An Orthopedic Surgeon Analyzes Shohei Ohtani’s Placement on the Injured List: “He Won’t Return to 100%”—The “5 Conditions” Necessary for His Return

A High Hurdle to a Comeback

“This might be the last chance we get to see Ohtani in action this season.”

This summer, there were likely quite a few fans watching Shohei Ohtani’s (32) every move with such mixed feelings.

This season marked his first time playing as a “two-way player” from the opening day since ’23—a span of three years. However, small changes were gradually taking place in Ohtani’s body.Pain in his left knee, inflammation in his right biceps, and discomfort around his neck. The Los Angeles Dodgers decided to place Ohtani on the 15-day injured list (IL).

His earliest return is September 23—at which point, only five regular-season games will remain. In other words, there is very little time left. However, it is believed that even after this rest period, “it will be difficult for Ohtani’s body to return to 100 percent condition.”

How much recovery is needed before he can return to the field? What are the risks of pushing himself to return while not yet at 100%? Dr. Kazutoshi Kameda, an orthopedic specialist and chairman of the Sapporo Central Orthopedic Clinic, offers the following analysis.

“This is strictly my personal opinion as a doctor, but for professional athletes, there is a significant gap between being able to function normally in daily life and being able to play in a game. Ohtani is expected not only to ‘hit’ but also to ‘run.’ In the future, he’ll also have to consider ‘pitching.’

What matters is not simply that the ‘pain goes away.’ Being in a condition to play just one game is completely different from being in a condition to battle through the postseason. If he is considering a return, he needs to confirm at least five conditions.”

Condition for Return #1: Left Knee—“The pain is gone” is not enough

This season, Ohtani has missed games due to issues with his left knee, which has also affected his pitching preparation. Ohtani has a history of surgery on his left knee—he underwent corrective surgery in September 2019 for a bifid patella (a congenital condition where the patella is split). His struggles this season must be viewed carefully in light of this surgical history.

The left knee isn’t just important for “pitching.” It also plays a crucial role in batting.

“You’re not swinging with just your arm. The power generated by your lower body as you push off the ground is transmitted through your core to your upper body and then to the bat. For a left-handed batter, during the latter half of the swing, you rotate while bracing your body with your left leg. The left knee is subjected not only to the weight-bearing load but also to rotational stress.”

When it comes to base running, the strain on the knee increases even further. Players sprint full speed to first base, sometimes coming to a sudden stop while running the bases; they also change direction to round the bases and perform slides. It’s completely different from walking or light jogging.

“Simply being able to walk normally or run lightly isn’t enough to return to a Major League game. Sprints, sudden stops, changes of direction, base running, and full swings—one of the conditions is that symptoms don’t worsen even when the workload is increased to that level.”

In other words, “the pain is gone” is not the end goal.

“Relieving the pain” isn’t the goal—it’s more like the starting line on the road to a return to play. Another issue is the discomfort in his right arm, including his right biceps.

Condition for Return #2: Right Arm — “Compensatory movements” could lead to a new injury

Ohtani was diagnosed with a ligament injury in his right elbow in 2018 and underwent Tommy John surgery in October of that year. Although he subsequently returned as a pitcher, he underwent surgery again in September 2023.

It cannot be definitively concluded that this current discomfort is directly linked to the previous surgical sites or the subsequent pitching workload. However, given his history of multiple surgeries on his right elbow, the decision to return requires careful evaluation not only of the muscles and tendons but also of the condition of his entire right upper limb, including the shoulder and elbow.

Ohtani himself has analyzed the issues with his left knee as resulting from “repeatedly shifting his weight onto his left leg during his pitching motion,” and the issues with his right biceps as being influenced by “his pitching volume.” A key point to consider here is whether the left knee and right arm should be viewed as completely separate issues.

The human body moves in a coordinated manner, with the lower body, core, and upper body working together. Dr. Kameda explains this from the perspective of “kinetic chains.”

“The ‘shortfall’ resulting from not being able to use the lower body sufficiently will likely be compensated for by the core and upper body. Furthermore, the body unconsciously tries to protect the area where pain is felt. The scary thing about sports injuries is not just the affected area itself. It’s a chain reaction of strain—where protecting one area results in increased stress on another.”

In Ohtani’s case, given his history of right elbow surgery, changing his form while experiencing discomfort in his right arm could place unnecessary stress on his shoulder and elbow. “While we cannot definitively conclude that his current symptoms are a result of the surgery, a careful evaluation based on his medical history is necessary.”

When determining whether he is ready to return, it is important not only to assess whether the pain has subsided but also to check whether any “compensatory movements” remain in his batting or baserunning form, or whether he is unconsciously making gestures to protect his right arm.

Condition for Return #3: Can he take a full swing “repeatedly” rather than “just once”?

