Joe Nathan's Torn UCL: Questions for the Injury Expert, Will Carroll
by Jesse on Mar 9, 2010 11:10 AM EST
in News
76 comments
Jesse: How often do pitchers continue to throw with torn UCLs, and how many of them maintain their level of productivity?
Will Carroll: Very seldom. Research by Jim Andrews showed that the success rate of rehab was much lower than expected. At the MLB level, I can only find two successful cases, though I'm sure there's more at the minor league level.
J: Nathan is resting his elbow for the next couple of weeks. Can "rest" do much help at this point?
WC: Probably not, but two weeks delay is nothing if it helps him come to terms with it. We all want a miracle after bad news, so consider this a chance for a miracle.
J: Let's say the rest actually does help and Nathan feels he can go without the surgery. Can this pain just go away, or will he have to pitch through it?
WC: The tear will heal -- this is not a rupture, which is a complete tear. The confusion is in the terminology. Any tearing in a ligament is a sprain. A complete tear is a severe sprain. Follow all that? Nathan has a "significant" tear, which has a medical meaning - it's visible on imaging - not a rupture. It will heal some, but enough to hold up under the loads of pitching?
J: Concentrating just on what's good for Joe, are there any benefits to not having the surgery?
WC: He wouldn't have to go through surgery, but then again, he might never pitch again. Again, you're hoping for a miracle.
J: Nathan is under contract through 2011 with an option for 2012. Knowing what you know, how would you approach this? Would you shut him down to get the most out of a healthy Nathan that you can in 2011 to make an informed decision on 2012, or do you risk having to shut him down later this season and lose him for all of 2011?
WC: All this assumes the miracle. Look, you're not "shutting him down." He's got a sprained UCL and in all likelihood will need Tommy John surgery if he intends to pitch again. If Nathan has the surgery now --- or in two weeks, that timeline really doesnt change much -- then he'll be throwing by this time next year. Ready to close? I don't know. Billy Wagner isn't a great comp, but he was back a bit under a year later. Having Nathan ready to pitch in December is irrelevant - it's having him ready next April. Just look how long it took Neshek to come back and he's not even all the way back.
Thanks to Will for taking my questions no short notice. Follow him on Twitter, @injuryexpert.
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Replacing Nathan
First off, well wishes to Joe Nathan — a great Twin and underrated player for his entire Twins career nationally in my eyes. Good luck in your recovery!
What makes sense to replace him?
There seemed to be some interest from the Padres in Glen Perkins during the Kouzmanoff discussion (if that ever even happened). The Pods are going nowhere this year and a closer is a luxury on a bad team. Why not some sort of Perkins for Heath Bell deal?
Also, would free agent John Smoltz consider moving back to the bullpen to be the closer on a contender?
A closer from outside the organization would keep the bullpen strong and deep and not put undue, early stress on guys like Neshek or young guys like Slama.
I would definitely do it!
I might even think about Liriano and including a midlevel prospect. Although Perkins would be preferred.
Does
Does anyone want to tell us if his contract is partially insured? I would actually guess quite probably not since he’s a very old pitcher, and therefore very likley to get hurt at one point or another. Maybe partially insured, enough to pay for a replacement?
"You can't sit on a lead and run a few plays into the line and just kill the clock. You've got to throw the ball over the damn plate and give the other man his chance. That's why baseball is the greatest game of them all."
~ Earl Weaver
"In God we trust. All others must provide evidence."
~ Billy Beane
He should just get it done and get going with the rehab
They tried rest with Neshek and Van Mil. Neshek needed surgery anyway. Van Mil ended up putting more pressure on his shoulder as a result and he’ll likely need some kind of surgery now. It just doesn’t work.
The Twins medical staff is fond of saying “Surgery is a last resort.” When it comes to elbow ligaments, it’s the first and resort.
One other thing. The sooner they designate a replacement closer, the better. If he fiddle farts around for a few weeks, we’ll be a week away from the season before the guy who needs to close games starts getting ready for his new role.
How big is the Rauch trade now?
"You're thinking too much. Just have fun." -- Bennie "The Jet" Rodriguez in Sandlot
+1
The importance of the Rauch trade was one of the first things that came to my mind too.
