Shohei Ohtani: The Hidden Cost of Greatness

More than a decade of injuries, multiple surgeries and recurring physical problems raise a bigger question: Have we been treating the injuries without fully understanding why they keep happening?

Shohei Ohtani is one of the most remarkable athletes baseball has ever seen.

His ability to dominate as both a pitcher and hitter has challenged conventional thinking about human performance. But as his injury history continues to grow, I find myself asking a very different question.

Has Ohtani's extraordinary ability to compensate allowed him to perform at an elite level while progressively losing the movement capacity that made him so exceptional?

Consider his injury history.

A right ankle sprain. Recurrent ankle problems requiring surgery. A left hamstring strain. Progressive right elbow UCL damage and Tommy John surgery. A congenital left knee condition becoming symptomatic enough to require surgery. A right forearm strain. Another UCL injury and another elbow procedure. A right oblique strain. Left shoulder surgery.

Now, in 2026, recurring left knee symptoms, right biceps problems, neck discomfort and declining performance.

Viewed individually, each injury has a diagnosis, treatment and recovery timeline.

Viewed collectively, I see a pattern that deserves a much closer look.

I believe Ohtani may have spent years adapting to previous injuries, maintaining extraordinary performance while progressively changing how his body generates, absorbs and distributes force.

And the story may begin with an ankle injury more than a decade ago.

2013: The ankle sprain that may have started it all

Ohtani reportedly sustained a right ankle sprain in April 2013, during his first professional season in Japan, missing approximately three weeks.

Ankle sprains are among the most common injuries in sport. They're also among the most underestimated.

An athlete may return when swelling resolves, pain decreases and basic function returns. That doesn't necessarily mean full mobility, proprioception, stability, strength and force production have been restored.

I've seen this repeatedly throughout my career working with professional athletes.

An injury is diagnosed, rehabilitation begins, and progression is often influenced by expected tissue-healing timelines.

Eventually, the athlete feels better, passes functional tests and returns to competition.

After all, it's only an ankle sprain. It's a long way from the heart, right?

Except the ankle is part of the foundation for nearly every athletic movement. A restriction there can influence how forces are generated and absorbed throughout the body.

The question shouldn't simply be whether the athlete can play again.

It should be whether objective testing demonstrates that the athlete has restored the movement capacity required to tolerate the demands of the sport.

The 2021 international PAASS consensus on return to sport following lateral ankle sprain identified five assessment domains: pain, ankle impairments, athlete perception, sensorimotor control and sport-specific performance.

These criteria reflect something I've emphasized throughout my career: recovery must be measured by function, not simply the passage of time.

Ohtani returned to competition and continued performing at an extraordinary level.

But elite performance doesn't necessarily mean an athlete has stopped compensating.

Exceptional athletes may be particularly effective at finding alternative strategies to accomplish the same task.

The question is what happens when those strategies persist.

2016–2017: An unstable ankle and a previously tolerated anatomical variation

This is where historical reporting adds an important detail.

In October 2016, Ohtani twisted his right ankle while running through first base during the Japan Series.

He continued playing.

Then, in November, he injured the same ankle again while stepping onto first base during an international exhibition game.

According to an April 2018 report in Nikkan Sports, a Nippon-Ham team trainer described Ohtani's ankle as naturally loose, with ligament laxity that made him susceptible to sprains.

That is an important observation.

We're no longer simply discussing an athlete who sprained his ankle once and recovered.

We're looking at a history of recurrent sprains, reported ligament laxity and symptoms that eventually interfered with his ability to compete.

The question now becomes whether the 2013 injury contributed to the instability observed several years later, and whether full dynamic stability and movement capacity had ever been restored.

The right ankle problems continued into 2017.

Ohtani withdrew from the World Baseball Classic and was limited to four pitching appearances during the Japanese season.

By October, surgery was recommended for posterior ankle impingement involving a symptomatic os trigonum and associated bony changes.

An os trigonum is a developmental anatomical variation that can exist for years without causing symptoms.

The structure itself wasn't new.

What had changed was the environment in which that structure was functioning.

