Sox medical staff heals internal rift

BOSTON -- Second baseman Dustin Pedroia was not the only Red Sox representative who sprang into action Tuesday night when the second batter of the All-Star Game, Robinson Cano of the Yankees, was hit by a pitch and came out of the game.

While Pedroia replaced Cano in the lineup, Sox trainer Rick Jameyson was part of the American League medical team that ultimately assured Cano and the Yankees that X-rays were negative and the injury was only a quadriceps bruise.

"We're not big on the limelight," Jameyson, who was selected to his first All-Star Game, said last weekend in Oakland. "Usually, if you see me on the field, it's not a good thing."

Jameyson was not the trainer who hustled onto the field with AL manager Jim Leyland to check on Cano. That was Tampa Bay's Ron Porterfield, who has been with the Rays 17 years, eight as head trainer. But Jameyson has been on the field plenty this season for the Red Sox, who in recent years have undergone major turnover on their medical staff, cutting ties with medical director Thomas Gill after the 2011 season and ending their relationship with former trainer Mike Reinold, who spent last year as the team's physical therapist.

In the three seasons the Sox have missed the playoffs since 2009, injuries have played a significant role. In 2010, the team placed 19 players on the disabled list for 1,018 lost games. In 2011, it was 18 players and 803 games lost, and last year, 27 players were placed on the DL in 34 stints that cost the club 1,495 games, the equivalent of more than nine seasons.

Beyond the injuries, the Red Sox front office also had to deal with what was described this spring to ESPNBoston.com as "open warfare" between various factions of the medical staff, which spilled over into the clubhouse. Star players were involved, Jacoby Ellsbury openly questioning Gill's diagnosis of his fractured ribs in 2010 and Jonathan Papelbon saying he did not trust Reinold, with several players telling ESPNBoston.com that they would not allow Reinold to treat them.

How preoccupied has the club's front office been in addressing the team's medical issues?

"Very," said Mike Hazen, the team's vice president/assistant general manager. "That's why we made the changes we did. It's not one person's fault necessarily, but everything we do, whether it's on the field or off the field, is to try to put together the best resources, to give our guys not only help and confidence in the preparation they're doing, but also maybe in some ways give them an edge.

"We're always seeking that out. Just like with team, you're always evaluating, always making changes, always trying to improve. We hope we're headed in the right direction."


The Red Sox have continued to have a significant number of injuries this season. Sixteen players have served 19 stints on the disabled list by the All-Star break, missing an aggregate 486 games. Closer Joel Hanrahan (elbow) and left-handed reliever Andrew Miller (foot) have sustained season-ending injuries since the start of the season. Catcher David Ross is also on the 60-day disabled list with concussive symptoms.

But the DL, Hazen said, cannot be regarded as the primary means of evaluating the team's medical staff, which since last November has been led by medical director Dr. Larry Ronan, the team's internist since 2005. Also serving in a new position with expanded responsibilities is Dan Dyrek, the longtime physical therapist most noted for treating Larry Bird. In his second year with the Sox, Dyrek was named the team's coordinator of sports medicine service.

"You can't just look at it as a black-and-white issue from a DL standpoint," Hazen said. "Every team has a ton of DLs. The Yankees have had DLs from the git-go. When Curtis Granderson gets hit by a pitch in the hand, that's not the medical staff's fault. Some of our DLs are the same situation.

"But look at some of the soft-type injuries we've had. We've gotten guys back on the field. We've avoided more DLs than maybe we could have had. That's one of the more telling things.

"We're not talking to [the media] about those type situations. You guys don't get that information. You get it when there's a clear DL situation. But the situations where you bring guys along without that and avoid that, that's when you start to evaluate and say, 'These guys are doing a really good job of keeping our guys on the field even though they're going through bumps and bruises.' Every team has them, but we don't make them public. Players don't tell you; we don't tell you. Everyday players are banged up and nicked up, and to get those guys to have the confidence they can go out on the field, that they're going to be able to go and not reinjure themselves, that's a big thing."

Perhaps the most significant injury that went unmentioned until weeks afterward was the one sustained by Dustin Pedroia, who tore the ulnar collateral ligament of his left thumb in the season's first game and was annoyed when it was finally reported weeks later.

"You're talking about a fairly unique individual," Hazen said. "He wasn't going to not be on the field the next day.

"But what you try to do is get as much information for the player to talk through all the scenarios, what's best case, what's worst case, and for the player to be able to say, 'I can go through this. Yeah, I'll be sore a few days, but as long as you guys are telling me I'll be OK, then I can go out there and play.'