Agreed, get rehab moving
We need Nathan ready to pitch early next year if there is any hope of having him back to pitching form by NEXT year’s post-season run.
Get the surgery, Joe.
Don’t risk your career here. We have the depth where we can survive. Thank goodness we have a good offense on paper this year.
"Risk his career"
The thing is, he’s got this year and next year left on his contract. He’s already in his upper-30’s. Surgery would mean rehabbing until his career was probably only a year from being over anyway, and then IF he did really well he’d maybe get two years. His carer could BE over.
"You can't sit on a lead and run a few plays into the line and just kill the clock. You've got to throw the ball over the damn plate and give the other man his chance. That's why baseball is the greatest game of them all."
~ Earl Weaver
"In God we trust. All others must provide evidence."
~ Billy Beane
Shades of Radke
but Radke was ready to be done. I don’t know that Nathan is. Sigh.
Relievers can go longer than starters
How old is Mariano?
"You're thinking too much. Just have fun." -- Bennie "The Jet" Rodriguez in Sandlot
From what Will Carroll said on the radio,
old closers are actually the exception rather than the rule, with Nathan already having gone further than most. I suppose they tend to put lots of pressure on their arms.
Rivera
I don’t think it’s fair to use Mariano Rivera as a comparison for… pretty much anybody.
"You can't sit on a lead and run a few plays into the line and just kill the clock. You've got to throw the ball over the damn plate and give the other man his chance. That's why baseball is the greatest game of them all."
~ Earl Weaver
"In God we trust. All others must provide evidence."
~ Billy Beane
Natan is 35
Dennis Eckersly saved 282 games after the age of 35. Trevor Hoffman saved 239 games after the age of 35.
"You're thinking too much. Just have fun." -- Bennie "The Jet" Rodriguez in Sandlot
It's true
What you’re saying is true, but I feel you know a little better than to throw some anecdotal evidence at me. You’ve now successfully named like half of the hall of fame closer club.
"You can't sit on a lead and run a few plays into the line and just kill the clock. You've got to throw the ball over the damn plate and give the other man his chance. That's why baseball is the greatest game of them all."
~ Earl Weaver
"In God we trust. All others must provide evidence."
~ Billy Beane
Elbow easier to comeback from than rotator cuff
Rotator cuff ended Sutter’s career. Elbow injury ended Rollie Fingers’ career.
Also...
…does anyone know how well, historically, older pitchers have done recovering from TJ? I mean, it seems logical to assume that when it comes to bouncing back from such an invasive surgery, youth would surely be an asset.
http://www.realityfish.com
by Robin G on Mar 9, 2010 12:39 PM EST via mobile up reply actions
Yeah, I'd assume that too.
Longer healing time, more risk. Odd fact: I was just looking for some stats on that, and noticed a ton of articles about how TJ surgery is becoming common among young, even high school age, pitchers. Interesting.
After his surgery in 1974, John spent 18 months rehabilitating his arm, returned for the 1976 season, and went on to pitch in the major leagues until 1989 at age 46.
Hmm.
RonGarde: Target Field is going to be exactly like Progressive Field, except you'll have a chance to die of frostbite in the middle of July
W/L record of 164-125 after the surgery
124-106 before.
He only briefly got his strikeout pitch back after the surgery and then was a junkballer for the rest of his career. Still had three 20 win seasons and four top-ten CYA finishes… all after the surgery.
Late in his career when people would tease him about how old he was, he’d say something like “yeah, but my arm is only 12 years old”.
It sounds like rest is wishful thinking
but if Nathan needs a couple of weeks to accept he needs TJ surgery so be it. He’s been a great Twin. I wish him all the best.
The Twins need to move on. They still have a division to win and hopefully a WS title. I’d like to see Bell from SD here but I think the Twins will try to string it together from within.
I don’t think this ruins the Twins chances at the division but it probably means there will be more nail biting in the 9th.
Put me in the "surgery now" camp.
We went the optimistic route with Neshek and Liriano and look what that got us.
http://www.realityfish.com
by Robin G on Mar 9, 2010 12:11 PM EST via mobile reply actions
I might be wrong about this...
but if the elbow is inflamed now they probably would treat that a little and wait for it to subside some before operating anyway.
www.bullpenbanter.com
Welcome to the club.
