A quest to get to core of MLB oblique injury trend
Midway through a routine bullpen session in Bradenton, Fla., Pirates pitcher Jeff Locke said he felt something “pull” in his right side. It was March 1, and just like that, his spring training was ruined.
A left-hander, Locke strained one of four broad, flat oblique muscles — two exterior, two interior — that form part of the abdominal core. He joined a long parade of players with similar injuries to the disabled list.
“It's definitely a trend that continues to spike,” Pirates trainer Todd Tomczyk said.
This season, 24 players have gone on the DL with oblique and related injuries through Friday. Before 2011, the most in any season was 29 during a 20-year time period studied by Los Angeles Dodgers trainer and medical director Stan Conte. In the past three seasons, Conte said, the totals were 50, 45 and 41.
The 2014 list includes Locke and two other Pirates pitchers, Jason Grilli — since traded to the Los Angeles Angels — and Francisco Liriano, plus big-name players Joe Mauer, Ryan Braun and Chris Davis. Victor Martinez missed several games but did not go on the DL.
When Conte latched on to the issue in 2011, he said he was inspired by “a bunch of name-brand players who were going down (with oblique injuries), and people asking questions we didn't have answers for.” Assisted by several orthopedists, he started researching the type, frequency and possible causes of abdominal injuries that sent players to the DL.
Conte compiled lots of data. Three years later, answers remain elusive.
“They really can't pinpoint one thing,” Tomczyk said. “There are a lot of variables.”
Conte's study of DL-related abdominal injuries — 92 percent of which involved the oblique — covered two decades going back to 1991, a time when such injuries still had generic labels like pulled rib cage or abdominal muscles. The specific reference to the oblique is relatively recent.
“I can't even spell it,” joked Pirates broadcaster Steve Blass, who pitched in the 1960s and '70s.
Conte discovered that oblique and similar injuries remained constant through 2010. But in 2011, they “exploded,” he said, spiking from 26 to 50 DL moves.
Such DL-inducing injuries averaged 22.3 per season from 1998 (when MLB expanded to 30 teams) through 2010. They dipped in 2012 and '13 but remained higher than before. The last three seasons averaged 45.3 abdominal DL moves.
Conte said he is considering a second study. Looking back to 2011 and afterward, he said, “Once is a fluke, twice makes it interesting, and three times makes it a trend. I've sat on this thing for three years, and it's definitely a trend. The question is how to get rid of it.”
Baseball has more serious medical issues. Strained obliques do not require surgery or threaten careers. But they are disruptive, often keeping players on the shelf for a month or more.
Consider Locke, who hoped a solid spring training would vault him back into the Pirates' rotation after back problems marred the second half of a breakthrough All-Star season. He was fit and ready to go until one pitch in a non-game situation changed everything. He was out for more than a month.
“It was just a fastball,” he said. “I was like, ‘Oh, no. What was that? Maybe I got short of breath, or maybe it was a little cramp. Take a deep breath, maybe a little pain over there, move around, and it's not too bad.' But as the (session) progressed, I couldn't go any further. It felt like every pitch I threw was more painful than the last.”
Locke, who pitched two innings in the Pirates' second spring game before getting hurt, rested and then threw on the side. He eventually worked his way back from the minors in early June (after one ill-fated emergency start in May) and has been mostly effective.
Grilli slipped badly in April immediately before going on the DL, later acknowledging that the injury had “bothered” him for “a few days.” He returned after a month but lost the closer's job and was traded in June. Liriano, facing the Chicago Cubs on June 11, left one pitch into the fourth inning. He returned last Sunday, 32 days later.
In 2013, strained obliques shelved Pirates second baseman Neil Walker and then-outfielder Jose Tabata, representing a trend within the trend. Not only are there more oblique injuries overall, but position players also are affected more than pitchers. This was a revelation to Conte, who said he “always thought it was a pitcher's injury.”
Conte said switch-hitters might be especially susceptible because they have two different swings. Walker, a switch hitter, was batting left-handed when he swung against Cubs righty Edwin Jackson last July at Wrigley Field.
“I never felt anything like that,” he said. “It certainly didn't feel good.”
Like most players who injure their obliques, Walker at first thought he had a cramp and had no real idea of the cause.
“Maybe,” he said, “I was a little extra aggressive with my swing.”
It's all “maybe” at this point. That and “speculation,” Conte said.
Speculated Walker: “In this day and age, with players as big and strong and fast as they are, and pitchers creating so much torque, maybe it gets to be too much for your body. Too hard of a swing or too much torque on a fastball.”
Pirates team doctor Patrick DeMeo said “no matter how well-conditioned somebody's core is, these guys are generating so much torque, stretching the physiological limits of the muscle-tendon unit.”
Joshua Dines, a New York Mets assistant team doctor and Dodgers consultant who helped Conte with the study, added, “It might be an overuse thing. Maybe we're overstrengthening.”
Conte said these theories on the cause of oblique injuries are sound, but they do not account for the sudden rise. He posed this question: “What happened to increase (players') strength and speed between 2010 and 2011?”
Other theories: Undertraining. The wrong training. Players coming off steroids. The lack of proper hydration, nutrition or stretching. Tomczyk offered the decline of the multisport athlete.
“In a world of win-now, are we doing too much specialization training and not enough holistic, entire-body training?” he said.
In what seems like a disconnect, core strengthening has become a point of emphasis, and strength programs overall are more high-tech and sophisticated. But Pirates strength and conditioning coach Brendon Huttman said core training has not fundamentally changed during his eight years in the majors.
“It's multidimensional, really,” he said.
Tomzcyk calls the issue “a very intriguing challenge.” He also said, “It's not going away.”