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Written on March 29, 2011 at 6:56 am, by Eric Cressey
Just over three years ago, during a period where oblique strains were on the rise in professional baseball and the USA Today profiled this “new” injury, I wrote an article on what I perceived to be the causes of the issue. Check it out: Oblique Strains and Rotational Power.
This year, the topic has come back to the forefront, as players like Joba Chamberlain, Sergio Mitre, Curtis Granderson, and Brian Wilson have experienced the injury this spring training alone.
While my thoughts from the initial article are still very much applicable, I do have some additional thoughts on the matter for 2011:
1. Is anyone surprised that the rise in oblique injuries in baseball is paralleled by the exponential rise in hip injuries and lower back pain? I don’t care whether you work in a factory or play a professional sport; violent, repetitive, and persistently unilateral-dominant rotation (especially if it is uncontrolled) will eventually chew up a hip, low back, or oblique; it’s just a matter of where people break down.
In other words, pro athletes are generating a tremendous amount of power from the hips – moreso, in fact, than they ever have before thanks to the advances in strength training, nutrition, supplementation, and, unfortunately, in some cases, illegal “pharmaceutical interventions.” Assuming mechanics are relative good (as they should be in a professional athlete), rotate a hip faster and you’ll improve bat speed and throwing velocity; it’s that simple. This force production alone is enough to chew up a labrum, irritate a hip capsule, and deliver enough localized eccentric stress to cause a loss in range of motion. The Cliff’s Notes version is that we’ve increased hip strength and power (more on this in a bit), but most folks have overlooked tissue quality (foam rolling, massage, and more focal approaches like Active Release and Graston) and mobility training.
If the hips stiffen up, the lumbar spine will move excessively in all planes of motion – and, in turn, affect the positioning of the thoracic spine. Throw off the thoracic spine, and you’ll negatively impact scapular (and shoulder), respiratory (via the rib cage), and cervical spine. Hips that are strong – but have short or stiff musculature can throw off the whole shebang.
2. “Strong” isn’t a detailed enough description. I think that it goes beyond that, as you have to consider that a big part of this is a discrepancy between concentric and eccentric strength. Concentrically, you have the trailing leg hip generating tremendous rotational power, and eccentrically, you have the lead leg musculature decelerating that rotation.
Moreover, because the front hip can’t be expected to dissipate all that rotational velocity – and because the thoracic spine is rotating from the drive of the upper extremities – you put the muscles acting at the lumbar spine in a situation where they must provide incredible stiffness to resist rotation. It is essentially the opposite of being between a rock and a hard place; they are the rock between two moving parts. Structurally, though, they’re well equipped to handle this responsibility; just look at how the line of pull of each of these muscles (as well as the tendinous inscriptions of the rectus abdominus) runs horizontally to resist rotation. That’s eccentric control.
How do we train it? Definitely not with sit-ups, crunches, or sidebends. The former are too sagittal plane oriented and not particularly functional at all. The latter really doesn’t reflect the stability-oriented nature of our “core.” The bulk of our oblique strain prevention core training program should be movements that resist rotation:
While on the topic, it’s also important to resist lumbar hypextension, as poor anterior core strength can allow the rib cage to flare up (increases the stretch on the most commonly injured area of the obliques: at the attachment to the 11th rib on the non-throwing side) and even interfere with ideal respiratory function (the diaphragm can’t take on its optimal dome shape, so we overuse accessory breathing muscles like pec minor, sternocleidomastoid, scalenes, etc).
So, to recap: I don’t think oblique strains are a new injury epidemic or the result of team doctors just getting better with diagnostics. Rather, I think that we’re talking about a movement dysfunction that has been prevalent for quite some time – but we just happen to have had several of them in a short amount of time that has made the media more alert to the issue. The truth is that if we worried more about “inefficiency” and not pathology,” journalists could have “broken” this story a long time ago.
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Written on October 28, 2010 at 6:06 am, by Eric Cressey
If you’ve had a groin strain (or adductor strain, for the anatomy geeks like me in the crowd) – or would like to prevent one in the first place – read on.
Those of you who check out this website regularly probably already know that I’m a huge advocate of good manual therapy – especially disciplines like Graston and Active Release. One area where we constantly see athletes really “gritty” is the hip adductors (groin muscles) – and it’s one reason why we see so many groin strains in the general population. Note that treatments DON’T have to be this aggressive to yield favorable outcomes; it’s just an extreme example of someone with a pale skin tone that makes it even more prominent:
Soccer and hockey players really overuse the adductors during the kicking motion and skating stride, respectively. And, even outside athletic populations, you’ll see a lot of people who don’t activate the gluteus maximum well as a hip extension – so you have the adductor magnus taking over to help out with this important task. The only problem is that the adductor magnus internally rotates and adducts the hip, whereas the glute max externally rotates and abducts the hip. Movements get altered, one muscle gets overworked and all fibrotic, and the next thing you know you’ve got a nasty “tweak” just south of the frank and beans (or female equivalent).
Really, that’s not the issue, though. Nobody is denying that groin strains occur – but there are different treatment approaches to dealing with this issue on the rehabilitation side of things. Some professionals use manual therapy during their treatments, while others don’t. Can you guess which school of thought gets my backing?
Well, it turns out that the “include manual therapy” side of the argument gets the backing of Weir et al in light of some new research they just published. These researchers found that athletes with groin strains returned to sports 4.5 weeks sooner when they received manual therapy plus stretching and a return to running program as compared to an exercise therapy and return to running program only. It took the average time lost down from 17.3 weeks to 12.8 weeks in those with good long-term outcomes! For a bit more information on the manual therapy discipline utilized in this particular study, check out this abstract.
Need a quick tutorial on how to come back from a groin strain?
1. Find a good physical therapist who does manual therapy.
5. Make sure you’re continuing to foam roll the area and getting the occasional treatment on them with that same manual therapy you had during your rehabilitation. Here’s a great self myofascial release option with the foam roller:
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Written on March 9, 2010 at 12:38 pm, by Eric Cressey
I just got back from speaking at the NSCA Personal Trainers Conference in Las Vegas, so I’m a bit short on content as I play catch-up now that I’m back in Boston. Luckily, Bill Hartman put together an excellent two-part series on femoral anteversion as it relates to hip mobility. Check them out:
Along similar lines, this old video blog of mine might interest you:
Written on November 30, 2009 at 7:13 am, by Eric Cressey
For more mobility exercises, be sure to check out Assess and Correct: Breaking Barriers to Unlock Performance.
Written on November 23, 2009 at 11:07 am, by Eric Cressey
Q: Inspired by your articles on T-Nation, I’ve started to measure IR/ER/Total shoulder rotation deficits using a goniometer. I did have another question, however: you mentioned in an article that Hip Internal Rotation Deficit (HIRD) is a serious problem among baseball pitchers and hitters due to the asymmetrical front leg blocking in both mechanics. I absolutely agree, and I use corrective exercises and stretches to help alleviate these problems. However, I lack a good way to test for this; do you have any suggestions?
A: We check hip internal rotation in the seated position. Basically, you just have the individual sit up tall at the end of a table, and position the hips and knees at 90 degrees. Then, without allowing the hip to hike, you internally rotate the femur. This is one of the many assessments on our new DVD set, Assess and Correct, and it’s featured on page 50 of the tag-along e-manual. Check it out:
For more information on how to correct the problem – and assess for other issues like this, check out www.AssessandCorrect.com.
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