Baseball Injury Report

In this first edition of the BIR Newsletter for the 2007 season, we have loads of player information for you. It’s the biggest report the Baseball Injury Report has produced, and we’ve also made it available to all Hardball Times readers. I will continue to post weekly injury updates on THT during the year, but you can read more comprehensive reports, like this one, five times a week at my Baseball Injury Report site.

Injury Profile:

Bartolo Colon (RHP, LAA)
Colon’s Shoulder Problems:
Reports first surfaced back in early September 2005 that Colon was battling a lower back strain. Not too long after those reports, he developed soreness in the back of his pitching shoulder. Inside baseball circles, it was rumored to be a strained infraspinatus muscle, one of the four muscles that make up the rotator cuff. This raises the question—are the lower back and shoulder strain related? Directly, no. Indirectly, very likely. When a pitcher has a muscle weakness or injury in the torso, the natural reaction is to attempt to compensate for that ailment. This puts more pressure on other parts of the upper body and can cause another injury. This would help explain Colon’s shoulder problems in the fall of 2005.

The Angels medical staff didn’t believe his original shoulder injury was serious enough to warrant surgery, so a rehab program was put in place to build up his pitching shoulder. We would later learn that he had a tear in the muscle, a much more serious injury. This would help explain the level of pain he was going through the prior fall, and why there was some talk of surgery. Mild strains don’t require surgery. He was so confident the shoulder was healthy he indicated that he was 100% entering Spring Training. He didn’t pitch well in March and early April, and wound up back on the disabled list with inflammation in his pitching shoulder.

The explanation was Colon tore some scar tissue from the 2005 shoulder injury. He returned in mid-June and lasted about six weeks before developing tendinitis in his right triceps. A week later, an MRI done on his shoulder revealed a torn rotator cuff. What happened to the triceps injury? Triceps can be misleading. That’s because we normally think of the muscle in the middle of the upper arm, not the tendon up near the top of the shoulder.

The Latest Shoulder Injury:
The injury Colon had entering this past offseason was a partial thickness tear of his rotator cuff. What is a partial thickness tear? Think of a stack papers. If you cut through some of the sheets, but leave a bottom section that doesn’t have any cuts or tears, that’s what a partial thickness tear is—a partial tear of a muscle that does not go through all the layers of tissue.

He rested the shoulder during the offseason while completing a rehab program to build up his shoulder muscles. During the rehab, Colon did not pick up a baseball. He got the green light in early January and began throwing in mid-January, but it will be some time before he throws off a mound, according to one veteran Angels observer. It’s safe to say that Colon is well behind where his fellow pitchers are in terms of shoulder strength. How far behind? We won’t know until pitchers report to spring training in February.

The 2007 Season
It’s almost written in stone that Colon will begin the season on the disabled list. He hasn’t been healthy since August 2005, and you can bet the Angels will be careful with his pitching schedule. They don’t have a timetable for his return—right now, their best estimate ranges somewhere between May and the All-Star break. Once he returns, even if he’s completely healthy, he’ll have some mental hurdles to overcome, simply because he hasn’t pitched for so long, and there will likely be some fear that his shoulder will start hurting again. Based on the available information, a May return would be a pleasant surprise. Our belief is that he’ll have little value before the All-Star break. If he doesn’t return until June or July, he shouldn’t be counted on to provide any value this season.

Injury Profile:

John Patterson (RHP, WAS)

Medical History:
He missed time with a groin injury and lower back strain in 2004-05. Last season was the first time he had problems with his throwing arm. The right forearm stiffness he experienced began last April, after he started experimenting with a new changeup. It’s possible the new pitch put undue stress on the forearm.

The 2006 Season:
The Nationals medical staff treated Patterson’s stiff and sore forearm with several cortisone injections. These provided short-term relief, but not enough to clear up the inflammation in the forearm/elbow area. After his first DL stint, he reported a “dead arm” in July. The diagnosis was pressure on the median nerve, no doubt due to the repetition of throwing a baseball.

In August, he underwent exploratory surgery to examine the median nerve and lacertus fibrosis. Lacertus fibrosis is a thick band of fascia (tissue) extending from the biceps tendon, and it can put pressure on the median nerve. During the surgery, the pressure from surrounding tissue on the nerve was released. That procedure should prevent a reoccurrence the “dead arm” and pain he felt in the forearm and elbow area last season.

