Under The Knife 6/28/24

Neurocognitive Rehab

I won’t dive too deep into the weeds here, but I’d invite everyone to read this Sportsmith article which details a new approach to an old rehab. The case study follows a simple “basketball sprain” of the ankle, but uses an entirely new and neurocognitively focused rehab. (That sounds like a deep cut from William Gibson.) The details here about the mental issues in a physical rehab are key and really open a door forward. Keeping an injury from becoming chronic is one of the key goals of any rehab and seeing how that may be mentally focused is eye-opening.

Full disclosure: I’m the CEO of a sports company focused on mental testing, so I’m super interested in this, but I have been for years. We’ve seen a sea change in how mental health and mental fitness have been addressed, in society and in sport, over the last decade. I can remember learning how the Brewers were using their EAP program back in the Oughts and wondering why no one in sports media was interested. (Believe me, I pitched stories at ESPN and SI that were met with “no one cares.”)

The key here is there’s not just small gains and progressions to be made in rehab, but wholesale leaps. Those things didn’t look to be coming, but more scientific research in sports means more things come to baseball, even if MLB isn’t doing much to help fund or forward it. When I go to conferences, I’m always heartened to see baseball people there, but when I ask them how they’re going to implement some of the things we’re seeing in soccer, basketball, and extreme sports - all three are significantly ahead in sports science - they seldom have an answer.

I have one: start their own. While all the MLB people get together at the Winter Meetings, there’s little in the way of outside voices. While cross-hiring has done some to get new voices in, it could easily be more and could help trickle it down to lower levels, where they’re even further behind. Like I said, read the article and think about what it means for baseball.

For now, plenty of injuries:

BRYCE HARPER, 1B PHI (strained hamstring)
KYLE SCHWARBER, CH PHI (strained groin)

It was a tough game on Thursday for the Phillies, with both Bryce Harper and Kyle Schwarber leaving due to leg issues. Harper notably grabbed his hamstring as he crossed first, running out a grounder, while Schwarber left with a groin strain. Both are likely headed for imaging on Friday which will give more details, but given the initial reactions and information, both of the team’s top sluggers could end up on the IL. Both happened late in the game, but it’s hard to put any sort of causation on this.

Harper’s looked more worrisome. He pulled up, grabbing at the back of his leg in classic fashion:

Harper grabbed at the top of his leg, with the key frame there showing it. To me, there was no clear odd motion, which often means the belly of the muscle is the focus. Harper said after the game that he hasn’t felt anything like this, so there’s no guidance there. The hope is that the pain was mostly cramp, but this could be one that ranges anywhere from nothing to weeks, so I’ll refrain from speculating.

The same is true for Kyle Schwarber. There was even less information late on him, aside from the location and that he too would be heading for imaging. Again, there’s such a broad range of outcome and lack of information currently that I’ll avoid the guesses and say that this is one I’ll be following closely. In past years, I’d say there would be updates on Twitter, but that place is nearly useless these days and I haven’t figured out a good way to do that here. Might be time to try these Substack notes …

ZAC GALLEN, SP ARZ (strained hamstring)

The D-Backs may just skip the rehab assignment, smartly, with Zac Gallen. There’s not much a couple innings in Reno can tell them that isn’t known from his bullpens, sim games, and rehab work. Gallen’s hamstring has passed the physical tests and while his chronic workload is down, it’s manageable and having him pitch in Phoenix is better than wasting one of a starter’s precious starts on minor leaguers. This is the key on the re-think of rehab starts that I’m seeing around the league. As pitchers throw less innings in less outings, each one for the best of them becomes even more valuable.

The expectation is that Thursday’s pen will function as Gallen’s throw day. He went 41 pitches, but I dont think that’s an indication of how deep he’ll go on Saturday. In that start, I think it’s more about getting a couple innings work, with him almost functioning as an opener or if he’s very efficient, a starter with a shadow. Gallen certainly won’t go too deep, but don’t be surprised to see him going deeper than you think on a count basis.

The bigger focus will be what he can do during the pitches he’s out there and on that, I’m told Gallen is solid. He has all his pitches, nothing’s off limits, and he won’t be limited on an effort basis. It’s not a unique viewpoint in baseball to use pitchers with low chronic workloads, but this kind of bold choice is one that few teams do make. I like the process, but we’ll see how the result goes over the weekend.

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