Under The Knife 2/22/21
Spring Opens
Another year of baseball brings another year of Under The Knife. Thanks to all of you who have been subscribing from Day One, a year ago, and reading for longer than that. Spring Training is open, albeit mostly behind closed doors as the pandemic heads into its second year. Spring Training is always a bit fraught, but besides the pandemic procedures of masks and tests, teams are also struggling with a visa system left behind by ol’ Donnie. There’s been a lot more issue getting the required visas and getting players through and to team sites.
There’s always a bit of this and yes, the pandemic complicates this, but one baseball insider told me that more than ever, the past two seasons have had issues because the system is designed to say ‘no’ when there’s any doubt. None of this appears to have a huge effect, just more people a bit late to camp, but it could be much more significant when the minor leaguers start coming through, though MLB has already pushed some people to countries like the Dominican where there’s numbers. There’s no visa issues with UTK - just spam filters - so let’s get to it:
JT Realmuto C PHI (fractured thumb)
Showing up to camp with a broken thumb was not what the Phillies were hoping for from their big re-signing of the off-season, but it could have been worse for JT Realmuto. The fracture is “clean” and is already healing normally, plus he was working out through it, thinking it was just the normal soreness a catcher so often deals with rather than a real injury.
I’m told that this is a simple impact fracture near the base of the thumb. There’s no real loss in function, but until it heals, there’s a risk it could displace and cause significant problems. The Phillies have plenty of time for Realmuto to heal, plus he more or less knows the staff, can work with them in pretty much every way besides actually catching them, and he can do pretty much everything on the hitting side except actually hit. I know that sounds funny, but he can take dry swings to do pitch recognition and I’m told he lined up almost as an umpire would during some bullpens to get a feel for how pitches were moving.
It all makes sense and the timing is in the Phillies favor here. This wouldn’t change any valuation on Realmuto for me and might be a chance for those in draft/auctions to steal him if others are shifting him down. There’s only a slight risk of recurrence, but that’s almost zero at this level. My only real question is timing and it feels like if this goes normally, Realmuto will have a couple weeks of game action which should be more than enough to be ready for Opening Day.
Stephen Strasburg SP WAS (post-wrist surgery)
Stephen Strasburg showed up to camp ready to go. Strasburg missed almost all of 2020’s abbreviated season with continued hand and wrist issues, but it appears they were cleared up quickly by a simple carpal tunnel release. Strasburg told the media that relief was almost instant and that he had a good rest then a normal off-season. That puts him in an interesting position, more akin to the many minor leaguers that were off rather than someone doing a surgical rehab.
I spoke to a hand surgeon that works with MLB players, but did not treat Strasburg, who told me that in terms of baseball skills, the surgery would have had nearly no specific rehab. “Once he gets full motion back and the scar has healed, which is usually about ten days, he would have been back to normal. But he’s a pitcher, so he couldn’t go right back to work. I’m curious why they chose not to come back at all in 2020. From the timeline, it was possible.”
The answer is likely the normal conservatism of baseball and the weirdness of 2020. It does put Strasburg and the Nationals in a good place for ‘21 - well rested, healthy, and building off what the pitcher says was a “great offseason.”
Chris Sale SP BOS (post-TJ rehab)
Chris Sale was placed on the 60-day IL*, which was not unexpected. Sale is coming back from Tommy John surgery and had a minor, unrelated complication with his neck ahead of spring training. As with most TJ rehabs, the Red Sox appear to be on the 14-18 month cycle, which means we weren’t likely to see Sale until May, though Jen McCaffrey of The Athletic indicated there’s been a lot of expectation that Sale might not be back before the All Star break.
That would be way too long - as most TJ rehabs are - but with Sale, we’ve already seen exactly where he is, even with the neck issue. He’s right at a year post-surgery and has been throwing for what amounts to a normal off-season after completing the medical part of his rehab back in November. That’s not to say the Red Sox won’t do this. The Yankees seem headed that way with Luis Severino - more on him next - but there’s no evidence that this helps the pitcher or has better results. A full year to get back to throwing is wasteful and eschews the kind of data that teams like the Red Sox love.
We’ll have to see exactly when Sale is back and we’ll get some clues based on his early spring usage. If the Sox are willing to scrap nearly half a season for no good reason, I’m at a loss for what can be done. The entire Tommy John rehab is based on work from the 1970’s done by Dr. Frank Jobe himself and then expanded on in the early 1980’s by Dr. Kevin Wilk. Better evolutions already exist, so it comes down to which teams or which practitioners are willing to step up. Getting pitchers back as much as nine months earlier is like getting a free year of production.
