Oblique injuries are common in baseball players, and not so common in other sports.
With baseball players training so much more in the offseason with high volume and max intent, it’s no wonder these injuries are rising.
Here’s how we approach these injuries and how to progress them back to hitting.
To view more episodes, subscribe, and ask your questions, go to mikereinold.com/askmikereinold.
#AskMikeReinold Episode 360: Oblique Injuries in Baseball Players
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Show Notes
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Transcript
Ben Fugiois:
Question from Samantha from Florida who asks, “I have recently started working with more baseball players this winter and have seen a couple of oblique strains. This is something I hadn’t seen much of before. I have been slowly getting them back to hitting, but I’m not sure how fast to progress.”
Mike Reinold:
Nice. Good job. I like it. Samantha, you know what? This is interesting and I like how you actually said it. I like the statement here, “Something I haven’t seen much of before.” Dave, do you have any oblique strains in gymnastics?
Dave Tilley:
Ish. They’re more like thoraco-rib stuff in the back. They’re not so much straight oblique in the sides. Gymnasts do more…
Mike Reinold:
So no?
Dave Tilley:
…Oblique exercises than everyone. No.
Mike Reinold:
So no?
Dave Tilley:
No.
Mike Reinold:
Okay, good. So oblique injuries are super rotational, baseball, right? And even if you look at tennis players and even golfers and stuff like that, obliques, it’s a fairly common baseball injury nowadays that’s going up, that we don’t see in a ton of other sports. So if you don’t see a lot of baseball players, it’s hard to get oblique strains. A true oblique strain from rotating. So, I thought that was pretty interesting here. She said, “I’ve been slow getting them back to hitting because I’m not sure how fast to progress.” So I think that’s one thing I can certainly hit on that too, and some of our criteria that we do with that. But for an injury that’s specific to a high intense rotational movement like hitting a baseball, why don’t we talk a little bit about that? Who wants to jump in? Anthony, you want to talk about even just your thoughts on maybe why we’re having this, what you do with them, what you like to progress on the rehab? You want to start?
Anthony Videtto:
Yeah, sure. I think with any type of injury, we always come back to what’s their workload look like. And I think I’ve seen this a lot in honestly some more high school athletes than maybe college or professional. Maybe that’s just the population that I work with more. But I think my main question is, “Well, what does your hitting look like? What’s it been the past couple of weeks or months?” And they’re like, “Well, I took a hundred swings Tuesday, and then 300 on Wednesday.” And it’s like, “Oh, well, that’s where it’s probably stemming from.” So, I think it comes down to education, and I think for rotational athletes, they do a lot of rotating in one direction. So, I think trying to program some exercise for them where they’re doing some maybe anti-rotation things once they can handle that after maybe some soft tissue and core work, and then having them rotate in both directions so that we’re working on more symmetry and we’re not just fully loading one side of their body.
I think that’s super beneficial for them. And then once they feel like they can handle this rotation stuff well and they’re pain-free on the table, it’s going through a hitting progression, which funny enough, we’ve been working on that at Champion the past couple of days. So working on some metabolic work, building some tolerance and capacity there, and then slowly progressing them from a tee to some front toss, and then building volume and capacity there, and then working on BP and eventually getting back to a machine and four to six to eight weeks there. So, I think it stems from too much workload, but then really making sure we’re working on rotation in both ways, along with some anti-rotational stuff there too.
Mike Reinold:
Yeah. And to Anthony’s point, the workload in kids nowadays is enormous. We’ve never seen it. But I think what we’re finding now with hitting, which is very similar to the pitchers, is that everybody is working on max intent swings all freaking year now. And that’s what it comes down to. It’s not just that they’re hitting, but it’s a maximum intent. It’s like, “I want to get my exit velo up. I want to get my launch angle perfected.” This isn’t just hitting just to get the body ready anymore. So now we have high volume and high volume of max intent reps like we’ve never seen in the sport before, in all honesty. We’ve never seen people train like this. So that’s a huge part of it, Anthony, is that to Anthony’s point with the volume and their workload of what they’re doing, it’s crazy. Len, any tidbits from your perspective before we maybe talk to Wes about it?
Lenny Macrina:
No, I’d just be curious… Is there a side that you commonly see? If a righty batter, you’re seeing left oblique? What’s your impression? What are you commonly seeing?