Reports from the Nationals indicate he’s already throwing breaking balls, a very good sign. The next major hurdle for Patterson is throwing at maximum velocity, which may or may not occur before the start of spring training. If Patterson can avoid setbacks during spring training and build up the strength and stamina in his pitching arm, he should be able to avoid a recurrence of those forearm issues in 2007.

Injury Profile:

Scott Podsednik (OF, CHA)
It was about a year ago Podsednik needed surgery to repair both a hernia and a sports hernia. With the double surgery, he went on to steal 40 bases, but that was 19 off his 2005 total and 30 below his career high of 70 in 2004. Now, for the second straight offseason, he is recovering from a sports hernia surgery.

What is a Sports Hernia?
It is a weakening of the muscles (or tendons) of the lower abdominal wall. The injury is seen much more frequently in hockey and soccer players than any other sport. Sometimes its called athletic pubalgia. The University Michigan medical center website perfectly illustrates the location of a sports hernia.

What is the Difference Between a Sports Hernia and Inguinal Hernia?
Inguinal hernia occurs there is weakening of the abdominal wall to allow a pouch, the hernia, to be felt. The sports hernia is not palpable during a physical exam.

Mental Health and the CBA
A particular bit of language in the latest CBA could have negative consequences for some players.

Can a Player with Strong Abdominal Muscle Avoid a Sports Hernia?
The sports hernia isn’t prevented by strong abdominal muscles, rather, the muscle in a certain area is too thin and the hernia forms.

While rest may be prescribed to treat the injury, in most cases surgery is the likely income if the player is to make a complete recovery. If surgery is performed, the lower abdominal muscles and connective tissue are released and reattached. Recovery time is typically 6-8 weeks.

Future Treatments?
In the area of medical treatment and surgeries involving major league baseball players, standard surgery is used and the player typically needs 6-8 weeks to recover. In Europe however, there is another option.

Dr Ulrike Muschaweck of Germany has mastered a“Minimal-Repair-Technique.” Minimal tissue is cut during the surgery, reducing the scar tissue and if a “mesh” isn’t needed, the recovery time is greatly reduced. Not using the mesh or very small piece of screen in the surgery helps keep the recovery time down to 10-14 days, This technique has not made its way to the U.S., and North American Athletes have not ventured to Germany for the surgery. If this changes, sports hernias won’t be nearly the concern as an injury as they are at the moment.

The 2007 Season and Beyond
No matter how successful his surgery is, he’ll have had four hernia surgeries (the latest was Feb. 1)in the past five years, which will likely cost him some of the flexibility in his torso. This in turn will reduce his effectiveness in stealing bases. There’s a good chance Podsednik could begin the season on the DL, especially if he needs the full eight weeks to recover from this surgery. Even if he does surprise us and bounces back quickly, there’s a good chance he’ll struggle to reach 30 steals this season.

Player Capsules

Anibal Sanchez (RHP, FLA)
Last March, Sanchez had some shoulder tendinitis and was shut down for a short period. He ended up going to Double-A for a while before earning a recall later in the season and throwing a no-hitter in September. In early January 2007, he felt some discomfort in his pitching shoulder and was told to rest it. An MRI reportedly didn’t reveal any structural damage, and he threw off a flat surface a week or so later. Early in spring training, he is throwing off a mound and doesn’t report (publically) and shoulder discomfort.

Because this is the second year in a row he’s had a problem, it might just be his shoulder reacting to early throwing after a layoff. In the coming weeks, we should watch for how he’s throwing to see if he’s falling behind his fellow pitchers. If he falls behind or we hear stories about shoulder weakness, then his shoulder may become a problem.

Josh Johnson (RHP, FLA)
Johnson’s 2006 season ended abruptly in September when he suffered a strained ligament in his pitching elbow, near the forearm. The Marlins said it wasn’t serious and that the shutdown was simply a precautionary move. But then in mid-January, while throwing from a flat surface, Johnson developed some additional discomfort, this time in the right biceps area. There’s a chance these two ailments are related—Johnson’s bicep may be working harder to compensate for forearm/ligament strain from last fall. Two arm problems, albeit minor ones, in the past four months is reason for concern. As we approach the last week of February, he is not throwing which isn’t a good sign. While it’s a bit early to talk about starting the year on the DL, it’s starting to look like that is the where he’s headed.

