Kuzul

There is no such thing as a five-man rotation anymore. Looking around the league, teams are planning ahead for injuries to their pitchers to determine how deep they can go, packing in seven or eight guys rather than trying to prevent injuries or shorten up the rotation. A great example of this is the Atlanta Braves, a team that is already suffering through injuries to Mike Minor, Kris Medlen and Brandon Beachy, as well as a known issue with new acquisition Gavin Floyd. 

The Braves announced Tuesday morning that an MRI on Medlen showed “ligament involvement.” Given that Medlen had Tommy John surgery in 2010, this is not a good sign. Dave O’Brien of The Atlanta Journal-Constitution had more info: 

While Medlen will have more tests, many speculate that he will need a second replacement of his UCL. Leo Mazzone, a former Braves pitching coach, was on 680 The Fan in Atlanta and said, “Any ligament involvement is bad.” Medlen does not have a complete tear (rupture) of the ligament, though it is also more difficult to read the ligament after the replacement, due both to physical changes and the hardware used.

What the Braves have now is a mess. If the season were to start today, the most likely scenario would have Freddy Garcia as the second starting pitcher and Alex Wood, who would be the bullpen lefty in a perfect world, would shift over to be the third man in the starting rotation. Behind them, the Braves would have to get creative, with prospect Cody Martin being the top possibility. 

That not only puts pressure on the back of the rotation, it puts a ton of pressure on the ace-by-default Julio Teheran. The young pitcher only went 185 innings last season, and to expect much more than 200 would be stretching things. While Teheran does project as a potential ace, the Braves also have to protect him in the first season where he’ll jump the 190-innings hurdle.

That one, more than any other mark, is a real test for pitchers. While 200 innings is used more because it’s a round number, my research from 2003 showed that 190 seemed to be the bigger test. Pitchers that stayed above that mark tended to do it year after year, but once they dropped below it, even by a little, it was tough to come back. There are a lot of pitchers who never make that mark, though they can be very productive otherwise.

A team goes into a season planning for 1,500 innings. The season is set to be 1,458, but there’s extra-innings games and maybe the playoffs, so 1,500 is a good number. For starters, the team needs to get somewhere between 900 and 1,000 innings. Having five 200-inning pitchers is unlikely, so a team either needs one or two to go above the mark, for the bullpen to take more of the load or for the load to be distributed over more than five pitchers. 

Given the situation now, general manager Frank Wren and his team are likely looking at all the options. Panic is a poor negotiating position, but when the plan for depth that they had—signing Garcia and Floyd to protect younger pitchers like Martin—has failed in mid-March, every other team is going to know the situation. I imagine that scouts are already watching the back fields at Disney for an ask.

Many are wondering if the Braves will make a last-minute offer for Ervin Santana, the last solid free-agent pitcher on the market. After firing his agent, Santana has received several offers and was strongly linked to the Blue Jays. While Santana has a preference to stay in the AL, the Braves could be forced to up their offer and make him consider Atlanta.

Others are asking whether Wren will hit the trade market. There’s very little available, with crazy Twitter ideas coming fast and furious. Options like David Price and Jeff Samardzija have been mentioned, but neither the Rays nor the Cubs would give up either of their aces without a ridiculous return, something the Braves just don’t have, even if they were willing to add on to a package starting with Christian Bethancourt. A major trade would gut the team’s system, though the Braves could give a lower-level prospect for a more ready pitcher.

On pure stats, the Braves had a terrible 2013. They ranked 27th out of 30 teams, losing over 1,500 days to the DL. For pitchers, it was over half the total, with four pitchers losing more than 100 days each. That is significantly up from losing pitcher totals in the 500-day range in the 2011 and 2012 seasons.

Most of those major losses was to Tommy John surgery. While many say it’s unavoidable, the sheer numbers that the Braves have had demand some attention. Compare having multiple pitchers in various stages of rehab to the Rays, a team that’s had three Tommy John surgeries in the past decade. Yes, it’s possible to reduce injuries, though it requires a serious commitment. 

As I mentioned earlier, one of the possibilities for filling in behind the injured starters is to transfer some of the load to the pen.

For the Braves, that may not work either. They already have Jonny Venters rehabbing to return and had lost Eric O’Flaherty to Tommy John as well, though O’Flaherty signed with the Oakland A’s this offseason despite his status. The Braves pen has more depth, even if Wood gets shifted to the rotation, but the pitchers are young and untested—precisely the type of pen that a team shouldn’t shift the load to if there’s another option. 

