Under The Knife 4/4/22
Fatigue Sets In
Seasonal fatigue is brutal. I tweeted this about an absolute flurry of ACL sprains across European soccer, but it is true for baseball as well. But first, let’s define the three types of fatigue:
Task fatigue - the body’s fatigue response to a single task. Think of this as a cost, such as each pitch. It’s not the same cost for any particular task, but can be measured for each of them. In soccer, one of the key tasks is the ability to make quick sprints over distance.
Game fatigue - This is the cumulative cost over a single period of activity. 90 minutes of a soccer game, a number of pitches for a pitcher, and the burst tasks for a baseball position player.
Seasonal fatigue - This is the cumulative cost over a single or even multiple seasons, built of all the game and training costs.
All of these are variants of the same internal constraints. The body is in a certain condition, has a certain amount of fuel, and has a number of tasks that have to be completed according to a schedule. All of them have costs, both single and cumulative.
On the reverse side is recovery. It’s so much a mirror image that I wonder if Dr. Mike Sonne’s fatigue units requires the existence of recovery units. It would be the yin and the yang, the positive and negative, matter and anti-matter. (Sonne told me it’s already baked into the calculation for fatigue units.) I think recovery units have to be better quantified, though we may have to get to the cellular or transport levels to really see it, or at least to see it more accurately.
There is research from estimable people in the field that says that injury timing is random. While I acknowledge this, I don’t feel that any of this research is definitive. Fatigue does not work on a schedule and being at the end of a season does not mean someone is fatigued. Our lack of data on all of this leaves it, to me, an open question.
What we know is that we see two clear periods in baseball where more injuries cluster - the beginning and the end. This is ramp-up and seasonal fatigue, to me, but again, there’s no definitive research or holistic case studies to back me up. My hope is that we’ll see a lot more on this in the coming years as we get more data on recovery from sources just coming into use, like Eight Sleep, Therabody, Hyperice, and even simpler trackers like the Apple Watch. Things like CGMs from Levels and others might give us even more insight into current state, fatigue, and readiness.
There’s so much more research to do and so little is being done or even supported by MLB. We’re seeing leadership come from the college level, where places like Wake Forest, Michigan, and Louisiana Tech are putting up labs and supporting some bold research. I expect to see some fruit from that soon, but as the NFL has done with helmets, MLB could do that with arms - use money as an accelerant. Let’s get to the injuries:
JACOB DEGROM, SP NYM (fractured scapula)
Now that the panic about Jacob deGrom has mostly passed, we can get down to the analysis. DeGrom’s scapula stress reaction is not unheard of, but also not common. There have been several pitchers who have had this and come back, but none of those pitchers threw as hard as deGrom. Which is interesting, in that the force itself may not be the issue.
Instead, this is a biomechanics problem. Specifically, this is a deceleration problem. “All gas and no brakes” is a nice t-shirt slogan, but it’s really bad for a pitcher. This has happened to several pitchers and I can’t find a situation where a pitcher hasn’t come back from it. It’s weeks not months, but it will necessitate both a ramp-up and an assessment of why this happened.
The Mets need to be doing some soul-searching around why this keeps happening, not just to deGrom, but to far too many of their pitchers. One thing a scout noted to me is that Noah Syndergaard has looked good this spring, making a couple starts and heading into the season healthy. The Angels say they don’t have an innings limit on him and with a one-year deal, why should they? If the Angels, a team with plenty of injury issues of their own have figured out how to keep Syndergaard healthy, why couldn’t the Mets?
MAX SCHERZER, SP NYM (strained hamstring)
Speaking of the Mets, Max Scherzer was scratched from his start with a mild hamstring strain. Buck Showalter got a bit poetic about it, but he’s had to be a bit of a dancing monkey, keeping the press and the manic-depressive fan base’s focus on him rather than the Scherzer scratches and deGrom shutdowns.
There was one report that I retweeted after being asked that stated Scherzer’s issue was in the semimembranosus tendon. That’s oddly specific and not something I can ever remember a team, let alone the Mets, giving out. This would also indicate that the source was deep in the medical staff. I don’t even ask for this level of detail because aside from the athlete and that staff, who cares? It doesn’t make a difference to you any more than knowing “mild hamstring strain.” Keep it simple, I say.