"Don't take life for granted, because tomorrow isn't promised to any one of us." -Kirby Puckett
"All morons hate it when you call them a moron." -Holden Caufield
by less cowbell, more 'neau on Mar 9, 2010 1:19 PM EST up reply actions
Thank you.
Is there a patch or somthing I get? I can sew it onto my jacket.
Or maybe some kind of membership card?
I always loved that one.
Would a ...
… black armband be considered overkill?
Worn over the right elbow
"You're thinking too much. Just have fun." -- Bennie "The Jet" Rodriguez in Sandlot
Not second-guessing really
But…. an All-Star closer has surgery in the off-season to “clean up some things” in his elbow.
He comes out in his very first appearance in Spring Training and blows out his elbow.
Didn’t anyone tell him: Hey, take it easy out there. Just throw nice and natural. Throw fastballs, No injuries.
I mean, what a way to lose your career, in the 3rd inning of a game the first week of March. That’s not the kind of legacy one wants to leave behind.
Yeah
I wonder if someone in the know could address whether there’s an inevitability to these things. In other words, if Nathan had taken the day off on Friday, might this have never happened? Or was it bound to happen sooner or later?
This is why Blackburn's deal was not a good idea
Assume all of the risk, gain little upside.
I see no basis for comparison here at all
Please elaborate. If you believe Mike Marshall, he can teach pitchers to never get injured, but an injury like this can really happen at any time.
It's just that pitchers get injured
Was the $8M option for Blackburn’s free agent year worth the injury risk to the Twins? Doubtful.
Well, that's why it's an option.
If he’s hurt or under-performs, they don’t pick it up. If he’s healthy and is the same guy, it’s a bargain.
Umm
If he’s hurt this year they owe him $14M. Before he signed the contract they owed him nothing.
Not quite the point
Of course the $8M option isn’t guaranteed. I think DJL’s point was that the option year was basically the only thing that the Twins gained by signing Blackburn – they have dibs on him for the next four years no matter what, and unless he suddenly becomes a Cy Young contender, they aren’t saving a ton of money on those seasons. On the flip side, those years, which were basically like contract options, became guaranteed with the signing of the contract.
At some point, you probably will have to commit to a guy for more than a year at a time. I have a much higher threshold for doing that with a pitcher, since it’s so simple for an injury to wipe out a season or more.
"There are only two things that are infinite, the universe and human stupidity, and I'm not sure about the former." - Albert Einstein
I get your point, but there is some risk to not signing him
Let’s say he does exactly as he has done his first two seasons for two more seasons. I think they’d be paying a premium for him in arbitration. That’s the risk they’re mitigating by signing him now.
Does that risk outweigh the injury risk? Probably not. But it’s not like they signed him for no reason.
"You're thinking too much. Just have fun." -- Bennie "The Jet" Rodriguez in Sandlot
It's more than just the option year
Arbitration hearings can be quite contentious. There is something to be gained by not cheesing off your players. I’d imagine that giving a player a multi-year deal gains some favor in not only the players eyes, but also in his teammates eyes as well. PR ain’t cheap.
Neshek
was originally going to be the successor to Nathan before his injury/surgery. If he’s anything close to how good he was before his injury, he may be a serviceable closer this season.
Word is that Rausch may get the closer role, but I’m going to think Gardy spreads the responsibility across the bullpen until he finds a solid replacement.
Sign Smoltz!!!
I personally think we should sign John Smoltz to be are Closer! I know we have 3 guys within that could step in and take over the job but why weaken what I thought was gonna be a top 5 bullpen! We should also see if we could get Heath Bell for Glen Perkins and maybe a propect…your thoughts???
Worth considering
but don’t overpay for a closer. They are overrated.
by ckb on Mar 9, 2010 4:02 PM EST up reply actions
Within could be risky
There are a long line of guys with closer material that failed as closers because of the nature of the job and there are also a long line (Bob Wickman, Todd Jones) of effective closers that may not have closer stuff but have the closer mental/psychological makeup.
It’s risky to experiment with players on a team set up as the Twins are — meaning, ready to make a deep run.
You may minimize this risk by taking on an established veteran, even if he’s not as good of a pitcher overall as, say, a healthy Neshek or Raush or Crain.