In fact, more of this pen may need to be shifted over. Wirfin Obispo is fighting for a pen slot, but at age 29, he might be pushed to make a couple spot starts. The same is true for David Hale, who has the advantage of having worked as a starter for much of last season at Triple-A Gwinnett. Besides Cody Martin, the bulk of the Braves’ pitching prospects are in the low minors, making that a tougher shift. 

Some of this may recall the Toronto Blue Jays. For over a decade, the Jays have had a terrible time keeping pitchers healthy. Their medical staff is well regarded, but pitchers at all levels and of all types end up with all sorts of arm issues. It’s a major hole in their plans and has held them back by causing depth issues and taking out some top prospects from longer-term usage. 

The Braves are also well regarded, but their pitching problems have seemingly been coming to a head over the past few seasons.

One source I spoke with believes that the pitching program the Braves use is at fault. “You can’t look right at when Leo Mazzone left. That’s been too far out, but his influence and his program has faded. There’s probably no one left that worked with him,” I was told Monday. 

There are no easy solutions here, though the Braves are looking at all possibilities. The team has not been progressive in regard to biomechanics, but the Braves do use video heavily to assess pitchers. My source also told me that the team is willing to get creative with organizing its staff and would consider a four-man rotation if it felt that was the best way to get through the season. 

Frank Wren and skipper Fredi Gonzalez have a big task ahead of them. It’s hard enough to build a pitching staff in modern baseball. It’s even harder to rebuild one on the fly.

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The Minnesota Twins got the news they were dreading Saturday morning. Their top prospect, Miguel Sano, will have Tommy John surgery and miss the 2014 season, as reported by ESPN.com.

While Tommy John surgery has a shorter recovery period for position players than it does for pitchers, who obviously throw more, a lost season and a possible position change could change the fortune of the player ranked No. 6 in the game by Baseball America.

An MRI and exam confirmed that Sano has torn his UCL (ulnar collateral ligament of the elbow). Sources tell me that there is still some worry that there is more extensive damage inside the elbow and that the surgeon, when chosen, will need to check it thoroughly when he goes in.

One source told me that the biggest fear is damage to the articular cartilage of the elbow, which could affect his long-term ability to throw with power. This could necessitate a position change.

The elbow was checked immediately after Sano injured his elbow in an intrasquad game on a simple throw. The doctors were concerned that the UCL had been compromised. Sano had previously hurt his elbow during winter ball, but he had cleared his physical coming into camp.

Since the team knew about the winter injury and monitored it, it is hard to believe that it would not have checked this in addition to the normal pre-camp physical. These physicals are often superficial, but known problem areas are usually checked thoroughly in order to maintain a paper trail for possible insurance and worker’s compensation issues down the line.

The normal recovery time for a pitcher having Tommy John surgery is between 10 and 12 months. For a position player, it can be less, as little as six months but normally closer to eight or nine. For more information on the surgery itself and its background, please read this award-winning series of articles.

The Twins’ Rob Antony, the assistant general manager who is running the club while Terry Ryan is recovering from cancer surgery, told the media that the team believes Sano will be back to hitting in four months.

Here is Sano himself discussing the upcoming surgery, courtesy of Mike Berardino of the St. Paul Pioneer Press:

But they do not expect Sano to play this season. He may need winter ball again next season, though teams are often reluctant to let rehabbing players play outside close supervision of their own medical staff.

The list of position players who have had Tommy John surgery isn’t as extensive as it is for pitchers—but it’s not short either. Players like Jose Canseco, Luis Gonzalez, Tony Womack, Shin-Soo Choo and Kyle Blanks have had the procedure. All returned normally and without significant change to their game. However, there’s not many in the way of plus-throwers in there. 

While Albert Pujols did not have Tommy John surgery, he did damage his ulnar collateral ligament. It forced his move from third base, initially moving him to left field. He was limited in throwing so much that Tony La Russa devised a new relay system, sending shortstop Edgar Renteria deep into the outfield to shorten any throw.

Pujols quickly moved to first base after the throwing because of untenability. He later had nerve transposition surgery on the elbow, but refused to have Tommy John surgery.

The downside for Sano is that he no longer has as many options as Pujols did. Joe Mauer’s shift to first base from his previous catcher slot makes it nearly impossible to move Sano there. In fact, Mauer’s position was switched in part because Sano was expected to play third. Mauer is athletic enough to hold the position, so those plans may have to shift somewhat if Sano shows any throwing deficits.

