Injury talk: Key pitchers to track
The primary concern for major league pitchers is always their arms, those amazing, talented and expensive arms. The offseason provides welcome relief in the form of a rest from pitching, while also offering time to strengthen and recondition the arm and the whole body.
Like every season, fantasy owners have questions about several pitchers as spring training approaches; unlike some seasons, those questions surround legitimate Cy Young-caliber pitchers. Are they recovering? Who will be lights-out, and whose light is fading out?
We examine several key pitchers coming back from injury and offer up an assessment of risk versus reward. Just like traffic signals tell you whether to stop, slow down or proceed, we will do the same with each pitcher to guide your fantasy decision. A "Green" means we have high confidence that the player will bounce back and deliver this season. Of course, we can't predict future injuries, but based on the pitcher's injury management in the offseason, these are athletes we have high expectations for. A "Yellow" means to proceed with caution (not speed up, like some of you do when driving). This player might have high upside but comes with the risk of not being available for the entire season. And finally, a "Red" means to, well, stop. Avoid the pitcher because the risk outweighs any potential reward. Shop elsewhere. Enjoy.
Francisco Liriano, SP, Twins: Liriano represents the most anticipated comeback player in 2008. He underwent Tommy John surgery to reinforce the inside of the elbow joint, technically known as ulnar collateral ligament reconstruction, in November 2006 and spent all of 2007 rehabilitating. As is often the case during this long recovery period, Liriano's body got a nice extended rest, and he had the opportunity to fine-tune all the muscles that contribute to his pitching, not just those in his forearm.
Twins general manager Bill Smith says Liriano looks healthy and strong. So far the lefty has been throwing full-speed bullpen sessions and live batting practice and is chomping at the bit to face regular batters this spring. So what can fantasy owners expect? Past history of players on the same timeframe suggests that although the arm comes back strong and the velocity is there, the time away from the game (Liriano has been out for close to a year and a half) necessitates some adaptation to regain finesse and command. This is not unlike the return of an NFL running back after ACL reconstruction; it generally takes a year of competition to regain full confidence and mobility in the leg, even if it is comparable in strength to the nonoperative side. Given their recent roster moves (including the trade of Johan Santana), the Twins must be confident that Liriano can deliver, and it is reasonable to expect that he will be solid in his return. It might take him a while to return to the Liriano of old, but by the second half of the season, he should be a top fantasy pitcher once again.
Chris Carpenter, SP, Cardinals: Carpenter opened the 2007 season with a rock-solid performance, only to develop elbow pain afterward. He had bone spurs in his elbow and underwent surgery to remove them. Unfortunately, he didn't make it back and ultimately went under the knife again, this time for a Tommy John procedure. Carpenter is currently at the light-tossing stage, but his one-year mark -- usually a rough estimate for return to pitching -- won't come until July. Thus, the earliest fantasy owners should expect to see Carpenter back would be sometime around the All-Star break. Given the time it takes for a pitcher to truly return to form, though, it would be wise to temper expectations for Carpenter until the 2009 season.
Jeremy Bonderman, SP, Tigers: Bonderman overcame blisters during the 2007 season but could not overcome an episode of elbow pain that eventually ended his season in September. Bonderman's reported diagnosis, "elbow inflammation," is just nonspecific enough to be worrisome. It lacks definition, which is not altogether surprising; like with many injuries involving pain and inflammation, it might be extremely difficult to identify a specific structure (tendon, muscle, etc.) that is directly responsible for the symptoms. The problem, of course, comes in determining whether this is a minor ailment, such as minor soft-tissue inflammation as a result of overuse, or a hint that further breakdown of a serious nature -- you know when you start talking about a pitcher's elbow that you must consider the possibility of ulnar collateral ligament damage -- is on the way.
There are some positives when it comes to evaluating Bonderman from a fantasy perspective. He had a great first half of 2007, so his skills seem to be peaking. He is only 25 years old, so he has the advantage of youth on his side. He has been working on strengthening his forearm in the offseason, and strength in these muscles is critical to countering the torque produced at the elbow during throwing. But -- and you knew there was a "but" coming here -- nonspecific elbow inflammation in a pitcher raises a red flag. At the end of the day, Bonderman represents a fantasy pitcher who comes with moderate to high risk but has high upside if you're willing to take the gamble.
Joel Zumaya, RP, Tigers: Zumaya has had a rough go of it recently. In 2007, he endured a torn tendon in his right middle finger that required surgery and several months of rehabilitation. Then, during the offseason, Zumaya's family was confronted with the scary wildfires in Southern California. While moving, a box reportedly fell on his right (throwing) shoulder, and the next thing we heard was that he had undergone acromioclavicular (AC) joint reconstruction to repair the damage.
