UTK Flash 7/27/22
Mike Trout Confronts Spinal Condition
The Angels and Mike Trout reported Thursday afternoon that the star outfielder is undergoing treatment for what the team called a “rare back condition.”
The Angels and Trout gave specific details of the condition, but given the current treatment and the discussion of what Trout will need to do “for the rest of his career”, in the words of Angels AT Mike Frostad. The costovertebral dysfunction at his T5 vertebrae is rare, according to two surgeons I spoke with. It’s a joint issue, between the rib and the spinal column, the bony part.
What this is not, as some early reports had, is spinal stenosis, which is a narrowing of the column within the vertebrae where the spinal cord runs. That narrowing can cause a pinching of the cord and with impact can be dangerous. This is the injury that ended Prince Fielder’s career and contributed to the end of Peyton Manning’s, including a spinal fusion ahead of his late career run in Denver.
Trout is being treated by Dr. Robert Watkins III, one of the top back surgeons in the world and one that’s dealt with virtually every major back injury in pro sports, along with a few others, over the last generation. (Dr. Robert Watkins IV, his son, is also a top spinal surgeon and the numerals can be a big confusing, especially since they tend to work together. More on them at the bottom video, if you’re interested.)
Unfortunately, I couldn’t find any good royalty-free diagrams of the costovertebral joint (click the link), but it’s the interface between the spine and the rib, so there’s not a lot of movement, much like the joint in front between the ribs and the sternum. That’s a pretty good design for protection, but like any joint, inflammation or motion can cause problems.
The issue here is that the precise kind of movements that can cause an issue here are exactly what Trout (and any baseball player) need to do. The two most taxing, according to the surgeons I spoke with, are hard twisting, which requires the body to turn and for the ribs to slightly deform with that motion. The second is simpler but even more important: breathing. “If his [joint] is being taxed with simple rib expansion, that’s not something he’ll be able to just stop,” one explained. At least we hope not.
The issue here is that the Angels medical staff seems to be indicating this is a chronic condition, either some damage or change to the anatomy itself, which could be bony, ligamentous, or more likely, a problem with the way it moves, analogous to a knee or elbow ‘catching’.
The T5 is in the upper back, part of the thoracic spine and is roughly nipple high on most men. There’s no indication that there is any issue with the spinal cord, spinal nerves, or any of the associates spinal discs, which is good news. While a fusion at that level would be an involved surgery, there’s no indication that’s needed here, but neither is there a simple, known fix, even if involved.
While some are calling this career threatening, this becomes a maintenance issue for Trout and for the Angels. If he can be comfortable and functional, he can play, and it’s unlikely this is a purely new condition. However, if they can’t find that management or if Trout isn’t willing to deal with the pain and discomfort that will come from this, he could elect to walk away, since his normal life would not be the exacerbation on the area that playing baseball would be. That big Top Golf swing we saw might be out.
So far, the cortisone injection is the only known treatment, but I have to believe there’s more going on. Trout’s response to this treatment is going to be key, as well as developing a program that will keep him in a good place. That’s difficult, especially with the demands of travel. I’ll have more on this in Friday’s UTK.
Kudos to the Angels for giving details on this, and to Trout for allowing it. While there’s still much to learn, there was no value to hiding this. How this news alters anything, including speculation about Trout’s future, Shohei Ohtani’s trade status, and how the Angels self-assess their team right now is going to have to change quickly. If nothing else, this Angels team has been willing to be bold in the last two seasons.