The rehab process is very similar for position players as it is for pitchers. Sano should be able to recover, but for a player who has already overcome so much to be in this position, he can’t make up the time lost. Along with Byron Buxton, Sano is the vanguard of Terry Ryan’s team remake; losing a year won’t help, while positional issues may alter the plan altogether.

While Sano should return, there are more questions than answers at this stage.

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To understand the ratings here and why these specific players are risky, first you must understand risk. This is not a general term, but a very specific term of art most closely related to the insurance industry. While we all know Flo and the Geico gecko, few of us have learned how insurance works or why it’s so profitable. If you want to know why Matt Kemp, Derek Jeter and Joe Mauer—three of the biggest names in baseball with contracts to match—are risky, please let me explain before you blow up in the comments.

The Risk Ratings are based on a system that I have been developing for the last 14 years. I was lucky enough to be given access to the actuarial tables created by baseball back then from their actual injury data. Those “Red Books” stopped being published a while back, but the data continue to be developed. Much like you have a rating when you go to insure your house or car, players have the same type of rating. 

If you drive a Corvette, your insurance base will be higher than if you drive a Camry. If you’re a teenager, your rates will be higher than that little old lady from Pasadena. The same is true for baseball players. Age, position, injury history and several other factors go into the ratings. They begin with an actuarial base and then are adjusted up or down by the various factors.

The ratings are then simplified into bands. While there is an underlying number from 0-110, I collect them into three bands—red for high risk, yellow for medium risk and green for low risk. It’s simple and while people often ask for more specific numerical ratings, I don’t feel that it adds significantly to the value of the Risk Ratings.

(Also, I’m admittedly paranoid about people trying to reverse engineer the system! It’s been tried.)

I’ll have the full ratings for you on Friday, in plenty of time for your fantasy drafts, but for now, here are 10 top players whose risk is such that you’ll need to really think about them before putting them at the heart of your team. Of course, the managers and general managers of these teams have real concerns as well. 

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The 162-game penalty meted out by baseball’s arbitrator barely registered, but the 60 Minutes piece with Tony Bosch seems to have shaken baseball fans. Seeing a snake-oil salesman telling his story made many wonder why several of baseball’s biggest stars, including Alex Rodriguez and Ryan Braun, would trust him with their careers.

The better question is, how many Tony Bosches are there out there? With a “Low T” clinic on every corner, there will be more than a few who think they know how to beat the system. There are always salesmen who can persuade someone who’s been told their whole life that they need to be just a little bit better, and baseball players are told so often that PEDs are a magic bullet.

They aren’t. 

The drugs listed in this article that I did when the Biogenesis story first broke aren’t really the issue. While Bosch showed he wasn’t even sure what drugs were banned—he also didn’t care—all but one of them have a test in place. What Biogenesis proved is that there are challenges for the drug testers, not that “the cheaters are ahead,” as many have put it.

There’s no magic drug or protocol that Bosch or anyone else has in baseball or any other sport. What cheaters are doing is using a low amount of testosterone that stays below the detectable level. But does a dosage less than what is normally taken have any performance-enhancing effect? The levels that Bosch discussed on 60 Minutes are well below the levels that a person using prescription testosterone such as Androgel would be given. 

The success of Bosch’s program is illusory. While the 13 athletes who were caught by non-analytic methods got the notice, few remembered that Braun, Melky Cabrera, Bartolo Colon and Yasmani Grandal all were caught by the testing program. There are likely a few more in the minor leagues as well, though MLB refused to comment. 

Bosch’s clients were playing roulette, hoping their number didn’t come up. They didn’t “beat” tests, but generally got lucky. Low doses and short detectable periods make it difficult to catch people using, but only in terms of timing, not testing. If the testers happened to come with a cup, the offenders got caught.

This is not a loophole. This is how a random system is supposed to work. The athletes never know when their name will be called, which should be a deterrent to most. With a positive rate below one percent, down from over five percent just a decade ago, the system is working. Increasing the frequency of tests would work, yes, but outside of daily testing, gaps will still exist.

What many think is possible with protocols like what Bosch sold simply isn’t. There are undetectable drugs, but the reasons go beyond testing. At this time, there’s no new “Clear.” BALCO sold a drug it called “The Clear,” which is an anabolic steroid known as THG that had an unknown chemical structure and therefore couldn’t be tested for. (A test was quickly developed when a BALCO rival turned in a sample.) 

