Los Angeles Angels superstar Mike Trout has vowed to return this season after it was revealed he had a spinal condition that could affect the rest of his unmistakable Hall of Fame career.
“I appreciate all prayer requests,” Trout said, “but my career is not over yet.”
So what is this condition and what does it mean for his 2022 season and beyond? Sportzshala’s Stephanie Bell answers the most important questions related to the three-time American League MVP.
What is Mike Trout’s injury?
Angels athletic coach Mike Forstad told reporters on Wednesday that Trout has “costovertebral dysfunction at the T5 level.”
The first hint of trouble came when Trout pulled out early on July 12, reportedly with back spasms. Subsequently, he was placed on IL with the so-called inflammation of the chest.
The reality is that all three of these descriptors are interconnected.
Let’s start with the actual diagnosis of costovertebral dysfunction at T5. “T” means thoracic, which refers to the middle part of the spine. Inside the spine, there are three main regions with separate articulating vertebrae: the neck (cervical spine), which consists of the top seven vertebrae, the lower back (lumbar spine), which consists of the five lower vertebrae, and the middle back (thoracic spine), which consists of of twelve vertebrae in the middle. Each vertebra is labeled by its position in the corresponding section in descending order from the head. For example, in the thoracic spine, the vertebrae are labeled T1-T12, where T1 is the first vertebra immediately after the cervical spine and T12 is the last vertebra immediately before the lumbar spine.
T5, the level given in Trout’s injury, is the fifth thoracic vertebra. For context, it is located approximately at the level of the top of the shoulder blades.
Complicating the anatomy of the thoracic spine, each vertebra connects or articulates with a rib. These joints form joints. The joints are very small, but they are similar in structure and function to any other joint in the body: cartilage covers the mating surfaces, the capsule and ligaments around them provide support, and the muscles in this area control movement. The specific joint at which a rib articulates with the body (basic box portion) of a vertebra is called the costovertebral joint, “costo” for a rib and “vertebral” for a vertebra, and the thoracic spine has a joint at each level and with each sides (for the left and right ribs).
In addition to motor properties, the costovertebral joint can be a source of pain in case of injury. As with other joints, trauma or overuse can lead to localized pain and inflammation, which can then cause muscle spasms as a defense mechanism. Spasms are often the body’s way of putting a splint on a joint to prevent excess movement that can lead to further injury; pain is a means of preventing this movement.
Trout indicated that he was not sure how or when the injury occurred, which is not uncommon, especially in cases of repetitive motion or overuse. It may have developed over time, but eventually reached the point of causing enough pain and spasm to limit his ability to perform baseball activities. Somehow, he developed a T5 costovertebral joint injury, which now, due to pain, inflammation (chest) and spasms (back), does not allow normal movement. The overall situation presents costovertebral dysfunction at the T5 level with concomitant chest inflammation and back spasms.
What does such an injury mean for a baseball player? What parts of his game will be affected?
This can affect every aspect of his game, especially in the acute stage, as pain and inflammation will restrict movement in all directions. However, baseball is a largely rotational sport, and the rotation associated with swinging the bat, throwing the ball from the outfield (regardless of which side is affected, as the rotation creates movement on both sides of the spine) can be particularly problematic. Jumping to play in the outfield or slip into base can also be affected given movement associated with any of these skills. Running in a straight line might be less of a problem but It is worth noting that breathing creates movement of the ribs, so running can also be affected in the acute phase.
What does this mean for this season?
Trout is undergoing the kind of treatment you would expect for any joint injury. He’s already been injected with cortisone to deal with local inflammation and is taking a break from baseball. As the inflammation subsides, he will likely gradually improve his mobility and fitness and perform very specific exercises to strengthen the small muscles of the spine and chest that help control movement in the joint.
Assuming he can perform these activities without pain, he could gradually progress to baseball-specific activities, including light throwing and bat-swinging, with the ultimate goal of returning to competition. It’s impossible to tell how quickly or effectively he’ll progress, and Forstad told reporters they haven’t made a decision about the rest of the season yet. For his part, Trout says he expects to play again this year, which certainly sounds reasonable assuming he can get his current symptoms under control.
What about his career?
Trout was very clear the other day when he said, “My career is not over yet.” And he’s right. It doesn’t have to be a career-threatening injury, at least as described so far. But it may be that, as with any other joint injury in an athlete, he is on a supportive care program that includes exercises designed to build muscle strength in that area.
Could there be an outbreak in the future? Of course. And if it does, the regime will probably be very similar. It might even resolve faster given the knowledge gained in this first episode. But there is also a chance that he can live for years without flare-ups. There really are no guarantees.
Is it related to other injuries he has suffered in recent seasons?
Certainly not, unless he’s dealt with something other than what sent him to IL in the past. He suffered a ligament injury in his thumb five years ago from a head-first fall that led to surgery. He had a sprained calf that cost him most of last season. And he had a few other little things, but, as far as we know, nothing to do with the ribs or the spine.
Can this be compared to the injury of any other baseball player or athlete?
Let’s put it this way: as far as we know, no. Many athletes have dealt with rib injuries and many have dealt with spinal injuries. We rarely hear of an injury described with the same level of specificity as Trout’s. This does not mean that the other player did not have a costovertebral injury. In fact, it’s highly likely that several players have dealt with something similar, but we just might not know about it. It is also credit to Trout’s medical staff, including spinal specialist Dr. Robert Watkins, whom he consulted about this injury. Having people who will seek out and be aware of the small details that determine a particular diagnosis can be the key to a successful outcome.
*There are also five fused vertebrae below the lumbar spine that make up the sacrum, and the coccyx attaches to the bottom of the sacrum. Because they are not separate articulating joints, they are not included in the above description.