Mound Musings: How to Handle the Inevitable Injuries

Injuries are a huge part of baseball, the actual game itself, and its fantasy counterpart. Success in the fantasy world makes assessing injuries mandatory. But, it's not just who will replace the injured player in your lineup, as there are many other factors that are part of the equation. How much time will my player miss? What should I expect when he returns? Was the poor performance immediately prior to his hitting the injured list related to the injury? Does this injury often include lingering side effects? Should I pursue an injured player on draft day, hoping for a significant discount?

That's lot to think about.

Naturally, we will focus on injuries to pitchers. I haven't compiled statistics, but it seems to me pitchers, on average, suffer more injuries of longer duration than position players. It may be a product of my bias, but I actually think it is a fact. Now I'm not a surgeon, a doctor, a trainer or even a first-year med student. My thoughts here are based on observation and experience, not an in-depth knowledge of the body. Folks, it's been a very long time since I took anatomy and kinesiology.

Let's start by stepping back and taking a deep breath. What you've seen regarding injuries, may be changing over time. Fifty years ago, it wasn't unusual for many starting pitchers to exceed 300 innings during the regular season. Today, only a handful will break 200 innings. There has to be a reason. There is, and it's probably three-fold. First, young people are asked to pitch at a very high level younger than ever before. That puts a lot of miles on their arms long before you see them in the major leagues. Second, the development of "new" pitches could put much more stress on the pitcher's arm. More velocity, and, more importantly, more movement, have brought newer pitches into prominence. Most notably, in my mind, the slider has become a key pitch for many, and by nature, it puts a lot of stress on the arm. And, finally, theoretically, bigger and stronger is good, but "max effort" pitching may be approaching the body's limits.

I don't see those factors changing. There is too much money involved. Teams will pay the big bucks for a high school kid with a big arm. Kids are going to be encouraged to chase that dream. Injuries, even major injuries involving surgery, are an accepted part of the equation. Missing time as a teenager is the norm now, and it's the price being paid for a triple-digit fastball and a wicked slider before the pitcher is old enough to drive a car. We just have to deal with it.

Some injury observations to consider:

The list of potential injuries would go on for pages. Everything from serious injuries requiring surgery (and rehab times of a year or more) to minor bumps and bruises you will probably never hear about will impact performance. In fact, over the course of a full season, most pitchers, literally almost all, will have stretches of performance that range between exceptional and horrible, and injuries are often part of it. You have to always keep this in mind. Being human, those pitchers out there on the mound will perform differently from day to day, and in some cases even from inning to inning. Again, not as a medical expert, I would like to share observations about injuries we read about every day and discuss my approach to handling these injuries.