Despite continued demands for increased testing and a more sensitive testosterone screen, the associated costs and ability to conduct that many tests are prohibitive. MLB’s drug-testing budget isn’t released, but the cost of collection and tests alone puts its expenses near that of the entire budget for the UK’s drug-testing program, one that’s undergoing cuts over the next few years. While there are certainly small changes needed, MLB’s drug testing is singularly effective in sport.

For years, human growth hormone couldn’t be detected, but a test was developed and added to baseball’s testing program a few years ago. It is a blood test and there are still serious scientific questions about its effectiveness. Bosch said that Rodriguez used IGF-1, which does not currently have a test, though there are also major uncertainties regarding the drug’s effectiveness.

There is one other drug that is widely used and undetectable. While I don’t want to give details, it’s a natural substance that simply cannot be tested for, now or in the foreseeable future. There are major side effects to its use, including death, and it requires considerable knowledge or supervision. All major organizations turn a blind eye to this because there is no answer.

The problem is not with the testing, but with the fact that baseball and sports in general continue to treat Biogenesis like an isolated incident. When the BALCO story broke, it was the same thing. Kirk Radomski? One bad guy. Brian McNamee? Another bad guy. As Yahoo’s Jeff Passan wrote, “Bosch isn’t special. He isn’t different. He’s just the latest.”

Let’s face it, there are a lot of bad guys out there and they’re not all stupid. It’s the smart ones who should scare us. 

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Tim Hudson‘s 2013 season with the Atlanta Braves ended with a gruesome ankle injury, but that didn’t stop the San Francisco Giants from signing the free agent to a two year, $23 million deal this week.

He’ll step into Barry Zito’s slot, replacing his old teammate on the payroll, but can the Giants really expect Hudson to come back from such a dramatic injury and solidify the rotation behind Matt Cain and Madison Bumgarner?

Hudson’s ankle injury was one of the toughest to watch in recent memory. Covering first base, he was accidentally stepped on, fracturing the fibula and spraining one of the significant ligaments of the ankle. Those were repaired surgically in late July with the pin fixating the fibula. The pin was removed earlier in November. That removal is a very good indication of his progress.

In congruence with that removal, it appears Hudson is on pace to have a normal spring (h/t to Alex Pavlovic of The Mercury News):

Things are going to plan. 

“The ankle’s coming along just fine, not quite 100 percent right now but it’s well on its way,” Hudson said in a news conference Tuesday, as reported by the Associated Press. “I anticipate in the next month or so start throwing bullpens.”

While the injury was dramatic, the rehab has been typically boring. Bones heal normally and predictably and can easily be monitored. Speaking to sources with knowledge of Hudson’s injury and rehab, Hudson is still relatively early in the rehab process. Due to the timing of the injury, Hudson has been able to essentially do nothing but rest and heal up to this point. I’m told he has done very light rehab and cardio work with the expectation that he would be able to have a normal offseason schedule leading up to next season. 

Hudson, 38, and his agents likely considered more than just money when it came to signing with the Giants. The Giants medical staff, led by Dave Groeschner, has been one of the best of the last decade. Over the last three years, it ranks a bit down from their historical norms. According to my proprietary database, the Giants rank 13th in baseball from 2011-2013 based on days lost to injury. The Braves were ranked 18th over the same period. 

There are no good comparable players for Hudson in terms of this injury. The unique nature of the injury makes it tough to find anything comparable, which is good. Hudson’s injury was to his right (push) ankle, which could cause some issue with force generation. However, the ankle is expected to be stable, which should mitigate any real issues. Hudson’s velocity has trended downward, so he may not have much margin for error if he does lose more to injury and time.

So what can we expect from Hudson’s move back to the Bay Area? One of the most accurate projection engines, Steamer, has Hudson roughly matching his stats from the past two seasons. Remember that in 2012 Hudson was returning from Tommy John surgery; even with his age going up, it’s not unthinkable that a healthy Hudson could exceed these expectations.

I also don’t believe this projection adjusts for AT&T Park, which plays slightly more pitcher-friendly than Turner Field. Current estimates have a win above replacement (WAR) costing just over $7 million. The Giants would gladly take a two-win season, even if it’s overpaying a little for the privilege.

The details of the deal have yet to be released, but there are likely incentives included. Those could be safety nets like innings-pitched bonuses that would be proxies for Hudson’s health and effectiveness. There is also sure to be a “pending physical” in there that would allow the Giants to back out if something unexpected is found. That would be unusual since Hudson’s situation is well-known and he is likely to have submitted to more tests, if not a hands-on examination. 