"That's one of the things about having a great medical team. What we're striving for is to be able to give that kind of information to a player, have them believe it and give them confidence that they'll be all right, that everything they were told would happen, happened."

Another special case cited by Hazen is John Lackey, who is in the midst of a remarkable renaissance after undergoing Tommy John reconstructive elbow surgery in November 2011. When the Sox signed Lackey to a five-year, $82.5 million contract before the 2010 season, they knew there were potential risks, Hazen said.

"Anytime we trade for, or sign, an older pitcher, if you have an MRI of his arm, it looks like a bomb went off," Hazen said. "None of these guys are clean. But it's not just wear and tear. Is he pitching healthy? Well, he shut us out in the playoffs [in 2009], so yeah, he's still dealing. You look at a velocity drop, but that doesn't mean he was hurt."

Was Lackey hurt from the time he got here?

"I don't know, that's hard to say," Hazen said. "He took the ball and didn't complain. Maybe he wasn't healthy, but he took the ball, which is why he's so respected in the clubhouse. Beyond all the other stuff -- the way he treats everybody, which is off the charts -- it's that toughness that has got the respect of the clubhouse.

"Even when was going through all that stuff, if the team needed him, he went out and pitched. He never said anything, never bitched. He was frustrated, obviously, but looking at the guy now, he obviously made some hard choices and made some changes, and god, aren't we lucky for it."


On the front lines of the players' daily treatment is Jameyson, a 43-year-old former quarterback at Baldwin-Wallace College, a Division III school in Cleveland, who quickly discovered that playing football and studying to be a trainer were mutually incompatible, so the football was jettisoned. A trainer just a couple of years ahead of him in school got a minor league job with the Indians, and Jameyson, a native of the small Ohio town of Wellington, about 45 minutes southwest of Cleveland, was intrigued. When the Indians held a minicamp for some of their draftees on campus, Jameyson made an impression. He also met the right people, and when it was time for him to graduate, the Indians had a minor league job for him, too, in Watertown, N.Y., in the short-season Class-A New York-Penn League.

He worked 10 years in the Indians' minor league system, made it to the big leagues as an assistant trainer for 10 seasons, and while in Cleveland became acquainted with Hazen, who also worked for the Indians at the time.

Jameyson was hired by the Sox as head trainer before the 2012 season, and with Reinold gone, has assumed a more significant role this season.

"Medically, [the Indians] do a lot of cutting-edge stuff, and Rick was part of that," Hazen said. "He came very highly recommended by those guys."

Tuesday was Jameyson's first All-Star Game at any level. He was not hand-picked by Leyland; he said that after 10 years in the big leagues, he was eligible to be selected, and it was his turn in the rotation.

"You're in charge of the best of the best," he said. "It's quite an honor. Humbling at times."

Besides his competence medically, Hazen praises Jameyson for his "toughness."

"He's got a good demeanor with the guys, but also a toughness that resonates as well," Hazen said. "I think he shows confidence in players, and physically they get confidence from him. 'Hey, you're going to be all right, we're not putting you out there into a game if you're not healthy. But if you are healthy, we think you're not going to do further damage.'"

Jameyson said he didn't want people to hear "toughness" and think he's getting in the players' faces, demanding they play. His job, he said, depends on cultivating trust with the players.

"There are times when you've got to have that tough conversation with a player, where you say, 'You shouldn't be playing,' or vice versa, 'I think you can go out there, I think you're safe,'" he said. "It's not all my decision. It's a decision we make together, between [manager] John Farrell, myself and the player, or [pitching coach] Juan [Nieves], John, the player and myself. Communication is huge. The toughness comes from the sense you're real honest and forthcoming. You let the [players] have a voice, but let them know that decision is not made by just one person."

No situation is perfect, Hazen said. One medical issue that could have a profound impact on whether the Sox return to the playoffs this October is the health of pitcher Clay Buchholz, who has had neck and shoulder problems that have limited him to two starts since May 22. Tuesday in New York, in addition to his All-Star duties, Jameyson played catch with Buchholz, who is tentatively scheduled to throw a bullpen Thursday in Boston. Buchholz said this week in New York that earlier in his rehab he felt some pressure to return but is adamant that he not do so until he is fully satisfied he will not be dealing with a chronic issue.

But overall, Hazen sees progress, a mark of which has been the absence of the kind of friction that has existed in recent years.

"I think we've made a lot of strides," Hazen said. "Rick and Dan Dyrek have done a fantastic job. That trust is growing. Probably the most important aspect of what we do is to keep the best players in baseball on the field for 162 games. To win the most games, keeping the best players on the field are the most important thing."