Angels face unique challenge in trying to get Shohei Ohtani right

ANAHEIM, Calif. -- Shohei Ohtani's situation isn't just complex, it's unprecedented.

One hundred years had passed since a major league player simultaneously handled pitching and hitting the way Ohtani did during his first 10 weeks with the Los Angeles Angels. Now Ohtani is nursing a tender elbow that saps his ability to pitch without actually affecting his ability to hit, igniting a recovery process for which there are no parallels.

In other words, the Angels have unintentionally taken on the responsibility of crafting the blueprint for rehabilitating two-way players.

They don't seem to mind.

"It actually kind of fits the way that we prefer to operate here," Angels general manager Billy Eppler said. "It pushes us more into a mindset of staying present rather than trying to worry about the future or trying to obsess over the past and things like that. It keeps us, really, present-focused."

That present, from which Eppler refuses to stray, looks like this: Ohtani has a Grade 2 sprain of the ulnar collateral ligament of his right elbow, which basically constitutes a partial tear. In hopes of avoiding Tommy John surgery, the Angels -- specifically Steve Yoon, an expert in the field of orthobiology -- injected Ohtani's ligament with platelet-rich plasma and stem cells, part of a low-risk, conservative treatment plan that uses a patient's own blood to accelerate regeneration.

The Angels plan to re-evaluate Ohtani on Thursday, three weeks after the procedure. But a detailed plan for his recovery may take even longer to map out.

Staying flexible, Eppler said, is "critical" in this circumstance.

Ohtani, with a .907 OPS and a 3.10 ERA as a rookie, could conceivably help as a hitter while recovering as a pitcher, a concept the Angels seem to be open-minded about. But the possibility of Tommy John surgery, which typically knocks pitchers out for at least 14 months, complicates everything.

"I think that's kind of jumping," Eppler said, "and the only reason why is because nobody has said 'surgery' to me. So I'm not going to think about it until somebody who's a qualified M.D. tells me to think about it."

For now, the Angels seem to at least be thinking about giving Ohtani a chance to hit. The 23-year-old has spent more than a week swinging a bat with his left arm in order to keep his hips active. On Friday, he stood in for Felix Pena's bullpen session to track pitches and maintain some semblance of timing.

Eppler claims he has not yet spoken to Ohtani about the possibility of hitting while he recovers as a pitcher.

"Right now it's rest mode," Eppler said. "And when it moves out of rest mode and into action mode, then we'll talk about those things."

What, specifically, would "action mode" entail for baseball's most captivating player?

We speculated on the divergent paths Ohtani's recovery might take, starting with the most ideal.

Hit now, return as a starter later this season: Eppler was the Angels' GM when Garrett Richards and Andrew Heaney used stem-cell therapy in hopes of avoiding Tommy John surgery in 2016, and he was the Yankees' assistant GM when Masahiro Tanaka used PRP for the same reason in 2014. What did he learn from those experiences? "Every player's different," Eppler said. "That's all I know."

Tanaka made it back to the Yankees rotation in about 10 weeks. Heaney's elbow swelled up like a balloon following his injection, and he underwent Tommy John surgery eight weeks later. Richards' elbow responded just fine. He avoided surgery, but he also spent the final five months of that season rehabbing. Pitchers typically start throwing six weeks after PRP and stem-cell treatment, but that can vary drastically based on the nature of the tear and the player involved.

This much is certain: The Angels will be very, very careful with Ohtani's progress as a pitcher.

Hit now, return as a reliever later this season: Imagine Ohtani's triple-digit fastball and wipe-out splitter coming out of the bullpen to close out a game in the ninth inning. The Angels are in desperate need of help in the back end of their bullpen, and a healthy Ohtani could solve that (though we should note that only three of Ohtani's 85 appearances in Japan came as a reliever). If his arm feels good, and it's September, and the Angels are in the hunt, and Ohtani isn't stretched out to be a starting pitcher, perhaps we see this. But the Angels have some ground to make up first.

Hit now, pitch in 2019: We'll get into the hitting component here. Ohtani pitches right-handed and bats left-handed, which means his injured elbow is the "lead" elbow when he bats. Part of Stephania Bell's thorough breakdown of this subject stated that the stress on Ohtani's elbow would thus be "minimal when he is swinging the bat." Very specific motions put UCLs under stress, and the act of guiding a swing with your lead elbow is not necessarily among them.

That's why Angels manager Mike Scioscia recently described Ohtani as "two different players," adding that "one does not necessarily impact the other."

But Eppler brought up other concerns -- that of an awkward swing, a bad headfirst slide or an errant throw that causes a collision.

"Just events that happen on a baseball field," Eppler said. "Those types of incidents, even though they have a low probability, could affect him in this time period. At least in the early stages. So that's why we needed to give him this time off."

Here's something to consider about the pitching aspect: To rule out surgery, the Angels will want to be certain it's not necessary. And the only way to get that clarity is to ramp up Ohtani's throwing program to the point that he tests his UCL by throwing hard, even if he ultimately doesn't have enough time to return to pitch this season. Imaging can't paint a clear enough picture for a ligament that is so complex. And the last thing the Angels want is to find out Ohtani needs surgery during spring training.

Hit now, be a full-time DH in 2019, pitch in 2020: This, of course, would mean he needs Tommy John surgery. But there's an important point to consider here: Regardless of whether Ohtani undergoes surgery now or in the offseason, his estimated return to pitching would probably be the start of the 2020 season. In terms of pitching, the Angels don't seem to lose anything in the calendar by waiting. But they do gain the possibility of him helping their lineup in the interim.

Hit now, play the outfield in 2019, pitch in 2020: This is an interesting one. Ohtani played 54 games in the outfield for the Nippon Ham Fighters in 2013, but only eight in 2014 and none from 2015 to 2017. Offseason Tommy John surgery should give Ohtani enough time to serve as a DH early in -- if not for the start of -- the 2019 season. But he could be available to play the field shortly thereafter, with position players typically needing six to eight months to recover from elbow-ligament replacement surgery.

Ohtani DHing means Albert Pujols playing first base. And Pujols will be 39 next year, with a litany of lower-body ailments in his recent past. It's a lot to ask of Pujols to play the field every day so that Ohtani gets in the lineup, which is why putting Ohtani in the outfield -- at least occasionally -- seems so tantalizing.

Nothing this season: Nobody -- the Angels included -- really knows if Ohtani will actually be able to hit the rest of this season, let alone pitch.

Maybe Ohtani struggles at the plate and the Angels decide to shut him down so that he can focus on his pitching rehab (Ohtani was batting only .200 over his last 14 games before the injury). Maybe Pujols' lower half doesn't allow him to play first base regularly enough to free up the DH spot for Ohtani in the first place. Or maybe the Angels' place in the standings makes the risk, however small, seem unnecessary.

Ohtani hasn't spoken publicly about his injury, but chances are he would exhaust every option to contribute in some capacity. Asked what he has learned about Ohtani in his short time with him, Eppler said: "That this is his passion; this is his love."

"Not playing baseball, part of him is altered because he loves to play this game. It's hard for him, there's no doubt about it."