One of baseball’s biggest stars is down with a shoulder injury. The good news is initial reports indicate surgery is not necessary. As we will explore in this article, surgery is still a potential outcome and the timeline for Fernando Tatis Jr.’s - Star of the San Diego Padres - is murky. Regardless of the path he takes, physical therapy will be part of the process.
A Mighty Swing
After swinging and missing a pitch during Monday's game between the San Diego Padres and the San Fransisco Giants, Tatis immediately hit the ground and grabbed his left shoulder in obvious severe pain.
Soon after he was removed from the game, reports from the medical team indicated Tatis suffered a shoulder subluxation – when the shoulder briefly and partially comes out of the socket and returns on its own. While less damaging than a dislocation – when the shoulder comes completely out of the socket and requires manual relocation – a shoulder subluxation can still cause damage.
The Padres had an aggressive offseason to build a World Series contender. With the talent in the LA Dodgers camp, the Padres can’t afford to lose their star player. Padres fans and fantasy baseball owners across the country were left wondering the extent of the injury.
On Monday evening, one of my buddies in my fantasy baseball league asked what I thought of the recovery timeline. Not knowing the extent of the injury at the time, my guess was the best case he returns in a few weeks and the worse case he needs season-ending surgery.
The recent MRI results give us a better picture.
What was the damage?
The MRI report revealed Tatis has inflammation and minor labral tearing. The Padres medical team and Tatis elected to avoid surgery and focus on rehabilitation. Optimistic reports having him returning after the minimum time necessary when placed on the MLB injury list – 10 days.
This is unlikely.
Let’s put the tearing aside for now. The pain and inflammation resulting from the incident will take roughly a week to subside. Medication can speed the timeline for pain and inflammation resolution, but the healing timeline won’t shift much.
Research shows that after only a few days, changes in muscle quality and activity can occur, as well. This injury is not a case of resting for a few days and then the shoulder feels good as new.
As a right-handed batter, Tatis generates a substantial amount of power through his left shoulder. The shoulder also requires rotational control during the follow-through. He needs to generate maximum power and the ability to quickly slow the bat multiple times a game. He also needs the confidence to quickly move his arm in any direction for fielding.
If there is significant pain or apprehension with movement, his performance will suffer. Hitting 100 mph fastballs does not allow for apprehension. Players have about 300 milliseconds to decide where they will swing and need to get the bat to the ball in about 150 milliseconds. You can’t do that with a significant shoulder injury.
Why isn’t he getting surgery?
When looking at baseball-specific medical research, pitchers get all the attention. This is understandable as they are more frequently injured. While Tommy John surgery from a UCL tear is the more common and dreaded surgery in baseball, labral repairs and other surgeries still occur, more commonly in pitchers. As we just explored, however, the demand on the body is still great for a shortstop like Tatis.
The good news for Tatis is surgery is not always necessary for labral tears. Surgery is still on the table for him, though. One study in military personnel showed a greater likelihood of needing surgery in the presence of instability. A study assessing in-season rehab for athletes found 26 of 30 athletes were able to successfully return to sport, but about one-third had at least one additional episode of instability (e.g. another subluxation).
If Tatis only has to manage pain and restoring shoulder strength and power, physical therapy will likely do the trick. Although, this is no guarantee, especially as an overhead athlete. If he suffers repeated subluxations, surgery will likely be necessary.
Many studies show we can live our lives without any pain or disability despite have tears and degeneration show up on MRI scans. This is the case for the spine (herniations), knee (meniscus tears and arthritis), hip (the other labrum), ankle (tendon and ligament damage), and shoulder (labrum and rotator cuff tears). Pain does not mean damage is present and the presence of damage does not guarantee you will feel pain. However, athletes put the body through greater demands, increasing the likelihood they will experience symptoms when damage is present.
So, what will his rehabilitation look like? If we saw him in a PT Solutions clinic, what would the plan be?
Rehabilitating a shoulder subluxation
As mentioned earlier, Tatis will need to recover any lost strength and power.
Early rehab will focus on reducing his pain and swelling and helping him rapidly return to shoulder-specific activity. While the shoulder recovers, he will maintain lower extremity fitness – he can bike and strength train his legs. As the shoulder progresses, trunk exercises will likely be layered in.
I am not referring to crunches or sit-ups, rather resisted trunk rotation activities to generate rotational power necessary for hitting and throwing.
As pain decreases and he can tolerate shoulder-specific activity, Tatis will perform resistance exercises for his arms and shoulders. This likely will not occur for several days to a week after injury. I say all of this with a large grain of salt.
Tatis is a professional athlete. He has every resource at his disposal. Exercise and rehab is a full-time job. He is also only 22 years old and in fantastic shape. These factors speed up his recovery timeline compared to the average patient walking into a physical therapy clinic.
Still, the human body can only be pushed so far.
If he is going to return to 100% – hitting home runs, gunning runners down from shortstop, diving with an outstretched arm without apprehension – he will need to build strength, power, and resilience in his shoulder. He will need to do sport-specific activities to build comfort in practice before playing at game speed. If an athlete is not psychologically ready to return to the field, it does not matter how prepared their body is.
When Tatis returns to the field, whether that be two or six weeks from now, his rehab will not be over. The labrum will not heal in weeks or even months, but that does not mean the labrum needs surgical repair.
Season and Long-term outlook
Will Tatis ever need surgery? Maybe. It depends on how he responds to rehab.
Given the length of the season and the strength of the team, I would recommend Tatis take his time and not return for 6-8 weeks. The Padres will still be in a great position to take a wild card spot. However, if he rushes back and does suffer a setback, I don’t think it will harm his long-term prospects.
If he elects for surgery his season will be over, but he should be 100% for the next year. If he doesn’t suffer a setback during the season, he may still elect to get surgery in the offseason as a protective measure. A lot of scenarios can play out.
The Padres' recent investment in Tatis – $340 million over 14 years – is likely not in jeopardy because of the injury. There are cases of players struggling to return to form after shoulder issues – see former top prospect Jurickson Profar – but full recovery is certainly possible.
For the fantasy baseball managers with Tatis on their roster, you should have contingency plans in place just in case.