Batting presents another major hurdle for Ohtani’s return. The team has indicated that it will not let Ohtani swing a bat for several days, prioritizing his physical recovery before gradually resuming batting practice.

“Just because he was able to swing hard once doesn’t mean he’s in the clear. Even if he moves without any issues at first, pain or discomfort can arise from repeated intense exertion. At the plate in the majors, he’ll have to react instantly to fastballs exceeding 150 km/h and sharp breaking balls, and he’ll be making powerful swings repeatedly.

He can take a practice swing. He can take light swings. He can take a full swing. And the symptoms don’t worsen no matter how many times he repeats these at an intensity close to that of a game. By gradually increasing the workload, the return of ‘Ohtani the hitter’ will finally become a realistic possibility.”

Condition for Return #4: The True Test Is “The Next Morning”

It is said that the “next morning” is crucial when determining whether he can return.

“Just because there was no pain during exercise doesn’t necessarily mean there’s no problem. A few hours after intense exertion—for example, the next morning—pain, swelling, stiffness, or difficulty moving may arise. Has the pain or swelling in his left knee increased by the next morning? Has the stiffness or discomfort in his right arm worsened? Can he perform the same level of exercise that day? We need to confirm all of that.”

Major League Baseball features back-to-back games. And in the postseason, the stakes of each game are even higher. There’s a difference between a body that’s “fit to play one game” and a body that’s “fit to play tomorrow as well.”

Considering this distinction, it makes sense that Manager Dave Roberts — while stating , “I think he’d play if tomorrow were a postseason game” —deliberately chose to place Ohtani on the IL. He believes that what’s needed right now is not to push through and play just one game.

Condition for Return No. 5: What Matters More Than “100%” Is Whether He Can Maintain His Performance

So, should Ohtani not play in games until his body is back to 100%?
Dr. Kameda says that’s not necessarily the case.

“It’s unrealistic to expect a professional athlete who has played through a long season to be completely 100 percent—with no stiffness or discomfort anywhere in the body. What matters isn’t whether there’s zero pain, but whether the risk of worsening his condition by continuing to play is within an acceptable range. The key is whether he can consistently deliver the performance required.”

Manager Roberts’ remark that “he probably won’t be 100 percent” isn’t necessarily meant to be pessimistic. Rather than aiming for the “100 percent” mark, the key question is: to what extent can he regain the functional ability needed for the game? That will be the deciding factor in determining Shohei Ohtani’s return date.

Ohtani has made another major decision.

The likelihood of him taking the mound again as a pitcher this season has become extremely low. Ohtani has not pitched since July 3. Although he was at one point preparing to return to pitching, he subsequently halted his pitching practice. He himself has made it clear that a return to pitching this season is “highly unlikely” and that he intends to focus on hitting.

“Pitching places a significant strain not only on the right biceps but also on the shoulder and elbow. This is repeated not just once, but dozens of times. The pitching motion is a full-body movement that transfers power from the lower body through the core to the upper body. If there are still issues with his left knee, we need to consider the possibility that this could affect his pitching form.”

Just because he has recovered enough to play in games as a hitter does not mean he is ready to pitch again. A return to pitching requires a process of gradually increasing the distance and intensity—starting with catch, then moving on to bullpen sessions, and finally to game-like situations.

This season, he won’t aim for that and will instead focus on “Ohtani the hitter.” This doesn’t mean he’s giving up on being a two-way player. Rather, it’s a decision about how much he’ll protect his body this season in order to make the “two-way” role work again next season and beyond.

September 23 is merely “the earliest possible date for a return.”

“Medically speaking, we don’t calculate the return date by working backward from a specific date; rather, the day the necessary functions have returned is the return date. Especially with a major goal like the postseason in sight, we need to weigh the benefits of returning a few games early in the regular season against the risk of aggravating the symptoms again.”

Can his left knee withstand a full-out sprint and a full swing? Are there still any movements where he’s compensating for his right arm or any other part of his body? Can he repeat full swings at game intensity multiple times? Even after putting his body under heavy strain, do his symptoms worsen the next morning? And can he perform at the same level the following day?

Only after meeting these five conditions will Ohtani’s “return” come into view.

“What Ohtani needs isn’t to be 100 percent by September 23. It’s to get his body into shape so he can continue playing at a high level in October. Rather than rushing back by pushing himself too hard, he needs to recover to a state where he can consistently deliver the necessary performance while minimizing the risk of a relapse. I believe that judgment is what matters most.”

Fifteen days may feel like a long time.

However, what we really want to see isn’t Ohtani forcing his way back on the “earliest possible return date.” It’s not about whether he’ll be ready by September 23, but whether he’ll be ready to compete in October. We look forward to seeing Shohei Ohtani swing his bat powerfully once again in front of the huge postseason crowds.