ST. PETERSBURG, Fla. — The injury that has kept Aaron Judge out of the ALDS sits low in his right calf, in a muscle most fans never think about.
It is the soleus. It runs beneath the larger calf muscle and does much of the work when a player pushes off to run. Judge strained it Sept. 16 against the Minnesota Twins and left in the sixth inning.
The strain was graded moderate. Injuries like it typically need at least three weeks to heal, and soleus strains are known for slow recoveries because the muscle bears load with every stride.
For the Yankees, three weeks was too long. The calendar put Judge out of the Wild Card Series, and the ALDS against the Tampa Bay Rays began 17 days after the injury.
The timing made it worse. The calf strain came in only Judge’s seventh game back after more than three months on the injured list with a fractured rib. The Yankees had just gotten their captain back.
So the Yankees medical staff faced a familiar October problem with an unfamiliar twist. How do you speed up a muscle that heals on its own schedule, without risking a setback for the Yankees’ most important hitter?
Rest is the standard prescription for a strain like this. Teams sometimes add injections to speed things up, most often platelet-rich plasma, the treatment better known as PRP.
Judge knows PRP well. He received PRP injections in 2023 for a torn ligament in his right big toe, an injury that cost him nearly two months.
This time, the Yankees and their captain went in a different direction. They chose a less familiar cousin of PRP, one aimed at muscle.
Insurance companies still list it as experimental. Judge and the Yankees are counting on it anyway.
What platelet-poor plasma is
Judge received a platelet-poor plasma injection, known as PPP, in his right calf on Sept. 21. It came on the Yankees’ off-day after the team returned from Arizona.
Yankees team physician Dr. Chris Ahmad administered the shot.
PPP and PRP start the same way. Doctors draw the patient’s own blood and spin it in a centrifuge, which separates it into layers.
PRP uses the layer rich in platelets, the cells that release growth factors. PPP uses what remains, plasma with few or no platelets.
The difference is where each is aimed. PRP is widely used on tendons and joints. PPP has shown more promise for muscle tissue, which is exactly what Judge strained.
Despite growing confidence among doctors, insurers still consider PPP experimental because it is so new, NJ.com reported. The outlet said Judge sees it as the difference between helping the Yankees this October and waiting until 2027.
What the research shows
The case for PPP rests on a small but growing body of work.
A 2025 study in the American Journal of Physical Medicine & Rehabilitation compared PPP and PRP in 100 patients ages 16 to 45. All had acute thigh muscle injuries confirmed by ultrasound and were treated within four weeks.
Patients who received PPP returned to full, unrestricted sport an average of 22.89 days sooner than those given PRP. The edge held across every injury grade.
Reinjury rates after 12 months showed no significant difference between the groups.
The study has limits for Judge’s case. It covered thigh injuries, not calves, and its patients were not elite athletes. The authors also noted that evidence for PPP before their work came mostly from case reports.
At 34, Judge does fall inside the study’s age range.
How Judge has responded since the shot
Manager Aaron Boone kept expectations modest the day after the injection. He stressed that recovery comes in ranges.
“The range is for a reason and we’re at a point of the year where obviously we push it a little bit if that was in play but that’s a week away. I’m not expecting it, but I’m not ruling it out either,” Boone said Sept. 22.
Since then, Judge has progressed to hitting against live pitching and running. He had not run the bases as of the ALDS roster deadline, and the Yankees left him off the 26-man roster Saturday.
Boone has suggested Judge may not need to run the bases before activation, with some of that work possibly done under simulated conditions.
Judge has made clear how hard he is pushing his rehab.
“Saturday’s a long ways away, but I’m doing everything I can, all morning, night, during the game, everything to prepare myself to be ready to go,” Judge said.
The treatment’s timeline
Judge reaches three weeks from the injury on Oct. 7. The AL Championship Series opens Oct. 12, which would be 26 days after the strain and 21 days after the injection.
If the study’s average gain held for a calf, PPP could cut weeks off a typical PRP recovery. No one with the Yankees has said whether it will for Judge.
He is eligible to return only for the ALCS. The Yankees trail the Rays 1-0 in the best-of-five Division Series.
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