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Will 2-way star Ohtani have greater injury risk?

Playing two positions would come with additional wear and tear
MLB.com @lindsayberra

Shohei Ohtani, he of the 100-mph fastball and 110-mph exit velocity, the two-way "Babe Ruth of Japan," is the hottest topic in baseball this offseason.

Every team wants Ohtani, seven teams are still in the running for him, and every fan is wondering where he will end up. But regardless of which club comes out victorious in the Ohtani sweepstakes, the question will remain: can he become the first player since Ruth to pull double duty and make an impact in the big leagues both on the mound and at the plate?

Shohei Ohtani, he of the 100-mph fastball and 110-mph exit velocity, the two-way "Babe Ruth of Japan," is the hottest topic in baseball this offseason.

Every team wants Ohtani, seven teams are still in the running for him, and every fan is wondering where he will end up. But regardless of which club comes out victorious in the Ohtani sweepstakes, the question will remain: can he become the first player since Ruth to pull double duty and make an impact in the big leagues both on the mound and at the plate?

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Physically, it's a very tall order, but the 6-foot-3, 200-pound 23-year-old thinks he's up to the task, and so do big league clubs who are courting him.

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The teams in contention for Ohtani's services all have a plan in mind for how they can get the most production possible out of his talents, and these strategies might stray from the traditional "pitch every fifth day" model we are accustomed to in MLB. With that said, he is going to be switching to a league with a longer season (143 games to 162), and one that does not guarantee a day off per week, so that is one unavoidable change.

But for the purposes of this exercise, let's say Ohtani manages to make a seamless transition to the more rigorous Major League Baseball schedule, to traveling through time zones and playing night games followed immediately by day games. Say he manages to throw all his bullpen sessions, take all of his batting practice, field his pitchers' fielding practices, take care of his strength and conditioning and his arm care, watch all of his video and wake up every morning, fresh as a daisy, recovered and ready to go. Even then, Ohtani will still be subjecting himself to almost twice as many opportunities for injury as any other player.

No one in baseball gets hurt more than pitchers. We know that. In 2017, pitchers accounted for 52.5 percent of all DL placements (at 19.7 percent, outfielders were a distant second). There is nothing Ohtani could do at the plate that would be more inherently risky than taking the mound.

Video: Berra on impact of swinging for Ohtani's shoulders

"The bottom line is that by far, the biggest chance of injury is from pitching," says Dr. Glenn Fleisig, research director at the American Sports Medicine Institute in Birmingham, Ala. "Hitters, though, have three big sources of injury: getting hit by a pitch, the oblique and throwing out the front shoulder."

And, of course, there is the chance that a pitcher can get hurt on the basepaths, like Brewers right-hander Jimmy Nelson, who partially tore the labrum in his pitching shoulder diving back into first base in September. Even a hand injury, like the torn thumb UCL suffered by Mike Trout sliding into second base last season, would be devastating for a pitcher. But baserunning injuries, along with those caused by getting hit by a pitch, are far less common than other hitting injuries.

Video: Nelson discusses his season-ending shoulder injury

Let's look at obliques, which have been plaguing big league hitters in increasing numbers over the past several seasons. The oblique muscles, which are responsible for core control and rotation, are the most activated muscles during throwing and hitting. They also support and stabilize the spine. To keep the obliques safe, today's strength and conditioning programs almost always include anti-rotation exercises to develop the core muscles on the opposite side of the body to ensure that players are more muscularly balanced and stable.

Ohtani, though, throws right-handed and bats left-handed -- the coveted combination for big league slugging success. So unlike a player who throws and hits on the same side, Ohtani has his anti-rotation routine built right in; the swings he takes in the cage should balance out all the throws from the mound, keeping his core safer than most. But that doesn't mean there is no injury risk. Ohtani swings and throws hard, and as a big man, he generates a ton of force. Once fatigue begins to play a factor, as it does for all baseball players, the small oblique muscles can simply be overwhelmed by all that power.

Additionally, as the core fatigues, the spine will not be as supported. The spine is built to withstand tremendous amounts of compressive force, but it does not hold up as well to rotational forces. Again, because of all the force Ohtani generates on each pitch and swing, he will have to take extra care to ensure his core stays stable so his spine remains safe, lest he end up with disk woes like Miguel Cabrera.

Let's look at the shoulder. This is where Ohtani's left-handed swing could potentially cause problems down the road. As a left-handed hitter, Ohtani's pitching arm, his right, is his front shoulder when he is at the plate. In recent memory, we've seen several players battle injuries to their lead shoulder -- Aaron Judge and Michael Brantley included.

A 2013 article written by doctors at the Hospital for Special Surgery in New York and Massachusetts General Hospital in Boston detailed what has come to be known as "batter's shoulder," which is defined as "posterior instability of the lead shoulder due to repetitive batting swings, especially with missed balls."

When a batter makes contact, the counterforce from hitting the ball activates the stabilizing muscles around the shoulder. If he misses, the lack of counterforce means that all the forces generated by the swing are absorbed by the shoulder. And as Ohtani adjusts to Major League pitching, it is likely he will swing and miss more than he did in Japan.

"On a miss or an attempt at a ball outside, the lead shoulder is abducted and internally rotated before the arms come forward," says Dr. Jeff Dugas of the American Sports Medicine Institute in Birmingham. "If the hitter misses or catches the ball deep or outside, the humeral head is pushing posteriorly and can cause injury to the posterior labrum."

Video: MLB Tonight on how an AL or NL club should use Ohtani

Another problem is seen at the finish of the swing, when many hitters remove one hand from that bat.

"Imagine a left-hander swinging out of his shoes and missing," says Eric Cressey of Cressey Performance in Hudson, Mass. "The right arm continues to come back, and when the arm goes into external rotation or horizontal abduction, the ball tends to fly forward in the socket, which can irritate the front of the shoulder and cause anterior shoulder instability."

Ohtani will put slightly less stress on his front shoulder, because he has a two-handed finish -- at least at the moment -- but there will be stress on his pitching shoulder nonetheless.

Lastly, let's talk about legs. Hamstring strains have also plagued some of the big leagues' best in the past few seasons: Hunter Pence, CC Sabathia, Troy Tulowitzki, just to name a few. Hamstring injuries are common amongst pitchers, and they typically occur in the plant leg, which absorbs much of explosive force on each throw. For Ohtani, that plant leg -- his left -- will be his push-off leg each time he exits the left-handed batters box for first base. So he'll also have to take care that his hamstrings remain loose and strong to prevent any unwanted pops.

Now, Ohtani is only 23 years old. With a little luck and a lot of hard work and diligent preparation, it will be years before he is affected by any wear and tear. But as his suitors think about his role, these are unique factors they will all need to consider.

Lindsay Berra is a national correspondent for MLB.com.

This story was not subject to the approval of Major League Baseball or its clubs.