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Monday, August 01, 2011

McAdam: Buchholz has stress fracture, likely out for year

No Clay morrow? Anarchy!

With the benefit of hindsight, it’s easy to now understand why the Red Sox spent so much time and energy on finding a starting pitcher at the trade deadline.

Clay Buchholz, who’s been out six weeks, is suffering from a stress fracture in his lower back, according to a person with knowledge of the situation.

It’s unlikely that Buchholz will pitch again this season, though a return in the postseason has not entirely been ruled out yet.

Buchholz, whose last start was June 15, is scheduled to see noted back specialist Dr. Thomas Watkins in Los Angeles Monday. But Watkins will likely only confirm what has already been diagnosed.

Repoz Posted: August 01, 2011 at 11:19 AM | 52 comment(s) Login to Bookmark
  Tags: red sox

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   1. Benji Gil Gamesh Rises Posted: August 01, 2011 at 11:46 AM (#3890121)
Well, that explains a lot. They've probably known this for a week or more, kept it quiet.
   2. Steve Balboni's Personal Trainer Posted: August 01, 2011 at 12:13 PM (#3890123)
So we'll be seeing Wakefield and Miller for the rest of the season in the rotation. The problem will not be the regular season - both the Yankees and the Red Sox are treating the regular season like a warmup for the playoffs, and why not?

Tampa has tumbled out of the playoff race, and LA is the only team that has any chance of catching either NY or Boston. LA is 9 back in the loss column to Boston with 54 games to go. If Boston goes .500 from here on in, they'll win 94 games. To tie Boston, LA will have to go 35-19. To tie NY, 33-21. It's a very steep hill - and that's assuming NY and BOS slow their pace down very significantly.

So, getting a starting pitcher for Boston was really about two things:
1) Mitigate the already-low risk that the team would collapse in the final 55 games.
2) Much more importantly, identify a pitcher they trust enough to be able to effectively start a couple of playoff games.

If Bedard is healthy, he's going to be very helpful. If he's not, Tim Wakefield will start a playoff game. That's pretty much the difference.
   3. Mash Wilson Posted: August 01, 2011 at 12:32 PM (#3890127)
So we'll be seeing Wakefield and Miller for the rest of the season in the rotation.


If you're lucky.
   4. tfbg9 Posted: August 01, 2011 at 12:39 PM (#3890131)
Is this the same type of back injury David Wright had?
   5. snapper (history's 42nd greatest monster) Posted: August 01, 2011 at 01:04 PM (#3890138)
If Bedard is healthy

You do realize the last time Bedard pitched a game in Sept or later was 2006?
   6. Jose Is The Most Absurd Thing on the Site Posted: August 01, 2011 at 01:11 PM (#3890144)
You do realize the last time Bedard pitched a game in Sept or later was 2006?


So you're saying he's due? Woo-hoo!
   7. villageidiom Posted: August 01, 2011 at 01:19 PM (#3890150)
You do realize the last time Bedard pitched a game in Sept or later was 2006?
The last time Bartolo Colon pitched in August was 2005.
   8. rr Posted: August 01, 2011 at 01:41 PM (#3890164)
Too bad. Buchholz is good.

This year's BOS/NYY "race" (see post 2) is a good example of why I am not a fan of the Wild Card.
   9. snapper (history's 42nd greatest monster) Posted: August 01, 2011 at 01:47 PM (#3890172)
The last time Bartolo Colon pitched in August was 2005.

Sure, and no one's given the Yankees credit for him either, when talking post-season rotation.
   10. Mash Wilson Posted: August 01, 2011 at 01:47 PM (#3890173)
There's a fair chance Wandy will clear waivers, right? That might still be out there if the Red Sox get desperate, and the chances of getting fleeced by Ed Wade are pretty low.
   11. snapper (history's 42nd greatest monster) Posted: August 01, 2011 at 01:58 PM (#3890180)
There's a fair chance Wandy will clear waivers, right? That might still be out there if the Red Sox get desperate, and the chances of getting fleeced by Ed Wade are pretty low.

