Be cautious with Ryan Howard

It's a sad day for the Atlanta Braves and their fans. Veteran third baseman Chipper Jones has suffered a torn ACL and is done for the season. It has to make you wonder whether he will even return to baseball when he was already sounding like someone on the brink of retirement.

Of course, it's always disheartening to see a player go down with a season-ending injury. But it's especially sad when that player is a team leader, nearing the end of his career. Jones has always been known as a tough athlete who will play through pain and he once told me that as long as he felt he wasn't hurting his team by being on the field, he would continue to play through injuries.

Not this time. A torn ACL is something you can't just mentally push through. Instead, Jones will need that mental fortitude to get him through the lengthy rehab he will face following surgery. And fantasy owners, sigh, will need to find a replacement at third base.

Who else needs replacing these days? We discuss ...

Ryan Howard, 1B, Philadelphia Phillies: Many of you regular readers know I have been questioning the risk-versus-reward value of the head-first slide given all the thumb and finger injuries that have occurred this year as a result. Howard's injury proves that even tagging a bag with your foot comes with its own dangers.

The power-hitting first baseman suffered a left ankle sprain Aug. 1 when he made an awkward stride into second base. Howard was trying to get back to second base, lunged with his left leg and his foot appeared to catch the edge of the bag. The ankle then buckled laterally (outwardly) as his momentum carried his body weight forward. The fact that his foot was relatively fixed against the bag probably made this injury worse. Initially, the Phillies seemed optimistic that it would just require a few days of rest, but shortly thereafter Howard was placed on the disabled list and his time away will in all likelihood exceed 15 days.

Even a moderate sprain can sideline a player for several weeks and this is an injury that routinely gets underrated in terms of recovery time. First, the swelling and pain have to subside to the extent that the athlete can bear weight through the ankle and regain normal range of motion. As of Monday, Howard was off crutches (a good sign), but the Philadelphia Inquirer reported that he was still walking with a noticeable limp. If you can't walk, you certainly can't run, so Howard remains a ways away from full activity.

The defensive demands of Howard's position are less stressful on an ankle than, for example, those of a shortstop, but he, nonetheless, needs to be able to move freely. He also needs to be able to run the bases without hesitation. Above all, the Phillies certainly don't want to send him back to competition only to lose him again to reinjury during what could be a critical phase.

Howard got his first taste of baseball activities on Thursday, as he took grounders and did some work in the indoor batting cages, according to the Philadelphia Inquirer. However, fantasy owners should expect Howard to be away for at least another week (and more likely two) beyond his eligible return date of Aug. 17.

Rafael Furcal, SS, Los Angeles Dodgers: Just when it looked like we might not be writing about Furcal, as he was expected to rejoin the lineup Tuesday, pregame back stiffness instead sent him to the DL. The first important takeaway for fantasy owners is that this does not appear to be a serious episode and the Dodgers are hopeful that with the backdating of the DL date, Furcal could return within a week.

The second takeaway for fantasy owners, however, is to keep in mind that back problems tend to be recurrent and there's no telling when symptoms can crop up. Remember when Furcal had significant issues with his back in 2008, including pain radiating into his leg, which led to microdiscectomy surgery and a subsequent three-month absence? While this current problem does not appear to be directly related to his prior back problem (no leg pain, more generalized stiffness in his back than debilitating pain and, according to Dodgers director of medical services Stan Conte, no visible structural issues on MRI), it's not uncommon for anyone who has had prior back problems, including those who have undergone successful surgery, to experience another round of back pain.

It's worth noting that the demands of Furcal's position likely factor into the equation as well. He is an everyday player who, as leadoff hitter, is regularly on base (read: more running, more stealing) and therefore subjects his body to more strain than someone who doesn't carry the same load. While Furcal is known for being very diligent with maintaining his fitness program, it's not to say that the wear and tear he places on his body can be permanently kept at bay. Let's not forget he also dealt with a left hamstring injury earlier this year that sidelined him for the better part of a month (and hamstring issues often go hand-in-hand with back problems).

In essence, Furcal seems to be dealing with a minor episode of what could be, for him, a potentially recurring situation. In the short term, fantasy owners should be encouraged that this is not a major setback and Furcal is likely to return soon. In the long term, however, fantasy owners should bear in mind that such occurrences may be more likely to happen given Furcal's history. Not a reason to panic, but a reason to prepare.

Manny Ramirez, OF, Los Angeles Dodgers: When is Manny not being Manny? When he's not in your fantasy lineup, of course. And this year he seems to have been away more than he's been present, due to the variety of muscular injuries he's sustained across the season. Ramirez seems to have aged before our eyes this year and there are certainly plenty of reasons to speculate as to why that's the case, including the fact that he is, after all, 38 years old.

That said, he can deliver some power when he's in the lineup, so fantasy owners want to know when they can get that power back. If the Dodgers have their way, that time could come within the next couple of weeks.

