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They're playing medicine ball

The Red Sox are working to be at the forefront of injury treatment and prevention

By Peter Abraham
Globe Staff / March 27, 2011

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The Red Sox placed 19 players on the disabled list last season, with multiple stints for Mike Cameron, Jacoby Ellsbury, and Dustin Pedroia. By the time their fractured season was over, the team had lost players for 1,018 games.

Red Sox players underwent surgery six times between April 6 and Oct. 13 to repair fractured bones, shredded ligaments, and torn muscles. Of the 151 transactions during the season, 98 were related to injuries.

Head athletic trainer Mike Reinold had the responsibility of preparing a daily injury report for general manager Theo Epstein, manager Terry Francona, and other team officials. By the end of the season, it was inches thick.

“Like a book,’’ Reinold said. “I would go to my office in the third inning to start writing. It usually took a while.’’

Francona quickly grew tired of answering questions about injuries and the players took a fatalistic view best expressed by Pedroia, who on June 25 in San Francisco fouled a ball off his left foot and broke the navicular bone. With the exception of two games in August, he did not play again.

“Injuries just happen,’’ Pedroia said. “There’s not much you can do about it.’’

That is not necessarily the case. The Red Sox are working to be at the forefront of what could be baseball’s next landmark innovation, the ability to assess, treat, prevent, and perhaps even forecast injuries so effectively that it creates a competitive advantage.

Much like the revolution in statistical analysis last decade that changed game strategy and how players are evaluated, teams that pour staffing and financial resources into their medical departments could leap ahead of their competition.

“Theo has charged us to be innovators,’’ said Dr. Thomas Gill, the team’s medical director. “We want to be the best in the league and create that advantage. There’s no doubt in my mind it can be done.’’

For the same financial investment in a high first-round draft pick, teams can add personnel to their medical department, fund research, and better equip their facilities.

“It’s smart. The Red Sox are being forward-thinking,’’ said Will Carroll, who covers medical issues for Sports Illustrated. “Sports medicine is one of the cheapest ways to improve your team. You just have to be willing to make the investment. Just a few small things can make a difference.’’

In the shadow of Gillette Stadium, the home of the New England Patriots, the Red Sox are working to make an even more significant leap.

Innovative lab work The Brigham and Women’s/Massachusetts General Health Care Center sits across from a wine bar at Patriots Place in Foxborough and a row of stores offering sunglasses, mobile phones, and the like.

The MGH Sports Performance Center is inside. Eric Berkson, the Center’s director, is one of the Red Sox team doctors but is not identified as such in the team media guide.

“He’s a pioneer,’’ Gill said. “He’s single-handedly making some great advances in this field.’’

The Center’s lab includes a major league standard pitcher’s mound with 20 high-speed video cameras set up to capture every precise movement of a pitcher’s delivery or a hitter’s swing. Gyrometers developed with the assistance of researchers at MIT measure the force put on an athlete’s shoulder, elbow, hips, knees, and feet.

The three-dimensional images produced help doctors treat existing injuries but also identify flaws that put too much torque on tendons and ligaments.

Berkson and researchers from MIT were at the Red Sox facilities in Fort Myers, Fla., during the early weeks of spring training taking biomechanical measurements of minor league players, both pitchers and hitters.

In time, the Red Sox hope to maintain a database on all of their players.

“It can even be a coaching tool,’’ Gill said. “If we have baseline video of a pitcher throwing with good mechanics, when he needs a correction we can film that and superimpose the images on each other to show even a 1-degree difference in arm slot.

“When you show it to the pitchers and they can see the small difference, the light bulb blinks.’’

The data also gives Epstein another tool with which to evaluate players. A pitcher with a risk-inducing delivery may not merit a long-term contract, for instance. And as the system becomes more sophisticated, high-speed video could help judge the merits of free agents and amateur prospects.

Similar work has been done for several years by Dr. James Andrews and Dr. Glenn Fleisig at the American Sports Medicine Institute in Birmingham, Ala. Reinold was the coordinator of rehabilitation services at ASMI before joining the Red Sox, experience that helped him land the job in Boston.

The Red Sox had sent pitchers to Alabama for testing. But the proximity of the Mass. General facility will allow them to fully explore the possibilities of motion-capture technology.