Brad Wilkerson (OF, TEX)
Wilkerson underwent surgery on his ailing right shoulder last August. He had struggled with shoulder problems for a good part of two seasons, and wound up needing to have both his rotator cuff and labrum repaired. Within a month and a half after the surgery, he had regained some of the lost range of motion in his right arm. By mid-December, Wilkerson was hitting off a tee, another positive. Add in the loss of 15 pounds, and we have all the makings of a solid recovery for 2007.

However, before jumping on the Wilkerson bandwagon, be aware of a couple of upcoming hurdles. How well will he handle facing live pitching? Will he regain enough strength and stamina to avoid tiring quickly in spring training? How soon can he hit for power? Because he needed surgery for a labral tear, his power could be slow to return. So far, the progress reports are small yet positive steps in his recovery. Once he gets to spring training and the demands on his shoulder increase, then we’ll really get a better idea of how far he’s come since the surgery. At the moment, there is still some risk in drafting him for 2007.

Pedro Martinez (RHP, NYM)
Reports from the Mets camp are rosy regarding Martinez rehab from surgery. This doesn’t change the fact he needed 17 very small holes drilled into the bone in his shoulder so several ligaments and a tendon could be securely attached. This was major surgery and he will need a considerable amount of time to recover. We won’t see him pitching for the Mets until the second half of the 2007 season.

Jose Contreras (RHP, CHA)
Contreras’ season ended late last year when he collapsed on the field with a strained right hamstring. By all accounts, the hamstring healed, but it’s not the end of the story. We in a recent interview with Contreras that he struggled with sciatica beginning last May, a problem that worried and bothered him all last season. Sciatica is usually caused by pressure on the sciatic nerve from a herniated disc in the lower back (lumbar spine). We’ve heard nothing relating to a herniated disc in this case, but that doesn’t mean it doesn’t exist. In the last eight months, Contreras suffered a strained hamstring and a bout of sciatica. Back and hamstring ailments can be related. He could be developing back problems.

Working in his favor is the White Sox medical staff. Head athletic trainer Herman Schneider is considered one of the best in the business. In an injury study I published in the Baseball Injury Report 2007 Annual, the White Sox ranked first in fewest total DL days over the past five seasons. In fact, only three players landed on the DL with back ailments for the White Sox during that period. The odds are good the medical staff will keep his back issues in check.

Jason Kubel (OF, MIN)
Back in the fall of 2004, Kubel suffered a torn anterior cruciate ligament in his left knee while playing in the Arizona Fall League. Reportedly, he also suffered damage to the medial and lateral ligament in the knee. Kubel had to wait a month for the swelling to go down before surgery could be performed—it ultimately took place in December 2004. Then, over the course of the 2006 season, he developed problems with the right knee, due in part by favoring it over the surgically repaired one. He needed surgery this past November to repair damage done to the meniscus cartilage in his right knee. January reports point to a solid recovery without any setbacks. Considering his medical history, the Twins aren’t likely to push him in his return. Unless he stumbles in his recovery, Kubel is expected to play in the early spring games.

Scott Kazmir (LHP, TB)
Kazmir has been working out since October, and finally threw off a pitching mound last week. He reported no pain in his pitching shoulder while throwing at about 80% velocity. The other piece of news we received is that he’s yet to throw any breaking balls. The Devil Rays are likely being protective of his shoulder—not throwing breaking balls keeps the stress down off both his elbow and shoulder. Throwing them will be the next hurdle he has to face. Right now, it looks like Kazmir is slightly behind where most of the other Tampa Bay pitchers are, but he can catch up quickly without risking the health of his shoulder.

A.J. Pierzynski (C, CHA)
He injured his ankle during an offseason workout, and was seen wearing a protective brace on his right ankle during a recent White Sox outing. With no apparent ligament damage, he’s expected to be very close to 100% by the time Spring Training games start.

Darin Erstad (1B/OF, CHA)
Late last season, there was speculation that his career was in jeopardy because of an arthritic right ankle. One of the reasons he delayed surgery on it while with the Angels was because the medical opinions he received stated they didn’t think surgery would clear up the pain and inflammation. Now there’s word that Erstad has the green light to resume running at full speed. Confused? So am I. What about the dire reports from last season? If the reports about the ankle feeling great are correct, then last season’s speculation was way off base. We’re better off taking wait-and-see approach toward this situation. Erstad has a history of playing through pain rather than sitting out, so the ankle may not be as pain-free as we’ve heard so far.