Ramirez is currently working out in Arizona, gradually increasing the amount of load on his injured calf through various activities and conditioning. But he has not yet run at full speed. In order for him to begin a rehab assignment, Ramirez has to demonstrate that running is no longer an issue, which means full sprints with power, without pain. Hopefully, that test will come within the next week or so. If he passes it, Ramirez will then be able to progress to rehab games. As unpredictable as Ramirez is, his injury is even more so but at least there are some targets on the horizon.

Russell Martin, C, Los Angeles Dodgers: I feel like, more than in any other year, this year has made me say, "Wow, there's an injury you never see." First it was Joel Zumaya's elbow fracture that happened during a pitch. Then it was Jake Peavy's detached latissimus tendon. Now it's Russell Martin's subluxed hip and subsequent fracture.

For those of you still hoping Martin can return this season, let me help you put that to rest: He will not. But some questions remain as to exactly what lies ahead for him in terms of whether surgery will be required and how long it will take him to recover.

First, it's worth noting that the injury itself was truly remarkable in how it occurred. Martin was running home from third and at the plate he stumbles across San Diego Padres catcher Nick Hundley's outstretched leg. This causes him to flex forward as he continues to run and results in a few awkward strides. There is one particular step in which Martin lands on a completely straight outstretched leg. He is bent so far forward at the waist that his hip is the highest thing in the air. At the same time he twists to the right to look back at the plate, which further locks his hip. All the force of impact at Martin's heel travels right up the leg to reach its final destination of the hip joint. Bam! His hip fractures at that instant.

The posterior aspect, or back end, of Martin's hip joint sustained such force at that particular moment that the socket portion of the hip (acetabulum) cracked, causing a slight tear in the labrum (a cartilage ring that lines the joint) at the same time. While Martin was fortunate that his hip did not dislocate (come completely out of joint), Conte theorizes that the hip slipped in the joint just enough to cause the damage. As Conte told me, "The structures in the hip did their job, keeping it in the joint. But they paid the price."

The good news is that the fracture was non-displaced, meaning the bony structure remains in good alignment with minimal separation. Weighing all of the pros and cons of surgery to pin the fracture versus letting it heal naturally on its own, which was done in consultation with three of the top hip specialists in the country (Dr. Marc Philippon in Colorado, Dr. Bryan Kelly in New York and Dr. Thomas Byrd in Tennessee), the Dodgers have elected to allow the fracture to heal on its own. Given the non-displaced nature of the fracture, as well as its size and location, suggest that it can heal well. For the next few weeks, Martin will be on crutches, and he is only permitted to put a small amount of weight through his leg while the bone tries to repair itself. He will be re-evaluated in a month. If for any reason the bone is not doing its job, surgery then becomes an option.

As unusual as this injury is, and as disappointing as it must be to end the season this way, Martin has much for which he can be thankful. Had his hip actually dislocated, there could have been far more damage to the joint itself as well as to the structures around it. One of the biggest concerns with a major hip injury is damage to the blood supply in the joint. If that occurs, the next step is generally hip replacement (Bo Jackson underwent hip replacement after dislocating his hip). All indications at this point are that Martin did not suffer this type of damage to the valuable hip arteries. Assuming the fracture heals well (and there is good reason to expect that it will), Martin will have avoided surgery and can then get down to the business of rehabbing.

There is every reason to hope that Martin will be ready to start the season in 2011. But this injury is so unusual that when trying to find a comparison, as Conte puts it, "We're in no-man's land." Further complicating matters is the fact that Martin is a catcher and the crouch position he must sustain places significant load on the posterior part of the hip joint, the specific area that was injured. On a positive note, there is plenty of time between now and spring training for healing to take place and for Martin to regain his flexibility and strength. Assuming there are no setbacks, he could be charting a course for the next guy unlucky enough to suffer a similar injury.

And dare we say it ...

• Phillies outfielder Shane Victorino has been activated from the DL and is expected to return to the starting lineup on Friday. Victorino suffered an abdominal strain in his left side in late July, which thankfully did not end up as severe as it could have been. Within a week, he was swinging the bat and doing some long toss. By the second week he was playing in rehab games, testing the injury with multiple at-bats, slides and hard running. If the abdominal injury were still bothering Victorino, it would have certainly made itself known under that type of stress. Fantasy owners can feel confident putting him back in their lineups this weekend.

• Victorino's teammate, Chase Utley, got some good news this week. Utley was cleared to start taking swings with the bat after a visit with his surgeon, a good sign that things are healing as expected. However, Utley's goal to beat his projected timeline may not be reasonable. Associated Press reports indicate that while the team is encouraged by the positive news on Utley, assistant general manager Scott Proefrock says the team is sticking to its original timetable for his return. Utley, who had surgery to repair a torn ligament in his right thumb, has many hurdles to cross before he can return to full competition, which we outlined back in June. Fantasy owners should continue to eye the first week of September as an approximate return date.