Under The Knife 3/4/20

Sale, Judge, Stanton, Allen, Miller, Yelich, and more

“Why are there more injuries early in the season than late?” It’s one of the questions that I’m often asked and while there’s some relatively easy answers, there’s no good answer either, or at least not one I’m satisfied with.

The first issue is that there’s simply more bodies. In both MLB and the NFL, the number of rosters spots is vastly above where it is in season. Some can’t handle that load and break down before they get to the roster. It’s how the system is designed, like it or not.

On the other hand, that loading is part of the problem, especially for pitchers. We know from extensive study that workload ramping is done poorly and that the increase in workload early in the spring, even with new training methods, often overtaxes the arm. This is likely true for players with some overuse or changed-use muscular injuries. Even if they were working out and “in shape,” they may not have been prepared for the workload of specific activities.

It leaves us here, watching names added to the Injured List and the UTK column. It’s frustrating, especially when you consider teams are doing very little about it. There’s small steps - more sports science, more accountability to medical staffs, smarter off-season training - but there’s really been no reduction in injuries over the last thirty years unless you consider the relative flatness as success.

There’s so much more to be done and so much advantage to be gained for the team that cracks the code first. For now, we’ll just look at the injuries we have:

Chris Sale (SP Red Sox)

“Right now, Sale is on track.” That’s what I said Monday and here on Wednesday, things have changed. His elbow acted up and an MRI was ordered. They quickly sent it on to Dr. James Andrews and this is a situation that reminds me a lot of David Price a couple years ago. Price actually happened about a week earlier, forcing the Sox to fly Price to Indianapolis where Andrews and Neal ElAttrache were attending the NFL Combine. (Andrews is team doctor for Washington, ElAttrache for the Rams, in addition to their baseball duties.) There’s late word that Sale will visit ElAttrache in Los Angeles.

This is definitely worrisome but remember that a consultation with an ortho like Andrews is not doom and gloom. It’s an opinion. Years ago, someone had some stats on every time someone was noted to be visiting Andrews versus how many times they ended up having surgery. It was about 50/50, which matches anecdotal references.

Sources I spoke with weren’t entirely sure what direction this was headed, but thought the Price comparison was apt. The worry is less about the UCL itself and more about why the elbow is being irritated at this stage. If you remember back to Price, he had an injection and came back pitching relatively well and has since that point. That would be the best case scenario for Sale and I’ll acknowledge that it could be worse, maybe even much worse.

On track went to uh-oh in a hurry here so I won’t pretend that the Sale situation is anything but fluid or even that my sources can possibly be giving me all the information on this. There’s a massive risk discount that you have to get for Sale before you draft him and for the gambler out there, Sale coming back is going to give you an opportunity.

Before UTK existed, I once paid for a good portion of a Vegas trip by betting on the Rays over the Sox. Pedro Martinez was pitching and the Sox ace was not healthy. His shoulder was acting up, but this was Pedro over the still Deviled Rays. The money went one way, I went the other and +350 plays. There could be that kind of game again this year, especially against the Orioles. See you in Vegas.

Aaron Judge (OF Yankees)

Giancarlo Stanton (DH Yankees)

The Yankees look to start the 2020 campaign without two of their key hitters. Both Aaron Judge and Giancarlo Stanton missed significant portions of last season due to injuries and the Yankees managed to win a lot anyway. They might have to do it again with this current pattern.

Aaron Judge’s shoulder — stated as a pectoral strain — is problematic and additional images didn’t give much clarity. There’s been some references to an impingement, but no one I’ve spoken with close to the situation has used that terminology. No one’s also expressed any real concern about throwing, despite the pain being on his throwing side. It’s a real mystery at this stage and the clock is ticking. I’d expect a specialist visit or two in the next week if nothing clears up.

There’s a chance this injury is something bigger, but don’t get too far ahead of the diagnosis here. The worry is that it’s more than just the pectoral. Due to the location, both the biceps and labrum could be involved. Some doctors even call this the “biceps-labrum complex” and say that all three structures are interrelated. This is most seen in a procedure called biceps tenodesis, which has been done in baseball on a limited basis with no major success. Most of the work on the “complex” has been done at HSS in New York, so a visit there would be a tell.

For Stanton, the situation is at least a bit simpler. He has a calf strain and will need it to heal up. If he’s back first, there’s a bit of question about whether Stanton could play the field over Judge. No one I spoke with was very excited about the possibility of seeing Stanton back out in the field, so we’ll have to see how this all plays out. Judge’s calf is just one in a series of muscular injuries, so once this one heals, the focus will go back to making sure the next one doesn’t happen.

As I said, both are likely to start the season on the IL, though Stanton could get enough at bats for Aaron Boone to be comfortable with him playing out of the gate. No one could tell me if there’s some guideline, with one saying “If he’s hitting the ball out of the park, no one will care if it’s ten at bats or fifty.”

Andrew Miller (RP Cardinals)

There’s going to be someone out there that says Andrew Miller was doomed by his playoff usage in 2016. He hasn’t been as good before or since, but who has? Miller was optimized almost all the way to a world seres ring. This isn’t a Dusty Baker style drubbing, but a bullpen usage that made sense at the time and more so now.

People forget that Miller was never durable, going all the way back to North Carolina. Great stuff, but there were questions about whether he could start. When he couldn’t there were questions about whether he could pitch enough to close. When he couldn’t, apparently only Terry Francona hit the right mix. This is about Miller’s durability, not about Francona’s calls to the pen.

