Fantasy baseball: Spring training injury watch

Every year as fantasy baseball season approaches, we pay particular attention to two groups of players: those coming off a stellar season (hoping they can have some semblance of a repeat performance) and those whose season was interrupted, abbreviated or altogether preempted by injury (hoping they can do anything but replicate the events of the previoous year).

Forecasting the 2021 season from an injury perspective presents unique challenges. The arrival of COVID-19 resulted in a pandemic-induced short season and interpreting injury patterns and data from 2019 must be done with caution. Players did not experience a typical ramp-up to the start of last season nor did they endure the physical demands of a full complement of baseball games. Some dealt firsthand with COVID-19 and its associated complications; some opted to sit the season out. Through it all, injuries persisted.

With the 2021 season scheduled to begin on time, it seems like part of restoring normalcy should involve taking a look at some key players coming back from injury, so here we go.

Pitchers

The flamethrower known as Thor was reduced to mere mortal status when his elbow failed him and he had to undergo Tommy John surgery in March of 2020. The silver lining is that the extended rest and recovery period may be what his body needed to gear up for a second act. Presuming a normal course of rehab, Syndergaard will likely resume major league appearances by midseason. It is worth noting however that it often takes pitchers until the subsequent season to regain their pre-injury form.

Chris Sale, SP, Boston Red Sox: For years Sale's detractors predicted his demise given his delivery mechanics and work volume; for years he proved them wrong. But all pitchers are vulnerable eventually as the elbow and shoulder are forced through unnatural movements at high rates of speed over and over and over. Shoulder inflammation in 2018 portended problems on the horizon, but Sale battled through them until August of 2019 when his elbow became the primary problem. Tommy John surgery in March of last year had Sale looking at a 2021 mid-season return but a bout of neck stiffness in January may push that back by a couple months. Depending how his rehab and return to play progresses, Sale's 2021 major league appearances could be more of a warm-up for 2022.

Corey Kluber, SP, New York Yankees: There may not be a starting pitcher who had a smaller stat line in 2020 than Kluber, who delivered just one inning for the Rangers before exiting with a Grade 2 teres major tear in his right shoulder. The teres functions in conjunction with the lat (latissimus dorsi) as a coordinating muscle group for the pitcher's shoulder, important for both speed and control. Although it would cost Kluber the rest of his season, it was not an injury that required surgery -- just a measured, lengthy rehab process -- and it didn't deter the Yankees from making an eight-figure investment. While some will point out that Kluber only pitched seven games in 2019, it's important to note that the major injury that sidelined him in that season was not one of breaking down but rather the result of a line drive connecting with his arm (he later suffered an oblique injury while rehabbing which ultimately ended his season). Yes, it's a bit of a gamble on a 34-year old veteran, but Kluber had six seasons of at least 26 starts until that point. His velocity was declining somewhat by 2018, but it's hard to know how much might be attributed to the impending shoulder injury versus pure age-related decline. And, other pitchers in their thirties have discovered ways to extend their careers by relying less on heat and more on craftiness, something Kluber may have already been steering towards before injuries derailed his path. There are no guarantees he returns to his pre-injury success but the two-time Cy Young winner certainly has the talent to render it possible.

It's always something with Strasburg. Whether it's a rib that feels not quite right, scapular discomfort, neck spasms or another of the litany of injuries that have landed him on the DL/IL over the years, Strasburg is not an infrequent visitor. That said, there were some who thought he was on his way out as his velocity began to decline several years ago, yet he started the second-most games of his career (33) in 2019 and helped lead his team to a World Series Championship. One could argue that his sensitivity to anything being "off" in his body may have helped contribute to his longevity. Unfortunately, the most recent ailment (median nerve compression, aka carpal tunnel neuritis) cost him virtually all of 2020, and he went under the knife in August to address it. Alleviating the nerve irritation appears to have provided relief, and Strasburg, who resumed throwing in December, is expected to start the season on time. Providing there are no additional nerve issues more proximally (further up the arm), this is encouraging news. Whether Strasburg can replicate his 2019 effort in terms of volume or execution remains to be seen, but at least he should be coming out of the gate strong.