Pedro Martinez, SP, Mets: His comeback from an extensive rotator cuff repair was impressive in and of itself. It's worth noting that the numbers do not support the successful return of big league pitchers after a major rotator cuff repair. Martinez deserves a lot of credit for setting his mind to the task and rehabilitating diligently to make a successful return to the mound. Of course, there should be a fair amount of credit given to his surgeon, Dr. David Altchek, as well, and to his rehabilitation team for helping him to get there.
That said, though, Martinez, effective or not, is not the same pitcher he once was. His velocity is down. His endurance (no more than six innings per game, it seems) is less than that of most big league starting pitchers. This is not likely to change. Martinez is "mature" in baseball years, and his rotator cuff, as well as the rest of his throwing arm, has been put through the ringer. Owners should expect Martinez to be effective, not exceptional, and allow for the possibility of some down time during the season to rest if soreness develops.
Rich Harden, SP, A's: Harden was on the DL carousel for much of 2007, pitching only 25 2/3 innings during the season because of recurrent inflammation in his shoulder. This after pitching in only nine games in 2006 because of elbow and back problems. For someone who is only 26 years old, he has quite a significant injury history. Although no definitive structure was identified as being problematic in Harden's shoulder -- as reported earlier, this is not unusual -- the usual suspects (rotator cuff, biceps tendon and labrum) have to enter into the discussion as possible culprits.
One of the concerns in Harden's case is that despite the repeated stints on the DL and the rest periods afforded his shoulder during that time, the pain seemed to return every time he increased the vigor of his activity, suggesting that the tissue in its current state simply might not accommodate the rigors of pitching. Would more time off, like a complete offseason, change that? The A's are certainly hoping that is the case. In fact, Harden has been on a throwing program in Phoenix and began pitching from a mound in February. Of concern, the A's indicated on their Web site as recently as December that Harden didn't seem to be fully over what had bothered him during the season. However, according to a mid-February report in the San Francisco Chronicle, A's pitching coach Curt Young says that Harden "feels tremendous." The A's expect Harden to pitch when they travel overseas to face the Red Sox in March. There is still a lot of uncertainty here. Harden is poised to be a key pitcher for the A's this season, but until he proves that he can stay healthy, there is significant risk for fantasy owners.
Mark Prior, SP, Padres: Aug. 10, 2006 -- that's the last time Prior pitched in the major leagues. May 2008 -- the projected return month for Prior to the major leagues following surgery last April to address damage in his rotator cuff and labrum. A good 21 months later, Prior is expected to make his comeback. After several unsuccessful stints on the DL and various attempts at conservative rehab, Prior, whose most recent health issues was complicated by the fact that imaging studies on his arm were unable to find a significant injury (according to published reports),has been faring well in his rehab efforts postsurgery. In fact, Prior has been throwing off a mound, a big step in terms of increasing the workload on his shoulder, and appears to be on track for a May return. Prior has gotten a bad rap based on his injury history, but there are a few facts to consider when evaluating him.
You also have to consider the fact that Prior has motivating factors surrounding him. He is in his hometown San Diego, he is in a pitcher-friendly ballpark, and he has a one-year contract, giving him only one season to impress everyone.
If there is a negative, it is that Prior's traditional mechanics place his elbow high above his shoulder at lead-foot contact (when his front foot hits the ground), which places the shoulder joint under additional stress. If he modifies this during this period of recovery, it could significantly enhance his overall durability. At a minimum, there are enough items in the "plus" column to outweigh the negatives. This might be Prior's best chance for a solid season in three years. It won't be an easy path, and he might not return to the original Mark Prior, but there are enough ingredients to make him an intriguing prospect. Big injury histories always indicates relative risk, but in Prior's case, fantasy owners might want to take a chance if they can get him for a good value.
Randy Johnson, SP, Diamondbacks: Leading off in the 40-and-over category is Johnson, who is making yet another return from back surgery. Sound grim? Well, don't let that fool you. Johnson is doing very well in his rehab; he has some things working in his favor this time around. His surgery to address the latest lumbar herniated disc took place in late July, giving him more recovery time before the start of the season than he had last year (prior back surgery was October 2006). Not only that, but he has been through it all before -- the surgery, the rehab, the strengthening, the return to pitching ... and knowing what to expect goes a long the way in facilitating recovery. Additionally, he had already worked diligently to enhance his core strength after the first surgery, making it that much easier for him to fine-tune the system after this one.