*I still find myself typing and saying “DL” rather than “IL” over a year after the switch. Not sure why this is so hard-wired for me, but I guarantee that every time you see “IL” in this newsletter, about half the time I typed “DL” and had to correct. I used a bit of code to always switch it, but that two letter combo comes up way too often to work well!
Luis Severino SP NYY (post-TJ rehab)
Brian Cashman seemed to indicate that Luis Severino wasn’t going to be back before mid-season, but as camp opened in Tampa, there he was doing some long-toss. Or 120 feet, which should be mid-toss but that term hasn’t caught on. It’s our first indication that yes, Severino is well behind where he would be expected to be in rehab given the timeline. That could be a conservative timeline, or there could have been a setback, but given Cashman’s comments, I think it’s the former.
Given how much the Yankees have put into sports medicine and sports science, I’m a bit shocked here. This should be an advantage, or could be, but this rehab conservatism appears to be orthodoxy. If Severino is just now, 11 plus months after surgery, just getting on a mound, then he is well behind even the accepted and conservative timeline.
That’s not to say this couldn’t be part of a plan. The Yankees could know that Deivi Garcia can’t make it through a full-season and would like to get 90-120 innings from him. If you use him for that period, allowing Severino to gear up behind him, all you’re losing is half a season of Severino. To the Yankees, that might seem like a decent tradeoff and it’s not going to be used against him in arbitration, so who loses? The Yankees do have several injury worries, so balancing out how to get 1500 innings out of seven or eight arms is a bit of an equation.
The other key here is that Severino might be able to quicken up that progression if needed. The plus of a conservative rehab is that it can always be accelerated. We’ll see how they progress him over the next few weeks which will give some more clues about what the Yankees are doing here. They’re just too smart to be guessing.
Dinelson Lamet SP SDP (sprained elbow)
The Padres have a lot of pitching, but some of it is out (Mike Clevenger), some of it is risky, and almost all of it is new to the program. Dinelson Lamet is one of the risky ones, but has as much upside as any of them. Lamet had Tommy John in 2018 and damaged the ligament at the end of last year, which is very unusual. PRP and rest has him back to throwing, but those kinds of issues often recur on about a 50/50 scale.
Lamet says he feels good, but that tells us almost nothing. It’s nice and I’m glad for him, but we know that he’s over-stressing the elbow and causing damage. Can that be managed or changed? There’s no indication that the Padres have done anything mechanically and management is difficult. There’s questions about whether Lamet would be better off in the pen, but we don’t know how he responds to a different role. It’s more of a fallback than a good option at this stage, when we know he can be a successful starter if not a resilient one.
Ryan Weathers could end up the 5 here if Lamet isn’t ready for the start of the season, but the Padres have said they would rather he opened the season as a Double-A Sod Poodle. (Oh, the humanity.) Mackenzie Gore is right behind and another possible Poodle. Watch to see if Lamet is able to make all of his work, which could be difficult with limited access. Right now, I’m a bit down on Lamet due to the risk, but if you’re willing to take that on, he still holds good 2 starter upside despite being the defacto 3 or 4 for San Diego.
Carlos Martinez P STL (post-COVID)
Carlos Martinez thinks he’s a starter. The fact that he’s never stayed healthy raises some doubts, but it leads to a question - is starting ‘harder’ than relieving? The answer depends on the person, but in general, comes down to the workload and how the body responds to it. Four or five days to recover is great for some people, but others respond better or worse. There’s probably not a reliever in baseball that has pitched four back-to-back days since 2010, but there’s likely some that could. The old “rubber arm” cliche probably has some fact behind it.
The interesting here is that this is measurable and knowable. The Cardinals have used technologies to measure workload and have access to things like Trackman and Hawkeye, plus a big collection of smart people to manage these things. I’m not sure Martinez or any of the pitchers need to understand this, but in reading the comments and the context of his remarks, it doesn’t sound like he knows this even exists. Sure, it’s possible to do all of this and have the athlete oblivious - we see this a lot with Trackman at youth tournaments - but it’s surprising.
