00:00This is the Injury Report, presented by NYU Langone Health.
00:05The Yankees season is over and their biggest star never got a chance to help them in October.
00:09Aaron Judge missed all five of New York's postseason games while recovering from a moderate strain of the soleus muscle
00:15in his right calf.
00:16But here's the question, did the Yankees make the right call by keeping him sidelined?
00:19And could this injury have long-term implications for the 34-year-old slugger?
00:24Joining me on this edition of Injury Report to break down Judge's injury is Dr. Natasha Desai.
00:29You see her right there, and she joins me now. Dr. Desai, how are you doing?
00:33I'm good. How are you?
00:34I'm doing good. Can't complain here, but let's talk about Aaron Judge,
00:37because Dr. Desai, he suffered a moderate strain of the soleus muscle in his right calf, as I explained.
00:42And for viewers who might not be familiar with that particular muscle,
00:45what role does it play in a baseball player's movement,
00:48and what makes an injury to the soleus potentially more complicated than a typical calf strain?
00:54Yeah, so the calf is made up of two main muscles, the gastroc,
00:58which is what most people actually strain, and then the soleus, which is the deeper muscle.
01:04So both of those connect to the Achilles and are important in the push-off.
01:11So in a baseball player, it's going to be that kind of twist and push-off
01:14and their explosiveness and their ability to run.
01:18So the reason why it's different than the gastroc is that, like I said, it is deeper and longer,
01:25and these tend to be a little trickier because there is a higher re-injury occurrence with these compared to
01:36gastrocs.
01:37And so it is something that can lead to a little bit more time away from playing.
01:43And Judge had time away from the field, and we did know this, Dr. Desai, he wanted to play in
01:48the postseason.
01:49The Yankees definitely could have used his bat the way they went out,
01:51but from a medical standpoint, how do you evaluate their decision being the Yankees
01:55to keep him off both playoff rosters in the wildcard series and the division series?
01:59Was there a realistic scenario where he could have played safely or would have bringing him back been too much
02:05of a gamble here?
02:06I mean, in sports medicine, we are always trying to get people to play in the postseason especially.
02:12So my guess is the strain was bad enough to keep him out.
02:19It all depends on how much bleeding or hematoma there was within the muscle and how strong he was.
02:27If he had good strength in that plantar flexion or the push-off in the foot,
02:32then they may have let him play through it with a lot of compression and rehab and treatment.
02:40But my guess is he probably didn't have the power or it was too painful to push off,
02:46and that's why they chose to keep him out.
02:47They may have also been strategic in that hoping that they made it to the next round
02:51and a little bit more healing would have prevented the likelihood of re-injury
02:58or potentially an Achilles tendon tear because that's what it's connected to.
03:02So they may have been strategic in that and trying to sacrifice earlier games for later playoff games.
03:08Unfortunately, that was not realized.
03:10Yeah, unfortunately for the Yankee fans, they are not playing any more games in the postseason.
03:14And doctors decided there had been discussion about whether rushing Judge back from this injury,
03:19as you just kind of mentioned, could potentially lead to other problems involving his Achilles tendon or his hamstring.
03:24Can you explain how one calf injury might create a chain reaction elsewhere in the lower body
03:28and what the worst case scenario could have been if Judge returned before he was fully ready?
03:36I think the worst case scenario probably would be an Achilles tendon tear
03:40because that would take him out for a full year.
03:41I mean, we've seen a lot of our greats go down in many sports with that Achilles rupture.
03:46So we definitely want to make sure that we don't increase his risk for that.
03:53Hamstring tears are definitely a risk as well,
03:56but probably either an Achilles tendon tear or an ankle sprain would be the other things that you'd watch out
04:03for because of compensation.
04:05You don't really want to rush back from a soleus strain or a gastrointestrain either muscle
04:12because you usually feel better before you actually are better.
04:17And so there's monitoring for real healing that is required with ultrasound and strength testing and things like that.
04:25Got you there. Now, five days after the surgery, after he, not the surgery, excuse me, suffering the injury,
04:31Judge received a platelet-poor plasma injection in his calf.
04:35And we typically hear about platelet-rich plasma or PRP that many fans have heard of when athletes are recovering
04:41from injuries.
04:41What's the difference between PPP and PRP and why might doctors choose PPP with this particular injury?
04:48And what does the medical evidence tell us about its effectiveness?
04:51Yeah, it's really exciting. This is like the new thing that we are doing and that we're separating out the
04:57type of regenerative medicine that we are using.
05:01And the platelet-poor plasma is exactly what it sounds like.
05:05It's the plasma part of our blood, which has all the growth factors without the platelet.
