Do you have an OBLIQUE strain and it’s slow to heal or keeps coming back?  Why current trends are close but not quite enough…..

 

I’ve been studying the MLB injury list lately and it makes me ask the question:  What’s up with the Oblique strains.”  I broke the injury list down categorically into number of injuries per injury site.   No, it’s not a comprehensive research study or meta-analysis with a large N value with statistically significant values.  It’s just a guy counting the injuries per body part and is just a snapshot of time.  But….it’s still relevant and the numbers don’t just come out of a vacuum.  The list is the list and I bet if you did the same count a year from now it would still show similar patterns.

Here’s the breakdown:

INJURIES
Shoulder
Elbow/Arm
Back
Knee
Oblique
Ankle
Hip
Foot
Other
153
36
33
13
9
7
7
4
3
*41

*This is a summation of ALL the “other” injuries such as concussions, finger, thumb, rib, neck, toe, kidney, lat, and even suspension.

It is pretty much what one would expect for baseball injuries with the shoulder at the top, followed by elbow/forearm.  I was surprised the obliques came out ahead of the lower extremity injuries such as the hip, hamstring, quad and it even tied with the ankle.  There is a HUGE message between those lines.

Oblique strains have received more press as of late because it’s kind of new and sensational.  Yet, it’s not really new, there’s just more spotlight on the obliques. I want to add my own take on a component of oblique strains that has not been up to the plate yet.

Actually, there have been some good articles and posts describing the oblique, it’s role in baseball, and some potential reasons for it’s occurrence (Cressey does a good job in his post http://ericcressey.com/oblique-strains-in-baseball-2011-update ).

I’m not going to go into detail on the anatomy of the obliques, origins and insertions, or its function.  I think we could “lose the forest through the trees” on that.  I mostly want to focus on some of the current theories as to the causes and then address it biomechanically.

The obliques are involved in every aspect of baseball performance, but mostly play the Ace role in batting and throwing.  This has to do with the diagonal orientation of the muscle group and the axis of rotation of throwing and batting.

Let’s look at the throwing mechanism first.  Take an axis line through the shoulders and an axis through the pelvis or hips as above.  These axes are what load the core and obliques.  Either they are moving or rotating in OPPOSITE directions, or they are going the same direction except one axis is moving FASTER and/or FURTHER.  In the throwing mechanism, depending on which phase of the throw, the main load to the obliques is due to the axes of rotation going in OPPOSITE directions.  The pelvis is rotating forward and the trunk and shoulders are still rotating backwards.  This is how the pitcher loads the cannon to generate such power.  The core and obliques control the opposite hip and shoulder and, in the case of the throw,  they decelerate backward rotation of the shoulder.  As the shoulder reaches its end point of rotating backwards, stored elastic energy builds up in the tissue and fully lengthens to generate force for the throw.

With the throwing mechanism the axis of rotation through the shoulders and the axis of rotation through the pelvis are going in OPPOSITE directions which loads the core and obliques.  Let’s look at the batting mechanism.   On the wind up for the swing, the batter cocks the hips and the hips and hands load TOGETHER.  The axes of rotation are moving in the SAME direction and pretty much simultaneously. Then it’s not until the follow through that there is huge disassociation of the hips and shoulders and the axis of rotation through the shoulders is moving FASTER and FURTHER than the axis of rotation throush the pelvis.  By the end of the follow through, the left hip is maximally internally rotated and has stopped while the shoulders keep going.  This puts a huge eccentric load to the hip, core, and obliques.   Because the obliques have that diagonal orientation, they get maximally loaded.

Throwing Mechanism: Axes of rotation moving in OPPOSITE directions.

Batting mechanism: Axes of rotation moving in SAME direction where shoulder axis is moving FASTER and FURTHER

One article I read on oblique strains wrote, “repetitive force of the throw will eventually chew up a hip or oblique”.   But is repetitive force really the bad guy?  If it was just because of “repetitive use” we would see a higher attrition rate and more injuries of every type.  If you follow that line of logic, then wouldn’t every thrower have hip and oblique problems? True, bad repetitive force is bad.  By that, I mean that there is a biomechanical glitch in the system that causes something to breakdown. But repetitive force in and of itself is not bad and generalizations don’t get to the causes.   Another article stated, “Assuming the biomechanics are good, and they should be for a pro athlete…..” Wrong assumption.  Maybe the throwing or batting mechanics look good but the BIO-mechanics don’t.

Here’s is the conventional rehab and training philosophy.  A player has an oblique strain.  “It’s the core’s fault because it’s ‘weak'”.  So, we will do a strengthening program so the core can better resist rotation.  Some even go further and do address tightness in the hips that affect the core.  But neither of them answer “WHY.”  WHY did the obliques get strained?  The answer is in knowing the difference between COMPENSATIONS and CAUSES.