Also, you preserve your bullpen depth and keep players in expected, established roles. Plus, you don’t put undue pressure on Neshek to come back too quickly.
That said, I agree with many that say that the traditional “closer” is overrated. But I don’t think it should be the position of the 2010 Twins — the best team I’ve seen in a long while here on paper — to prove it.
Let’s just get someone with some experience.
Try within first
If it doesn’t work, everyone mentioned except perhaps Smoltz will be available at the trade deadline.
Twins will not panic
They will play the first part of the season with what they got and see how it goes. If they feel they need a closer, July would be the time to go find one because at that point, there will be a lot more of them available from all the scrub teams who are out of it. The price will be right, especially for a short term rental.
by Old Twins Cap on Mar 9, 2010 5:33 PM EST up reply actions
Maybe
There are a long line of guys with closer material that failed as closers because of the nature of the job
Who’s in that “long line of guys” besides LaTroy Hawkins? Seriously, I’m curious – everyone brings up LaTroy as the counterpoint to the “any good reliever can close” argument, but no others come to mind at all.
I understand that a closer needs to have an ability to forget his failures quickly and to not be rattled by pressure, but at the major league level, you’re talking about players who have likely had to make it through various pressure situations dozens, if not hundreds, of times. Anyone who makes it to the major leagues is likely good at dealing with pressure already, so my guess is that the differences are in small degrees, with cases like Hawkins being the exception, not the rule.
there are also a long line (Bob Wickman, Todd Jones) of effective closers that may not have closer stuff but have the closer mental/psychological makeup.
It’s not about “stuff” so much as “effectiveness” – those guys were good closers because they were good pitchers, and there’s no law that says that a closer has to be a power pitcher (although it makes sense, since you probably want a guy who can record a lot of strikeouts).
I think Jones is maybe even a counter to the “you need a veteran” argument. By the end of his career in Detroit, he was closing basically because of inertia – he was a Closer, so he had to Close. He wasn’t particularly effective at that point, and I always felt pretty confident when he’d come in to try and seal up a game against the Twins – better to go up against him than someone really good.
"There are only two things that are infinite, the universe and human stupidity, and I'm not sure about the former." - Albert Einstein
Closer Response
Armando Benitez comes to mind — has a solid career 3.13 ERA, 1.22 WHIP and 946K in 779 IP yet was generally considered a failure as a closer.
You cited LaTroy, not me, but he’s a good example.
Given more time and energy I could probably cite a couple more.
I agree with your assessment that most major leaguers can handle pressure but I’m of the belief that being that closer, that guy at the end of the game everyone is going to remember and complain about if you fail, is a little extra.
It seems that fans of the game like myself are the ones stating that being a closer isn’t any tougher (in fact, often LESS so) than being a set-up reliever. However, almost everyone in the game of baseball — from front office to team managers — stick with the theory that only certain guys can handle it. Why else would it still be so? There must be something there outside of “it’s just the way we have always done it.”
And yes using your Tiger/Jones example I would much rather face Jones than, say, a healthy Zumaya at the time. But (1) Jones to me had an uncanny knack of getting the job done which I think seemed impossible after his time with Minnesota and (2) By getting to Jones I probably already had to get through Zumaya.
I’d like to see our guys excel in positions they’ve already proven to excel and try an established guy to maintain our depth.
I wonder what it would take to get Soria
"You're thinking too much. Just have fun." -- Bennie "The Jet" Rodriguez in Sandlot
They probably won't trade within the division
But you never know, it is Dayton Moore we would be dealing with…
by what_would_gil_thorp_do on Mar 9, 2010 5:59 PM EST up reply actions
That would be awesome!
Take alot to get him! We woulda have to give them like Duensing and Revere….No Way! Maybe like Glen and Alexi!
No way
does anybody trade Soria for Perk and Casilla.
"Don't take life for granted, because tomorrow isn't promised to any of us." - Kirby Puckett
It would take two starters and a position player, I'm thinking
Perkins, Duensing and Casilla.
From the Royals perspective, to get two .500 starters and a shortstop to replace that slug Betancourt, that gets them close to a .500 team if everything falls right for them.
