Posted: Tuesday February 14, 2012 1:52PM ; Updated: Tuesday February 14, 2012 1:52PM
Will Carroll
Will Carroll>INSIDE BASEBALL

Expect different things from these injured aces upon their returns

Story Highlights

Baseball still doesn't have a proper way of figuring out pitcher's limits

Coming back as good as new from Tommy John surgery is almost automatic now

Adam Wainwright should return to being a co-ace for the champion Cardinals

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Adam Wainwright
Adam Wainwright last pitched in 2010, when he finished as runner-up for the NL Cy Young award.
US Presswire

In any given three-year period, better than four in 10 pitchers will end up spending time on the disabled list. It's a troubling stat and one that hasn't been helped by pitch limits. Since Keith Woolner and Dr. Rany Jazayerli first published their research showing the troubling effects of workloads, high stress starts have plummeted. In its place, we've been given a one-size-fits-all approach where pulling a starter at 100 pitches is the chalk move, one a manager can hide behind.

The problem is, it doesn't work. The best way to go would be to directly measure fatigue and use a progressive approach to find out how far a pitcher can go. If I wanted you to bench press 300 pounds, I wouldn't pop 300 on the bar and hope that you aren't crushed by the bar. We'd start out slow and build you up, a few pounds at a time. Eventually, you'd have bulging muscles and be kicking sand on people at the beach. (For more details on my progressive system, read this.)

Instead, baseball just hands a pitcher the ball and hopes. Few teams do any research into why they lose pitchers at this rate. No one has even experimented with a four-man rotation since 2003.

Last year, five of the best pitchers in baseball missed huge chunks of the season. Let's take a look at how their comebacks are going and what to expect from them when they return:

Tommy Hanson, Atlanta Braves

Injury: Torn rotator cuff

Return: Opening Day

Effect: Reduced velocity, change in mechanics

Hanson has great stuff and looks smooth on the mound, but as a young pitcher who jumped over the 200 inning mark in his age-23 season of 2010, he was pushed directly into the danger zone. The cost to Hanson was a tear, in 2011, in his rotator cuff, a network of four small muscles that act as the brakes for the arm. It occurred in mid-August and was a precipitating event in the Braves' late season collapse.

When one or more cuff muscles fail, tearing the fibers, the larger deltoid or latissimus dorsi are forced to take over, changing the way the shoulder works internally. Hanson's tear was small and easily repaired, but no tear in this area is good. He'll need to adjust to make sure that the same problem doesn't recur, which is all too frequent in these cases.

Josh Johnson, Miami Marlins

Injury: Shoulder inflammation

Return: Expected Opening Day

Effect: Reduced velocity, rapid recurrence

The check is in the mail. I'll call you. She's got a great personality. Add "there's no structural damage" to the list of lies. It's a semantic argument based on what someone calls structure and besides, it's all structure. When you hear "no structural damage", it means that the doctors can't find the root problem using images. Even with contrast arthrograms, which are becoming the gold standard, surgeons will remind you that until they get their tools into a body, they don't see everything.

The Marlins couldn't get Johnson back last season but with the rest, rehab and the time off of nearly a year, the inflammation and pain should have had every opportunity to clear. The worry is that since the team really doesn't know what caused the problem, it's quite likely to return. An even bigger worry is that Johnson has already had major reconstructive elbow surgery in his career. The kinematics of pitching are a chain, transferring power from the legs up through the torso, arm and into the ball. That chain always has a weak link. After some pitchers have their elbow fixed, that weak link becomes the shoulder. It's a very bad pattern, since it shows that the body is creating forces that it can't handle. Johnson's return could be fool's gold -- a great start with a quick descent.

Johan Santana, New York Mets

Injury: Anterior shoulder capsule repair

Return: Unknown

Effect: Reduced velocity, possible retirement

The shoulder is a complex structure. Compare it to the elbow, which is essentially a hinge, and you'll see that it has more actions and a plethora of muscles, ligaments, tendons and the structures that hold them in place. The shoulder capsule is a structure that even today, biomechanists and surgeons debate regarding it's function and necessary repairs. The preferred repair is to stitch any tearing and then shrink it with heat (thermal capsulorraphy.) If you think shrink wrap on a package, you've got it.

The problem is that a bit too much tightness in the repaired capsule is going to change the interaction and potentially create friction inside the shoulder. It's a procedure that doesn't have a great track record in MLB, even with recent advances in surgical tools and techniques. Santana, a two-time Cy Young winner, is not going to come back with the stuff we're used to seeing. Shoulder injuries usually evidence themselves as a loss of velocity, so the best case scenario is that Santana keeps his stuff and is able to become more of a pitcher. The comparable here is Pedro Martinez, who also had a shoulder injury, in 2006, and went from being a dominant power pitcher to someone that got by on guile well enough to pitch in a World Series three years later.

Santana is expected back in spring training, but the setbacks he had last year are enough to make it impossible to predict a return. Any setback, even a minor one, could push him close to the end.

Stephen Strasburg, Washington Nationals

Injury: Elbow reconstruction

Return: Returned September '11

Effect: None

Have I mentioned yet that Tommy John surgery is about as automatic a return as there is in sports? After the rending of garments and gnashing of teeth after Strasburg's traumatic ligament failure reminded the baseball world that we know almost nothing about keeping young pitchers healthy, Strasburg's return reminds us that as long as it's the elbow, we have the technology and can rebuild them.

Strasburg isn't better or stronger than he was before getting hurt in August 2010, aside from the enforced rest and strengthening of the year-long rehab. The continued myth that elbow reconstruction causes a pitcher to "throw faster" continues to plague the game, especially at the youth level. Strasburg came back late last season exactly as expected, throwing the same things in the same way ... but there's a part of the problem. Strasburg has a short few years where his new elbow probably won't break down, but he could follow the path of Josh Johnson, seeing the incredible forces of a triple-digit pitch translate into something new breaking down. The Nats didn't make any real changes to Strasburg's delivery and in doing so, are rolling the dice with his health.

Adam Wainwright, St. Louis Cardinals

Injury: Elbow reconstruction (Tommy John surgery)

Return: Opening Day

Effect: Reduced control early in return

Like 1-in-9 MLB pitchers, Wainwright is now a member of the Tommy John club. Dr. Frank Jobe's miracle has allowed those pitchers to come back rather than fading off into the baseball sunset. It's a predictable surgery with a 9-to-12 month recovery period. The rehab protocols established by Kevin Wilk are bringing pitchers back at a rate likely in the 90 percent range, though the most recent studies include high school and college pitchers, making it difficult to know for sure.

What we do know is that when pitchers come back, they almost always do so at the same level as before they were sidelined. Control is the last thing to return, and for a pitcher like Wainwright, who is so reliant on his curveball, finding his release point is going to be key. We'll get good looks at that early in spring training. Expect Wainwright to be back as the Cardinals' co-ace with Chris Carpenter when the season starts.

 
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