Under The Knife 7/10/24

Looking Deeper, Better

A reader last week asked me about why we were seeing a rash of unusual injuries like stress reactions. The simplest answer is “we aren’t”, but if a handful of injuries is unusual, the cause is almost making Jim Palmer right. Palmer famously (and wrongly) says that pitching injuries are caused by MRIs. Don’t say he’s being facetious; he’s been doing it for twenty years and even when challenged, he’ll double down on it and get into almost a Schrodinger’s cat argument that if you don’t diagnose an injury, it doesn’t exist and just pitch through it.

Rant aside, some of these injuries are simply unusual, like Fernando Tatis Jr’s femoral stress reaction and others are simply caught earlier or more clearly by new and better imaging technologies. Stress reactions are the earliest noted signs we have of bone issues that could lead to a stress fracture. Better MRIs, the use of portable and high-grade ultrasound, and other advanced imaging technologies are like going from standard to HD. Doctors simply get a better view and see more things. And yes, there are things to see.

Which is not to say it couldn’t get even earlier. We know that on a cellular level, there are changes that come even before stress reactions and are considered normal reconfiguration to some level, but in other ways could be seen as a sign. For a pitcher that might be a reduction in stress, a change in mechanics, or maybe the medical staff just monitors to see if the reaction gets worse or is manageable with treatment.

What we’re having then is not likely to be an increase in injuries, but an ability to better and more quickly diagnose things that were previously undetectable or took a longer process to get to. There’s more of this coming, and a wider rollout, to the point that there’s a medical grade ultrasound tool that connects to an iPhone.

One would think that getting better at diagnosing injuries and catching things earlier would be universally touted. Instead, the old school element sees more IL stints, rather than the longer term outcome of catching things earlier and having shorter, less serious periods of injury. The better medical staffs get at this, the more IL stints we’ll see, which will lead to something of a vicious circle. Normally, education would help, but with most of these in sports, few listen and we just have to wait for it to normalize.

While it’s asymmetric now, we’ll see quirks like one team being better at diagnosing things like this. It’s comparable to the Rangers having 80 percent of all baseball cases of thoracic outlet syndrome. It wasn’t that they had a higher incidence, but that their doctor was looking for it earlier … and finding it. I think we very well could be going for a step change in diagnosis and speed in the next five years, with better tools and AI leading the way.

For now, we have plenty of injuries:

TYLER GLASNOW, SP LAD (inflamed back)

This news came out of nowhere. Tyler Glasnow hits the IL with “back tightness”, said to be new and first noted over the weekend while he was playing catch. Yes, the schedule and ASB has a lot to do with the fact the Dodgers are willing to push him to the IL, but there has to be a bit of PTSD given all they’ve dealt with along these lines for Clayton Kershaw over the years.

A trusted source tells me this really is just soreness and a bit of spasm, nothing that they think will go past the minimum. Again, the context and timing seem to matter as much as a minor injury. Add in that the Dodgers pitching staff has been short all year, papered over by talent rather than depth, and an adept usage. The team now has SEVEN of their top expected pitchers on the IL, plus the quirk of Shohei Ohtani, so it’s eight. There’s a little more coming but like last year, rushing pitchers and pushing them further does have consequences.

Justin Wrobleski is likely to take the one start Glasnow is expected to miss, though with Kershaw on his way back, how the Dodgers put together their rotation heading into August will be really interesting. River Ryan (a perfect pitcher’s name) is coming fast at Triple-A, but is in much the same situation as Emmett Sheehan last year. The handling of this staff, which seems to almost never be stable, is absolute mastery by Dave Roberts and Mark Prior, and I’m finally hearing Prior mentioned as a possible near-future manager.

ZACH WHEELER, SP PHI (inflamed back)

Back tightness seems to be catching. Zack Wheeler left after five innings with what the Phillies called a tight back, and Wheeler telling the media he expected to make his next start. He also said he’d been dealing with this for a while, so it does seem to be exactly what they said and more a management/fatigue issue than something drastically wrong. It doesn’t make it less serious, but again, the timing of this makes it much easier for the Phils to skip Wheeler next time through if need be. Which is convenient.

A trusted source tells me that Wheeler has been getting more treatment lately and that adjustments to his between start work had been made as well. This is the first time it’s really acted up in game and Wheeler didn’t hesitate to let the medical staff know, a good sign.

I spoke with an AL pitching coach recently about the spate of back injuries around the league and he wondered if we’re seeing some sort of “cricket problem.” Bowlers in that sport have few arm injuries, but many back injuries due to the mechanics of their sport. As the force of pitching increases, we have seen changes. Thinking back just a few years, we had increased teres major and lat strains as velocity stepped up, but there’s so little data to work with outside of baseball as to be almost unknowable if we’re seeing more forces transferring to the lower back.