Miller describes his issue as not being able to normally feel the ball. According to MLB.com, we know a lot of things it isn’t, including thoracic outlet, carpal tunnel, and nerve issues. He never mentioned an MRI that was reported, so I have to wonder if they’ve already ruled out structural issues. The Cards medical staff will continue to work towards some sort of diagnosis, but don’t be surprised if Miller tries to get back out there in order to learn to pitch through it.

It doesn’t take much to ramp up a reliever for their normal workload. It’s not zero, but getting to a chronic workload that will support their role is much easier. Getting through the recovery is the tougher part given the unsure schedule. Miller’s role isn’t standard, so unless they limit him to one inning and treat him as standard, he will need more of a ramp up. Keep your eye on this one.

Byron Buxton (OF Twins)

If I grabbed you in 2012 and showed you the shape of Byron Buxton’s career, you would have thought it nearly completely derailed by injuries. Despite his comeback from labrum surgery this off-season, injuries have been the least of his issue over the course of his career. It’s been struggles everywhere else, so the idea of coming back from one of the most complex and misunderstood injuries in baseball - even with the solid Twins medical staff - has me concerned in both the short and long term.

Any labrum injury in hitters appears to alter the swing and it takes hitters an extended period. Think about Matt Kemp, BJ Upton, or Hanley Ramirez and their struggles. Greg Bird is still fighting his way back and Brendan Rodgers is only slightly ahead on the timeline. There’s a bit of bias to think that it’s a power sap, but really it appears to be some kind of internal issue that causes a change in the swing. There’s not Blast-type data to figure this out, at least in the public domain and certainly not historical data, which is the major issue with any sensor or camera-based data sets.

When Buxton begins taking live BP later this week, I’m not looking for power, but contact. That’s going to be the start for him and if everything else comes behind it, the Twins should be happy with that. I don’t think this is going to be an easy or linear rehab and if Buxton finds himself back in Rochester at some point, I won’t be surprised.

Christian Yelich (OF Brewers)

Christian Yelich is about to sign a big deal, over $200 million according to Jeff Passan. It’s hard to say he doesn’t deserve it, but coming off a season-ending injury and looking out all the way to 2028 requires some squinting. I immediately think back to the Winter Meetings - Dallas, I think - where Albert Pujols signed his ten year deal. I don’t remember my immediate reaction, but I know I think vastly different about that deal now than I did then. I imagine that Arte Moreno and Tony Reagins do as well.

There’s really nothing to go off of with the fractured kneecap that he suffered last year. It’s an exceedingly rare injury, but Yelich was walking without a limp by the time the Arizona Fall League rolled around. He was batting by January - probably before - and doesn’t appear to be wearing any sort of pad over the knee. Despite this, the Brewers are on record as saying they took the rehab slow, including a move to left field that doesn’t appear directly related.

Bones heal and this is the only significant injury of Yelich’s career. Worst case - and I don’t believe this to be true - is that he loses some speed and defensive range. That’s not going to cost him a significant amount of his value.

If you’re wondering about that value and how “small market” Milwaukee can afford this deal, remember that Mark Attanasio bought the team for slightly north of Yelich’s contract - $233m - from Bud Selig in 2004. It’s worth more than a billion today, generating cash. (https://www.brewcrewball.com/2019/4/10/18305029/milwaukee-brewers-franchise-value-2018). If you don’t think the current bond market is helping Attanasio’s portfolio (https://www.crescentcap.com/capital-markets) to be able to afford Yelich and pretty much whatever else he wants, you’re wrong. He’s adding an MVP to that mix and will likely hold it for the next decade.

Quick Cuts:

Cody Allen is three teams removed from being a closer and even then, he wasn’t the stereotype. With both the Angels and Twins letting him go, he’s nothing more than a lottery ticket for the Rangers. He’s having more problems with his elbow and forearm in camp, so I’m worried. He’ll throw a sim game this week, but the leash can’t be long for him … Victor Arano had a terrible no-good awful 2019, ending a bad spring with minor elbow surgery. He came up with shoulder issues during the rehab and is now so far behind, he’ll start the season on the IL … Jose Altuve is out with an illness. Guess no one warned him that was coming … The Astros are more concerned about the knee soreness on Yordan Alvarez. He has a big swing that puts a lot of torque on his body - knees, hips, back - so the idea that he might have some early signs of breaking down is worrisome. I’m watching this one … With Christian Yelich’s big contract, the attention has long been gone from Ryan Braun. He hasn’t been a superstar like he was ahead of his big contract and steroid suspension, but he’s been healthy and productive. He’s got a mutual option next year but at age-35, he doesn’t appear in steep decline or having injuries that signal it’s impending. He’s not a Hall of Famer, but he’s definitely been a good value for money.

A couple readers asked why I used the older clip of Chris Sale in Monday’s UTK. The answer is, it was an interesting angle and there was nothing recent available. Buying something like Getty Image access would cost in the thousands, so for now, YouTube clips are the best solution. It’s not great but I’ll do my best to at least keep them reasonably related to the topic.

Reader Ari Kellman had a good suggestion, asking me to put a list of players at the top. I’ll use those as a sub-head rather than in the body of the article. I think that should make them more searchable, though the shift to the pay subscription may change that. I’ll have to revisit that once that function is up and running. If anyone has suggestions on making this change work better, or anything else, let me know.

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