Yankees would claim to block him going to Boston.

They'd take him for just the $. They just won't give up $ and prospects.
   12. Dale Sams Posted: August 01, 2011 at 01:59 PM (#3890181)
   13. Mash Wilson Posted: August 01, 2011 at 02:22 PM (#3890198)
Good point, snapper, a good point. Plus when Colon goes down they'll probably get motivated to go ahead and give the Astros the damn prospects.
   14. IronChef Chris Wok Posted: August 01, 2011 at 02:27 PM (#3890202)
Epstein is genius. lets buchholz throw a bullpen session, makes everybody think he's not desperate, trades for Bedard, and THEN announces we're bat!@# F!@3ed
   15. Joel W Posted: August 01, 2011 at 02:29 PM (#3890208)
In their defense, I'd think a stress fracture in the lower back is actually a pretty hard one to figure out. David Wright tried to keep playing on it also/didn't think it was that bad, etc. Obviously they've mucked a lot of things up over the past few years, but I'm not sure I can pin them for this one.
   16. Jose Is The Most Absurd Thing on the Site Posted: August 01, 2011 at 02:39 PM (#3890214)
I find the complaining about the Sox medical staff to be rather silly. Mistakes get made but this isn't some idiot GM thinking a guy who hits .270/.280/.380 is good because he hits .270. Presumably these are professional doctors with some knowledge of what the hell they're doing. It's not like the Sox have a couple of scouts and Bill James looking at the X-Rays saying "hmmmm...looks fine to me."
   17. TVerik, the gum-snappin' hairdresser Posted: August 01, 2011 at 02:49 PM (#3890222)
Epstein is genius. lets buchholz throw a bullpen session, makes everybody think he's not desperate, trades for Bedard, and THEN announces we're bat!@# F!@3ed


I'd like to point out my #13 in this thread. I think the baseball world had ideas about this when the Harden deal fell through - if Mariners' management was smart, they'd have figured that out and extracted a bit of extra value for Erik.
   18. Paxton Crawford Ranch Posted: August 01, 2011 at 02:52 PM (#3890225)
If multiple outside specialists couldn't find this, I don't see how you can blame the Red Sox medical staff for missing it too.
   19. chris p Posted: August 01, 2011 at 02:54 PM (#3890227)
if Mariners' management was smart, they'd have figured that out and extracted a bit of extra value for Erik.

well, they did get the best hitter in the eastern league.
   20. Matt Clement of Alexandria Posted: August 01, 2011 at 03:02 PM (#3890235)
Chiang and Robinson for a rental is a very fair price.

And regardless of whether baseball thought Buchholz might miss the rest of the season or would miss the rest of the season, everyone knew the Sox needed a pitcher. I have a lot of trouble believing opposing GMs looked at the Sox roster and thought they'd be equally interested in an outfielder as a starting pitcher.
   21. Joey B. has reignited his October #Natitude Posted: August 01, 2011 at 03:28 PM (#3890260)
Hey MCOA, who are you going to sponsor on B-Ref with your $10 you owe for the Derrek Lee bet?
   22. Matt Clement of Alexandria Posted: August 01, 2011 at 03:36 PM (#3890264)
If Lee (current OPS+ 96) ends the season under 107 OPS+, as seems likely, you get to choose who I sponsor.
   23. Dale Sams Posted: August 01, 2011 at 03:42 PM (#3890267)
Presumably these are professional doctors with some knowledge of what the hell they're doing


Jacoby Ellsbury, line 1.
   24. Joey B. has reignited his October #Natitude Posted: August 01, 2011 at 03:43 PM (#3890269)
The terms were that if he got traded that only his numbers on the Orioles would count, per post #25.

Though reviewing it once again, technically you still have one out left to avoid losing in that he can still fail a drug test, which was another stipulation I made, so if you want you can wait until the end of the season.
   25. Matt Clement of Alexandria Posted: August 01, 2011 at 03:47 PM (#3890272)
I forgot about that.

