As every Toronto Blue Jays fan knows, Josh Donaldson’s left calf injury took much longer for him to recover than anyone ever expected. We also learned that the Blue Jays allowed him to seek treatment outside of the organization. The questions that they need to ask themselves are why his injury was so difficult to rehab and what led a professional organization to admit that they needed help.
Josh Donaldson being taken out of the game on May 28, 2018.
Why was this injury so difficult to rehab?
If it was just a standard garden variety left calf strain that occurred on May 28, 2018 then the expectation would be for him to recover within 3-6 weeks depending on the severity. About 4 weeks later, he had a setback while performing a fielding drill. Almost 2 months later, Josh Donaldson participated in a game with the single A Dunedin Blue Jays. Even then he did not play the full game and may not have been in the line up on the next day. After his trade to Cleveland, he spent another 10 days participating in minor league baseball games to get him back to where he would be ready to contribute to the major league team. That means that Josh Donaldson missed 3 ½ months for something that was expected to take less than half the time.
The calf muscles are part of what is called the posterior fascial chain. These are a group of muscles and tissues that run the backside of the legs and back. They have connective tissue that is continuous from the soles of the feet to the base of the skull. When one part of this tissue is tight, overall flexibility is reduced. In addition, tightness in one section will put an increased pull through other sections which if weaker can result in a strain. Let’s say that Josh Donaldson was stretching these posterior muscles and strengthening the calf muscles during his rehab. So why did he suffer a setback? What caused his massive calf muscles to again get strained?
What if Donaldson’s dead arm syndrome and the left calf strain were related?
How could they possibly be related? Josh Donaldson throws and bats right. While batting, he repeatedly twists rapidly to his left through his trunk putting his right hip and pelvis into extension while the left hip and pelvis are more in flexion. As a right hander throws, the trunk twists to the right opening up the right chest as the arm is cocked then moves rapidly forwards while the trunk twists to the left. When any batter runs the bases, the turns are always to the left with a shorter stride length on the left side and reduced hip and pelvic extension during the turns, while running in a straight line has relatively equal movements.
The video above shows Josh Donaldson throwing with a dead arm on Opening Day 2018.
The video below shows him throwing in 2016.
We know that Josh Donaldson was first put on the disabled list on April 13, 2018 (retroactive to April 11, 2018) with “dead arm syndrome.” Even when he returned, he was still demonstrating weakness with throwing. Looking at the footage of him throwing and comparing it to past years, it appears that his right shoulder and chest were tight causing him to throw from a half-cocked position with significantly less force and velocity. Even when he returned to action on May 3, 2018, the tightness had improved but he still could not throw from a fully cocked position. How can tightness through the front of the left hip affect the left calf muscle? As a person runs, only one foot is in contact with the ground at a time. As the foot moves back driving the body forwards, the back, hip and pelvis extend, and the ankle bends (dorsiflexes) before the heel rises and push-off occurs prior the foot swinging forwards. This means that tightness in the front of the hip will limit the extension through the back, hip and pelvis on that side thus limiting the stride length. To compensate for the lack of movement as well as reduced power from the hip, the hamstrings and calf muscles would have to push harder to maintain a runner’s speed. The increased demand on the calf or hamstring muscles could easily result in the feeling of tightness or a strain.
There are other factors that could be involved in the slow the healing of a calf muscle. Any tightness in the front of a hip can have an influence on the flow of blood and fluids into that leg. The front of the hip contains the femoral nerve, femoral artery, femoral vein, and inguinal nodes. The femoral artery is a major artery that supplies the leg with oxygen and nutrients and the femoral vein returns the oxygen depleted blood to the heart. The inguinal nodes are part of the lymphatic system that drains fluid, proteins and cellular debris from tissues outside of the arteries and veins and brings it back into the bloodstream. The lymphatic system is passive, meaning that it depends on muscle activity to pump the fluid, so even a small amount of pressure will impair the system leaving more fluid in the legs. Increased fluid in the legs will reduce the exchange of nutrients resulting in a slower recovery from injury.
Unfortunately for Josh Donaldson, the complicated nature of his injury led him to seek treatment outside the organization. For the Toronto Blue Jays to grant permission, they had to be convinced that he needed outside rehabilitation advice for him to return to action. Sports organizations tend to be notorious for having control over as many aspects of a player’s active life as they can. It is not beyond the realm of possibility that Josh, who lives his body, did not feel that his body was ready to return to action when the training staff thought he could. He may have had a sense that there was something missing from his rehabilitation and been convinced that he couldn’t get it with the Blue Jays. The Blue Jays had to have been desperate to get him back on the field and therefore must felt they had no choice but to support his request to see treatment outside of their organization.
What should they learn from this experience?
Even acute injuries may be more complicated than what is seen at first blush. The site of injury is almost never the location of the cause. Rehabilitation professionals need to look at any and all factors that increase the strain on a particular area then correct them. In the case of Josh Donaldson, I would have looked higher than his calves.