A compensation would be a tight hip.  Again, saw some good posts and articles on tight hips and how that affects the obliques and how to get more out of the hips and the obliques.  If a player cannot fully internally rotate through the hip, then the core and obliques can take up the slack and take the hit.  A traditional “core” training program where a player is doing crunches, or exercises on a stability ball, or any type of laying down exercise is just a waste of time and can actually de-train the core.  This approach actually sets the obliques up for failure because it proprioceptively trains the tissue to do something it rarely if ever has to do when throwing or batting ( Yet, I’ve seen some cool throws on the ground on ESPN’s Top 10 but never batting on the ground).  A sport specific, functional hip, core, and oblique program is the way to go and will have better results.  But it’s NOT ENOUGH.

Addressing only the compensations and implementing a strengthening program is not enough. A baseball trainer in an article in USA today states, “core strengthening has become a big part of training, and that would ostensibly help prevent oblique-type injuries, but their frequency hasn’t decreased.” ¹ WHY, because it still does not address the CAUSES.

This is the heart of what I’m talking about.  If you’re driving pull over and listen.  You ready?  (Wait, I say “causes” a lot, probably too much.  Let’s see what the Thesaurus has to say instead: Source, Root, Origin, Foundation…..alright, I’m going back to causes)Is the hip a cause or a compensation?  If the hip rotators or flexors are tight then there’s gonna be a hitch somewhere and, yes, it could be the obliques.  But it’s not because the hip just decides to not show up one day.  It doesn’t get “weak” without a little help?  It doesn’t get tight in a vacuum.  It frequently has a biomechanical “source.”  The foot is a huge player in the function of the hip.  The foot can shut the hip down.  Let me say it again. The hip can compensate for a foot deformity.  It compensates in the form of tightness in one or all three planes of motion.  Once it can’t fully lengthen, especially in the transverse plane, then it’s on the inevitable path to weakness and dysfunction.  It’s off the chain bro.  Compensated forefoot varus, forefoot valgus, rearfoot varus, plantarflexed 1st ray, yada, yada, can all be causes of hip compensation leading to oblique strains.  We can’t get the “cart before the horse” and just try to make the cart stronger and more “stable” and all that.  We need to look at the horse and determine why there is decreased power, strength, and performance (in the hip and obliques) which led to the symptoms (in the obliques).

Another bioemechanical cause could be a leg length discrepancy.  If the left leg is shorter, a player may compensate by opening up his left foot or toeing out, this functionally lengthens the leg.  By opening up the that left hip, due to the leg length discrepancy,  the hip external rotators get shortened.   In other words they get tight.  They shut down eccentrically.  They go to the bullpen and just sit there.  Bye bye hip internal rotation.  Hello strains.   So, when the batter gets to the follow through and has to use all of the left hip internal rotation to decelerate that powerful swing…..he can’t, because the external rotators are tight and won’t let it happen.  The obliques take up the slack, and…..bada boom.  The obliques become the pinch hitter for the hip.  The foot whispers under its breath, “I’m supposed to be the switch hitter but I don’t feel like batting lefty today so I’m making the hip do it.”  I’m telling you the foot gets overlooked.  It hides biomechanically.  Most treatments aimed at the obliques (or hamstring or back) just work on the obliques.  Period.  It’s not even on the grid.

Yes, we need to have a better training program for the obliques besides crunches or stability ball exercises.  But that is not enough.  Yes, we need to attack the HIP  and not just look at the symptoms in the obliques and strengthen the obliques.  But that still is not enough.  Get to the causes.  Find the culprit.  This is NOT just for oblique strains.  It can play into injuries of the hamstring (huge biomechanics), the groin, the back (huge again) and even the elbow.  Yes, I said it, the elbow (I will do a whole post or video on shoulder and elbow  biomechanical CAUSES and try to shut up for now because I’m about to go off).  If a pitcher can’t load the right hip on the wind up/initiation of the throw,  then increased force can get transmitted to the elbow because the hip/trunk was not able to fully add to the power of the throw.

I’ll let Jeff Ham be the CLOSER in his comment about oblique strains in a recent article in the Chicago Sun-Times, “Jeff Tam, who appeared in 251 Major League games over six seasons as a right-handed pitcher, knows that first hand.

‘If it’s not 100 percent healed, you’re going to do it
again for sure,’ said Tam, who suffered three oblique injuries while pitching
for the New York Mets, Toronto Blue Jays and Oakland A’s.”

Michael Griffith

www.3dperformancesystems.com

¹Antonen, M., Nightengale, B., White, P. Oblique injuries putting a strain on several major league teams. USA Today. 7/3/2008

²DeCotis, M. Why all the oblique strains in the MLB?  Chicago Sun-Times.  4/12/2011