I can’t sit here from where I’m at and tell you whether or not Carlos Martinez can be a starter, or should be a starter. I can tell you his injury history suggests he won’t hold up there, but that as a 4 or 5 candidate, he’s likely the most interesting. The Cardinals are smart enough to figure out how to squeeze the most out of Martinez, but my guess is that it won’t be in a traditional starter role. This kind of situation begs for innovation and maybe the Cardinals will be the team that does it.
All that said, Martinez appears to be past all post-COVID symptoms that really hit him hard last year as an asthmatic. Along with Eduardo Rodriguez, who had a good start to camp, it appears we haven’t seen any continuing “Long COVID” cases in baseball.
Justin Verlander SP HOU (post-TJ rehab)
Justin Verlander turned 38 and posted this tweet, which immediately got the Zapruder treatment:
Verlander’s TJ scar is visible on his right arm, which is slightly more bent than his left. That could be a bit of a contracture or it could be just how he was standing. He’s obviously leaning. I like the baseball art to his left, but I’m not big on the fireplace, which looks like it will be dated in a few years. He’s using Driveline weighted balls to hold the balloons in place as well.
At six months post-TJ, he’s doing well and obviously doing some normal activities.
Could he be back this year? Maybe, but I doubt it. Verlander has a pretty nice life, a guaranteed contract, and no real reason to have an aggressive rehab. It wouldn’t stun me if we saw him in the minors and maybe thinking about pitching out of the pen if he wanted to help the Astros make a run, but I’m curious to see if Verlander doesn’t target a return somewhere else in ‘22. The CBA discussions might complicate things, but I could see him slipping into the Dodgers or Padres rotation pretty easily if he’s wanting to win another ring.
Quick Cuts:
JA Happ tested positive for COVID. Sources at both the league and MLBPA tell me there’s still hopes for vaccinations for players and fans ahead of the season, but there is no current plan for this … Frankie Montas also tested positive, but he was placed on the COVID list despite not being in camp. It could be a roster move, but there’s no definitive timeline on Montas’ return or if this sets him back for the rotation … Wander Franco will get a long look in Rays camp, but don’t be surprised if he ends up starting in Triple-A Durham. The biceps tendinitis appears to be a thing of the past, but the Rays will test him hard early to see if it recurs. There’s a chance he breaks camp as the starting SS … Dakota Hudson is expected to miss all of ‘21 after having Tommy John in September ‘20. He thinks he can be back under a year, which is interesting if you read the spots above. Are the Cardinals willing to be aggressive with him? … As with Sale, Noah Syndergaard heads to the DL to open up a roster spot for Taijuan Walker. The plan for his return hasn’t changed … Forrest Whitley isn’t having a visa issue, but he’s not in camp either. Dusty Baker told the media it didn’t have anything to do with his arm, so at least there’s that. Houston’s rotation has some real questions at the back … Four surgeries have happened on Brent Honeywell since he last pitched in the majors, all of which will make some point to the screwball as a “bad pitch.” It’s not and Honeywell’s return should help. He’s expected to be throwing in games soon, despite the minor procedure he had in December … Brendan McKay won’t be a two way player this year after labrum surgery, but he is going to be a hitter. The downside is, labrum surgery has been a problem for hitters. Just ask Matt Kemp … Max Scherzer has a mild sprained ankle, the result of some conditioning work. There’s no major concern, but he won’t do any throwing work while it heals up, a matter of days … Very interesting stuff here about an unknown part of the return-to-play equation.
Under The Knife will be free for two weeks in March, ahead of Opening Day. It’s the normal business before and once the season gets started, so I think you’re still getting very good value. I’m hoping everyone will help this keep going by telling a friend or even giving a subscription to someone you think will enjoy it. There’s no anticipated changes, but I do need to grow UTK this year to make it sustainable. If anyone has ideas, please email me.
I don’t have an actual style guide, but I do try to consistently apply certain things. Some asked about “Sr” and “Jr” designations, as with Fernando Tatis Jr. Last week, I spoke about his father (and grandfather!) in the piece, so there’s a clear need to delineate the two, which is what those designations are for. If I’m just talking about the Padres star, I often drop the Jr, since you should know exactly who I’m speaking about. For initials, I often drop the periods — JT vs J.T. — to save some characters. I’ve done it since the initial UTK emails back in ‘02 when email limits were much stricter and things like Substack or blogs didn’t exist yet. Again, I don’t think it matters for terms of identification.