Roy Halladay (RHP, TOR)
The great thing about pre-Spring Training reports is some of the information that comes out. Take Roy Halladay. His pitching coach, Brad Arnsberg, admitted Halladay had problems with his pitching forearm in 2006 and gave the possible reason why—he was throwing a cut fastball last season. Some pitchers struggle throwing this pitch because it puts extra stress on the elbow or forearm. The Yankees’ Andy Pettitte is a good example of a pitcher needing a cutter to be effective, yet having problems with his elbow as a result. Arnsberg added that Halladay wouldn’t throw the pitch until late in spring training this year—instead he’ll focus on control plus fastballs and changeups. If he’s pain-free until late in spring training, it will be interesting to see if Halladay cans the cutter rather than risk a more serious forearm injury.

Bobby Crosby (SS, OAK)
Positional players report to spring training in a couple of weeks for the A’s, and there are still some unanswered questions. One is Crosby. He’s recovering from a fracture of the L-5 vertebra in his lower back (lumbar region). Crosby hasn’t had any pain in his back for about a month. He’s working out, but the A’s medical staff won’t allow him to do any weight lifting that puts pressure on his back.

Flexibility is the key right now. Last offseason, Crosby spent a lot of time in the weight room building strength and adding some weight. Not this year. He began swinging a bat early in spring training and didn’t report any pain. Even with this positive news, Crosby has a lot of hurdles to overcome before being ready for the season’s opener. Oakland is not expecting him to be ready for the season opener at this point. A pain and restriction free Spring Training would go a long way toward changing that viewpoint.

There are a couple more points to be made regarding Crosby. First is his health. In the past two plus years, he’s suffered a fractured left ankle, stress fracture in his ribcage and now the fractured vertebrae. The ribcage fracture and the vertebrae fracture are traced directly to his swinging the bat. Maybe there is too much torque in his swing? The other point relates to the A’s. With each of the three injuries he’s suffered, there was a misdiagnosis in the beginning. That probably hasn’t done much to instill confidence in Crosby’s mind about the advice of the Oakland medical staff.

Mark Lowe (RHP, SEA)
Tendinitis in his pitching elbow toward the end of the season turned out to be more serious than first thought. Lowe underwent arthroscopic elbow surgery in October to help regenerate cartilage because he had a “bone-on-bone situation” in his pitching elbow. Ouch. He needs to build up his arm strength, then regain confidence in his elbow. We aren’t going to see him pitch for the Mariners until the second half of the season.

Felix Hernandez (RHP, SEA)
If you had Hernandez on your roster last season and saw him eat his way to a nifty 4.52 ERA and a 12-14 record, you’ll be encouraged by this news—he is already four pounds under the 226-pound guideline the Mariners set for him for 2007. We don’t normally report many weight loss or muscle added stories for a lot of good reasons, but this one we’ll watch closely. In his short tenure in the majors, Hernandez already developed a reputation of enjoying the good life and not having the best of work habits. Talented players get to the majors on pure ability, and don’t think they need to stay in good condition. This season will go a long way toward telling us if he’s turned his attitude around.

Jayson Werth (OF, PHI)
The Phillies are taking a flyer on Werth because he’s convinced them his twice surgically repaired right wrist is 100%. He says he’s ready to hit like he did before all the wrist problems began. In this the season of optimism, all recovering players are either 100% or will be before Spring Training starts. Then the live pitching begins and we get the real status reports. Hold off on counting on those 300-plus at-bats for Werth as the Phillies fourth outfielder until he gets a few fastballs in on the hands and tries to fight them off. Then we’ll know how close he really is to 100%.

Victor Zambrano (RHP, TOR)
This is his second recovery from Tommy John surgery, which is rare. The Blue Jays signed him to a minor league contract with an eye toward midseason, but Zambrano is saying he’s way ahead of schedule and that he was 100% at the start of Spring Training, which was laughable. Last May, he needed reconstruction surgery on his pitching elbow. He also had bone chips removed and some ligament damage repaired in his pitching elbow. The recovery period for almost all pitchers who have this extensive surgery is up to 18 months. Zambrano is trying to tell anyone who will listen, he’ll cut up to 10 months off his recovery. If so, he’ll be on the cover of every sports medicine journal!

Dallas McPherson (3B, LAA)
The Angels are likely to lose McPherson for the season after he undergoes surgery for a herniated disc and fractured vertebrae in his lower back. McPherson has battled back and hip problems since 2005, and he’s gone from a top prospect to one that’s always hurt. His future is in doubt at this point.