This is not to say that Johnson is free from the risk of having more back pain, or any other injuries that can afflict 44-year-old pitchers, for that matter. But he still was effective when healthy last year, delivering strikeouts and winning games. In fact, prior to his diagnosis of a recurrent herniated disc, he had 42 strikeouts in five starts, with a 1.52 ERA. Johnson still has "the arm of a 25-year-old," according to manager Bob Melvin, and he is expected to be ready when pitchers and catchers report to spring workouts in mid-February. He is motivated, confident and, all things considered, relatively healthy. This looks to be a good year ahead for the Big Unit, and he could be a good value pitcher for fantasy owners.
Curt Schilling, SP, Red Sox: The late news on Schilling's problematic shoulder made him a must-add to this list. Schilling, who suffered through a bout of shoulder tendinitis during the 2007 season, had been doing well enough in the offseason to pass his physical and secure a one-year contract with the Red Sox. In December, though, his shoulder reportedly began to bother him. The problems were persistent enough that, by January, he called on his long-time personal orthopedist, Dr. Craig Morgan, who had operated on Schilling's throwing shoulder in the past.
What you are witnessing is something that happens frequently in medicine: professionals disagreeing about the best way to manage a particular condition. There are certain features about this case that are worth discussing in an attempt to understand why it is so complicated. First, the fact that Schilling's biceps appears diseased does not preclude him from pitching. Many pitchers have significant abnormalities on MRIs one would think would make them unable to use their arms, much less throw 90 mph fastballs. Yet they do. The problem is one of pain. Tissue can be abnormal and, surprisingly at times, not painful. Keep in mind, Schilling's tendon did not turn into spaghetti strands overnight; this is likely the result of his being a 40-year-old pitcher who has stressed his shoulder for years. When tissue becomes inflamed and painful, however, the body shuts down. This is, in essence, a protective feature, in which the brain is trying to tell the body not to use the injured part. Sometimes the pain is simply too severe, or the mechanics are so dramatically altered because of pain, that the athlete cannot continue. Sometimes, with rest, the pain subsides, and although that might be temporary -- from weeks to months to years -- it might be enough to function for an indefinite period of time. This is what the Red Sox are no doubt hoping will be the case with Schilling.
The other interesting thing to consider is the type of surgery itself. Although a specific procedure has not been discussed in Schilling's case, a biceps tendon, if it is indeed severely diseased, can be treated via tenotomy, during which the tendon is simply cut to release it completely, or tenodesis, during which the tendon is cleaned up and anchored back in a new position. A tenodesis requires a longer healing period to ensure the stability of the anchoring of the tendon. Following this procedure, it would be about three or four months before a pitcher could return to throwing. In the case of a tenotomy, because your biceps has two components, clipping the "long" head would still allow the muscle to function. Dr. Chris Mazoue, an assistant professor of orthopedic surgery and team physician at the University of South Carolina, has extensive experience with these types of injuries. He describes the tenotomy as a relatively simple procedure that allows for a fairly quick recovery. In fact, he says a thrower could conceivably begin throwing within about six weeks after the surgery. And what about the loss of one component of the biceps? Mazoue notes that after such a procedure, there is typically only about 5-8 percent weakness in the biceps for bending the elbow, and about 10-15 percent weakness in supination (rotating the forearm palm upward), and he says that these weaknesses do not translate into any significant functional change, although there can be muscle cramping and aching that can occur. There is also the potential "Popeye" defect, so-named for the balling up of the muscle that can result, but this is purely cosmetic. Mazoue goes on to say there is also the possibility that a biceps tendon could rupture spontaneously if it is already severely weakened, which would yield essentially the same outcome as a tenotomy. Mazoue adds that one of the factors complicating this entire scenario is that "there just isn't enough data to know with any certainty what the outcome would be of a major league pitcher undergoing a tenotomy, because there haven't been enough of those cases." The role of the biceps in the pitcher is multifactorial, but it does significantly aid in deceleration of the arm, and it is unknown how much additional stress would be placed on the rotator cuff during this phase of throwing if the long head of the biceps were to be eliminated. Perhaps this is one of the reasons there is not much evidence of this procedure in major league throwers.
