Boston Red Sox should exercise extreme caution with Mookie Betts

BOSTON -- The Boston Red Sox's season was already lost a week ago, and now the team is disintegrating. Will the last healthy man standing please turn off the lights?

Clay Buchholz, the team's best pitcher, won't be back until September at the earliest because of a strained flexor muscle. Dustin Pedroia, the team's heartbeat, on Monday had an injection of platelet-rich plasma into his right hamstring, suggesting this is no ordinary hamstring injury, one that has already put Pedroia on the disabled list twice.

And now, 22-year-old center fielder Mookie Betts, recognized in one recent study as the 11th most valuable trade chip in baseball -- occupying a tier just below such stars as Mike Trout, Bryce Harper, Anthony Rizzo, Andrew McCutcheon, Chris Sale and Manny Machado -- appears to be the next Red Sox player likely to miss significant playing time.

Betts is showing symptoms consistent with a concussion, manager John Farrell said, after making the type of play Tuesday night that has earned him raves all season. Betts, running at full speed toward the Sox bullpen in right-center field, reached as far as he could with his glove to snare Jose Abreu's deep drive in a 9-4 loss to the Chicago White Sox. Knowing that he wouldn't be able to slow down in time before colliding with the wall, Betts tried to minimize the full impact by going airborne but was unable to keep from going head over heels over the fence.

The play was originally ruled a catch and Abreu called out, but Chicago manager Robin Ventura challenged the call. It wasn't until he watched the replay, Farrell said, that he realized Betts had struck his head upon landing. The ball also had come dislodged from his glove, which meant a no-catch and home run for Abreu, but that took on secondary importance when it became apparent Betts was hurt.

"As he's coming in, he's starting to experience some light-headedness," Farrell said. "He sat down, went through some field tests right there, and it was immediate to get him off the field and out of the game."

Betts had been taken for more testing after the game, and until the Sox know more about the results, they are reluctant to speculate how long Betts might be out.

At minimum, Betts would seem a likely candidate to be placed on the seven-day disabled list MLB established four years ago for players displaying concussive symptoms.

But the Sox, who have had considerable experience with concussions in recent years, know they might be looking at a much longer absence.

In 2013, catcher David Ross played in just 36 games for the Red Sox after taking multiple foul balls off his catcher's mask, the seriousness of his concussions leading him to consult with a specialist, Dr. Micky Collins at the University of Pittsburgh Sports Concussion Program. His symptoms were so debilitating that he was told to go home to Florida in the middle of that summer because the baseball environment was not conducive to his recovery.

Ross eventually came back to play a critical role in the postseason, catching on a nightly basis through the American League Championship Series and World Series.

"Amazing," he would say later. "It's like seeing a movie you wouldn't believe. Who could believe that I couldn't play with my kids without getting dizzy at home, and then I'm catching the last out of the World Series. Crazy."

In spring training that year, shortstop Stephen Drew was hit by a pitch in an exhibition game on March 7 and expected to miss just a game or two. But soon he began displaying more severe concussive symptoms, missed the rest of spring training, and began the season on the seven-day DL.

"You just could do nothing," Drew said upon his return. "You get hit in the head, and it's your brain, and it's one of those things that takes time to heal. I thought I was fine during the game, and going home, I knew something wasn't right. It's like I said, that concussion took a little while longer than I thought it would be."

And last year, rookie Brock Holt's season was cut short after a collision with Pedroia. He played for about 10 days after the collision before becoming ill. He, too, eventually became a patient with Collins, and missed the final 21 games of the season.

"[Collins] said sometimes the symptoms build, that's what happened in my case," Holt said later. "I've never had a concussion before, so I didn't know what to look for, how I should feel or not feel."

Given Betts' importance to the team, the Sox are guaranteed to take a cautious approach. If tests confirm Betts has concussive symptoms, the club must submit a "return to play" form to MLB's medical director, a process that must be followed regardless of whether Betts is placed on the seven-day DL.

On Monday, after trading Shane Victorino to the Angels, the Sox recalled outfielder Rusney Castillo from Triple-A Pawtucket. While Farrell was not prepared to announce a roster move Tuesday night, it's reasonable to expect that Jackie Bradley Jr. will be summoned from the PawSox on Wednesday.

The rash of injuries is reminiscent of the 2010 season, when Pedroia, Buchholz, Jason Varitek and Victor Martinez all sustained disabling injuries within days of each other. That team still managed to win 89 games and play meaningful games in September. These Sox are already out of contention.

There is no cause for haste with Betts. You can be certain none will be exercised.