“At the professional level, our goals are making the team better,’’ Gill said. “But this is also going to help all of our patients. It’s ground-breaking.’’

Only a handful of teams, the Giants and Brewers specifically, are as engaged as the Red Sox in this endeavor. Within baseball, the work is considered proprietary and Epstein would speak of it only in the most general terms.

“Baseball sports medicine is changing quickly,’’ Reinold said. “We’re part of the groups that are doing the research. By the time everybody else knows about it, we’ve been doing it for a couple of years.’’

Preventative philosophy The Red Sox employ enough medical people to staff a small hospital. Gill is one of five team doctors and oversees a major league staff that includes three trainers, an operations coordinator, a strength and conditioning coach, a physical therapist, two massage therapists, a nutritionist, and a chiropractor.

The minor league staff has 10 more health professionals.

“The resources here are unbelievable,’’ said John Lackey, who signed with the Red Sox in December 2009 after spending eight years in the Angels organization. “I came from a pretty good team and we didn’t have anything like what we have here. There are more hands and more help for you here.’’

When Gill became medical director before the 2005 season, the philosophy shifted from treating injuries to trying to prevent them.

“We try and take a more prospective approach as opposed to a retrospective approach,’’ said Reinold, who became the head trainer last season after four years as an assistant.

“In terms of percentage, I’d say the majority of our work is trying to prevent. You deal with the strains and the sprains, but we spend all day working with the healthy guys.

“We have the support of ownership and the front office to hire a large medical staff. It’s a very large group because we want to provide as many services as we can to enhance performance.’’

To that end, Reinold developed a shoulder-strengthening program six years ago, a series of exercises with light weights designed to curtail injuries by improving range of motion and the muscles in the joint. Pitchers who join the Red Sox quickly receive a binder of instructions.

“It works,’’ Lackey said. “I think it helps a lot. It’s something we’re constantly doing over the course of the week.’’

Said Reinold: “I’m proud of it. But I’ve been here six years and it has changed six times. We want to evolve. We’ve put the research in to say what’s the most effective, what’s the most beneficial.’’

Gill said the communication with Reinold and the other staffers is constant.

“It’s a lot like the team,’’ he said. “The buck ultimately stops with Tito [Francona] but it’s not a one-man show. We have a lot of people working hard to get these guys on the field and keep them there.’’

Projection assistance In Epstein’s eight years as general manager, the Red Sox have a mixed track record with injuries.

Some low-risk acquisitions (Wade Miller, Matt Mantei, and John Smoltz) proved almost worthless. But signing the oft-injured J.D. Drew worked out, given the 131 games played he has averaged in his four seasons. Josh Beckett was another health risk that proved worth taking.

Behind the scenes, the Red Sox and other teams are working on risk-assessment formulas to help make such decisions easier. By compiling data on a player’s history, experience, and body type, a team can project the boundaries of his long-term effectiveness.

“We’re getting better at it,’’ Epstein said. “I don’t know how we are in relation to the rest of the industry, but we spend a lot of time thinking about it.’’

The information can impact contract extensions, free agent signings, and draft picks.

“Projection is an important part of scouting any amateur player,’’ Epstein said. “You can also project for future durability and future injury risk. You can have two guys the same age and same profile. You can have an old 20-year-old body that doesn’t have much room for projection and you can have a young, projectable 20-year-old.

“High school kids and especially college kids all have track records of injury and durability and that’s important as well. And mechanical issues, too, that can represent red flags.’’

There’s debate within baseball about the accuracy of such assessments. Unlike performance statistics, there is a wide margin for error.

“The more we study it, the more we look at it, the more accurate we can get,’’ Reinold said. “The issue is that these guys are the outliers. They’re the exceptions to the rule.

“It’s like other statistics, I think it’s worth trying. But it’s subjective. You can look back at a traumatic injury, somebody crashing into a wall, and it puts them on the DL for two months. Do you mark them down? Does that make them injury prone?’’

As decisions are made, the medical department has a voice.

“When you think about it, the medical director of a team is probably as important as the scouting director,’’ Carroll said. “The Red Sox are doing some smart things. It’s hard to say how many wins that translates to on the field. But that number is getting higher.’’

Peter Abraham can be reached at pabraham@globe.com. Follow him on Twitter @peteabe.

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