No matter how you look at it, there is much uncertainty in Schilling's situation. There are no guarantees, no matter which route Schilling goes, that he will pitch in 2008, or in the future. Even Morgan acknowledges that possibility. For now, Schilling has opted to go with the plan that the Red Sox have outlined -- whether he is going willingly or begrudgingly is unclear. Schilling received a cortisone injection to counter the inflammation, and he is now in the resting and recovery phase. What happens next will be determined by how he responds to this shutting-down period. What does that mean for fantasy owners? By now it should be clear that any investment in Schilling is a risky proposition because of all the uncertainty. Proceed at your own risk.
Kelvim Escobar, SP, Angels: Shoulder inflammation reared its ugly head again this winter for Escobar, who suffered through a similar bout near the end of the 2007 season. The Angels have placed him on a rest and rehabilitation program. They are hopeful that a slow, cautious approach now will mean a largely healthy 2008, even if it means starting the season without his services. A recent MRI showed no significant changes in his shoulder, according to a Los Angeles Times report. That is positive in that there is no evidence of a major injury. Keep in mind, however, that an athlete can have plenty of pain and discomfort in the absence of any major MRI findings.
The main concern here is that Escobar both started and ended last season with his shoulder bothering him (along with his knee during the latter few weeks) and the hope was that offseason rest would help alleviate the problems. For him to have recurrent symptoms this early on, before the spring workouts even begin, raises a red flag that this a lingering problem. Shoulder tendinitis and inflammation are a pitcher's ongoing nemesis, and the key for Escobar will be a gradual return in the spring and maintaining the strength and flexibility of his shoulder across the season, something that gets harder to do as the season wears on. Don't be surprised, fantasy owners, if the shoulder forces Escobar to take pitching vacations during the season, even when he does return.
Yovani Gallardo, SP, Brewers: It's never a good sign when one of your young pitchers, projected to be a key component of your starting rotation, goes down with an injury before you even hit spring training. This is exactly what happened to the Brewers and their young star Gallardo, who is coming off an impressive rookie season, and it serves as a reminder that surviving spring training with a healthy starting rotation is not automatic.
Gallardo began having discomfort in his knee after a throwing session in mid-February, according to a report in the Milwaukee Journal-Sentinel. As it turns out, Gallardo had a lateral meniscus tear in his left knee (his plant leg) and underwent arthroscopic surgery Tuesday, Feb. 19, to address the injury. According to the Journal-Sentinel, Gallardo is projected to be sidelined at least four weeks, suggesting that the procedure performed was a meniscectomy, where the torn piece of meniscus is removed (as opposed to being repaired, which would be a longer recovery). The lateral meniscus, a fibrocartilage disc, provides a cushion for the lateral aspect of the knee joint and, along with the medial meniscus, enhances overall knee stability. That said, an athlete can certainly return to full function after a meniscectomy, although there is some concern that the knee joint is subject to greater wear and tear where the piece of meniscus has been removed. For a pitcher, the plant leg is subject to a fair amount of torsional force as the pitcher follows through on his delivery, so the increased risk of wear and tear is not insignificant. In the short term, however, the recovery should be fairly uneventful (although lateral meniscus injuries tend to be a little slower than medial meniscus injuries), especially given Gallardo's youth and overall health. Although Gallardo is not expected to be available for Opening Day, he feasibly could rejoin the rotation within the following month, and, assuming no setbacks, he should be able to return to full form. Gallardo is still a strong prospect for the Brewers, and your fantasy team, once he rejoins the lineup.
Brad Lidge, RP, Phillies: Lidge's knee troubles began in May 2007 while he was with the Astros. He missed time then with what was described initially as "irritation" in his right knee, then came back to pitch only briefly before going on the DL with an oblique strain. When Lidge recovered sufficiently from the oblique injury and began throwing off a mound in early July, his knee again acted up. The team discovered he had torn cartilage that would require offseason surgery.
Lidge underwent surgery to repair cartilage damage on Oct. 1, and despite the fact that he was not 100 percent, the Phillies were willing to trade for him anyway. According to a November report in the Philadelphia Inquirer, assistant general manager Ruben Amaro Jr. said the Phillies were "comfortable that he'd be 100 percent by Opening Day," adding, "Naturally, with any procedure, there is some risk. We think it's a very low risk." Lidge did appear to be on track in his recovery, and as recently as two weeks ago, he was saying that his knee was "ready to go." Talk around the clubhouse when I visited at the beginning of spring training was that Lidge would be available for Opening Day.