Research published in Knee Surgery, Sports Traumatology, Arthroscopy in 2019 examined 80 professional athletes with os trigonum syndrome.

Those with chronic lateral ankle ligament injuries had approximately ten times the odds of requiring surgery compared with athletes with acute ligament injuries.

The proposed mechanism involved chronic instability and repetitive posterior ankle compression.

Now consider Ohtani's history.

A previous ankle sprain. Recurrent ankle injuries. Reported ligament laxity. Persistent symptoms. Eventually, surgery to remove a painful anatomical structure.

Was the os trigonum the underlying problem, or had altered ankle mechanics made a previously tolerated structure symptomatic?

Those possibilities can coexist. The structure may genuinely have been painful because the forces acting on it had changed.

Surgery offers something understandably appealing: an identifiable structure, a procedure to address it and a defined recovery timeline.

But removing a symptomatic structure doesn't necessarily restore the mobility, stability and neuromuscular control that may have contributed to the problem.

The operation can be technically successful while the broader movement dysfunction remains.

That's the distinction I believe deserves greater attention.

And in Ohtani's case, the next injury had already occurred before he underwent ankle surgery.

April 2017: The opposite hamstring breaks down

While continuing to deal with his right ankle problems, Ohtani sustained a left hamstring strain running to first base in April 2017.

Japanese reporting at the time described his ongoing concern about the ankle, and contemporary accounts confirmed that the ankle had already limited his pitching and running.

The hamstring injury involved his left biceps femoris.

This is an important moment in the chronology.

An athlete protecting an injured right ankle may alter how force is generated and absorbed through both lower extremities.

Stride mechanics, push-off, pelvic control and loading through the opposite leg can all change.

When the right ankle cannot contribute normally, the left leg may be asked to perform a different role.

Ohtani was already dealing with a significant right ankle problem when the opposite hamstring failed.

To me, that is a meaningful relationship worth investigating.

It also raises a question about the rehabilitation process.

Was the focus on allowing the ankle to heal, or was there objective evidence that Ohtani had regained the mobility, strength and movement strategies required for sprinting and pitching?

An athlete can return to sport while continuing to protect a previously injured region.

And those protective strategies can influence the loads experienced elsewhere.

October 2017: The ankle and elbow converge

On October 12, 2017, Ohtani underwent right ankle surgery.

Eight days later, he received platelet-rich plasma treatment in his right throwing elbow.

A subsequent medical report documented a Grade 1 UCL sprain.

The injection was described publicly as preventative, with the Angels reporting no associated elbow discomfort.

Nevertheless, this wasn't an entirely healthy ligament being discussed. Structural concerns involving the UCL had already been identified.

Think about the timing.

Ohtani had spent much of 2017 dealing with a right ankle problem that limited his ability to pitch. He underwent surgery on that ankle, and within days, treatment was administered to his right elbow.

For a right-handed pitcher, the right ankle is part of the drive-side foundation.

It contributes to how force is generated through the lower extremity and transferred through the pelvis, trunk, shoulder and throwing arm.

Pitching is a whole-body movement.

Research into throwing biomechanics has repeatedly demonstrated the importance of coordinated lower-extremity and trunk function in managing the forces experienced at the shoulder and elbow.

Restrictions in ankle mobility or altered lower-extremity mechanics can influence the movement strategies available farther up the kinetic chain.

My theory is that Ohtani may have been developing compensatory movement strategies around his right ankle for years.

Those strategies could have allowed him to maintain extraordinary pitching performance while changing the demands placed on his throwing arm.

By June 2018, his UCL injury had progressed to a Grade 2 sprain.

He received further biological treatment, including PRP and stem-cell injections.

By September, the ligament had deteriorated further.

On October 1, 2018, he underwent Tommy John surgery.

The damaged ligament was reconstructed.

But what had changed in the movement system that was loading that ligament?

And had those changes been addressed?

2019: Another congenital structure suddenly becomes painful

During rehabilitation from his first Tommy John surgery, Ohtani began experiencing increasing left knee discomfort.

Imaging identified a bipartite patella.

Like an os trigonum, a bipartite patella is a developmental anatomical variation that can remain asymptomatic.