"You're thinking too much. Just have fun." -- Bennie "The Jet" Rodriguez in Sandlot
No way the Royals do that
They have to get a player with star potential if they trade Soria.
by Eric in Madison on Mar 9, 2010 5:25 PM EST up reply actions
You would think that
I’ve seen some closer deals that did not involve stars. The Bill James theory of overrated closers has led to a lot of GMs trading their closers for enough parts to make their teams competitive. Oakland has done it a few times without getting “top prospects”. I don’t know if Moore is in that class, but I wouldn’t be shocked if something like that happened. A closer is only as good as the team he pitches for. IF Soria only gets 30 chances to close games, he’s a wasted talent on that team, imho.
"You're thinking too much. Just have fun." -- Bennie "The Jet" Rodriguez in Sandlot
True, you are right, and closers are overrated
But…Soria is one of the Royals true bright spots. He is the symbol of good work by the front office-finding a jewel in Rule 5. Trading him for what amounts to the Twins’ castoffs really isn’t an option for them.
by Eric in Madison on Mar 9, 2010 5:38 PM EST up reply actions
Other Options
Not Sexy but the Twins could look at old guys Troy Percival or Jason Isringhausen who are coming off injuries and are both old enough to remember Sid having a paper route. But, if reasonably healthy, they could possibly plug the hole at least to start the year.
Ha1 Ha!
Sid’s paper-route. Hilarious.
Remember, the Twins line-up may be a bit mroe powerful that we may not need the 1-2 run closer as much as, say, other seasons. Then we could absically have the bulklpen of rotation. Two long guys. 4 set-ups. If the starters can go a requried 6-innings most outings, the Twins, with a 7-man pen, could be sitting just fine.
Visit www.TwinsCards.com and check out "rosters" to see my collection!
Not Percival or Isringhausen please
Percival has been terrible the last 2 seasons – below replacement level. Isringhausen has a history of elbow injuries and is coming back from the same UCL injury that just hit Nathan.
Both are huge injury risks. Their value would be a question mark, they would be as likely to hurt the team as help it. Much better to promote from within.
by what_would_gil_thorp_do on Mar 9, 2010 6:05 PM EST up reply actions
Guys...
This sucks big time but it’s not the end of the world by any means. Twins have lots of bats and a great bullpen. Someone will fill Joe’s shoes. We’re going to be just fine. Don’t panic.
The beard abides.
by Jason Kubel's Beard on Mar 9, 2010 5:35 PM EST reply actions
I generally think that closers are overrated
But even then it’s hard not to hit the panic switch when Nathan goes down. To go from an elite closer to a question mark really hurts!
I hope Nathan plays it safe. As much as this sucks, it would be so much worse to see a guy that’s been so great for the Twins go down with a career ending injury!
by what_would_gil_thorp_do on Mar 9, 2010 6:10 PM EST reply actions
Everyday Eddie was a pretty good closer
that seems to give me faith that the Twins can figure this out, but it still sucks that Nathan won’t be playing this year.
Soria is a nice dream but so is waking up next to Kate Winslet. I’ll let you know what she likes for breakfast when you show me the link that the Royals have traded Soria to the Twins.
I’d prefer not to go after Smoltz but if the Twins wanted to, I say do it now and not in June or July.
Let’s see who rises to the challenge. Solving a problem from within seems to be what the Twins do. I just hope us fans and the players don’t get too down about this. The Twins are still a good team with a good chance at the Division.
Win Twins!
Bone spurs can stabilize elbows?
Someone on espn just said that while bone spurs can cause damage to ligaments, which was the reason they were removed from Joe’s elbow, they can also stabilize the elbow. So it’s possible that removing the bone spurs actually weakened the elbow and maybe even contributed to his injury. She pointed out that Carpenter’s ligaments tore after bone spurs were removed from his elbow. No idea how credible this is, but I suppose it’s possible. Here’s the interview.
How about Liriano as the new closer?
He has the stuff (I think) and won’t have pitch for more than a few outs, sounds like a perfect situation to me.
