Updates on Alex Rodriguez, Brad Lidge and others

We're actually at the point in the season when we can start welcoming back players who began the season on the DL. Two huge fantasy impact players are expected to make their return this week, but what can fantasy owners expect from them initially and long term?

Joe Mauer, C, Twins: Mauer returned to Minnesota on Wednesday and is scheduled to return to the lineup Friday, according to the St. Paul Pioneer Press. He is recovering from right-sided sacroiliac joint inflammation. Mauer has been able to do everything required of him both at the plate and behind the plate during his rehab games. During spring training, the biggest challenge for Mauer was running. After consulting with specialists, changing medications and very, very gradually working his way back with conditioning, Mauer has responded well to running. He has had no reported setbacks in this latest effort, and the Twins are encouraged with how well he has been playing.

The hope is that this episode is behind him, but I am still puzzled by what caused this unusual injury in the first place. And my concern is how Mauer will hold up once he must play consecutive games for an extended period of time. Apparently the Twins are slightly concerned about this, too, since they have made it clear that their plan is to regularly give him days off, probably every third day initially, according to the Minneapolis Star-Tribune. In fact, manager Ron Gardenhire told the Star-Tribune that it would not be "impossible" to keep three catchers on their roster. I am thrilled for Mauer that he is making his way back to the majors, but he is not out of the woods just yet. Fantasy owners need to remember to check daily lineups once he returns.

Trevor Hoffman, RP, Brewers: Hoffman sustained a right-sided oblique injury that forced him to the DL to start the season. It is a bit of an unusual injury for a pitcher because the oblique is on the same side as his throwing arm. The Brewers' medical staff has been very deliberate in working Hoffman back to form to ensure that this does not become an injury that bothers him throughout the year. So far, so good, as Hoffman experienced no setbacks throughout the rehab process. He might be getting up there in baseball years, but he is still unmatched in toughness. I expect good things from Hoffman, and he has started off well with two scoreless innings this week.

On that note, here's who I have a close eye on this week in the world of baseball injuries:

Alex Rodriguez, 3B, Yankees: Remember him? The Yankees sure do, and they're hoping to become reacquainted with him sooner rather than later. As of Wednesday, the tests that Rodriguez has passed as he works his way back from hip surgery suggest that he could return to the lineup a week before the Yankees' targeted date of May 15. It won't be a moment too soon, either, as teammate Cody Ransom has been placed on the 60-day DL. The New York Times is reporting that Angel Berroa, who until last Saturday had played exactly one inning at third base in his career, will man the hot corner until Rodriguez returns. But Berroa's stint at third has not gone so well thus far, and Ramiro Pena is seeing some action there, as well.

Of course, the Yankees maintain that Rodriguez will not be rushed, but don't think they're oblivious to how well his rehab is going down in Florida, either. His own surgeon, Dr. Marc Philippon, watched him work out at the Yankees' minor league training complex in Tampa on Wednesday, and according to the Yankees' official Web site, Philippon summed up his impression this way: "He's looking good. Looking awesome."

You have to admire the way in which Rodriguez has approached his aggressive rehab schedule, and how successful he has been so far. There really is no precedent for a baseball player to return to this level of activity this quickly following such a procedure. The test I was waiting to see -- his first attempt at sliding -- came and went Tuesday without incident. Granted, it was on a sliding mat (a shock-absorbing mat with an overlying sheet that slides on the pad when the player does, decreasing friction and therefore decreasing risk of impact or injury), and there was no one waiting to crash into him at the end of it as there might be if he were sliding into home, but you must take these things one step at a time. Rodriguez is now expected to begin playing in extended spring training games Thursday, and it will be his impromptu maneuvers that will dictate how ready he is to return. How is his lateral agility? Can he make a play on a bunt? Is he willing to dive and slide when the situation calls for it? We already know that he can hit.

(As a bit of an explanation: Extended spring training takes place at a team's regular spring training site in April and May and usually involves a combination of practices, intrasquad and exhibition games. Many of the players are minor leaguers biding their time before the short-season Class A and rookie leagues begin in June. A number of other players, like A-Rod, are rehabbing injuries and use the time to get extra workouts and game action without interrupting the flow of the minor league season.)