05:10So platelets are a good stimulator of the immune cascade.
05:15The problem is, is that muscles are very vascular as it is.
05:19Like I was talking about hematomas and lots of bleeding in muscles.
05:22So there's a lot of immune activity and blood flow anyways.
05:27So if we're overstimulating that with platelets, the worry is scar tissue.
05:31So there's some thought process that PRP into muscle may actually, it might make them feel better faster, but it
05:40may not actually simulate good muscle regrowth.
05:44It might actually scar the muscle.
05:46So the trend is towards platelet-poor plasma and the evidence is all very recent and very small studies that
05:54show that there's better recovery faster and better quality recovery and less re-injury rates with platelet-poor plasma, particularly
06:03in hamstrings.
06:04Most of the studies are in hamstrings, but we're kind of translating that to other muscles.
06:08So doctor decide with the Yankees season now over, judge, he's got the entire offseason to recover.
06:13If you were overseeing his rehabilitation, what would the next several weeks and months look like for him?
06:18What specific milestones would he need to reach before returning to full baseball activities?
06:22And how would doctors determine that his calf is fully ready for baseball activities?
06:28Yeah, so the first step is getting rid of the acute bleeding and injury, which I'm hoping he is over
06:33with the five weeks and the PPP.
06:36The next step is going to be really rebuilding strength.
06:39So we try not to stretch our focus on range of motion too early.
06:43We really kind of strengthen everything up, both the gastroc and the soleus and the hamstring and all the other
06:49supporting muscles.
06:50And then once he has met the criteria of at least 80 to 90% regaining of strength, then we
06:59really focus on the flexibility because he has to be able to push off and still get to the normal
07:06flexibility.
07:06And so there's some testing that the physical therapists are going to do with him from heel raises to flexibility
07:14testing that he will need to do before he's even cleared to do any plyometrics, running, jumping, things like that.
07:22And then he'll go into baseball.
07:25So I think, you know, we'll see hitting and catching and throwing drills a lot sooner than actually like running
07:32bases.
07:32Okay, that's good news there for the Yankees fans.
07:35The Yankees fans might have this question here too, Dr. Desai.
07:38Judge, Aaron Judge, he's 34 years old.
07:40He's dealt with multiple significant injuries throughout his career.
07:42So when you look at his age, his physical size, and the amount of time that he's missed just this
07:46season,
07:47how concerned should the Yankees be about his durability moving forward?
07:51And could a soleus injury like this have lingering effects on his explosiveness or increase of the risk of re
07:57-injury in 2027?
07:59Yeah, he had a tough year.
08:01He missed a lot of games, a couple of significant injuries, right?
08:04So I think it's tough when you injure yourself early in season.
08:07It makes for a very difficult season in general.
08:11I think, you know, really utilizing this offseason to fully rehabilitate.
08:16Yes, he's 34, but he's an amazing athlete and he's got an amazing team.
08:20So I think that we shouldn't be too afraid.
08:24I think that he could come back and play.
08:26There's going to be a lot of rehab and a lot of care continually for him.
08:32But hopefully he fully recovers and he'll be back.
08:37That is the hope for the Yankees fan.
08:38Last thing for me, Dr. Desai, look, regular people, non-athletes, they sometimes get this injury too.
08:45Would you treat, how would you treat this injury on a non-athlete?
08:50How would you treat this injury if this happened to a non-athlete?
08:53I feel like you guys ask me this all the time and I say the same thing in that I
08:57will treat them the same.
08:59In that I am always trying to get you guys back to activity first.
09:04But really shutting down, just like, you know, whether you're a professional baseball player or trying to brave the subway
09:12is very important.
09:14And so activity restriction is going to come first.
09:17Making sure that if there is a hematoma or if there is a lot of bleeding in the muscle that
09:24we kind of immobilize you either by aspirating the hematoma and putting you in a boot or putting you on
09:31crutches or heel lift or something like that, depending on the severity of the injury.
09:36And then gradually progressing in the same way.
09:40But it's very individual in terms of each person.
09:45It really depends on the amount of bleeding and where the injury is, whether it's in the muscle, where it
09:50has a really good blood supply, or if it's in that muscle-tendon junction, which takes a little bit longer.
09:56It is a process.
09:57Either way, hopefully the process back for Aaron Judge to the baseball field will be a good one.
10:01And Yankees fans will see him on the field at the stadium in 2027.
10:06That is Dr. Natasha Desai with NYU Langone doing a fantastic job for us here on Injury Report.
10:11Dr. Desai, thank you so much for your time.
10:13We'll talk again soon.
10:15Thank you so much.
10:16Thanks for having me.