Hudson should fit well in the rotation and the team. He’s familiar with the Bay Area and the media, so there should be little adjustment in that regard. Dave Righetti is a relatively hands-off pitching coach and Hudson isn’t someone who needs hand-holding or regular work on his mechanics. From a medical standpoint, there is some risk, but I believe both Hudson and the Giants are well-equipped to deal with it. 

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Miguel Cabrera fought through the last month of the season and then the playoffs while dealing with an amorphously defined injury. The Tigers variously called it a hip, groin and abdomen issue during the season, then Tigers GM Dave Dombrowski announced that Cabrera had a Grade II or III groin strain.

According to Jason Beck of MLB.com, surgery performed Tuesday finally gives us clarity: Cabrera had a core muscle injury repaired.

Wait, what?

Dr. William Meyers is one of the top sports hernia doctors, having performed this surgery on many professional athletes including Josh Hamilton, Magglio Ordonez, Troy Tulowitzki and even the NFL’s Adrian Peterson. However, Dr. Meyers has made efforts over the past few years to change the nomenclature on his specialty, writing articles about how “core muscle injury” should be the preferred term. 

(Quick trivia question: What MLB doctor coined the term “sports hernia”? Dr. Tim Kremchek of the Reds, in an attempt to explain the injury simply.) 

For Cabrera, this is a normal and expected outcome. While the Tigers weren’t clear on the nomenclature, they clearly had a handle on the injury, even when Cabrera was refusing treatment and hiding the injury as best he could. He avoided doctors as long as he could, though one does have to wonder if earlier treatment might have made him more effective.

Probably not, given the need for surgery. As with the others who have had this surgery, there appear to be very solid results and very little in the way of recurrence after repair. As with most surgeries, it is done arthroscopically, giving a short recovery time of six to eight weeks. That means Cabrera will not only be ready for spring training, but he’s likely to have a near-normal offseason program.

Using some of the past surgical repairs, especially the ones done by Meyers, as a guide, there’s little reason to think there will be any drop-off for Cabrera. The sample size of this cohort is small, to be sure, since it’s a recent diagnosis, but even the top-end talents did not have major drop-offs. Of the ones who did, such as Hamilton, it’s hard to pin any of that on the surgery. 

Cabrera had lost both speed and power while dealing with the injury. His running in the playoffs wouldn’t have beaten a Molina, while his power was sapped as well. Even on homers, Cabrera was fooled. One homer in Oakland looked like a towering shot that would go deep into the O.co seats, but ended up a wall-scraper that made Cabrera quicken his trot a bit. Those should both be improved after surgery, though don’t expect him to be a speedster! 

I do want to be clear that even though there has been different nomenclature used, I don’t believe the Tigers were being deliberately misleading. Sometimes, the exact injury is not known until the player is opened up, and frankly, when managing an injury like this, the focus is on symptom relief, pain management and functional value, not differential diagnosis. 

Miguel Cabrera is at the top of his game. The 2013 Hank Aaron Award winner is one of the best hitters of this or any era, so keeping him at his peak is key for Tigers’ hopes to get back to the World Series. His surgery should help him get there. While another run at a Triple Crown isn’t likely, being healthy gives him a chance that few others will ever have.

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The World Series is going to be tight. Both the Boston Red Sox and St. Louis Cardinals are talented but flawed teams. They match up well at nearly every position, which means things like execution and fundamentals could be key.

In Game 2, one play appeared more Little League than major league, allowing a couple of runs that could have been the difference in the game.

In tight matchups such as this one, injuries can be amplified and one to a star like Carlos Beltran can be a game-changer.

However, Beltran’s injury doesn’t appear to be affecting him on the field. The treatment he’s received, his own struggles with previous injuries and a secret weapon might just make Beltran a game-changer in the positive sense.

Beltran injured his ribs running into the outfield wall at Fenway. That wall is iconic, once known as Williamsburg due to how many balls Ted Williams put into it. With that said, the odd angle, short warning track and height make it a unique challenge for right fielders.

In the ALCS, we saw Torii Hunter go up and over. The difference? While their heights are only one inch apart, Hunter has longer legs and was more extended, raising his center of gravity. The difference does explain why Beltran was injured while Hunter was only a bit bruised.

Looking at those pictures would make one think there’s much more than a one-inch height differential between the two.

The momentum of their runs manifested themselves differently.

Hunter’s head of steam took him over the wall, with some of it dissipated by the pinwheel action and some by catching himself on the other side. Almost all of the force went directly into Beltran’s ribs. The total force isn’t known, but it’s reasonable to assume they were moving at similar speeds. 