So far Rodriguez has met or exceeded all of his targets, and the ease with which he is accomplishing each goal suggests that his hip is doing extremely well -- so much so that it's worth revisiting the original issue. Rodriguez reportedly had a cyst that was creating pressure on some of the hip musculature, which was in turn creating a weakness that affected his performance. It also contributed to stiffness and tightness at the hip, as did the torn labrum which was itself responsible for the cyst's development in the first place. Every aspect of Rodriguez's treatment -- the aspiration of the cyst, the labral repair and the resurfacing of the acetabulum or "socket" portion of the hip (where a bony abnormality is often described as a "pincer" lesion) -- has increased his mobility, which no doubt has contributed to his hip joint feeling better as he puts it through various stresses. Additionally, he is probably stronger than he has been in the past year, as his muscles can now perform optimally without the cyst to interfere.

In fact, the rate at which he is progressing suggests to me that the cyst might have been the primary limitation to his performance, as opposed to the labral tear or the bony anatomy. Addressing the labrum was critical to preventing the cyst from recurring, and addressing the bony surface helps ensure the integrity of the labrum, so these elements cannot be overlooked. As far as Rodriguez's specific complaints and limitations, however, it is possible that the cyst might have been the main culprit. With newfound range of motion after surgery, accompanied by an increase in strength of the primary muscles that support the hip, Rodriguez might be feeling as good as new.

The big question that remains, assuming Rodriguez progresses through his rehab games without incident, is whether he can perform up to the level of expectation under the bright lights, and whether he can do so consistently. From a physical perspective, Rodriguez seems to be acing all of his tests, but those are conducted in isolation, under the protective umbrella of the minor league system. Once he returns to the glare of the media and the pressure of performing day in and day out, it will be interesting to see whether Rodriguez can live up to projections. The final test of rehab for any athlete is returning to play at pre-injury level and intensity. In other words, minor league games are a good start, but until a baseball player returns to a major league setting, he has not fully tested himself. If Rodriguez struggles when he returns, will he be able to brush it off as part of the entire return-to-play process, or will he begin to question whether he moved too quickly? The answer might be the key to his performance for the remainder of the season.

Only time will tell, but I'm now convinced he could make a splash far sooner than expected. The physical component of the entity that is A-Rod is in phenomenal shape. Now the Yankees and A-Rod's fantasy owners have to hope he gets off to a strong start upon rejoining his team so that other elements do not become a factor.

Hanley Ramirez, SS, Marlins: On Monday, Ramirez was hit on the right hand by a 94 mph John Maine fastball. Ouch! Luckily for Ramirez, initial X-rays showed no fracture, but he did have immediate swelling in the area and was subsequently removed from the game. Any significant swelling in the hand or wrist area is going to create discomfort because of the pressure it places on all the adjacent structures within a relatively small space. That pressure also results in a decreased ability of the muscles to contract, resulting in decreased power. The key to getting Ramirez back quickly is eliminating that inflammation.

Ramirez did not play Tuesday or Wednesday but hopes to be back in the lineup Thursday, according to the Marlins' official Web site. While it certainly looks at this point as if he will avoid a trip to the DL, it will depend on a day-to-day assessment of his ability to perform, based on how the swelling in his wrist area is responding. The immediate challenge for Ramirez is being able to close his hand enough to grip the bat, and then he needs to actually be effective swinging it. Fantasy owners with daily lineup settings will need to monitor this closely.

Brad Lidge, RP, Phillies: Manager Charlie Manuel told the Wilmington News Journal that Lidge has inflammation in his right knee and is considered day-to-day. The good news is that an MRI showed nothing unusual, and the Phillies have not considered it problematic enough to place Lidge on the DL. Even more encouraging: Lidge threw on flat ground Wednesday without incident. He is expected to throw off a mound Friday, and if all goes well, he could return to action Friday night, according to the Phillies' official Web site. Considering that just a few days ago Lidge hinted that the DL was not out of the question, these recent developments should definitely be considered good news. But he is not completely in the clear.

Lidge underwent surgery in 2007 to address a cartilage injury and then suffered a meniscal injury to this same (right) knee during spring training in 2008, forcing him to start the season on the DL. After returning, though, Lidge was dominant; he didn't blow a single save opportunity, and the Phillies won the World Series.

This season has not started off so well for Lidge, however, and now that we're finding out his knee has been bothering him for a while now, his recent command troubles might be explainable. After all, this is his stance leg during his windup and acceleration. This requires good balance initially, followed by significant torsional stress through the knee as the motion develops. The meniscus, of which there are two, functions as a cushion within the joint, and with each subsequent surgery, a small portion of that cushion is removed. Ultimately that translates into more stress on the joint cartilage surface, which can break down over time. Irritation results in exactly the types of symptoms Lidge is experiencing now: swelling and stiffness.

