BOSTON -- Chris Sale was still throwing 99 mph against Baltimore a week ago Sunday in his first start since coming off the disabled list. He could have stayed on the roster and tried to pile up his inning total and strikeouts.
Instead, by speaking up about his throwing shoulder discomfort and going to the DL twice now, Sale showed he’s not just leaning on cliches when he talks about team-first goals.
Sale could still win the American League Cy Young award in 2018, depending on how well the Astros’ Gerrit Cole pitches down the stretch. Trevor Bauer, also injured, isn’t necessarily out of the picture. Justin Verlander, Corey Kluber and Luis Severino deserve mentions, too.
But these DL stints could knock Sale from the top spot in voters' eyes.
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Regardless of how the votes eventually fall, Sale's dominance this season has been unparalleled. His 1.97 ERA, 0.85 WHIP and 13.9 strikeouts per nine innings are the best in the majors. Innings totals do count for most voters, though.
It’s surprising that someone so good -- Sale is a Hall-of-Fame track pitcher -- has yet to actually win pitching’s top award. He’s been a top-six finisher the last five seasons. He appeared a lock to win a year ago, until a poor end to the regular season nudged Kluber into the lead.
“He’s dealing with a little bit of bursitis in that shoulder, so best way to knock that out is rest, which is exactly what he’s doing,” Red Sox president and CEO Sam Kennedy said on WEEI’s Kirk and Callahan show on Wednesday morning. “And I know it’s hurting him to be on the bench. This guy is, for those of you who don’t know him or haven’t seen him, he’s the ultimate competitor. He’s pissed off that he’s not in the stating rotation right now.”
Of course, Sale’s personal interests long term are being served as well: He’s being wise about his body and his own career. He's a free agent to be after the 2019 season.
In the case of his shoulder inflammation, the condition is common.
“Bursitis, tendinitis, it’s all kind of part and parcel of the same thing,” said Dr. Chris Geary, the chief of sports medicine at Tufts medical school, a shoulder expert who has not examined Sale. “There’s a bursa, which is basically a little fluid sac, which goes between the tendons and the bone up top. The bursa is there to kind of lubricate between the tendon and bone.
“Rotator cuff tendinitis, or impingement or bursitis, it’s all kind of the same thing. Technically, the bursitis is inflammation of the bursa, but you don’t really get one without the other.”
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Rest and physical therapy are the cures, and bursitis can be diagnosed without an MRI.
“This is the kind of thing that every pitcher deals with on some level pretty much,” Geary said. “That’s why they’re all doing their bands and treatment and icing it.”
One possible remedy: A cortisone shot. It’s unclear if Sale has already gotten one, but this period he’s in presently, without throwing, suggests it's possible.
“Not the kind of thing where you do an injection and then have him go out and throw two days later,” Geary said. “Shut him down a week to 10 days. Quiet down the inflammation. If you do a shot then immediately go back and throw, it kind of defeats the purpose."
A shot, as long as not administered too often, would be a routine means of treatment. Cortisone reduces inflammation and can be more than just a band-aid, because it addresses the inflammation.
"It's like taking a bottle of ibuprofen and dumping it in your shoulder all at once," Geary said. "The hope is by decreasing the inflammation, you can proactively decrease it from coming back as much."