By: Mark Vinson, MEd, ATC, CSCS
Oblique strains are a common injury in baseball. The actions of both hitting and throwing require tremendous activation of the oblique muscles in order to produce the acceleration required for these high-speed rotation movements. A 2017 study using data collected from MLB’s Health and Injury Tracking System (HITS) looked specifically at the prevalence of oblique injuries and the average return to play for pitchers and position players.1 The study found that the two most common mechanisms for injury were hitting (47%) and pitching (35%). Pitchers averaged 26 days missed per injury while hitters averaged 21 days missed per injury.
Acute oblique strains are characterized by pain and soreness with trunk rotation and often involve pain with coughing or sneezing. Timelines for return to play can vary depending on the severity of the injury. However, a typical treatment plan involves rest for the first one to three days, followed by light activity for the first week. Rehabilitation involves core strengthening and progressing into low resistance, slow and controlled rotational exercises as long as the athlete is asymptomatic.
Rotational movements in a pool are an example of lower resistance, controlled exercises. Performing underwater medicine ball rotations or swinging a bat in the pool can provide resistance through a full range of motion, while protecting against reaggravation of injury due to lower speeds.
In addition to progressive loading of the oblique muscles, emphasis should be placed on maintaining range of motion in the thoracic spine and hips.
At 10-14 days post-injury, higher speed functional activities may be initiated if symptoms are no longer present with coughing or sneezing and with eccentric loading of trunk rotation. Eccentric loading can be achieved through manual resistance exercise (MRE) with an athletic trainer/therapist providing resistance through the range of motion (see Fig. 1).
A common progression for pitchers includes “sock throws” where a sleeve is placed over the hand and wrist with a ball placed in the hand. The pitcher then goes through the throwing motion, releasing the ball into the sock.
Once the pitcher is able to complete sock throws without pain, then he is able to progress to a flat ground throwing program. Gradual increases in distance and the volume of throws should be monitored to prevent setbacks due to overtraining.
For hitters, an example of a progression may start with “dry swings” using a fungo (lighter weight) bat. If there is no discomfort with a fungo bat, then the dry swings can be repeated using a regular weight bat. From dry swings, the hitter can progress to hitting off the tee with a fungo bat, followed by hitting off the tee with a regular bat. Increases in volume (number of swings) should be implemented slowly before progressing to soft or front toss and finally progressing back into regular batting practice. This progression typically lasts another seven to 10 days and includes recovery days designed to limit all rotational activities on those days.
During the rehabilitation phase, many modalities can be utilized to help with recovery. In addition, taping or wrapping the rib cage and abdominals may provide support and reduced discomfort. Various methods for using kinesiology tape for the obliques are available online. One particular method involves a very simple application of one or more strips on the affected side in a diagonal fashion starting at the posterior wall of the thorax and extending down toward the umbilicus (see Fig. 2).
For additional support, the tape may be covered with an elastic bandage or a neoprene support.
- Camp, CL, Conte, S, Cohen, SB. Epidemiology and impact of abdominal oblique injuries in Major and Minor League Baseball. Orthop J Sports Med. 2017;5(3):2325967117694025.