The key to longevity in this situation is ongoing management. Lidge's knee will never be 100 percent healthy, but that doesn't mean he can't function at a high level for years to come. It does mean, however, that when the knee signals that it's under duress, the appropriate response is to back off and protect it, even if for just a few days at a time. In the absence of significant new damage, Lidge will likely be able to return to a high level of performance once the recent irritation settles.

Brandon Webb, P, Diamondbacks: At first, this did not have the makings of a significant injury, but the longer Webb is removed from throwing, the more concerned we become. Webb, who was initially placed on the DL on April 13 after reporting stiffness in his throwing shoulder, was expected to rest briefly and then return to a throwing program. There was no specific evidence of tissue damage on the MRI, and his symptoms were not particularly worrisome.

But Webb just cannot seem to progress. A week ago, he threw a 33-pitch bullpen session and experienced no discomfort whatsoever. Feeling encouraged, he threw another bullpen session Friday, but this time, while warming up, he experienced the same stiffness in the back of his right shoulder. Manager Bob Melvin summed up the situation perfectly when he told The Arizona Republic, "This is absolutely confusing because he felt good last time out, and all the maintenance stuff leading up to this would suggest he felt good."

The plan now is to shut down Webb for a few weeks, which means he will take a complete break from throwing and then will gradually resume a shoulder strengthening program. Upon completion of that component, Webb will once again attempt to resume throwing in an effort to get back to the mound. The situation is nothing if not puzzling for all involved. There is still reason to believe he can return for the long haul, but it won't be anytime soon. Webb will have to complete a throwing progression, followed by a minor league rehab assignment before he can rejoin the team, so don't plan on his being available for at least five weeks.

Brad Hawpe, OF, Rockies: This injury goes on record as the scare of the week. Hawpe was hit in the neck Monday night when Padres catcher Nick Hundley tried to throw him out as he slid back into second in the sixth inning. He was taken off the field in a neck brace and then transported to the hospital to be evaluated for a possible concussion. An Associated Press report indicated that Hawpe experienced numbness in his arms and down to his waist, symptoms that could certainly be suggestive of a spinal injury. Fortunately, CT scans of his spine were negative, and Hawpe was allowed to return home that evening.

Diagnosed with a neck contusion (deep bruise), Hawpe is still feeling stiff (and probably will be for a while) and might not take the field before Friday. He might be available to pinch hit before then, but don't be surprised if he's hesitant to slide. Hawpe had his hand stepped on by a cleat when diving back into second during a spring training game, and he needed stitches for his wound. This time he went feetfirst and ended up with a neck injury. Aside from sliding in sideways, I'm not sure Hawpe has other options for approaching the bag. Fantasy owners can breathe a sigh of relief, though, as it appears he will not require a trip to the DL, and he could be back in the lineup within a couple days.

Josh Hamilton, OF, Rangers: Despite the early thought that he might be able to avoid it, Hamilton might yet be headed for the DL. That decision has not been made yet; the Rangers are still calling him day-to-day with his rib injury, according to The Dallas Morning News. But it might depend on how he responds to new medication. A week ago Tuesday, Hamilton crashed into the center-field wall, and in the process jammed his left elbow into his ribs. At the time manager Ron Washington told MLB.com that "the ribs are not a problem." Famous last words.

The ribs have been such a problem that Hamilton has been able to do virtually nothing since the injury. He attempted to return to the lineup later in the week, but on Saturday, after trying to run out an infield hit, he was forced to leave the game because of pain. Despite a cortisone injection, Hamilton continued to struggle with the pain. He did not play Monday and was re-examined by team doctors Tuesday. The good news is that the injury is still being referred to as a muscle strain (there is no reported evidence of a fracture); the bad news is that rib injuries are notoriously slow to improve.

Hamilton himself acknowledges that it hurts to do just about anything, telling the Morning News that he is experiencing "extreme pain." Everything hurts, according to Hamilton: "Taking deep breaths. Running. Throwing. Hitting." As far as I'm aware, running, throwing, hitting and, yes, breathing are all important for the game of baseball. The ribs move with each of these activities, so any attached soft tissue (muscle, cartilage) moves along with them. If that tissue is damaged, each movement aggravates the injury and causes pain, making it difficult, as Hamilton attests, to do anything pain-free. If standing and breathing are painful, then anything requiring exertion or increasing torsion through the trunk is going to exacerbate that pain exponentially.

As of now, the Rangers are still hoping the symptoms calm down enough to allow him to return shortly, but fantasy owners should make plans for the next week or so, just for insurance.

On the mend

The Angels really should have their own section in the blog since they have a number of significant players moving through various stages of rehab.

