injury is more than a simple lower back strain.

Don't be simple. It's too easy to call Erik Bedard injury prone. Yes, it's true, but Bedard's been a solid find, returning some of the value that the Mariners have poured into him over the past couple years this season. It's not his arm that sent him to the DL this time, but a sprained knee. It's not even a significant sprain, but the team knew that trying to pitch through it was likely to cause some sort of compensation which could endanger that fragile arm. He'll miss around the minimum. Bedard's availability becomes even more important to the M's as the season goes on. If Bedard's not available, it will be harder to shut Michael Pineda down when he hits the wall.

I don't want to belabor the discussion about Stephen Strasburg more than I have, but I do want to clarify one thing after responses to my Wednesday column. I'm not saying that Strasburg's mechanics are a problem. I'm saying that we don't know if they're a problem. The real problem is that neither do that Nationals. Strasburg had major surgery and as yet, the Nats haven't done anything to check his mechanics. A pitcher could have a valid biomechanical study at about the 80% effort level, I was told by Dr. Glenn Fleisig, the leading scientist in the field. If your car's engine needed a rebuild, I'm guessing you might take it to a mechanic if the check engine light came on. That's where Strasburg is right now. It's not that the team or Strasburg himself isn't conscious of the issue. In this must-read piece from Peter Gammons, Strasburg notes his own mechanics. He talks about "landing early," which is the reverse of the way most pitching coaches and biomechanists would discuss it. They would normally say that his arm is late, but that's semantics. All I want - and all baseball fans want - is to see Strasburg pitch. He's a phenom, a ticket-seller, and possibly a great pitcher. We've got enough "what ifs" in the game, careers ended or derailed by injury, going from Sandy Koufax to Mark Prior. There's simply no valid excuse for not finding out what Strasburg is doing right and wrong with a biomechanical analysis. For that matter, there's very little excuse for any pitcher not having that.

For those of you wondering just how effective baseball's drug program is, ask Luis Vizcaino. Despite not being with a team, Vizcaino was still subject to random testing and got popped ... Kevin Slowey's scheduled rehab start at Ft Myers was rained out. It may alter his return schedule ... Kevin Youkilis was already dealing with a mild sprain of his ankle, so fouling a ball off the same-side foot is a double whammy. There's no fracture, but he'll need some time off to let both heal ... Brian Matusz's velocity was way off again, as he got shelled again. The O's are going to have to do something here ... The Yankees are encouraged by Rafael Soriano's progress. If things continue like this, he'll be back just after the All Star break ... Bartolo Colon got through his final test, a side session on Thursday, and now will make his start on Saturday across town against the Mets. He will be on some sort of pitch or innings limit in his first two starts ... Joba Chamberlain will be doing his rehab in Pensacola rather than Tampa, which is a bit intriguing given the Yankees success at getting pitchers back ... Andrew Cashner is going to be cleared to start a throwing program soon. The Cubs aren't sure when he'll be back, but they are going to keep him as a starter. At least that's the plan for now ... I've never heard of a team doing what the Rockies are trying with the struggling Tyler Matzek, the former first rounder ... Thanks for all the birthday wishes. I'll be off on Monday, like most of you, but I'll see you back here next week.