Okay, Time for My Surgery! Heading for the Doctor After Getting Bounced from the Playoffs

Within a few days of their seemingly invincible teams getting bounced from the playoffs, Placido Polanco and C.C. Sabathia announced they’d undergo near-immediate surgery, Sabathia on his knee and Polanco on his elbow. “[It] nagged me all year,” said Sabathia of the pain in his right knee. Of Polanco, the Philadelphia Inquirer wrote, “It was the middle of August, between his third and fourth cortisone injections, when Placido Polanco first acknowledged he’d probably need surgery on his left elbow following the season.”

Baseball players are taught to minimize pain, while castigated for hiding an injury. Ultimately, this philosophy isn’t particularly good for the players’ health, and it isn’t good for the team, either, when a player playing hurt botches a play. The logical tension may not be quite as stark as Pittsburgh Steeler linebacker James Harrison’s telling recent admission, “I don’t want to injure anybody… I try to hurt people,” but it’s a similar attempt to create a bright line out of a grey area. What’s worse, an article in yesterday’s New York Times reviews a study in the medical journal The Lancet that suggests that cortisone may actually have deleterious long-term health effects. (According to the study, “Corticosteroid injections reduced pain in the short term compared with other interventions, but this effect was reversed at intermediate and long terms.”) So Polanco may be paying for his four cortisone shots well down the line.

There are two issues to consider with pain and injury, then: the long-term health consequences, and the short-term game consequences. Will Carroll’s efforts notwithstanding, player health is still one of the less-understood areas of baseball analysis. We have an imperfect understanding both of the causes of injury and of the effects of playing through pain and injury. Players are lauded for playing through pain — Sabathia and Polanco had fine seasons, despite Sabathia’s carrying his 300-pound frame on an injured knee all year, and Polanco playing with bone fragments and chronic tendon damage in his elbow — but we don’t really know what the long-term consequences of playing through injury will be. (Alan Schwarz has done admirable work examining the effects of concussions, but that’s only one of many types of injuries that baseball players are likely to receive in the course of the job.) Because Sabathia is younger and is signed to a longer contract, the Yankees have a greater incentive to protect their investment than do the Phillies. But neither team has any financial incentive to worry about their player’s health beyond the length of their contract: it’s in their interest to patch the players up and get the maximum utility of them for the duration and no longer.

The short-term game consequences may be a more persuasive reason for the teams to take their players’ injuries more seriously. Sabathia obviously didn’t pitch well during the playoffs, allowing 11 runs in 16 innings, and going six innings or fewer in each of his three playoff starts — that, despite having gone more than six innings in 26 of his 34 starts this year. So, with the usual caveats about small sample size, it seems plausible that the injury that nagged him all year may have affected his stamina and effectiveness in the playoffs. Likewise, Polanco’s 6-for-29 in the LDS and LCS may suggest that he was playing at appreciably less than 100 percent. The Phillies have him under contract until 2012, so they have to weigh their need to win now — especially in the playoffs, when the end of the season is always perilously close — with their needs to keep him healthy for the next two years. Obviously, neither Sabathia nor Polanco was the biggest reason the Phillies and Yankees lost. Still, it’s easy in hindsight to say, if they were going to lose anyway, they might as well have benched them. That’s a facile conclusion, but the premise is inarguable: the players were playing through chronic pain, they played poorly, and the teams lost.

Obviously, what we need most of all is a better understanding of health and pain. Clubhouses would benefit from encouraging players not to ignore pain but to acknowledge it, and openly and honestly assess whether they’ll play better tomorrow if they sit today. There’s no way to play a completely pain-free 162 games of baseball, but there are ways to make the pain more manageable. The first thing that needs to be done is to acknowledge the realities and consequences of that pain. Only then can teams make informed and educated decisions about their players’ health.