• Tommy John surgery, or rebuilding an elbow – Perhaps the most publicized of all injuries a pitcher will face, serious ligament damage in the elbow is so common place these days it's nearly a forgone conclusion. The majority of pitchers will miss at least a year to rehab following this surgery. There is usually no warning. Something "pops," and the trainer walks the pitcher off the mound. Surgery typically occurs within a few days, and you can expect the pitcher to be out from 12 to 18 months. In the best-case scenarios, he can be back in 12, but may not be completely back for 18. Velocity comes back pretty quickly, but the finer points of control and command usually take longer. But, interestingly, there can actually be a positive side (if that's possible) to TJ surgery. Think of this surgery as providing a new elbow. Trade in that old worn out elbow for a brand new one with no miles on the odometer. The wear and tear will begin again, but most pitchers (not all) won't face this surgery again any time soon. At any given time, there will be quite a few high-profile pitchers at various stages of recovery from this procedure. For example, Carlos Rodon and Corey Knebel are expected back later this year, while Chris Sale, Jameson Taillon and Noah Syndergaard won't return until next season, and may not be completely back until mid-season 2021. The anticipated timeline is key in fantasy planning.
• Shoulder injuries are the most difficult to assess – I hate shoulder injuries. There are so many of them, ranging from relatively minor strains to more serious ones requiring surgery, and they all tend to be very difficult to assess. Most have a "typical" rehab schedule, but shoulders are finicky. Setbacks are common, and the pitcher's expected return can drag out for weeks or even months. Each case is individual – some follow the anticipated timeline – but more often than not, there will be delays, and my only real advice would be to exercise patience, waiting until he returns to mound work with positive reports following that work before beginning to plan on the pitcher getting back into game action. To be honest, I tend to avoid pitchers with an extended history of shoulder woes. I will add them if the potential return outweighs the risk, but even then I look for a pretty significant discount. A recurrence of shoulder issues seems to be the most likely scenario, so the risk requires an alternative plan.
• Thoracic Outlet Syndrome – I know what TOS is, in general. It's a compression of the blood vessels and/or nerves between the first rib and the collarbone. I suppose that makes TOS a shoulder injury, and more than most, this injury and the frequently resulting surgery carries with it a very unpredictable outcome. Years ago, Bill Singer underwent TOS surgery and came back to continue a solid career, but J.R. Richard never made it back following the procedure. More recently, Mike Foltynewicz appears to be bouncing back, but there are others like Tyson Ross, Phil Hughes, Luke Hochevar, and, perhaps most notably, Matt Harvey, who have failed to make a complete recovery. I'll admit, I am at a loss to explain why (there's that lack of medical training again) but the bottom line is, the percentage of pitchers who return to their previous performance levels following this procedure is very low, and the procedure seems to be happening more often of late. Until that trend changes, I will probably avoid these guys, at least until they have pitched enough innings to prove a complete recovery.
• Lower-body injuries should never be overlooked – It may be a bit counter-intuitive, but injuries below the waist can be very problematic. Arm and shoulder injuries can obviously impact a pitcher's performance, but pitchers actually rely very heavily on their lower bodies. Again, the range of severity can be wide, from minor muscle strains to injuries to the knee, for example, that can require surgery. Pay particular attention to injuries that involve the push leg – the right leg for a right-handed pitcher – since much of the pitch velocity and power is generated by the legs. If the pitcher can't drive off the rubber, the velocity will dip, and more pitches could end up in the top half of the strike zone. There can be setbacks, in rehab, but most lower-body injuries typically resolve and the pitcher can return to his normal capacity. The biggest concern here is the potential for mechanics getting out of sync to compensate for pain.
• The case of the "hidden" injury – How many times have you watched one of your pitchers string together a series of lackluster (or worse) outings before eventually, and mercifully, landing on the injured list? Aches and pains are part of sports. Most pitchers will try to pitch through a minor injury, and if there is just minimal pain, there's a good chance that will work. However, sometimes the injury is more problematic. Intensely competitive pitchers, and notably, young pitchers trying to establish themselves might try to pitch through a more severe injury. The team's trainer and medical staff may not even be aware of the injury. It's human nature to make "adjustments" to minimize discomfort, but those adjustments in mechanics and pitching motion can be devastating, and could linger long past the recovery of the injury.

The Baseball Return Watch: If baseball is going to happen in 2020, we have to be getting very close to a resumption of "spring" training. It's mid-June and baseball likely needs to start having games that count by early July. I'm still hopeful, but the deadlock really needs to break in the next few days. 

In just the past couple of days, the owners and the player's union have exchanged proposals and counter-proposals, but there are still major hurdles to clear. Part of it is the number of games. The owners have proposed 76 games, while the players union is asking for 114 games. There's some realistic hope they can settle that includes 80-plus games, but the owners don't want the regular season to extend past the end of October, and the two sides remain FAR apart on the pro-rated salary structure.

Some Notable Rotation Ramblings:

• Speaking of injuries, Chris Archer was lost for this season after undergoing thoracic outlet surgery. It came out of the blue with no real mention of problems until after the surgery. Like all TOS casualties, Archer is now on my wait and see list. Recovery is unpredictable, and I need to see some positive results.
• Kansas City's Brad Keller could be closing in on a breakout season. He has lacked a reliable off-speed pitch, but his changeup showed some improvement last season, and he is reportedly working on a curve that could give him the needed depth of repertoire to more easily keep hitters off balance.
• The St. Louis pitching staff is getting healthy, and while it's also getting a bit crowded, Carlos Martinez will probably have a spot in the rotation. Martinez was considered a possibility to close early on, but a compressed schedule, if and when play resumes, likely will make a six-man rotation part of the plan.
• One pitcher on the path back from TJ surgery is the Angels' Shohei Ohtani, and reports have been positive, as he has been pitching batting practice. He wasn't expected to be ready for the scheduled beginning of the regular season, but the pandemic delay has provided the necessary time to complete his rehab.

Endgame Odyssey:

The Phillies have likely lost their best relief pitcher until mid-2021. While he wasn't expected to close games, that job probably belongs to Hector Neris at least early on, Seranthony Dominguez was expected to be a key member of their pen. He is expected to undergo Tommy John surgery in the near future. Part of the reason the Cardinals are leaning toward Martinez serving as a starter is the probability that Jordan Hicks will be able to contribute. He may not be ready right out of the chute, but Giovanny Gallegos likely can fill in until Hicks is up to speed. I will be very curious to see how the Dodgers' Blake Treinen comes out of the long offseason. He struggled through an injury plagued 2019, but now reportedly healthy, he likely will be counted upon to serve as their primary set-up man, as well as an insurance policy for Kenley Jansen.