I don’t want to rant about random people on Twitter sourcing things because once, before Twitter, I was that guy. I don’t know whether the guy has a miracle source, or is just making up oddly specific things as a troll. You build credibility over time, but can tear it down quickly.
Back to Scherzer, all indications are that this is indeed minor and that Scherzer is pushing to get back out there on or near Opening Day. I’m not sure the Mets will do that without him at least showing he can pitch on the mound, maybe a sim game, maybe a retro IL move (since it’s ten days and that there are minor league games to start him in even before the MLB season. It’s an odd combo to be sure, but it might work in Scherzer’s favor. We should know much more early this week.
WADE MILEY, SP CHC (inflamed elbow)
Maybe the Reds knew something? I doubt it - he passed the incoming physical - but Wade Miley not throwing in camp was a red flag. The Cubs said it was part of his program, but that program involves some inflammation inside his elbow (not his forearm) and he’s shut down for at least a couple weeks. At age-35, this is obviously not ideal and the whole idea of “veterans need less spring work” is a terrible one, especially in a spring where the pitching coaches and ATs haven’t been able to be in regular contact with someone they’re not that familiar with!
The vague “inflammation” doesn’t tell us much, but there’s worry within the Cubs camp that Miley will be out longer than what a ten day shutdown will say, nor is there any indication of what the team is doing now. PRP injections are common at this stage, with very mixed results. If this is indeed a UCL sprain, we know where that often leads.
The Cubs are shifting Justin Steele to a starting role, but the fact that they’re making that decision this late is interesting. The Cubs have had other injuries to their rotation and are super top-heavy with Marcus Stroman and Kyle Hendricks. The other starter brought in, Steven Brault, is out with a lat strain, so the Cubs have brought in some cheap depth, but in doing so bought some injuries. We’ll see how that works out in the long run.
CHRIS PADDACK, SP SDP (no current injury)
I’m going to give you a crazy theory. I think the Padres have so much pitching depth but so much injury risk that they’ll go with some strange plan to make the rotation work. Nine man? Four piggybacks? Playing with the numbers it could work, but going down to five or six relievers is interesting. Yesterday’s pairing could go on the inactive list and you’d have a throw day pair that could be used for an inning each, but I don’t know that it could be sustained the way modern baseball is played. I’m also not sure it couldn’t work.
On Paddack, the rumored deal to the Mets didn’t happen - and remember all the people telling me that Hosmer couldn’t be dealt, even without a salary floor - but it does show that Paddack’s UCL sprain last season isn’t worrying teams too much. I’m told by one source that the Mets got medical on Paddack and at least one other pitcher and that the Mets didn’t stop, though the trade would have been contingent on a physical which would have involved more imaging.
While the Padres could take their collection of oft-injured pitchers and do something creative, I think the more likely path is that they trade a pitcher or two, keep a couple starters in El Paso, and hope that something they did this off-season or just simple regression to the mean keeps them away from the kind of injury numbers they’ve seen over the past couple seasons.
LUIS CASTILLO, SP CIN (inflamed shoulder)
MIKE MINOR, SP CIN (inflamed shoulder)
The Reds have some issues, and they also have some flame throwers. With Luis Castillo and Mike Minor down for the start of the season, the Reds are down to four or five starters. The team will go Tyler Mahle, Reiver Sanmartin, Vladimir Gutierrez, and then phenom Hunter Greene. Those are the locks, but an off-day makes it so Mahle could go again and there’s an opening there for Nick Lodolo, the 1A to Greene’s 1. A team would never rather have injuries, but the Reds might get the unintended consequence of seeing the future.
Luis Castillo is “making progress” according to one source, but he’s also not yet throwing significantly. The shoulder inflammation has abated, but there’s worry that it will return when he gets back to a normal throwing schedule. The question is how his shoulder recovers, so there’s been discussion about limiting him more or sticking with a six-man for a while as the team figures out what it can get out of Castillo.
