This week: Robbie Ray’s flexor strain has some fantasy players worried about eventual Tommy John surgery, we try to pin down a Jorge Polanco timeline, we unwrap the Kenta Maeda situation, there’s some optimism with how Edwin Díaz was injured… and more!
First, here’s a quick glossary of terms commonly used by Inside Injuries:
- IRC = Injury Risk Category (three designations: “Low,” “Elevated,” “High”) — the overall likelihood a player will get injured
- HPF = Health Performance Factor (Peak, Above Average, Below Average, Poor) — our metric to predict player performance
- ORT = Optimal Recovery Time — the amount of time a player needs to fully recover from an injury (not the same as how much time they will actually miss.
Q: How bad is Robbie Ray injured? – Matthew F.
Robbie Ray underwent an MRI that revealed a Grade 1 flexor strain, leading to him getting shut down over the weekend. GM Justin Hollander initially announced a two-week absence, later extending the timeline to six weeks. Flexor strains are common injuries resulting from repetitive throwing motions, causing stretching or tearing of the forearm flexor muscle group’s fibers.
Returning to play before fully recovering from a flexor strain can exacerbate the injury and cause further damage, prolonging recovery time and potentially leading to more serious injuries, such as a ligament tear or a more severe strain.
Ray’s Injury Risk is considered High. The increased recovery timeline and the fact that flexor injuries often precede ulnar collateral ligament tears in the elbow, which require Tommy John surgery, are concerning. This doesn’t necessarily mean Ray will need Tommy John surgery, but it’s a legitimate possibility to keep in mind. Factoring all that into play, we can’t definitively say when Ray will be back. Providing his tests go well, it’s entirely plausible he returns in late May or early-to-mid June.
To ease any concern, a few recent examples of pitchers who battled similar flexor strains and returned in the same season include:
- Rich Hill (2019) – In 2019, while with the Dodgers, Hill performed well through May, pitching 53 innings and achieving a 2.55 ERA. A flexor strain diagnosis in late June sidelined him for the rest of June, July, and August. He returned to the mound on September 12.
- Jon Gray (2021) – As part of the Colorado Rockies, Gray received a flexor strain diagnosis in early June but only missed a few weeks, returning by the month’s end. His season was relatively unremarkable, finishing with an 8-12 record and a 4.22 ERA.
- Zack Greinke (2022) — Royals’ Zack Greinke was diagnosed with a flexor strain in late May and managed to return before the end of June. He concluded the season with a 4-9 record and a 3.68 ERA.
- Adrian Houser (2022) — Houser struggled in the 2022 season, posting a 4-8 record with a 4.72 ERA through June. Diagnosed with a flexor strain in early July, he missed the entire month before returning to the Brewers rotation in late August.
Q: Thumb injuries, how easy are they to recover from? I can only imagine how hard it is to hit or throw a baseball without your thumb intact. A couple of players including Lars Noothbar are recovering from Thumb injuries. Is this a 2 week issue, or generally something more severe? – Jelani L.
Thumb injuries indeed have a significant impact on both throwing and hitting in baseball, as they affect control and strength. With a range of thumb injuries, including sprains, fractures, dislocations, and tendon and ligament damage, the severity is crucial in determining the recovery process. Fortunately, the majority of thumb injuries tend to heal with minimal complications.
Issues arise when these injuries are not given enough time to heal or are improperly treated. For example, Mariners catcher Cal Raleigh experienced ongoing pain last year due to playing through his injury, resulting in intermittent missed games. After undergoing surgery in the offseason, he started this season strong.
As for Nootbaar, reports suggest that catching the ball causes more pain than hitting for him. His Injury Risk is on the lower end of Elevated, but there’s no indication of a long-term issue, provided he doesn’t suffer further damage.
Q: How optimistic are you about Edwin Díaz returning to form next season? Stashing him on the IL all season in a dynasty league with two IL slots is tough to stomach, but so is letting him go. – David H.
There are reasons for concern regarding Díaz’s return to form. Interestingly, he didn’t injure his knee while pitching, which is significant. Athletes in sports like basketball and football often struggle to regain their pre-injury performance level due to a lack of trust in their injured knee, particularly if the injury occurred during game-specific activities. Díaz doesn’t have a history of knee issues, but a patellar tendon rupture is among the worst injuries an athlete can experience.
In 2021, Zach Eflin suffered a similar injury and performed well in 2022, though not spectacularly. It’s worth noting that Eflin had a history of patellar tendon issues before his surgery. Garrett Richards also ruptured his patellar tendon and returned to a good, but not great, performance level. There isn’t a comparable example of an elite pitcher like Díaz with this type of injury that we can think of.
While it’s reasonable to be concerned, Díaz’s injury didn’t occur in-game, and he isn’t a starter, which means a significantly lower workload. However, it’s difficult to envision him dominating next season as he did last year.