Outfielder Vladimir Guerrero, who was set to be out for a month because of a torn pectoral muscle, was able to run the bases before Tuesday's game. In fact, the Los Angeles Times is reporting that manager Mike Scioscia said Guerrero might resume baseball activities next week when the Angels return from their road trip. It's certainly conceivable that Guerrero could return sooner to provide a bat for the lineup. Throwing a ball from the outfield, however, is far more demanding on the pectoral muscle, and if indeed there is a significant tear, this will be the most challenging activity to resume.

Muscular tears are very hard to predict because the timetable can be highly variable, depending on the extent of tissue damage (more is worse, obviously) and the location of the tear (tears within the muscle belly tend to heal faster than tears in the musculotendinous area -- where the muscle and tendon meet -- and the latter is where most injuries tend to occur). The requirements of the muscle within the sport also play a huge part in determining readiness to return. If Guerrero played a contact sport and was responsible for tackling an opponent, the injury could threaten his season. Luckily, that is not a requirement for him. Hard throwing is a requirement, however, which places a significant demand on the pectoral muscle. Since it was a throw that originally led to the injury, there is all the more reason to be cautious in returning to that activity. Fantasy owners should keep an eye on his progress. He might be able to serve as a DH within a couple of weeks, but expect additional time for him to return to the field.

Meanwhile, pitching teammates Ervin Santana and John Lackey are inching closer and closer to a return to the lineup. Santana has been able to throw innings in a simulated game and was expected to do so again Wednesday. If all goes well, he should be designated for a rehab assignment shortly afterward and could rejoin the rotation in mid-May. Santana has a partial tear of his ulnar collateral ligament (UCL), so there is some concern about how well he will continue to hold up, but so far he is meeting all his targets.

John Lackey is also throwing and getting close to a minor league assignment. According to the Angels' official Web site, Lackey, recovering from a strain in his throwing elbow, will pitch again Thursday. If that goes well, he will move to the minors to work on increasing his pitch count before rejoining the team, also slated for mid-May. Lackey is dealing with his second round of elbow problems to start the season. Last year he returned to finish out the season. The negative for him is that this is a repeat offense by his elbow, after it has aged another baseball year. He reportedly is throwing the ball well, and all looks positive for his return. My concern is whether he will be able to finish out the year as he did in 2008. Clearly, both of these pitchers provide high upside for fantasy owners, but there remains some risk attached to them based on their injuries and history.

Other notable rehabbing pitchers include Red Sox starter Daisuke Matsuzaka and struggling Yankees starter Chien-Ming Wang. Matsuzaka, recovering from a mild right shoulder strain (arm fatigue), seems to have responded to his recent period of rest. He has performed satisfactorily with his long-toss program and even threw a bullpen session Wednesday. According to the Red Sox's official Web site, Matsuzaka is expected to throw another bullpen session Saturday, and if that goes well he could begin rehab starts shortly thereafter. The Red Sox have no reason to rush him given their performance lately; they have the luxury of bringing him back at a very controlled pace. Their wise medical staff slowed this one down before it turned into a major injury. Give him a couple more weeks, and Dice-K should be ready to go.

Meanwhile, the Yankees have to hope that some of A-Rod's spectacular rehab efforts will rub off on Wang. The Yankees pitcher was placed on the DL after a series of horrid starts, and although it was not acknowledged, at least publicly, Wang's recovery from a severe right foot injury last season seems to have been a factor. Keep in mind that Wang had a Lisfranc injury (a fracture dislocation at the midfoot) and a tendon injury that were both very serious. He had to undergo surgery and then restore his range of motion, strength and balance before he could even begin to throw. Sure, the injury was not to his throwing arm, but this is not unlike a player returning from arm surgery because the time absent from throwing can become a factor in and of itself. On top of that, changes in the entire lower kinetic chain can occur, from the foot all the way up to the spine (even in a subtle manner, as a response to deconditioning after surgery).

Apparently that was indeed the case with Wang, as the New York Post reported this past week that he was found to have residual weakness in his hip abductor muscles, which could be related to his foot injury. The abductors, which in isolation raise the leg out to the side, have a far more important role in standing and walking. During single-leg weight bearing, the abductors help control stability at the pelvis, critical for a pitcher who is in a single-leg stance virtually all the time. Balance, stability and strength through the trunk and the legs provide much of the support for the throwing arm, and even a small deficit can result in poor mechanics, decreased control and a drop in velocity. In an effort to rebuild his hip strength, Wang has been performing some of A-Rod's exercises, and so far everything seems to be going well. He threw off a mound Tuesday and might pitch near the end of the week in an extended spring training game. If he continues progressing at this rate, he should come off the DL when eligible, about May 10.