Mike Reinold:
Contralateral.
Lenny Macrina:
To a hitter and a pitcher. Contralateral?
Mike Reinold:
Yeah. So it could be both, but it’s usually contralateral, yeah.
Lenny Macrina:
On a hitter and a pitcher?
Mike Reinold:
Yes. Oh no, no, excuse me. No, ipsilateral. Ipsilateral. They’re pulling over on that side. You know what? I’m going to take that back. It’s probably like 60/40 for where those are. We actually have those numbers. Let me pull up those numbers while you’re talking. I have those exact numbers for you.
Lenny Macrina:
I was curious if there was a pattern that… I thought it was ipsilateral, but I just wanted to, just for the viewers and myself… I don’t see a lot of oblique strains. It’s just what my practice has gone to. And so it was just my curiosity to get a conversation going about it because I think that’s a thing to consider as well with kids that are hitting. Because it’s either going to be an oblique strain or they’re going to get some kind of spondy, is what we typically see in these kids is a low back…
Mike Reinold:
All right, so here’s the latest numbers. This just came out, that’s why I was going to say I just have these numbers. 71% lead side in hitters and 84%. So again, the reason why, I don’t want to say you tricked me… It’s the contralateral versus ipsilateral, and it’s like which one with your throwing arm? It’s lead side. I want you to think lead side.
Lenny Macrina:
Got you. Yeah, okay. Yeah.
Mike Reinold:
Like nomenclature wise. And then if you really break it down, it becomes lead side internal obliques and trail side external obliques, and if you want to talk about EMG activity of everything. So that’s where it comes down to. So, lead side. So again, if you’re hitting, it’s left, if you’re throwing, it’s left, if you’re right-handed on both sides. So I guess that’s contralateral?
Lenny Macrina:
I guess, yeah. I like the way you put it though, lead side. Kind of like golf, if you’re trail side, lead side.
Mike Reinold:
I guess if you’re right-handed… It’s funny. That’s why we just say lead side versus trail side, but that’s kind of funny. I’m still confusing myself on that. Yeah, that’s what we see, right? And you see it all the time with these guys just doing too much. Lenny, I’m sorry, did I interrupt with that stuff? Did you have more on that? I apologize.
Lenny Macrina:
No, I think it’s pretty neat that when those stats are out there, so for strength coaches and PTs and anybody else that are out there, athletic trainers, you can build that into their programs. Kids that are ramping up here, hitting. And I imagine Diwey has talked about it and we’ll talk about it. What can we do to work on preventative stuff and help with that explosiveness? Because we know it’s going to be potentially an issue down the road. And there are patterns to this.
Mike Reinold:
And it’s crazy. Every injury in baseball… So I’m working on building out this big baseball rehab course. I have a graph on pretty much every injury that shows “injury rates are rising.” With every injury, every type it is. It’s amazing, they all just go up year to year. It’s crazy. But Diwey, from your perspective in the gym, I know when obliques first started it was kind of funny. People were looking at the blame game, it was kind of big, and strength coaches tend to get blamed for stuff in baseball, unfortunately. But they’re just like, people are like, well they’re doing… At first it was like, “They’re not doing enough core work. These guys aren’t doing enough core work.” And then they’re like, “These guys are doing way too much core work.” And it literally happened within a two-year period. All the doctors and stuff started saying this at meetings and stuff.
You’re just like, “Oh my gosh, where are we going with this?” And then they’re like, “Well, they’re not doing the right core work. They’re not doing the right type there.” They literally had that happen. And then again, I’m sitting there, I’m like, “We’re swinging too much.” There’s nothing else. It’s just throwing, it’s like there is nothing else. We’re swinging too much, we’re swinging way too hard. It is what it is. But all right, so Diwey, you got a kid coming back from an oblique and maybe even have a kid that has a history of oblique, which might be an interesting one for you. What do you do different in the gym with him?
