Posted: Wednesday September 19, 2012 4:55PM ; Updated: Wednesday September 19, 2012 4:55PM
Will Carroll

Under The Knife: Playoff drive may put futures of many hurlers at risk

Story Highlights

Twenty-seven pitchers have worked themselves into risk of future health issues

Impingement in hip has muddied treatment and return for Clayton Kershaw

With playoffs ahead, Nats won't rush Danny Espinosa back from bruised shoulder

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Chris Sale has battled through arm trouble to post a 17-6 record while pitching a career-high 175 innings this season.
Chris Sale has battled through arm trouble to post a 17-6 record while pitching a career-high 175 innings this season.
Mitchell Layton/Getty Images

I won't step too far into Tom Verducci's territory, but while everyone's wringing their hands about Stephen Strasburg, a number of other pitchers are extending themselves beyond previous workload peaks and are headed toward the playoffs, which could extend them even further.

Recall Jaret Wright, who, even more than Mark Prior, is the example of how the playoffs can shred an arm. The momentum to push a pitcher is great, since "flags fly forever" and some saying "he can rest in the offseason." That's fine for someone with a mature arm, but not for younger pitchers. Not so much.

In compiling a list of pitchers who fall under Verducci Effect candidates, I used the Verducci guidelines -- 30 innings or more over the previous max, including minor league innings, and age-35 or younger -- to simplify things. The list actually goes 27 deep, in large part because so many teams are still "in it." I'm less concerned about relievers like Addison Reed, Robbie Ross or Jake McGee. Statistical flukes like Yu Darvish are their own case. That leaves us with several that need special attention:

* A's starters: The A's have four guys who meet the conditions, plus Brett Anderson, who is just back from Tommy John rehab. Jarrod Parker, A.J. Griffin, Tommy Milone, and Tyson Ross are all on this list. The first two could be in a playoff rotation.

* Rays starters: The Rays may have an amazing record of pitcher health, but having Alex Cobb and Matt Moore extended into the playoffs could really test them.

* Cardinals starters: The Cards pushed Lance Lynn to the pen to hold his innings down, but he and Joe Kelly are well into the danger zone.

* Chris Sale: Sale has already had arm problems this season, has questionable mechanics and now a workload issue.

How these pitchers are handled could have huge implications, especially since two of these franchises are known for small payrolls. The reliance on young pitching can go sideways quickly, as the A's showed in 2011, but there's upside as well. Whether that upside potential can be managed to minimize the downside risk could end up deciding not just this playoff race, but the next couple seasons as well.

Powered by the new Brother Ali album, on to the injuries:

Max Scherzer, Tigers ("shoulder fatigue," TBD)

The Tigers are fighting for a playoff spot, and losing Scherzer, who's been as good or better than any pitcher in the game over the second half, could be devastating. Scherzer lasted only two innings and had nothing in his latest start. His velocity dipped from 94 in the first inning, going down about 1 mph per batter. There was a jump up in the second inning, but it quickly fell and Scherzer was pulled. The velocity jump is worrisome, as that's usually a sign a pitcher realizes he's off, so he reaches back for a bit more. If this is nothing more than fatigue, the Tigers are lucky, but this feels like more. Monitor this closely over the next few days, but fantasy teams, like the Tigers, will be hard-pressed to replace Scherzer if he's out even a short time. A quick MRI showed no structural damage, which is good news, but still gives no guidance as to when or if Scherzer will be back, or how he'll pitch when he does.

Clayton Kershaw, Dodgers (inflamed hip, TBD)

The Dodgers reported that Kershaw has an impingement in his hip and not a torn labrum. As with the shoulder, impingement can mean a lot of things, few of them good. The diagnosis doesn't tell us whether Kershaw will eventually need surgery on his hip. We don't know yet whether waiting is significant for recovery time. We don't know yet if Kershaw can pitch this year without causing more damage. We don't know yet if Kershaw can pitch without altering his mechanics, risking that priceless arm. There's no way to tell what a proximate cause might be, leaving it to the medical and coaching staffs to make an educated guess. That's risky. This would be a perfect time to get a biomechanical work-up on him, to see if his arm is getting more stress during his delivery. The next few days will tell the tale, but the race for the Wild Card is close enough that this injury alone might tip the balance.
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