Discussing Michael Young’s Hamstring with Injury Expert Will Carroll of Baseball Prospectus

Will Carroll, author of Baseball Prospectus’ Under the Knife column, is considered the leading expert in the baseball media world on injuries and understanding medical treatments. Carroll, who lives in Indianapolis, authored the book Saving the Pitcher in 2004 analyzing pitching injuries and offering theories on how to suggest them. He’s a good friend of those who cover the Rangers and has been a regular (and popular) speaker at Newberg Report Night at Rangers Ballpark the last couple of year. We caught up with him Wednesday shortly after he’d finished writing an Under the Knife entry on Michael Young’s injury.

“The Rangers got the news that, as expected, Michael Young has a significant strain of his left hamstring. “Significant” usually means a Grade II and early speculation on the timeframe matches that. The best case has him back in two weeks, just in time for a big series with the Angels. The more realistic case has him out until about the end of the month. Some people caught that my ERD for Young was very optimistic yesterday, spotting him at the 12th. Since Young won’t have to go on the DL (almost no one will in September), the Rangers can play a bit faster and looser than normal. Young is undergoing the fashionable treatment, platelet rich plasma injections, to try and heal up. I think in about ten days, Young will have made enough progress that he’ll push himself into a discussion with the Rangers brass about playing. I’m not sure if it will be a full start or some lesser role, pinch hitting perhaps, but I think we’ll end up seeing Young more quickly than most. The downside here is the recurrence risk, but the Rangers are going to have trouble keeping Young on the bench.”

Follow the jump for more from Carroll on the Platelet-Rich Plasma (PRP) and the Michael Young case.

Evan: Will, what are your first thoughts when I tell you a guy is having platelet therapy for a hamstring strain?

Will Carroll: PRP (Platelet-Rich Plasma) and the prolotherapy kick we’ve seen in baseball this year has yet to convince me that it’s effective. I recently read a study on PRP in a general population and also the Wired article about placebo effectiveness. There seems to be some middle ground. Look, it doesn’t seem to hurt, but it’s pretty unclear if it helps. We’ve seen some positives (Andrew Miller), some negatives (Xavier Nady), and some “shrugs” …

Evan: Can you brief our folks on the Miller and Nady cases?

Will Carroll: Miller had an oblique strain and credits PRP for getting him back quickly. Downside there is it wasn’t a significant advance on the timeline – he was at the low end of normal expectations – and he didn’t pitch that well when he came back.

Nady had PRP in hopes of avoiding Tommy John surgery. This was ligament/tendon (Nady had previous TJ, so there’s debate on what his ulnar collateral ligament) rather than muscle like Young. It didn’t work for Nady, but it was worth the try.

Evan: If that’s the choice of treatment, does it give any indication how severe the strain may be?

Will Carroll: No, I think the strain is what it is. It’s in the middle given what I know about the injury, likely a Grade II. Given that and the normal time frame and the time of year, plus the Wild Card chase, I think the Rangers will give it a shot.

Evan: OK, I should have asked you to explain this earlier, but I’ve linked a couple of basic stories on Platelet-Rich Plasman Therapy. Can you give our readers a quick, basic explanation of what it is and why it is supposed to work.

Will Carroll: For anyone that went to college and wasn’t rich, they’re familiar with donating plasma. It’s a similar procedure, but instead of having just the plasma, they leave in the platelets. Platelets are what clots up when you cut, so no one really seems sure about why they help with healing, other than maybe stopping the bleeding internally. There’s a lot of claims with PRP, not a lot of scientific data.

Evan: Is there a hamstring case study out there to cite?

Will Carroll: Case study … Well, there’s a comparable player, but I don’t think Rangers fans are going to want to hear that Jose Reyes is the best comp here. It didn’t work. Reyes is still not back, never got that close, and while it was a different injury (Hamstring tendon vs. hamstring muscle), it’s not a great comp.

Evan: Young says the injury is in the lower part of the hamstring, but not the tendon. Does the area make a difference in recovery time?

Will Carroll: Yes, it does. The muscle heals better than the tendon and the closer to the “belly” of the muscle, the easier it is to heal. The ends have less fibers so the same tear takes out more stability. Low is better than high in baseball. I can’t tell you why, but it’s functional demands on the muscle.

Most of the issue for Young is going to be pushing out of the batter’s box, no surprise since that’s how he injured it. At 3B, he’ll have less “turn and run” plays. 3B is more reaction and quick lateral steps.

I doubt they’d try it, but it’d be interesting to see Davis/Blalock at 3B and Young at 1B. I don’t know if the defensive drop would be worth it.

Evan: I don’t think they’d risk weakening themselves at multiple defensive positions if they can at all avoid it. And like you said, the biggest issue for Young is going to be pushing off out of the batters box.

Will Carroll: Very true. Us writers can theorize all we want, but it’s harder to make changes than most think.

Evan: Also, let’s clear up the grading issue of the strain. Young said it was called a “Grade 1-plus.” What is a Grade 1 strain? And what is Grade 2?

Will Carroll: Strains are graded as either 1, 2 or 3, usually written as I, II, III to be extra confusing. Worse, we have “+” added in, like “it’s a I+ strain.” All that means is it’s in between 1 and 2. A 1 strain is some mild tearing of the muscle. It hurts, it gets sore, but it heals up quickly. You hobble a bit, you ice it, you rest and back out there. A 2 strain is characterized by tearing – a “palpable defect.” You can actually feel in many cases where the muscle fibers have torn.

Evan: But in a 2, nothing becomes detached, correct? You get detachment and you are into a 3 and headed for surgery, no?

Will Carroll: A 3 strain is often called a “tear” or “rupture.” Of course, any strain involves tearing. (I am convinced my tombstone will say “a strain is a tear!”) It’s a complete or near-complete tear. The muscle goes in opposite directions. Think Dean Palmer … or don’t. Correct on a 3, that’s when the muscle becomes detached, but short of a 3, surgery is seldom the answer. You’ll occasionally see severe 2′s and 2+’s that surgery helps speed the healing. Athletes have different timelines than normal people.

Evan: Not sure what info you’ve got on Young’s injury or what you know about Young, but do you think it’s realistic he will be on the field for the Sept. 18 game against the Angels?

Will Carroll: Young’s so determined that I do think he’ll push to be back out there for that or even sooner. I know the Angels are a division foe, but it’s clear that every game counts at this point of the season.

That determination — “gritty, gutty” — can be good or bad, depending on if he pushes out too soon. A re-injury would do him in longer. I think Jamie Reed and Keith Meister (plus whoever is doing the PRP) will keep a close eye on him, not to mention Ron Washington.

Evan: Will, you’ve been a great help. Thanks for helping us better understand the situation.