Q: Is there any feel at all for a timeline on Jorge Polanco? This seems like something where he could be back in two weeks or miss the whole season. – Mark T.
Polanco was reported to be dealing with left patellar tendonitis toward the end of last season, but recent reports have been vague, simply referring to it as a “knee injury.” Assuming the initial diagnosis of patellar tendonitis is correct, this overuse injury results from repeated vigorous activity causing tissue damage or irritation. Baseball activities such as jumping, sudden changes of direction, and sudden acceleration and deceleration can contribute to this condition.
Many athletes attempt to play through patellar tendonitis, as the pain is not unbearable, and they can still move with some discomfort. However, the severity of the injury plays a significant role in the recovery process. If left untreated or aggravated by continued play, the injury can become chronic, more challenging to treat, and lead to early arthritis due to chronic inflammation.
The optimal treatment for patellar tendonitis includes stopping the activities causing the pain, strengthening the surrounding muscles, and adhering to the R.I.C.E. protocol (rest, ice, compression, and elevation). Rest is particularly crucial, potentially requiring weeks of inactivity. In severe cases, surgery may be necessary to remove inflamed tendon tissue or correct misaligned bone in the patella.
Considering Polanco’s situation, it’s difficult to predict a precise timeline for his recovery. The key will be proper treatment and allowing sufficient time for healing to avoid complications or chronic issues. That being said, his history does not inspire hope that his knee holds up all season. As a result, his Injury Risk is on the edge of Elevated and High.
Q: How concerned should we be about these starters that throw 100 mph? Are they at an increased injury risk because of how hard they’re throwing? – Stanley T.
The relationship between high pitch velocities, like 100 m.p.h., and injury risk is a topic of ongoing debate and research. Some studies have found a correlation between increased pitch speeds and injury risk, while others have not identified a clear link. It’s generally believed that a combination of factors contributes to a pitcher’s injury risk, including:
- Pitching mechanics: Proper mechanics are essential for injury prevention. Poor mechanics can place excessive stress on elbow and shoulder joints, increasing injury risk. Realistically, high-velocity pitchers with sound mechanics might be at a lower risk compared to those with poor mechanics, even if they throw at lower speeds. The issue here is that high-velocity generally equates to high-energy, and high-energy with poor mechanics is a recipe for disaster.
- Fatigue: Overuse and fatigue can raise injury risk for any pitcher, regardless of pitch velocity. High-speed pitchers with a heavy workload may face higher risk due to increased stress on their arm and body. Monitoring pitch counts and ensuring adequate rest can help mitigate this risk.
- Physical conditioning and strength: Injury prevention relies heavily on appropriate strength and conditioning. A well-conditioned pitcher with strong arm, shoulder, and core muscles is better equipped to handle the stresses of high-velocity pitching. Strength and flexibility training should be integral parts of a pitcher’s routine.
- Genetics and individual factors: Some pitchers may be more prone to injuries due to genetic factors or individual differences in anatomy and physiology. These factors can be challenging to control but may influence a pitcher’s injury risk.
While there is some evidence suggesting that high-velocity pitchers may be at an increased risk for injury, it is essential to consider multiple factors that contribute to injury risk. Proper mechanics, physical conditioning, and workload management can help minimize the risk of injury for pitchers, regardless of their pitch velocity.
Q: What are your thoughts on Tatis? – Victor H.
I’m sure he’s a nice guy, but don’t know him personally. All jokes aside, once his suspension is up, we don’t see much concern regarding his health and performance. He was healthy to return last year but couldn’t due to his suspension — and he looked solid in Spring Training. Tatis was dealing with a knee bruise for a bit earlier this year, but that really shouldn’t be anything too major.
Q: The Twins are downplaying it as arm fatigue, but how worried should any of us be about Kenta Maeda being pulled Tuesday night? – Sasha F.
Maeda delivered a solid performance in his first start since undergoing Tommy John surgery in August 2021. Over five innings, he threw 79 pitches, allowed only three hits, and struck out nine. Although it seemed like there was an issue with his arm when he was pulled from the game, manager Rocco Baldelli later clarified, “Kenta is fine […] I think he was gassed in a lot of ways. He had to work and then come into the dugout. And truthfully, he was not in the dugout very long because [Sandy Alcantara] was having some very, very quick innings.”
The Twins appear optimistic that Maeda will make his next scheduled start on April 10 against the White Sox. We share their optimism for now. Considering Maeda hadn’t pitched in a professional game for over 18 months, fatigue is a plausible explanation. However, it’s always somewhat concerning when a player returns from Tommy John surgery and seemingly experiences an injury in the same arm. We’ll be keeping a close eye on this situation, but for now, his Injury Risk remains Low.
(Top photo: Steph Chambers/Getty Images)