The MLB regular season is in full swing. As summer approaches, teams look to maintain a rhythm in the midst of this 162-game marathon. The Philadelphia Phillies, however, will have to shuffle its pitching rotation after they lost their ace pitcher, Roy Halladay, to a latissimus dorsi strain near his right shoulder. Halladay was diagnosed with a Grade 1-2 strain last Tuesday. He is expected to be out of action for six to eight weeks.

Latissimus dorsi
The latissimus dorsi is a muscle (red arrow) from the lower back whose tendon inserts on the upper part of the humerus.
The latissimus dorsi is one of the largest muscles in the body. Originating at different places on the vertebral column, it makes up a large part of the muscle mass of the lower back before inserting on the upper part of the humerus. It is an important muscle in the pitching motion, as it helps to transfer force from the legs, trunk, and lower back up to the shoulder and arm. This muscle is often injured in the lower back, but occasionally it can be a source of posterior shoulder pain in overhead athletes. While it is not technically one of the four rotator cuff muscles and tendons, pitchers with pain in the back of the shoulder from overuse could irritate the latissimus dorsi tendon or even partially or completely tear it.

Halladay was removed from a game against the St. Louis Cardinals recently after only two innings, and the team placed him on the 15-day disabled list days later. After Phillies team physician Dr. Michael Ciccotti examined his shoulder, Halladay went to New York for a second opinion with Dr. David Altchek. Little information other than the diagnosis of a latissimus strain has been reported in the media. According to a team official, Halladay is expected to speak publicly about the situation once the Phillies medical staff and Altchek confer.

It seems likely that the star pitcher has undergone tests to determine if any structural pathology exists that would likely require surgical treatment. An MR arthrogram, where a radiologist injects contrast into the shoulder prior to an MRI, is among those specialized tests performed to look for potential surgical pathology, such as labral tears and rotator cuff tendon tears.

Interestingly, several major league pitchers have reportedly suffered injuries of the latissimus dorsi, including Kerry Wood, Brad Penny, and Jake Peavy. While most of them were partial tears of the tendon and thus could be treated with rest and physical therapy, Peavy needed surgery to reattach the tendon when it pulled completely off the bone.

Peavy offered Halladay some advice about this injury. “There have been documented cases of lat strains where time heals and if you have a significant part of your lat still attached, once the others heal, it will slowly grow back and re-attach itself along with the rest of the majority of your lat that is attached. I would not think any part of this would need surgery, from what I’m hearing”.

Although Halladay is slated to miss 6-8 weeks, it is likely that if he does not need surgery, doctors will still hold him out as long as is needed to get the tendon healed and allow the pitcher to throw safely and at his usual level of pitching. At a minimum, he likely won’t even be allowed pitching for weeks.

He also will likely undergo daily exercises to strengthen the rotator cuff muscles and other muscles of the shoulder, muscles of the upper and lower back, and core muscles. Doctors could also follow the healing with follow up radiographic studies to ensure that the tendon is healing appropriately. When he regains full motion and strength and has no pain, the doctors, athletic trainers, and physical therapists then would progress him through a functional program including a long-toss program. If he progresses without pain or other setbacks, they will then make a determination as to when Halladay can return to the mound.

The Phillies, who have won the last five National League East titles, have already had an injury-plagued year, losing Chase Utley, Ryan Howard and Vance Worley. Manager Charlie Manuel acknowledged that his team must continue to show resiliency over the next couple months.

“Our division is going to be very tight. That’s why it’s very important for us to kind of keep our head above water. We want to win all the games we possibly can, but we’ve got to stay alive.”

The Dr. David Geier ShowFor a longer discussion of Halladay’s injury, listen to my discussion of it in the That’s Gotta Hurt segment of Episode 41 of The Dr. David Geier Show. The discussion starts at 14:07.

I want to thank Prateek Prasanna for his tremendous help with this post.