Twins Call on Paparesta to Fix Injury Woes

[Lucas Seehafer PT]

The Minnesota Twins hired new athletic trainer Nick Paparesta to lead the team to more healthy waters. But how much impact can one athletic trainer have?

Image courtesy of Lance Iversen, USA Today

Forgive me for beating a dead horse, but the Minnesota Twins were among the most injured teams in MLB during the 2022 regular season. In total, Twins players missed a staggering 2,332 days due to injury, the second-most in baseball and the fifth-most since Baseball Prospectus began tracking injury data following the 2018 season. 

As a result, the team parted ways with head athletic trainer Michael Salazar, who had served in the position since 2020. The Athletic’s Dan Hayes cited the number of soft tissue injuries suffered by the Twins as well as questionable rehabilitation practices, particularly that starting pitcher Tyler Mahle had not been participating in a shoulder strengthening regimen despite landing on the IL three times with shoulder fatigue, played a large role in the team’s decision to move on.

This past Thursday the team announced that they had hired former Oakland A’s head athletic trainer Nick Paparesta to fill the hole left by Salazar. Paparesta spent the last 12 years with Oakland and was named to the 2018 Major League Athletic Training Staff of the Year. (For what it’s worth, Salazar was also named to the team in 2016.)

According to Baseball Prospectus, the A’s have been among the league’s healthiest teams over the last five seasons, though it should also be noted that the Twins weren’t far behind. Below is how the two team’s have stacked up as of late:

While both teams overall have been well-managed, there is a noticeable trend over the past three seasons with the A’s ranking among MLB’s healthiest squads and the Twins falling down a well. Minnesota is hoping that the arrival of Paparesta will help right the ship, but the question is: How much can one athletic trainer impact a team’s injury rates?

The unsatisfactory answer is that it’s difficult to know. Injuries and re-injuries are complex, multifactorial, and often random events, making it difficult, at times, to determine direct cause and effect. Nutrition, genetics, anatomical makeup, sleep hygiene, chronic workload, acute workload, and past injury history are all critical variables in determining an athlete’s injury risk and not all of them can be treated or modified, particularly by a single athletic trainer. 

As such, it’s critical that the entire performance team—often comprised of the athletic trainers, strength and conditioning coaches, and sports scientists—be in lockstep with each other and communicate with the athletes efficiently and effectively. The best rehabilitation and strength training techniques aren’t of much value if the athletes don’t buy into their individual management routines.

From purely a treatment perspective, it’s unlikely that Paparesta will employ anything unique from what Salazar was performing. Most athletic trainers at the MLB level have similar skills and levels of knowledge. However, what may change are details around the margins, such as refined exercise prescription, soft tissue management frequency, sleep practices, interactions with the athletes, etc.

It's impossible to know how the hiring of Paparesta will play in the clubhouse from the outside. By all accounts, Salazar was well-liked by the athletes and coaching staff and it's tough to stick around a team for over a decade in Paparesta's case if you aren't respected.

While it's difficult to project how the transition from Salazar to Paparesta will impact the team's health, it isn't particularly difficult to make the following claim: Michael Salazar was not the lone reason why the Twins were depleted by injuries last season and Nick Paparesta won’t be the the lone reason why the team may be healthier next summer. It’s possible that Salazar did everything “right” and simply ran into bad luck. It’s also possible that Paparesta simply possesses intrinsic qualities that are difficult to describe and quantify, but simply lead to better outcomes. (There’s a lot of “soft science” in rehabilitation, such as psychology and personal skills in addition to the “hard science” of concrete data.) 

Regardless, there’s no way that the Twins can be more injury-plagued in 2023, right?

 

 

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[EGFTShaw]

>>Regardless, there’s no way that the Twins can be more injury-plagued in 2023, right?

 

You Bastard, You Killed Kenny.

 

Dear god I hope not.