Ohtani had competed at an extraordinary level with this anatomy throughout his career.

Then, during his return to pitching, it became symptomatic.

According to reporting from the Los Angeles Times, the discomfort increased as his bullpen sessions intensified.

The Angels reduced his lower-body training loads. Eventually, surgery was recommended.

But here's what I find particularly revealing.

Ohtani himself was concerned that compensating for his knee pain could create another problem in his throwing arm.

He recognized the potential relationship between his lower-extremity function and the stresses experienced farther up the kinetic chain.

This is precisely the relationship I believe needs greater attention in rehabilitation.

Ohtani's left knee is particularly important because he pitches right-handed and bats left-handed.

When pitching, the left leg is his lead leg, responsible for accepting substantial forces and contributing to the deceleration and stabilization of his body.

When batting, that same leg functions as his rear leg, participating in force generation and rotational movement.

Now consider the sequence.

An earlier right ankle injury, subsequent ankle surgery, left hamstring injury, right elbow reconstruction and, during rehabilitation, a previously asymptomatic left knee condition becomes painful.

Was the knee simply responding to increased training demands?

Or had years of altered lower-extremity loading changed how forces were being distributed?

I believe that question should be central to understanding why the knee became symptomatic.

Instead, the identified anatomical structure became the focus of surgical treatment.

Removing or repairing a painful structure can be an effective intervention.

But treating the structure identified on an image and understanding why it became symptomatic are two different things.

2020–2023: The throwing arm continues to break down

In August 2020, Ohtani sustained a right forearm flexor-pronator strain after returning to pitching.

The flexor-pronator muscle group plays an important role in dynamically stabilizing the medial elbow.

These muscles help manage forces experienced around the UCL during throwing.

Following ligament reconstruction, the body must regain far more than structural stability.

It needs coordinated muscle function, adequate joint mobility, appropriate force transfer and the capacity to repeatedly tolerate high-velocity pitching.

A forearm injury following UCL reconstruction raises questions about how the reconstructed elbow and its surrounding musculature are managing load.

Ohtani subsequently returned to exceptional performance.

But in August 2023, he suffered another significant right UCL injury.

A second major elbow procedure followed in September.

That same month, he also sustained a right oblique injury while batting.

By this point, his injury history involved repeated problems affecting the lower extremities, trunk and throwing arm.

Each new injury introduces the potential for further changes in movement.

Some adaptations are necessary and protective.

But when an athlete repeatedly loses mobility, strength, control or tolerance to load, the available movement strategies may become increasingly constrained.

The body continues finding ways to accomplish the task.

Until those strategies can no longer meet the demands being placed on them.

2024–2026: When compensation becomes impossible to ignore

Ohtani sustained a traumatic left shoulder injury during the 2024 World Series, requiring subsequent labral surgery.

He returned to pitching in 2025 following his second major elbow procedure.

Then came 2026.

Recurring left knee symptoms. Right biceps discomfort. Neck symptoms. Another interruption to his pitching.

The left knee is particularly significant given his 2019 surgery.

A congenital anatomical variation that became symptomatic during his first elbow rehabilitation is now part of the injury discussion again.

And this time, the relationship between lower-extremity dysfunction and the throwing arm was openly acknowledged by the Dodgers.

In July 2026, manager Dave Roberts explained that compensation for Ohtani's knee pain had placed unintended stress on his upper body.

The team stopped his throwing progression, concerned that he was attempting to generate velocity without being fully healthy.

This is an extraordinary detail when viewed against the earlier injury history.

In 2019, Ohtani was concerned that compensating for his painful knee could create another arm problem.

Seven years later, the Dodgers were discussing knee-related compensation as a contributor to stress on his throwing arm.

The relationship between the knee and throwing arm is no longer just a theoretical concern. It has become part of the team's own explanation for his current problems.

That doesn't establish that the same mechanical problem has persisted uninterrupted since 2019.

But it demonstrates why lower-extremity function cannot be separated from throwing-arm health.

October 2026: Now the performance is suffering

Ohtani's struggles have become increasingly visible.