Jameson Taillon, SP, New York Yankees: Two Tommy John surgeries, testicular cancer, an inguinal hernia -- all before the age of 30. Taillon has certainly had more than his share of challenges in the first decade of his professional career, but the good news is his career is forging ahead. Traded to the Yankees in January of 2021, Taillon is hopeful that revised mechanics coming off a second UCL (ulnar collateral ligament) surgery will help him achieve success. The data on revision surgeries (as second TJ surgeries are called) is, well, interesting. In a 2019 study published in the Orthopedic Journal of Sports Medicine looking at trends and outcomes following revision surgery in professional baseball pitchers, the authors discovered that while 77% returned to play, only 55% returned to their same level of play. It remains to be seen just how Taillon will be able to perform, but his efforts to modify his delivery may be critical to his success.

Hitters

Gio Urshela, 3B, New York Yankees: Urshela underwent surgery in December to remove a bone spur from his right (throwing) elbow. He may not be a pitcher but throwing with velocity and accuracy is key to Urshela's highly touted defensive skill set. Anything taking up space in a joint can limit motion in addition to causing discomfort; the benefit of having the space-occupying debris removed -- in this case a spur from Urshela's elbow -- is not only for pain relief but also to restore motion. He may be eased into a spring training workload but should be ready to go when the season gets underway.

Matt Chapman, 3B, Oakland Athletics: A labral repair to Chapman's right hip in mid-September meant his entire offseason would have to be dedicated to rehab. Apparently, it was. By the end of the year he had progressed well enough to increase the rigor of his rehab activity, and by early February his video posts on social media showed him smoothly swinging a bat. While his hip and core strength will translate to sport-specific improvements as he ramps up baseball activity during spring training, Chapman appears well on his way to beginning the season as anticipated.

Hoskins missed the final two weeks of the season with an elbow ligament injury, and in early October he underwent a surgical repair. According to Jim Salisbury of NBC Sports, this was not Tommy John surgery but rather a UCL repair with internal brace (IB), performed by Phillies team physician Steve Cohen. Although the concept of internal bracing reinforcement as an augmentation for tissue repair has been around for a number of years, the use of procedure at the elbow specifically for the ulnar collateral ligament (UCL) has only come into play more recently. Pioneered by Dr. Jeffrey Dugas at Andrews Sports Medicine in Birmingham, Alabama, the procedure involves repairing the torn UCL (typically re-attaching the torn end to the bone) and reinforcing it with a synthetic tape or brace. The procedure is not indicated for all UCL tears (for instance, one criterion requires the ligament tissue to be largely healthy, having avulsed or torn off the bone at one end versus a degenerative or frayed ligament that has broken down as a result of repetitive wear and tear; Hoskins had an acute injury on his non-throwing arm as a result of a collision) but when it is an option, it can accelerate the recovery by months. In Hoskins' case, this particular repair of an acute injury combined with the fact it was his non-throwing arm suggested he would be able to return to some level of competition by spring training. After the team's first full-squad workout Monday, Hoskins told reporters he has been medically cleared, and if he can get the at-bats he needs this spring, Opening Day is a possibility.

It has been a painful couple of seasons for Haniger. Really painful. In June 2019 he suffered a ruptured testicle after fouling a pitch off his groin. That is also the last time Haniger played in a major league game. Since then he has undergone core muscle surgery and a microdiscectomy. The latter two surgeries resulted in Haniger missing the entire 2020 season. This past year he underwent intensive training to address movement imbalances, and resumed baseball activities in December. He will be gradually progressed into competitive action throughout the spring but is on track to play as the season opens. And, if he is able to maintain his newly discovered thoracic mobility and core strength, it will bode well for his chances of staying healthy as he returns to baseball.

The typically durable Mancini was forced to step aside in 2020, the result of a colon cancer diagnosis in March. Between surgery to remove a malignant tumor and subsequent chemotherapy, Mancini lost the entire season. The good news is that he is now cancer-free and enters the spring with a clean bill of health and no activity restrictions. Some stories are bigger than baseball.