Let me know who you want sponsored. (If Lee put up a 96 OPS+ while on performance-enhancing drugs, I'll still have lost the essential part of the bet, so I definitely don't need to wait for that.)
   26. cardsfanboy Posted: August 01, 2011 at 04:00 PM (#3890284)
if Mariners' management was smart, they'd have figured that out and extracted a bit of extra value for Erik.


What actions in the past couple years makes anyone think the Mariners management was smart? You are right of course, which is probably why the Red Sox choose to deal with the Mariners, they are an organization that isn't really known for their collective brainpower.
   27. Joey B. has reignited his October #Natitude Posted: August 01, 2011 at 04:10 PM (#3890293)
How about former Red Sox pitcher Biff Schlitzer, since you're a Sox fan and the name jumped out at me looking through the list of cheap pages.
   28. Drew (Primakov, Gungho Iguanas) Posted: August 01, 2011 at 04:18 PM (#3890300)
Jacoby Ellsbury, line 1.


And he's only Exhibit A in a list that goes to about Q.
   29. Biff, highly-regarded young guy Posted: August 01, 2011 at 04:34 PM (#3890314)
So we'll be seeing Wakefield and Miller for the rest of the season in the rotation.

Don't you mean Wakefield OR Miller? Beckett-Lester-Lackey-Bedard?

How about former Red Sox pitcher Biff Schlitzer, since you're a Sox fan and the name jumped out at me looking through the list of cheap pages.

Hey...your bet wasn't with me.
   30. Matt Clement of Alexandria Posted: August 01, 2011 at 04:34 PM (#3890315)
Joey -

Done and done. Well played. I thought I had a little time for Lee to pick up, but not enough. He was probably injured to begin the year, the risk of which I assume was a big part of your making the bet.
   31. Joey B. has reignited his October #Natitude Posted: August 01, 2011 at 04:44 PM (#3890327)
He was probably injured to begin the year, the risk of which I assume was a big part of your making the bet.

He may have been, though I think he has had a tendency to be a slow starter for much of his career.

Mostly I just didn't think he'd be able to cut it playing for a lousy team in the best division in baseball, though he's been showing some signs of heating up lately. Now that he's headed back to the worst division in baseball, he may well have a strong last two months.
   32. jacksone (AKA It's OK...) Posted: August 01, 2011 at 04:47 PM (#3890333)
Presumably these are professional doctors with some knowledge of what the hell they're doing


Oh, I can answer that. You see, whenever I picked up an X-ray, I'd always hold it like this. [picks up Clay's X-ray photo to demonstrate. His thumb falls right where the fracture would be] My thumb must've covered up the fractrue every time. [chuckles] I'll show myself out. [leaves]
   33. Dale Sams Posted: August 01, 2011 at 04:50 PM (#3890335)
And he's only Exhibit A in a list that goes to about Q.


Look, I understand how we're not there. We're not employed by the Sox. There are a lot of variables with each case....it just seems to me that after an X-Ray, an MRI would be the next logical step and one that should have taken place a long time ago. It's not an arcane procedure. It's not a one-time thing. It's not exploratory surgery. And this isn't the first time I've heard "We thought it was (X) and decided to do an MRI and found it was (Y)"...weeks later.
   34. Jose Is The Most Absurd Thing on the Site Posted: August 01, 2011 at 05:06 PM (#3890348)
And he's only Exhibit A in a list that goes to about Q.


What are B through Q? I don't ask to be a smartass, I'm generally curious because it seems to me that everytime someone says "oh the stupid Sox medical staff" they mention Ellsbury (which in fairness seemed to get botched) but I don't know what else the Sox blew. Just thinking back to recent years;

2008 Mike Lowell was either a mess up by the medical staff or a great job to get as much out of him as they did
2010 Dustin Pedroia may have been a case of a mistake. I think it was more likely a stubborn guy refusing to admit he was hurting when he came back
2011 Kevin Youkilis has been battling a lot of injuries and I think the Sox are doing a good job to keep him in there.