The ribs are a complex structure. It’s not as simple as a bone issue, even in the case of a fracture, like with Hanley Ramirez in the NLCS. The ribs are interconnected, with both cartilage and muscles in between each and a unique movement that allows for breathing—breathing is good.

It’s exceptionally efficient at protecting the internal organs, as evidenced by both Ramirez and Beltran. Neither has injuries to his spleen or liver, which would be worse than a painful rib issue.

Pain management is difficult because of the function and nature of baseball.

A painkilling injection is difficult because of the complexity of the structure and the enervation. A general painkiller is unthinkable. It’s difficult enough to turn on a 90 mph fastball. Forget it after someone’s popped a couple of Vicodins, let alone the worries about reaction time if one of those fastballs come at his head.

Beltran has experience playing through pain and dealing with limitations. His well-chronicled struggles with a damaged and deteriorating knee have given him experience with this kind of situation. He understands the difference between soreness and pain.

He also clearly has a high pain tolerance, given the damage inside his knee that almost necessitated career-threatening surgery.

Beltran will have the most issues with rotational activities. The problem there is that almost everything in baseball is rotational. Swinging a bat or throwing a ball, two things the Cards need from Beltran, are precisely the kind of activities that will tax him and test his pain tolerance.

The benefit for him might be the gap between these activities. A long at-bat with several fouls or swing-and-miss attempts will likely be the biggest test for Beltran. 

During Game 2, it was apparent that Beltran was wearing some sort of flak jacket under his uniform. Fox Sports’ Tim McCarver noted that it was “kevlar” early in the telecast.

I was able to confirm with multiple sources that Beltran is wearing a garment from Unequal Technologies. Beltran has a high level of protection from another collision or a ball to the ribs. If you’re wondering how effective this type of material is, check the video to the right.

Beltran showed with his Game 2 performance that he can be productive through the injury.

While he does have his limitations, adjustments and accommodations are easy. Getting back to St. Louis will help as well. Beltran is much more comfortable with that park, where the walls are not likely to induce issues and the Cardinals’ medical staff has all of its equipment and facilities.

The toughest game for Beltran was always going to be Game 2. Getting through that without any apparent issue makes it much likelier that he will make it through subsequent games. The bruising and inflammation should subside as well, with both time and treatment, making it possible that he won’t need the kevlar later in the series.

Look for Beltran to continue on with no major difficulties as the Cardinals fight to gain another World Series title.

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Jason Kendall. Ruben Mateo. Cliff Floyd. These are not names that Manny Machado wanted to be mentioned with.

Machado, the Orioles‘ phenom, is more used to being in the conversation with Bryce Harper and Mike Trout, but a gruesome leg injury Monday in Tampa had many wondering if there’s a chance he’ll be mentioned with the former much more than the latter now.

The Orioles had an MRI conducted on Machado’s knee on Tuesday afternoon. Machado was diagnosed with an medial patellofemoral (MPFL) sprain, but the MCL and ACL are not sprained (or not sprained enough) to require immediate reconstruction, confirming the expectations from manual testing both on the field and after Machado returned to Baltimore.

Remember, a sprain is a tear, but in all likelihood, the MPFL is not ruptured (a Grade III sprain) while the MCL and ACL have a lower grade of damage. There was no word as yet on the meniscus. The “conservative treatment” means that they will try to help the leg heal through rehabilitation rather than surgery, though it does not rule out the possibility in the future.

Machado is unlikely to miss much, if any, of the 2014 season. His recovery could take him to midseason if it took a long time, but it’s not likely. While there is little doubt he will return, there is some concern about his range. Age is often cited as a positive for a young player, but youth really has very little to do with recovery. 

The video is tough to watch. There’s no clue prior to his leg buckling that there’s any problem. Machado is running hard to try to beat out a grounder that had drawn the first baseman away from his zone, but he’s not overextended. It’s not even clear exactly how he stepped on the bag, but it is obvious that something gave way.

The angle of the video makes it tough to see, but it appears that his knee buckles both forward and medially. Early speculation ranged from an ankle injury, like what we saw with Jason Kendall, to a knee hyperextension. The medial, or inward, movement of his knee recalls a football player getting rolled up from the outside, a common injury.

Machado had no known history of knee issues as far as I could find, going back into high school. His pre-draft physicals were “very clean,” according to a team source. The Orioles did say in their press conference that Machado had a previously unknown injury during his time at Delmarva (Single-A) that could have weakened the ligament.