[Cris E]

You seem to have access to the BP data. With the lockout and access to training staffs cut off last winter, were injuries up across the league in 2022?  I'd think a good differentiator between training staffs might be how they prepare off-season programs for the guys and how well they work with their personal trainers, so removing that influence could reflect on how helpful training staffs were when they could influence behavior. Perhaps this collapse shows that Salazar was good at parts of his job?  Who knows.

Also, I might guess that team age could play into those health numbers.  Both the As and Twins tend to run young and cheap (with a couple exceptions like Nelson Cruz) and that would make 2022 look particularly bad for MN.  But I'm not sure how true my hypothesis is (maybe some "type" of guys get hurt more often? Maybe the super-intense tweaked out hardcore guys get more ab injuries than the lethargic fatsos? Maybe cigarettes/weed are good for you?) so it may be chasing coincidences. 

Last point: I believe Rocco's approach to resting everyone and trying to avoid injuries is rooted in his wreck of a career. A good player, he just couldn't stay on the field.

Quote

First came the torn ACL and the Tommy John surgery -- both results of freak injuries -- that cost him the entire 2005 season and much of '06. Then came the recurring hamstring issues. And, worst of all, that all led to the persistent fatigue and muscle challenges that eventually culminated in his diagnosis with a rare mitochondrial disease that pushed him to an early retirement at age 29.

He's going to err on the side of caution rather than just playing a guys into the ground like they used to.  Arreaz only saw as much time as he did down the stretch because of the batting title race. I really think Baldelli would have benched him with his legs like that without the compelling reason to keep playing. I wonder if we have a problem not sitting guys when things are serious but sitting them too often for nothing. In other words, how good are our diagnosis skills in the face of his tendency to sit everyone?

[Lucas Seehafer PT]

14 minutes ago, Cris E said:

You seem to have access to the BP data. With the lockout and access to training staffs cut off last winter, were injuries up across the league in 2022?

In short, no. The longer version: days missed due to injury actually decreased from 2021 (44,516) to 2022 (42,925), but that's still a lot of injuries. In 2018, team's missed a combined 30,344. So while things trended in the right direction this year, there's still a massive problem going on. 

[Nine of twelve]

5 minutes ago, Lucas Seehafer PT said:

In short, no. The longer version: days missed due to injury actually decreased from 2021 (44,516) to 2022 (42,925), but that's still a lot of injuries. In 2018, team's missed a combined 30,344. So while things trended in the right direction this year, there's still a massive problem going on. 

My unscientific, unresearched opinion (in other words, my guess) is that more and more players are pushing themselves (or being pushed) closer and closer to the physical limitations of the human body. Hence a higher number of injuries and injuries that are more serious.

[Lucas Seehafer PT]

42 minutes ago, Nine of twelve said:

My unscientific, unresearched opinion (in other words, my guess) is that more and more players are pushing themselves (or being pushed) closer and closer to the physical limitations of the human body. Hence a higher number of injuries and injuries that are more serious.

That's definitely a component. The key now is finding ways to maintain peak performance while reducing the strain placed on the body. Biomechanical analysis plays a role here. Basically, athletes may be toeing the line of the upper limit, but may be doing so inefficiently on the whole. Improved efficiency may reduce injuries.

[Doctor Gast]

I agree w/ Chris that trainers need to work closely with players in the off season conditioning, otherwise players are apt to get injured & burned out early. Last season with the lock out, coaches & trainer were prohibited to reach out to the players & spring training was cut short. That said, management should have known the risk to their pitchers  & spread out their work load between SP, long RPs & short RPs. Keeping pitch counts lower than usual. Yet they relied heavily on poor short relief and over stretch their SPs while abandoning long relief. No wonder we had so many injuries & ineffectiveness.

Players don't want to sit on the bench, Nelson Cruz realized latter in his career that diet, off season conditioning, not playing hurt & rest is crucial to longevity & seasonal productivity. Coaches need to ingrain this into each player. especially not playing hurt & not encouraging it. IMO Buxton's knee injury  should have been dealt with right away, not avoiding the IL & playing well below 100% most of the time,  not playing CF, keep aggravating the injury which caused a different injury. If a stint on the IL won't do it then have the surgery done right away.