Just some high profile ones there but I think the complaints about the medical staff get overblown.
   35. Dale Sams Posted: August 01, 2011 at 05:21 PM (#3890361)
Don't forget telling Schilling to rehab when he wanted to immediatly have surgery so he could possibly pitch at the end of the year.
   36. Drew (Primakov, Gungho Iguanas) Posted: August 01, 2011 at 07:05 PM (#3890456)
What are B through Q? I don't ask to be a smartass, I'm generally curious because it seems to me that everytime someone says "oh the stupid Sox medical staff" they mention Ellsbury (which in fairness seemed to get botched) but I don't know what else the Sox blew.


Q is probably an exaggeration, but I'm looking at a list of players who didn't have injury problems until they reached the big club via promotion or trade:

Lester (to a lesser extent)
Buchholz (the present biggie)
Lowrie
Matsuzaka
Tazawa
Doubront (WTH's wrong with him anyway? Heard nothing.)

Heck, even Crawford, who with the exception of 2008 was very durable.

That's a lot of players.
   37. TVerik, the gum-snappin' hairdresser Posted: August 01, 2011 at 07:10 PM (#3890461)
I'll bet that when you composed #16, you didn't think that you would end up defending the Sox medical staff point by point.
   38. ellsbury my heart at wounded knee Posted: August 01, 2011 at 08:18 PM (#3890525)
That's a lot of players.


The problem is there's really not a good way to tell if the medical staff is doing a good job without more information, like what the expected outcomes would be with the particular injuries they faced. They could actually be miracle workers with what they're facing, but you would never know it. Plus you can only compare them to other teams. Injuries are going to happen. Lowrie's always had a history of missing time, and the other guys on that list are pitchers. If that's the list, I'd say that's actually pretty good.

They really missed Ellsbury last year, but even if they'd made the diagnosis perfectly right off the bat, I don't know if the treatment would really have changed things that much. Broken ribs take forever to heal.
   39. jacksone (AKA It's OK...) Posted: August 01, 2011 at 08:20 PM (#3890528)
Lester (to a lesser extent)
Buchholz (the present biggie)
Lowrie
Matsuzaka
Tazawa
Doubront (WTH's wrong with him anyway? Heard nothing.)


How do you blame cancer and being Mr. Glass on the Red Sox doctors? Just because someone gets hurt doesn't mean the doc's effed up, it's when there are misdiagnoses that questions occur. I think Ellsbury and Buchholz were clear mess-ups, and probably Matsuzaka (although much of that might be on Matsuzaka himself).
   40. ellsbury my heart at wounded knee Posted: August 01, 2011 at 08:26 PM (#3890537)
I'm not convinced Buchholz is a mess-up. The Red Sox had every reason to act like Buchholz would be coming back at any moment, and even if they'd released the 'correct' diagnosis immediately, the outcome would be the same.
   41. Jose Is The Most Absurd Thing on the Site Posted: August 01, 2011 at 08:36 PM (#3890544)
I'll bet that when you composed #16, you didn't think that you would end up defending the Sox medical staff point by point.


Nah, I've been here long enough to know there was a pretty good chance I would be doing just that.

To take the list in #35 and 36 quickly;

Lester - Seriously? Cancer?

Buchholz - At the moment this seems to be a fairly complicated thing. I think Dale raised some good point on this one earlier.

Lowrie - Hard to say what the medical staff could do about this guy. He certainly seems pretty fragile.

Matsuzaka - I think this is an issue of communication and goes two ways. Whether it is with Tito/Theo/Coaching staff or medical staff I don't know but I suspect the cultural differences were a part of this. I think there is enough blame to go around.

Tazawa - Pitcher has Tommy John surgery, film at 11.

Doubront - PeteAbe (I think) said recently that Doubront was out of shape when he showed up in Ft. Myers this year. This feels a little like a planted story (and I'm not one to make "ooh the Sox are evil and devious with the media" leaps too often) but his season has progressed like seasons other guys have had (Schilling, Beckett) when they were out of shape.

Schilling - I think there is probably a compelling argument that major arm surgery on a 40 year old pitcher who is signed to a one year deal is not the best course of action for the club. My guess is this is more on the Sox FO than the medical staff. I suspect from a purely medical standpoint surgery made sense but there was not a lot of motivation for the Sox to try that when there was a chance of a mid-season return with R&R. (working off recollection).