If you are able to watch the video, there’s something interesting. Often, the athlete’s first, unconscious reaction is one of the best indicators of a problem. Machado’s first reaction is with his right hand, and it’s not what I expected or even noticed on my first few viewings.

Instead of reaching down, Machado reaches for his lower back. My speculation is that the twisting of his knee below him caused a quick and painful twinge in his back as his body tried to adjust to the sudden weight shift. It’s about like when your foot slips on ice and you catch yourself, but wrench your back.

Of course, Machado fell just after this and immediately pulled his knee up to his body. This was difficult to read. He could be reaching to stabilize his knee or protect his leg to minimize motion. (This is most commonly seen in ankle fractures.) 

Orioles Athletic Trainers Richie Bancells and Brian Ebel were out on the field quickly, as was Dr. Koco Eaton, the Rays team orthopedist, and other members of the Rays medical staff. Their quick and professional care will go a long way in getting Machado back and minimizing the damage as best they can.

One of the best things I saw was the way that Bancells and Eaton seemed to calm Machado down while he was on the field. With as much pain and fear as he showed, just getting him back to a focused point is a huge plus for everyone and worthy of notice.

While any knee injury is a negative for Machado or any player in baseball, it is clear that they can come back. Serious injuries like an ACL reconstruction are becoming relatively sure recoveries. Mariano Rivera had his ACL reconstruction last season and has shown no deficits, coming back in just nine months.

Even a catcher like Jason Castro was able to return and showed few problems after having his ACL repaired. A few years back, Brewers pitcher Yovani Gallardo came back from his ACL injury during the season. 

An MPFL sprain is rarer in baseball. In fact, my injury database does not have any comparable injuries. 

Dr. Tim Kremchek, one of the top sports surgeons around and the team doctor for the Cincinnati Reds, says he would repair this kind of tear. “He’s an infielder and needs the lateral stability. There was so much valgus stress on the knee that I think you would want to make sure it’s fully healed.”

Dr. Kremcheck was positive on the chances for a player to come back from these types of surgery. “With an ACL/MCL, I think it would be about six months for a full recovery. Just an MCL? That’s more like four.”

Both of those possibilities were ruled out by Tuesday’s MRI.

Expect Machado and the Orioles to seek a second opinion on this. That is very common and likely is already in motion. Dr. James Andrews is going to be the first name to come up, given his success with Adrian Peterson and Robert Griffin over the past year. Andrews is the Rays’ medical director and trained Dr. Eaton as one of his ASMI Fellows. Eaton’s firsthand knowledge of the injury could have helped guide the surgeon had it been necessary, so it wouldn’t surprise me to see him involved. 

While there is no positive to this injury, the fact that it came at the end of the season gives Machado four full months to recover before spring training without missing any action. The Orioles can focus on minimizing any time lost in the short term while making sure they get Manny Machado back to full function in the long term. 

In fact, Machado could be in the lineup on Opening Day. That would be amazing, but not a miracle. It’s a testament to modern sports medicine, plus the quick action of the medical staffs and doctors that treated the young star. 

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After several weeks of rest and rehab, Matt Harvey and the Mets announced on Tuesday that he will not have Tommy John surgery yet, according to Anthony DiComo of MLB.com.

Harvey first experienced issues with his elbow in early August. However, he was able to pitch through it for a couple of starts before noticing something “alarming” in his last start. He was immediately sent for an examination with Dr. David Altchek, the Mets’ team physician and one of the top elbow orthopaedists in the game.

At that point, it was suggested that Harvey undergo Tommy John surgery, but he elected to wait after consulting with advisors, physicians and other pitchers who have gone through the process. Harvey said that he was convinced in large part by Roy Halladay, who rehabbed an elbow injury in 2006 and went on to have some tremendous years. His visit with Dr. Andrews kept him on that path.

(One note here: I looked back at my articles from 2006, when Halladay had his issue. None of my information at that time indicated an elbow problem. Halladay had forearm issues that were associated with the development of a cutter and with a comebacker that hit him near the elbow. I took a lot of flak from the team for suggesting that forearm issues often morph into elbow issues. Nice to know I was right at the time!)

The positive here is that Harvey must have a very low-grade sprain of the ulnar collateral ligament.

The majority of surgeons will advise surgery when the tearing is between 25 and 33 percent. Most that go under the knife have very significant, if not complete, tears. If Harvey is able to avoid surgery by strengthening the elbow and letting the ligament heal, he will have bought time while retaining only the limited downside of losing a year to surgery and rehab.

