Fantasy Baseball Injury Report: Fish Out of Water

Pitchers

Josh Johnson and Cliff Lee

Texas ace Cliff Lee is fighting through back soreness and recently received a trigger point injection (TPI) for the pain. TPIs are utilized to relieve muscle knots that are making a muscle tight and irritating neighboring nerves. The problem has been an issue for a while and likely attributed to Lee's 2-4 record since the All-Star break. The former Cy Young winner missed his last scheduled start but hopes to pitch against the Yankees over the weekend.

In the National League ,a pitcher hoping to win his first Cy Young is also nursing a back injury. Florida's Josh Johnson will miss his scheduled start on Friday and could see his season end prematurely as he deals with his injury. Apparently the back has been an issue for the last several weeks and like Lee may be at the root of Johnson's post All-Star break struggles. Johnson is 2-3 since the break with a 3.50 ERA, up from 1.70 prior to the All-Star Game. He has returned to Florida to have the injury examined by a specialist.

It is easy to understand how back injuries may have affected the performance of elite pitchers like Lee and Johnson if you carefully examine the biomechanics of pitching. Hurling a pitch is broken down into four phases: the windup, cocking, acceleration, and follow-through phases. Back strains can be very limiting for a pitcher during the cocking and acceleration phases. In the cocking phase the back muscles stabilize the arm and trunk and allow for the shoulder to gain additional degrees of rotation. During the acceleration phase the muscles of the back are actively contracting to help deliver the pitch with accuracy and velocity. If the back is strained, a pitcher is unable to properly complete these phases limiting the effectiveness of their pitches. Lee and Johnson hope to pitch again this season but with the Marlins out of the playoff hunt the team may elect to shut Johnson down. Fortunately for Lee owners, the Rangers are contending for the AL West crown and need Lee to rejoin the struggling ball club.

Johan Santana

Santana has a strained pectoral muscle and missed his last scheduled start on Tuesday. To understand what Santana is dealing with let's reexamine the phases of pitching. Like the back muscles, the pectoralis major and pectoralis minor are most utilized in the cocking and acceleration phases. The pecs act as an active stabilizer during the cocking phase and actively contract during the acceleration phase to bring the arm across the body while internally rotating the humerus. This motion helps generate velocity for pitches and controls the arm during follow-through. A strain to these muscles can cause a major dip in a fastball's speed and render a pitcher ineffective. The Mets elected to throw Dillon Gee on Tuesday despite a promising long-session from Santana on Saturday. Expect New York to ease Santana back to the mound.

Hitters

Miguel Cabrera

The Tigers' slugger is currently battling a case of biceps tendinitis that forced him from Tuesday's win over the White Sox and also sidelined him during a recent game against the Royals. The biceps muscle is a two-headed muscle responsible for flexing the forearm and a motion known as supination. Both the long and short heads of the biceps originate on the scapula, better known as the shoulder blade. The short head attaches to a bony prominence on the scapula known as the coracoid while the long head attaches to supraglenoid tubercle. The long head actually runs within the cavity of the glenohumeral joint and helps stabilize the humeral head while throwing and swinging a bat. It exits the cavity through the bicepital groove, an indentation in the humerus bone. Unfortunately, this location makes the tendon very vulnerable to impingement and inflammation. Biceps tendinitis is best treated with rest and anti-inflammatory medication and it sounds like Detroit will give Cabrera as much time off as needed. Cabrera admitted he is having a trouble swinging the bat and is unsure how long he will be sidelined. He was held out of the lineup Wednesday. The timing could not be worse for fantasy owners who will miss his production down the stretch.

Josh Hamilton

Another slugger is dinged up as the Rangers outfielder nurses bruised ribs sustained when he collided with the outfield wall. The collision forced his left arm into the left side of his rib cage. X-rays on the area were negative but Hamilton likened the feeling to being "in a car wreck." Hamilton has a history of rib injuries missing 13 games last season following a similar incident. Furthermore, rib injuries tend to linger, just ask anyone who has owned Jacoby Ellsbury this year. Texas expects to be without his bat for at least a week, putting fantasy owners in the middle of the playoffs in a tough spot. Even when Hamilton does feel OK to return, his production may slip as he eases back into things. Without the advantage of a disabled list, it is hard to wait around on a player even if he is leading the majors with a .361 average.

Jose Reyes

Reyes has not played in the Mets' last 12 games after aggravating a right oblique strain. The internal and external oblique muscles work together to complete trunk rotation. Strains to this area result in limited motion and pain. For Reyes, this is more of an issue when at the plate then when in the field. The switch-hitting shortstop wants to be able to hit from both sides of the plate upon his return and is progressively regaining his swing. However, the Mets may elect to rest Reyes when the opposing team places a right-hander on the mound as batting from the right side of the plate will be more problematic and put more strain on the injury site. New York does not expect him back until the weekend at the earliest and will likely give him frequent days off until he is close to 100 percent. Ruben Tejada continues to start in Reyes' absence, but is known more for his glove than his bat as suggested by his .192 average.