Lew Ford (OF, MIN)
Ford underwent surgery in January to repair damage to the meniscus cartilage in his left knee. By the end of the month, he had begun rehab work on the knee. Because of the surgery, he will be behind positional players when they arrive to spring training, and any kind of setback in his recovery will put his early season status with the Twins in jeopardy.

Casey Kotchman (1B, LAA)
The Angels are pleased with the progress Kotchman showed in winter ball, playing in over 45 games after missing almost all of the 2006 season with mononucleosis. His swing looked rusty at times, but that was expected after the long layoff. The Angels believe he was 100% when he showed up to spring training.

Kendry Morales (1B, LAA)
Morales suffered a strained right knee while playing winter ball and was shut down immediately. The initial MRI done on the right knee didn’t reveal any serious damage. Right now surgery isn’t being planned and he’s still in the picture at first base.

Michael O’Connor (LHP, WAS)
When O’Connor underwent surgery to repair a small defect in a piece of cartilage in his pitching elbow in early November, it was supposedly just a minor procedure. Now, just a couple weeks before the start of spring training, O’Connor is behind schedule—mostly because his recovery has gone a lot slower than anyone expected. It’s starting to look like he’ll miss the opening of the season and stay behind to work in extended spring training.

Ben Sheets (RHP, MIL)
The Brewers got a scare last month when Sheets let them know he was having trouble with his back. Sheets underwent back surgery a couple of winters ago, and hasn’t had any trouble since, with the exception of occasional minor back spasms. They sent trainer Roger Caplinger down to Texas to check out his back. The front office let out a sigh of relief after he reported it wasn’t serious. Reading between the lines, it sounds like Sheets hadn’t done much conditioning work on his back, something the Brewers are now encouraging him to do. It’s a false alarm unless more back pain surfaces this spring

C.C. Sabathia (LHP, CLE)
Even though he had surgery way back in September to repair some cartilage damage to his right knee, Sabathia indicated this week he’s only about 80% recovered. One would expect him to be closer to 100% four months after having the surgery. Not known as a workout warrior to say the least, his lack of progress could be attributed to a slower than expected rehab pace. Ideally, by the end of February, Sabathia should be caught up with his fellow pitchers. If not, it wouldn’t be a surprise if he needed a couple of extra weeks in extended spring training to get game-ready.

Jason Bay (OF, PIT)
Bay underwent surgery in November to remove some irritation underneath the patellar (kneecap) in his left knee. His recovery is on time and the Pirates believe he’ll be close to 100% by the time March spring training games start.

Corey Koskie (3B, MIL)
The troubling decline of Mike Matheny due to post-concussion syndrome last year could be repeated in Milwaukee. Koskie is going through the same struggles, though his situation isn’t as dire as Matheny’s … yet. He’s doing some working out, but every time he increases the intensity, the post-concussion syndrome symptoms return. The Brewers will bring him along slowly during spring training. As of right now, there is an air of uncertainty surrounding his career and how much he’ll play in 2007.

Juan Rivera (OF, LAA)
Rivera suffered a fractured left tibia while playing winter ball in December, and needed surgery to repair the damage. A rod and several screws were used to set the fracture. This news tells us he had multiple fragments, and the hardware was needed to help the healing process. Rivera’s injury will be watched closely by the medical staff, with multiple X-rays planned to make sure the bone heals in alignment and without any problems. With Spring Training underway, Rivera isn’t in camp and won’t be for a while. We may not see him play for the Angels until the middle of the season.

Jim Edmonds (OF, STL)
Edmonds underwent his second surgery this winter, this time for a “hammer toe” on the second toe on his left foot. It’s considered minor surgery, even though Edmonds battled the ailment most of the 2006 season. It’s not expected to hamper his Spring Training, but the shoulder surgery he had earlier in the winter might.

Nick Johnson (1B, WAS)
He’s walking without crutches but still has a limp, which isn’t a surprise. Johnson suffered a fractured right femur (thighbone) late last season. The latest estimate has him missing a good chunk of the 2007. Factor in his history of being a slow healer and its easy to see why the Nationals are not encouraged early in spring training.

Vladimir Guerrero (OF, LAA)
He admitted a few weeks ago that his sore right knee bothered him all of last season, but he says it isn’t a problem anymore. He added he wouldn’t need surgery on the knee, leading to speculation he has some cartilage damage. It looks like a non-issue, but one that bears watching.

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