As for Mike Minor, his shoulder injury is also progressing slowly, with the Reds also hoping he’ll be able to come back mid-April and acknowledging that he will be innings-limited. If Castillo and Minor can only go three or four innings, will they be sent to Louisville, or will the Reds piggy-back their titular 1 and 2? I’d argue the latter is better with expanded rosters and options early, but depending on how late in April those happen, the door could be closing.
GARRETT CROCHET, RP CWS (sprained elbow)
The Chapman Conundrum continues. If you haven’t read The Science of Baseball yet (shame on you) this is my term for the concept that pitchers throwing 100 mph at the major league level do not survive. (The actual number is 98, but round numbers, man.) Garrett Crochet throws hard and now he is headed for Tommy John surgery.
Another hard thrower from Tennessee, Crochet has had elbow and forearm issues almost since reaching the Sox roster. He did that quickly, but while he’s been effective, it’s been sporadic and even the wizards with the White Sox sports med and sports science staff couldn’t hold him together. The stress on the arm is pretty high, as you can see below.
There was one report that Crochet had Tommy John surgery in high school and I don’t believe this was correct. I wasn’t able to confirm with anyone, but there’s no note of it or big gap in his record that wasn’t explained by something else. (He broke his jaw on a comebacker in college.)
Crochet should be back for the ‘23 season or thereabouts. The 14-16 month common timeline would put him back at mid-season. The White Sox will be watching Michael Kopech closely and if he stays healthier in the rotation, it might be something they try again with the similar Crochet.
Quick Cuts:
Let’s have some good news. Jack Flaherty is kind of throwing. The team says Flaherty is doing “plyometric throws.” Either Oli Marmol isn’t keeping up on the pitching side or he was just being oddly specific. Either way, plyos are a positive step … More good news? Dustin May threw his first bullpen after Tommy John surgery about a year ago. He’s slightly ahead of the Dodgers’ “midseason” schedule … Alex Cora said the team found a flaw in Matt Barnes’ delivery - a lower leg kick - that they believe might be costing him velocity. Very curious how they monitored this and to see if there’s quick results … Add Luke Jackson to the Tommy John club. While a final decision hasn’t been made, the Braves announced he had a significant sprain. He was used heavily in their World Series run, but also has a ring to go with the scar. Seems a fair deal, if you can even blame one on the other … Austin Meadows has a quad strain. The team will monitor, but there’s a chance he starts the season on the IL … Lance Lynn has a torn tendon near his knee. That description is vague enough that I need to find out more before making sense of this, but the team says he’s out four weeks and then will build back. There’s late word that he’ll have surgery early this week, but no timeline change … Chris Sale still isn’t throwing, but there’s no hard timetable on that yet, or his return either … Josh Rojas has a significant oblique strain and will miss somewhere around four weeks. This kind of injury usually affects guys with a big, long swing more and that’s not Rojas … Via Jim Allen’s indispensable NPB News, 2020 Japanese MVP Tomoya Mori will miss six to eight weeks after breaking his finger. He reportedly threw his mask and, well that’s unclear. Did he catch his finger in it or did it bounce back? Regardless, a big blow for Seibu … With the Ricketts family raising their bid for Chelsea without adding other entities to the bid, there’s going to be more pressure for them to spend on the Cubs or at least, not sell off any more pieces. If the Cubs are bad at mid-season, that bid, successful or not, will tie Carter Hawkins’ hands … The rumored Jose Ramirez extension is down to the last days to get it done. I’m told that David Blitzer (another Chelsea bidder) is not involved at all. Wonder if he’d be more inclined to get a deal done … One of the things I always wonder about is what a suspended player does to keep up his at-bats. Marcell Ozuna is the latest case. After his year gone, he’s batting 182 with one homer this spring. Robinson Cano, admittedly older, is hitting 222.
The next column will, I hope, be made up of any pre-Opening Day questions you have. I’ve never done a full “mailbag” because no one will approach Bill Simmons’ mastery of the format in the Page 2 days but I do try to answer questions, whether here or via email. (theinjuryexpert@gmail.com, in case you didn’t have it.)