In essence, rehab may buy six free months of Matt Harvey. Imagine what that could be worth.

Harvey becomes the latest in a long line of young power pitchers who have faced Tommy John surgery. Pitchers have had success through rehab, including Adam Wainwright and Nolan Ryan. Both pitched for years without further problems, enjoying plenty of success before the ligament failed. 

There is no downside here besides the potential for a lost year. Pitchers tend to come back virtually unchanged. The velocity is at the same level. The pitching repertoire is no different, and significant modifications to the mix of pitches aren’t required. Suggestions that the slider or cutter contribute to the problem don’t seem to subside, though the data is admittedly shaky.

Overall, there’s no reason that Harvey won’t return to his “ace” form the same way that so many others have.

The biggest issue for the Mets is that despite doing everything within their power to keep Harvey healthy, it was an unreasonable task.

While he may come back the same pitcher, that is the same pitcher that got hurt. Harvey did not have high pitch counts, was thought to have good biomechanics and is in excellent physical condition. The same was true for Stephen Strasburg and top prospect Dylan Bundy, who had Tommy John surgery earlier in 2013 after trying to rehab through a forearm issue.

Harvey avoids becoming the latest statistic in the saga of Tommy John surgery. Research done earlier this year for my series on Dr. Frank Jobe and Tommy John surgery showed that one in three current major-league pitchers has had the surgery. Anecdotal research indicates the numbers are comparable in the minor leagues. 

While I understand why fans and the Mets front office may want a definitive answer, it’s Harvey’s arm and Harvey’s decision. Tommy John surgery is not an easy process, nor is it perfect. Ask Daniel Hudson, who underwent a second Tommy John surgery after reinjuring the ligament in rehab, or Ryan Madson, who still hasn’t made it back after two lost seasons in the wake of surgery. 

It remains to be seen whether the rehab process will work, but in the meantime, Mets fans can hold out hope for 2014 while knowing that 2015 is a sure thing. There’s no question that Matt Harvey will be back to being a top young pitcher, but the question is when. 

For more on Matt Harvey’s injury, please read this piece that I wrote at the time of the first announcement. 

Will Carroll has been writing about sports injuries for 12 years. His work has appeared at SI.com, ESPN.com and Baseball Prospectus.

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The Biogenesis saga has become the Alex Rodriguez saga. Rodriguez was hit with the oddly-constructed 211-game suspension on Monday and without explanation or evidence, it’s hard to have much of a position based on facts, though that hasn’t stopped many. 

What’s been most interesting to me is how little people seem to know about the testing program. Referred to as the “JDA” or joint drug agreement, it spells out in minute detail how the program is supposed to work. It’s legalese, but important legalese. 

Few seem to understand “A” sample and “B” samples, collection procedures, location registration, methodology for randomization, but I wouldn’t expect them to. I can see why people might gloss over lists of chemicals, appeals procedures and even the precise language requiring secrecy throughout the process, up to and including the wording of press releases. 

This document, negotiated and re-negotiated by the commissioner’s representatives and the players’ association was supposed to have governed this process but instead was shattered by it. Whether it was Bud Selig’s edict, congressional grandstanding or a public perfectly willing to let both sides make end runs around the letter of the law, the JDA is now not worth the paper it’s printed on.

A few weeks ago, I wrote an article here at Bleacher Report discussing possible replacements for Bud Selig. I ended up with his most likely “replacement” being Selig himself, with the commissioner set up to once again extend his reign. Now, I’m not so sure. This episode has weakened the position of the commissioner’s role. The MLBPA will not allow the “integrity clause” to be as unfettered as it has been since the days of Landis and negotiations on the JDA itself will end up more tense. Selig likely doesn’t care.

Selig has instead lashed his legacy to this mast, forever tying himself to the beginning, the heyday and perhaps the end of the so-called steroid era. Selig wishes to be remembered as the commissioner who revived the game and perhaps saved it from an enemy greater than even an angered public after the World Series was cancelled. 

This was Selig’s moment, when he stood at the lectern and pronounced his sentence on Alex Rodriguez. While appeals and who knows what else in this saga awaits us, down to a potential 2015 return, Selig should seal the moment with his own resignation. It is clear that he feels this is his defining act and that nothing after could compare.

Selig dropped the hammer. Now he should drop the mic.

But there’s still injuries around baseball, so let’s take a look around the league:

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