Then, as quickly as you could say "MRI," Lidge injured the knee during batting practice Saturday, Feb. 23. Pitching from the stretch, he reportedly caught a spike in the mound on his push-off leg (his right, surgically repaired knee) and immediately felt some discomfort, enough to cause him to limp off the mound toward the clubhouse with the medical staff. An Associated Press report quoted Lidge as saying that the knee "swelled up a little" but that he was optimistic he just pulled some scar tissue loose. Although Lidge's assessment wasn't quite accurate, the team did get some good news the next day. Lidge told the Philadelphia Inquirer that his MRI showed "no big new tears, nothing substantially wrong, but enough on the medial side of the knee that would warrant a scope." So Lidge went under the knife Monday, Feb. 26 as a bit of a proactive measure to "clean up" the knee. Reports from the team after the surgery have all been positive. Lidge's medial meniscus was, in fact, torn, and according to Phillies head athletic trainer Scott Sheridan, the results of the surgery formed the "best-case scenario" for the Phillies. Dr. Michael Ciccotti, team orthopedic surgeon for the Phillies, indicated that he removed about 15-18 percent of the medial meniscus, and according to Sheridan, "The other side of the knee that he had repaired is fine."
One would have to surmise that the lateral knee, or outer part of the joint, is the region where the first surgery to address torn cartilage took place. If it looks fine at this stage, that is reassuring to everyone in the Phillies organization. The other positive is that a minimal portion of the medial meniscus was removed. The menisci function as shock absorbers and joint cushions between the femur (thighbone) and the tibia (lower leg bone) and provide stability to the joint. It is desirable to keep as much of each meniscus as possible over time. Meniscectomies, or procedures in which a piece of torn meniscus is removed because it is interfering with the ability to function normally, are fairly common, though. The extent to which the meniscus is cut out can have a significant impact on the overall health of the knee. Since Lidge had only a small piece removed, that bodes well for the health of that side of the knee. The bigger concern would be what led to him injuring the knee in spring training? Was he still lacking some strength and muscular stability that resulted in a compensation that compromised his knee? Or was it just a random occurrence that had nothing to do with the November procedure or previous injury?
Those questions might be impossible to answer with any degree of certainty, but they are certainly the type of questions that can cast a shadow of doubt over Lidge's fantasy value. Given his recent injury history and, in particular, the fact that this right knee has forced him to have surgery twice within the last year, there must be some concern heading into 2008. The Phillies are maintaining a poker face related to their closer situation, and there is the possibility that Lidge will return without incident. As the Phillies pointed out, Lidge's injury problems have had nothing to do with his throwing arm, leading them to remain optimistic about his future. Nonetheless, trends have a way of playing themselves out when it comes to injury, and his being in the "over-30" age bracket doesn't help. Expect solid performances this year from Lidge, who appears happy and confident with his new team, when he's healthy, but exercise some caution when it comes to value because his injury risk is present.
Truthfully, it is not uncommon for a pitcher to sustain a relatively minor strain in the early part of spring training as he gets his throwing arm back into game shape. The challenge is that sometimes it is difficult to know whether the incident is a one-time strain that should quiet down and have minimal impact, or whether it is a sign of problems to come throughout the season. Based on the information we have on Kazmir's situation, it seems reasonable to treat this as a blip on the radar that should not significantly impact Kazmir's value -- yet.
The plan will be to shut down Kazmir's throwing long enough for any inflammation to calm down, then gradually reintroduce him to throwing in a way that does not threaten to flare up the elbow. Although, as the Times reports, the Rays have not put a specific timetable on Kazmir's return, the fact that the team is suggesting an absence of weeks, not months, as well as suggesting that he would miss at most a few starts, is encouraging. The Rays have a top-notch medical staff as well, and you can be sure they would prefer to delay his debut with the team in the interest of maintaining his long-term health across the season.
So will he be ready for Opening Day? Kazmir seems to think so after announcing that he felt much better after only one day of treatment. Yes, but that's one day of treatment, and without throwing. Don't be surprised if Kazmir does not make the opener, even if it is just because a gradual return-to-throwing program does not fit that timeline. Also, we need to keep an eye on how Kazmir responds over the next two weeks when his activity is increased. Any additional setbacks would significantly drop his value, whereas a clean return would suggest that this is one of those early, harmless spring "warm-up" strains.
Keep in mind that Kazmir suffered through some arm issues at the end of the 2006 season and had some mechanical issues in 2007. Adjustments to his mechanics last year, which were of great concern to many observers, helped him to put together a very successful second half. Retaining those mechanical adjustments will be critical to Kazmir maintaining both his health and his strikeout rate. With youth on his side, and assuming he maintains good form and has no setbacks from this incident, Kazmir remains a solid prospect. If, however, he suffers a setback over the next three weeks, the signal light is changing, and it can go in only one direction.
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