Polanco was playing hurt, well below his potential the 2nd half until he could no longer played & was lost for the season. Arraez was dogging it the 2nd half and his productivity plummeted and could have lost the Title if they hadn't given him a breather towards the end. Rest is essential for health, limiting injuries & ineffeciency. Especially in a lock-out season. Here again is poor management, we had the depth. If we had all our pitchers rested, healthy & strong for the post season & Buxton, Polanco and Arraez 100% together with Correa, this would have been a different story. 

Sports scientist should be more involved in trades that includes injured players, to avoid the lost of Mahle for the final stretch & Paddack for practically all of '22 & '23. Again poor management.

[Fire Dan Gladden]

There are parts of this problem that we, the ignorant public, will never be privy to:

Like many things on sports club, this issue can't really be traced back to one individual.  Not just the decisioning by the trainer, but how aggressive is the upper brass pushing return to work?  How much money is being spent on equipment?

How are the players acting towards trainer messaging?  Are they taking care of their bodies?  Eating right?  Not coming to work hungover?  Are they putting in the work for injury prevention and injury rehabilitation?

Expectations:  Are players letting staff know about "minor" injuries or are they expected to play through them?

The Head Trainer matters, but culture probably matters more. Would be interesting to know how teams handle things down to these levels

[Minderbinder]

My unscientific opinion is that getting a late start on Spring Training because of the strike may have curtailed the ordinary amount of conditioning to start the season thus resulting in the high number of soft tissue injuries.  Then again, the athlete may just be soft....  Any professional athlete who's not staying in near-peak condition year-round isn't worth the investment.

[CRF]

This should solve all our injury problems and we'll never need to use the IL again. 162 games by Buxton? Done, Kirilloff wrist issues? Gone. Pitchers going under the knife for TJ? Never. Baldelli with a hangnail? Perish the thought. Ocean front property in Arizona? You betcha!

[Dave The Dastardly]

7 hours ago, Nine of twelve said:

My unscientific, unresearched opinion (in other words, my guess) is that more and more players are pushing themselves (or being pushed) closer and closer to the physical limitations of the human body. Hence a higher number of injuries and injuries that are more serious.

 

My semi-scientific opinion: too much effort on building muscle, which in turns stresses joints and connective tissue not designed to handle the extra muscle.

[DocBauer]

I do think it's possible, at times, to have a team just prone to injury. It usually happens to an older, more veteran team, OR, a team that drafts, signs, trades for players with an injury history hoping to not have a repeat. But even then, mass injuries are just impossible to predict. In Minnesota professional history, I always think about the Vikings Robert Smith. He was an explosive, supremely talented athlete who couldn't stay healthy his first couple of years. And while I'm sure he worked hard to build his body up to endure the pounding of the NFL, he got some great advice from Tony Dorsett, which was, the team needed him all year, not just a partial year, and it was OK to drop down, or run out of bounds once in a while, and don't always look for contact or fight for the extra yard every play. And while that advice may have not been the sole reason he suddenly found better health, he did find it. And he became a better player, an All Pro, and became one of the greatest RB in Vikings history until he retired early to preserve his health and pursue other ventures.

I use that as a reference to further state you just don't always know why and how injuries happen. They are unpredictable. And trying to avoid them might be anything from not playing through them all the time, to changing how you approach conditioning. 

I don't believe the Twins hired Salazar a couple years ago believing he was in any way incompetent. In fact, they've been pretty strong in brining in various coaches and support staff from a variety of places. But the number of soft tissue injuries has really bothered me. I've even half joked before how former Twin Nick Punto credited pillates as a major reason for health and improvement, and maybe the rest of the team should do the same. 