He finished the 2026 regular season with a .275 batting average, .889 OPS and 30 home runs.

Those numbers would represent an excellent season for most players.

For Ohtani, they represent a decline from his extraordinary recent offensive production.

The postseason struggles have been more pronounced.

Through October 13, he was 3-for-20 with no extra-base hits and seven strikeouts.

The Dodgers were even considering whether to remove him from the lineup.

And Ohtani's own comments provide another important clue.

On October 13, discussing his offensive struggles, he distinguished between reducing symptoms and ensuring he was moving properly during his swing.

That distinction is central to my entire argument.

Pain reduction and movement restoration are not the same thing.

An athlete may feel better without regaining the movement capacity needed to perform at the highest level.

And when that athlete has experienced repeated injuries and surgeries across the kinetic chain, the potential cumulative effect deserves serious attention.

Previous injury is one of the strongest predictors of future injury. Why?

Previous injury is consistently identified in sports medicine research as an important risk factor for subsequent injury.

The underlying mechanisms can include residual strength deficits, reduced mobility, impaired proprioception, altered neuromuscular control, reduced tissue capacity and changes in how forces are distributed throughout the body.

This is why I believe rehabilitation must move beyond healing timelines.

An MRI can show structural damage.

Surgery can repair or remove the damaged structure.

Rehabilitation can restore strength around the injured area.

But none of those measures, individually, tells us whether the athlete has recovered the coordinated movement capacity required for their sport.

The body doesn't organize performance according to individual anatomical diagnoses.

It organizes movement around the capacities and limitations of the entire system.

When one region loses function, other regions adapt.

Those adaptations can be remarkably effective.

They can also alter loading patterns in ways that increase the demands on other tissues.

And when injuries accumulate, the athlete may gradually lose the movement options that once allowed them to perform efficiently.

This is especially relevant in an athlete like Ohtani, whose extraordinary abilities may allow him to maintain performance despite physical limitations that would be more apparent in others.

The question isn't simply whether the surgery was successful

Ohtani has received extensive medical treatment throughout his career.

His return to elite performance following major surgeries is remarkable.

But the continuing injury pattern raises questions about how we define a successful recovery.

Was the damaged structure repaired?

Did the pain improve?

Did the athlete return to competition?

Those are important outcomes.

But I believe we need to ask more.

Did the athlete regain the mobility that existed before the injury?

Was force production restored?

Could the athlete absorb and redistribute load efficiently?

Were compensatory movement strategies identified and addressed?

And were those capacities reassessed as training and competition demands increased?

These are the questions that should guide reconditioning.

What if the elbow was never the beginning of the problem?

My working theory is that Ohtani's injury history reflects more than a series of unrelated structural problems.

I suspect his early right ankle injuries may have contributed to changes in how he generated and distributed force.

Over time, those changes may have influenced loading through his lower extremities, trunk and throwing arm.

Subsequent injuries and surgeries could have introduced additional adaptations, progressively narrowing the movement strategies available to him.

His extraordinary athletic ability may have allowed him to compensate for years while continuing to produce remarkable performances.

Now, with recurring physical problems and declining performance, those adaptations may be becoming more difficult to sustain.

The repeated injuries are documented. The role of persistent compensation is my proposed explanation for the pattern, informed by biomechanics, research and years of working with injured athletes.

I believe the pattern warrants a much deeper investigation than examining each injury in isolation.

The broader lesson extends far beyond Shohei Ohtani.

Tissue healing follows biological timelines. Restoring movement capacity requires objective assessment, progressive loading and an understanding of how the entire body functions together.

When rehabilitation focuses primarily on the injured structure, we risk overlooking the adaptations that may contribute to the next injury.

And when surgery resolves the pain associated with an anatomical finding, we still need to understand why that structure became symptomatic.

Ohtani's history illustrates why those questions matter.

Perhaps his greatest athletic gift has also made his underlying physical limitations more difficult to recognize.

Because the ability to compensate can preserve performance for years. But it doesn't guarantee the body can continue absorbing the consequences indefinitely.

And that leaves me with one question:

What if Ohtani's elbow was never where the problem began?