Just as an aside they have kept J.D. Drew pretty healthy throughout his time here and Josh Beckett is heading towards (knock on wood, knock on wood, knock on friggen wood) his fourth 200 IP season. I don't know that the medical staff deserves much if any credit for those things but I think they deserve as much credit for the successes as they get blame for the failures.
   42. Matt Clement of Alexandria Posted: August 01, 2011 at 08:51 PM (#3890552)
It's also not at all clear that even if Buchholz was a missed diagnosis, it weighs all that heavily against the medical staff. A stress fracture in the back is not an easy thing to identify.

I do think that we can identify a more specific problem of bad communication between players, trainers, doctors, and management. Matsuzaka was apparently pitching for a really long time with serious things wrong in his elbow, but it wasn't identified as a clear problem for years. Pedroia tried to come back way too quickly and blew his recovery - he should have been warned against that, he should have been honest and clear about what he was feeling, and it never should have happened. The Ellsbury thing may have been a definite medical ######, but it was also a breakdown in communication where Ellsbury and his doctors and his management couldn't get on the same page about his diagnosis, rehab, and recovery. Tazawa pitched for a couple months - in the majors no less - with a torn elbow ligament. That's got to be identified earlier, and players have to have a culture of presenting problems like that honestly to medical staff. The Schilling problem seems pretty clearly to have been a case of a player not listening to his doctors, or his doctors and management not being clear about what Schilling needed to do.

I think people blame the medical staff alone for problems that are deeper and not necessarily precisely medical. There's a culture of not being wholly honest with doctors and trainers, a problem of poor communication from medical and training staff to players, and a problem where management doesn't seem to know how and where to step in and demand certain kinds of rehab or medical intervention.

Overall, it seems to me that the DL trips of Buchholz, Lester, and Lowrie are mostly cases where the system functioned pretty well. Lester's minor problem was immediately presented, correctly diagnosed, and a rehab program was implemented which everyone agreed on, and seems to have been entirely successful. We don't know how successful Buchholz and Lowrie will be at coming back from their injuries, but everyone seems to have been on the same page in presenting and identifying problems.

I don't think that identifying players who were healthy in the minors and hurt in the majors is very helpful. The sample is way too small for one - injuries happen at least semi-randomly, and seven players hardly makes up a pattern strong enough to reject the null hypothesis of randomness. Further, the majors and the minors are different, especially for pitchers. Pitchers are on very short leashes in the minors, because it doesn't matter that much whether the team wins or loses. In the show, it's a matter of balancing protecting a pitcher's arm with the need to actually win games. You'd expect there to be pitchers who are healthy in the minors on strict inning and pitch counts, who might get injured in the majors when they're stretched a bit based on the need to win today's game.
   43. MM1f Posted: August 01, 2011 at 08:55 PM (#3890554)
Schilling - I think there is probably a compelling argument that major arm surgery on a 40 year old pitcher who is signed to a one year deal is not the best course of action for the club. My guess is this is more on the Sox FO than the medical staff. I suspect from a purely medical standpoint surgery made sense but there was not a lot of motivation for the Sox to try that when there was a chance of a mid-season return with R&R. (working off recollection).

Further, and maybe Schilling said something about this (I don't know), why knows if a 40 year old pitcher would want to go through a Tommy John surgery and the year of grueling, boring rehab that comes with it.

EDIT-and now I see post 35. Disregard all this I guess
   44. Drew (Primakov, Gungho Iguanas) Posted: August 01, 2011 at 09:15 PM (#3890568)
The problem is there's really not a good way to tell if the medical staff is doing a good job without more information


Agreed...but how do we acquire that extra information?

How do you blame cancer and being Mr. Glass on the Red Sox doctors?