I do believe the lockout had an adverse affect on a lot of ballplayers this year. And a couple recent things I've heard has me convinced of that. Buxton's family had a big bout of covid in the offseason, and he was unable to contact the Twins training staff in regard to treatment and medicine to treat. Now, Buxton's unfortunate knee injury, and the hip that bothered him while compensating, has nothing to do with that. But it indicates how EVERYONE across MLB was simply allowed ZERO support from the training staff in any way. So how do you advise or monitor your players in the offseason?

And while not trying to throw any shade whatsoever towards Mahle and what he may have done to prepare for 2022, he has stated that he may have thrown too hard, and too long to begin the season and developed his "tired arm" as a result. As a reminder, multiple doctor exams and MRI's have shown no injury. But what really bothers me is reports that he wasn't on any kind of shoulder strengthening program. Is that on the Reds, the Twins, or both? Could this have affected Winder and Balazovic as well, getting ready for 2022? 

Right or wrong in blame to change things up, I applaud going out of the system to find a different voice and a different approach. The one thing I'm curious about is the head trainer, and his staff, is only part of the equation. Every professional sports team also has a strength/conditioning coach and staff that work with the trainer and his staff. Have the Twins missed the boat on the S/C side of things? Does this need to be re-visted? 

 

[Nine of twelve]

7 hours ago, Fire Dan Gladden said:

The Head Trainer matters, but culture probably matters more. 

If I ran a MLB team the Head Trainer's responsibilities would include defining the culture.

[tarheeltwinsfan]

21 hours ago, Lucas Seehafer PT said:

In short, no. The longer version: days missed due to injury actually decreased from 2021 (44,516) to 2022 (42,925), but that's still a lot of injuries. In 2018, team's missed a combined 30,344. So while things trended in the right direction this year, there's still a massive problem going on. 

Does missing games for Covid related reasons count in the above statistics? 

[farmerguychris]

Getting this hire right could be the biggest move we could make this off season.  I hope we really hired the right guy, not just recycling someone who had qualifications at the right price.

[Karbo]

IMO the FO can take an awful lot of the blame this year. investing in so many players with known injury concerns.

[jmlease1]

5 hours ago, Karbo said:

IMO the FO can take an awful lot of the blame this year. investing in so many players with known injury concerns.

Well, let's look at the players they brought in for 2021:

• Correa (played 136 games)
• Sanchez (played 128 games, mostly at catcher)
• Urshela (played 144 games)
• Bundy (made 29 starts)
• Archer (who made 25 starts...but never showed he could stay healthy for extended innings work)
• Gray (made 24 starts)
• Pagan (made 59 appearances...even if we wished he hadn't)

So the investments for 2021 actually worked out ok from a health perspective. but we had injuries all over the place from the guys carried over from the previous year and up from the minors (Sano, Maeda, Kirilloff, Larnach, Jeffers, Buxton, Kepler, Lewis, Polanco, Ober, Alcala, Garlick, Winder, etc) and critically a lot of them piled up at the same damn time.

Some of these guys it was reasonable to bet on them not staying healthy (Buxton, Kirilloff, Sano, maybe even Lewis and Winder...but the last two weren't guys that were being counted on for this year, really) and they certainly didn't have Maeda in their planning as anything other than "Maybe he'll be able to contribute late". But should they have predicted/planned for Kepler, Polanco, Larnach, and Jeffers all going down?

I dunno. A lot of these guys who were hurt in 2022 were healthy in 2019 & 2020, when the twins won a lot of games.

[terrydactyls]

I wish the players would follow the conditioning protocols of possibly the greatest ballplayer in history - Babe Ruth.  He hardly ever missed a game even when his hangover was pounding away.

[Vanimal46]

The problem with using raw days lost to IL data is that teams use that as a loophole to keep a player in the organization instead of making a DFA decision. The Twins had that very scenario with Miguel Sano. It was very clear that he was placed on the 60 day IL a 2nd time because they were done seeing him in a Twins uniform. At the same time, I’m sure throughout the league there have been players who have exaggerated the extent of their injuries so they can continue collecting an MLB paycheck.