The Hochevar Principle: The future comes to all teams. Some teams wait for it. Those teams finish in last place a lot. -Joe Posnanski
What we really see from Nathan
To be honest, I think Nathan is a pretty dang good pitcher, but to tell you the truth it scares me to see him pitch. What I mean is that the Twins need to have at least a three run lead in order for him to get a save. I know I’m over exaggerating here, but seriously how many times has he given up 2 base hits with nobody out, and come close to losing the game for us. Or how many times has he given up a home run because people just sit and wait for him to throw a fastball. I know that it could be anyone up there on the mound in a game winning situation and a person could say this about any closer, but it seems to me that more often than not, when the game is on the line, I find myself hoping that Nathan isn’t on the mound.
Respectfully….
by AlreadyMockingly on Mar 9, 2010 6:59 PM EST reply actions
How many times?
They actually do count up these things, and the answer is, not very many, not many at all. In fact, fewer than almost anyone in baseball. Last year his batting average against was .171, his WHIP was 0.93, and his ERA was 2.10. Ah, but were all those outs obtained in low leverage situations, but he failed in the clutch? Actually they measure that stuff too. In 70 appearances last year, he had a total of two losses and five blown saves, but gained 47 saves. In perhaps the best single stat for measuring the impact of performance in specific situations, Win Probability Added, his contributions toward Twins victories have been consistently superlative, placing him among the team’s leaders, usually second only to Joe Mauer. I for one do not feel one teeny tiny smidgeon of relief that we are now without his services. Quite the contrary.
I think you are right when you point out that your anxiety watching him pitch would apply to any closer. Their job is to pitch in high leverage situations, when the game is on the line. It’s tense because it’s close and late. The team is teetering on the edge of failure. And more than anyone else in baseball, with the possible exception of only Mariano Rivera, Nathan almost always got the job done. My hat is off to you, Joe.
Burnett (or Slama) = Andrew Bailey
Or even throw in Papelbon. I love Nathan, and I was never in the ‘trade him’ camp, but if there is an area of strength in the Org, its relief. Wasn’ t that long ago that Nathan suddenly appeared and became a great closer. So many options. Shoot, if Neshek, Rauch, Mijares, or Guerrier can’t do it, and neither can Slama, Delaney, or Burnett—throw Guttierrez in there, or Bromberg. For every Mariano, there is a young closer like Papelbon or Jenks (or Wainwright) who got it done in the playoffs.
At any rate, I see the Twins trying to solve this internally and then trading for reinforcements at the deadline.
Papelbon and Jenks are actually really good to bring up
I think Slama has the ability to be an MLB closer but I was skeptical if he could do it as a rookie. Papelbon and Jenks were both very effective closers as rookies. Could Slama come from the same mold? I doubt the Twins will even try it but I might do it if I was in charge.
One more thing, this time a question
Slama clearly has had some spectacular minor league numbers. Does his stuff match, or is he just a good but perhaps unremarkable pitcher with a firm handle on how to pitch for the level he is at?
A smart pitcher without dominating stuff can be a good closer, but I would think it would be easier for a rookie closer if he has unhittable stuff. Both Jenks and Papelbon are basically just flame throwers, or were as rookies.
Job filled from within
You wont see the Twins make a trade at this point of the season because it will not be fair market value in their favor. Everyone knows the Twins are looking for a replacement and will want to squeeze extra out of them. Come the July trade deadline the other teams are looking to move players to clear payroll and acquire picks or signed players for would be FA or dead weight on their team.
What needs to be done is a quick decision now so everyone else in the pen knows what their role is going to be. It wont be bullpen by comittee because that never works. The move they should just make is give Slama a try. Even with Nathan the closer they are solid with 7th and 8th inning set up and situation pitchers in Rauch, Neshek, Mijares and Guerrier. Keep them in their current roles and lets see what the closer in waiting can do at this level. If that doesnt go well then you make your next move.
From the look of it Liriano might have his stuff back and it may be a benefit to have him in that 5 spot in the rotation because this could be one of the best staffs in the league. With him in the 5 spot that would be like having a #1 pitcher appear in every 3 game set and with quality starts still works to the Twins benfit and stregth of their overall bullpen situation.
We all know injuries are part of the game, its how you adapt and overcome them that keep you a winning team. Dont panic, the team can overcome this injury and still be a WS contender. Just make the decision and dont drag it out and let it mentally affect the staff and get them wondering and thinking if they are good enough to close out games. Baseball is the most mental game of them all and they cant drag out this decision and leave the organization open to questioning themselves.
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