I'm talking about Lester's yearly trip to the DL, not cancer. Also, Mr. Glass wasn't glassy before arriving to the bigs.
   45. Jose Is The Most Absurd Thing on the Site Posted: August 01, 2011 at 09:26 PM (#3890578)
I'm talking about Lester's yearly trip to the DL, not cancer


Wasn't this Lester's first trip to the DL since the start of 2007?
   46. ellsbury my heart at wounded knee Posted: August 01, 2011 at 09:39 PM (#3890586)
Lester's made at least 32 starts a year for the past 3 years, so while he usually misses a start or two, I don't think you can really count that against the medical staff. He's not Verlander or Sabathia, but he's been pretty healthy.
   47. Matt Clement of Alexandria Posted: August 01, 2011 at 09:45 PM (#3890593)
Also, Mr. Glass wasn't glassy before arriving to the bigs.
Lowrie missed about 40 games in 2006, and he was not very good when he did play because of a wrist injury (iirc).
   48. Dale Sams Posted: August 01, 2011 at 10:47 PM (#3890626)
should have been honest and clear


Gawd, isn't that the truth. "Shedding the culture of 'Real Men play with injuries'" should be the new market efficiency. Supposedly Youk endangered his career last year with his odd thumb injury.
   49. villageidiom Posted: August 01, 2011 at 11:36 PM (#3890659)
Just as an aside they have kept J.D. Drew pretty healthy throughout his time here and Josh Beckett is heading towards (knock on wood, knock on wood, knock on friggen wood) his fourth 200 IP season. I don't know that the medical staff deserves much if any credit for those things but I think they deserve as much credit for the successes as they get blame for the failures.
They've done a great job keeping Papelbon healthy after he pitched his arm out of its socket. We've been waiting for the career ending shoulder injury for quite a few years now - Fly moreso than others - but he's been pretty durable on that front.
   50. SteveF Posted: August 02, 2011 at 12:52 AM (#3890708)
These kinds of stress fractures really do present as lower back muscle strains. It's not overly surprising it took a while to diagnose, though stress fractures (even these kind) show up quite clearly on an MRI even in the early stages. It's hard to really know at what point they should have suspected a stress fracture based on his symptoms. Buchholz has indicated in the past he had a similar issue towards the end of the 2010 season. Was that the beginning of the stress fracture (bone bruising) or was that simply muscle stress and fatigue that ultimately may have contributed to the stress fracture in 2011?
   51. Sam M. Posted: August 02, 2011 at 01:30 AM (#3890749)
In their defense, I'd think a stress fracture in the lower back is actually a pretty hard one to figure out. David Wright tried to keep playing on it also/didn't think it was that bad, etc. Obviously they've mucked a lot of things up over the past few years, but I'm not sure I can pin them for this one.


But doesn't the whole Wright thing -- which predated the Buchholz injury (early June; Wright was finally diagnosed with the fractured back in mid-May) -- kind of cut against giving the Red Sox medical staff a break here? I mean, if I had a player with a "phantom back injury," and a star player down the coast had, a month earlier, just been put on the DL with a stress fracture in his back and (presumably) similar symptoms, I'd hope that maybe it would occur to somebody to propose that as a possibility and check for it. I'm more inclined to cut the Mets' medical people some slack, because to be honest I can't remember the last baseball player before Wright with an injury like this. I kind of think Wright's situation might have put it on the Red Sox' radar screen -- especially when they went as long as they did without coming up with any explanation. I mean . . . duh?
   52. Something Other Posted: August 04, 2011 at 03:02 AM (#3892357)
MRIs are freaky things and a lot of folks hate them: the noise, the tight space. Some literally can't handle them. I know a few people who also resist them on the ground that they rotate/line-up all the hydrogen atoms in the body. That upsets them. They think it changes something fundamental. Which it does, I suppose.

My point is, it's not the easiest thing to simply order particularly an established player to take an MRI.

Another problem that people forget is that diagnostic medicine is hard. Sure, there are times when it's straightforward, but that's often not the case. Just to have an outside shot at being competent a doctor has to be smart, alert, wise, humble, has to very, very diligently keep up with the literature... There are a remarkable number of incompetent doctors practicing, but one reason for that is that medicine is damnably difficult.

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