Diwesh Poudyal:
Yeah, I think it comes down to having a very well-rounded way of preparing. So like you said, the stress is going to be there no matter how you cut it. So you got to make the torso as robust as possible. So Anthony mentioned, “All right, let’s make sure we have a good volume, anti-rotation stuff, maybe anti-lateral side bending stuff.” But I would say that you probably need to do some work moving in that direction too, because I think one thing that happens with baseball over and over again is its high velocity rotation. So, all the body’s primed to do is high velocity rotation, but they don’t have a good base of slow rotation. And I think that’s one of the buckets that’s usually missing, is we either do completely anti-rotation and anti-lateral bending, or we do just bending and just rotation to high speeds.
There’s nothing that’s happening in that mid-ground. So I like covering that entire spectrum of isometric, to slow and heavy, to fast and aggressive. So, cover all that. I think the other bucket is making sure that we’re understanding what kind of an athlete we’re working with. Meaning, are they extremely mobile just at a baseline. If their spine just moves a ton, there’s just a lot more potential for end range movement where the obliques are completely stretched out, and we know that the obliques are not going to be strong and resilient in a centrally lengthened position.
So making sure that we have an awareness of what total rotation looks like and total mobility looks like, and making sure that we give them strength, ownership, and stability within that entire range. And then I think the other thing, it does go back to what you said, it’s just too much volume at too high of an intensity. So some of it ends up being education. And I’ve definitely had these talks too of, I don’t know if this is stepping outside of my lane, but I think if I’m there to try to help the kid, I think it’s okay to mention like, “Hey dude, I think you’re just taking too many swings.”
Mike Reinold:
“Diwesh doesn’t get it. He’s so old school.” That’s what they’ll say.
Diwesh Poudyal:
And they probably will think that, but at least if I can control it, at least in the timing sense, because kids will come up and ask me this… Because some kids hit here at our facility and stuff like this. Sometimes they’ll want to come in and hit for an entire hour and then go do our entire strength program after that, and then probably go hit some more afterwards. So at least at that point, I can try to control the narrative a little bit and talk a little bit about how we spread out the volume of rotations at least. So yeah, I start with just making it as robust as possible, keeping in mind mobility and stability, and then workload.
Mike Reinold:
That sounds like Lenny and I at the driving range, honestly. That’s the same approach for us. But I’ll give a couple of tidbits just because working within baseball, I think you see this more than outside of baseball. So I probably have a couple of gems that most people don’t get. There’s, in terms of criteria to progress, it’s not always pain-free. There’s actually two phases for me. The first phase, to progress out of that, you have to be pain-free with. This is very scientific, the cough test. If you cough and you have pain, we’re not really getting out of that early phase one, facilitating healing. But once that cough test goes away in the first few days, maybe a week, and you start to feel better and you don’t feel it with coughing, we actually allow some discomfort in the oblique as they go through their progression, both in the gym and with a hitting progression.
You don’t have to wait until it’s zero out of 10 for them to start a progression. I think that’s one thing that people don’t understand a little bit. So, I think to me that’s very important. The other thing we do, and I think this is again unique to inside baseball sometimes, and this is my colleague, one of our past students, Brooks Klein did a really good job getting some data with this. We do an anti-rotation press. We do it on the Kaiser because you can increase the poundage by a pound at a time. And we’ll slowly go up on each side. So left and right with an anti-rotation press until they get to a point where they can’t do it with discomfort and that’s their number. So say like 54 pounds, whatever it may be, that sort of thing. And then we compare that side to side. And that’s how we give a quantitative number on their oblique.
So anti-rotation press, start at a certain poundage, slowly go up, hold that for five seconds, see how it goes. And you’ll get to a point where you can’t do it. And we’re looking for that symmetry side to side with that. So they may have some discomfort, but if they can do that, we’ll start a slow progression. So the key is it’s okay to go through maybe a two out 10 pain, but each step, even what Diwey just said, each step, you might have two out of 10 on the current step, but the step we did last week should now be zero out of 10. You’re starting to get used to it over time.
So a couple of just tidbits on obliques, because again, if you don’t see that and you don’t work a lot like internal baseball, these don’t often go to a PT clinic and they’re shut down. Sometimes kids just rest a week on their own and then ease back in and they’re okay. But if you really want to go through it, well, those are a couple of tidbits on how we know how to progress and when to progress. So, great question. If you have stuff like that, head to mikereinold.com, click on that podcast link, and you can ask away. And be sure to subscribe so you get notifications. See you on the next episode.
