Abdominal Oblique Injuries in Rotational Sports

Abdominal oblique injuries, also known as side strains, are common in rotational sports such as baseball, tennis, golf, and track and field.  These injuries are characterized by a sudden, sharp onset of pain near or on the side of the rib cage.  The injury usually occurs during some type of rotational sports movement such as swinging a bat, club or racket; or throwing a ball.

Trunk rotation plays an important role in generating and transferring power during sport.  It is through the trunk or core, that forces are transferred from the lower body to the shoulder and arms. Activities such as throwing and swinging require the core muscles to both stabilize the trunk and create force in order to transfer power to the upper body.

Anatomy of the Abdominal Oblique Muscles

The core includes the thoracolumbar, abdominal, pelvic, and hip musculature.  These muscle groups provide trunk stability to allow integrated limb movements, such as throwing and swinging, to occur. The abdominal core muscles include the rectus abdominis, transversus abdominis, internal oblique and external oblique.  Most abdominal injuries occur in the internal and external oblique muscles.  Less commonly, injuries can occur to the intercostal muscles between the ribs themselves.

The Role of the Oblique Muscles in Sport

The internal and external oblique muscles are responsible for flexion and rotation of the trunk, as well as providing trunk stabilization during complex sports movements.    Poor mobility of the hips or thoracic spine can contribute to excessive stress and compensation through the trunk musculature during swinging or throwing.  Rehabilitation often addresses hip mobility with manual therapy techniques performed by the physical therapist.  An imbalance between right and left side oblique muscles are also common is in sports such as golf and baseball.  This may place excessive forces through the lead side oblique musculature.  Finally, the large forces generated by lower body muscles (quadriceps and hamstrings) may overpower the weaker core musculature leading to injury during explosive sports movements.

The incidence of Abdominal Oblique Injuries in Baseball

A 2010 study in the American Journal of Sports Medicine investigated the incidence and trends of abdominal injuries in professional baseball players.  From 1991 through 2010, abdominal strains accounted for approximately 5% of all injuries in Major League Baseball.   Nearly half of these injuries occurred in pitchers.   These injuries occurred most often during the early part of the season.

In both pitchers and position players, the majority of injuries occurred on the side opposite to their throwing arm.  Pitchers missed, on average 35 days on the disabled list, while position players missed 26 days on average.  Players who receive steroid or PRP injections have been shown to miss more time from injury.   More than 1 out of every 10 sustained a re-injury during their career.  Most of these re-injuries occurred during the same or the following season.   As a result of these injury trends, many MLB teams have increased their focus on preemptive core and trunk strengthening exercises for all players.

Closing Thoughts

The incidence of abdominal oblique injuries is on the rise in rotational sports such as baseball and golf.   These injuries can result in substantial loss of playing time.  Proper training can prevent abdominal oblique injuries from occurring.  In a few weeks, I will post an article describing exercises which can help reduce the risk of sustaining an injury.  These exercises can also be part of a comprehensive rehabilitation program to safely return an injured athlete back to sport.

References

  1. Camp CL, Conte S, Cohen SB, et al. Epidemiology and impact of abdominal oblique injuries in major and minor league baseball. Orthop J Sport Med. 2015;5(3):1-8. doi:10.1177/2325967117694025.
  2. Conte SA, Thompson MM, Marks MA, Dines JS. Abdominal muscle strains in professional baseball. Am J Sports Med. 2010;40(3):650-656. doi:10.1177/0363546511433030.
  3. Nealon AR, Kountouris A, Cook JL. Side strain in sport: A narrative review of pathomechanics, diagnosis, imaging and management for the clinician. J Sci Med Sport. 2017;20:261-266.

Resistance Training & Performance in Young Athletes

Previously, the safety of strength training and its role in reducing youth athletic injuries was discussed. We now turn our attention to the role of resistance training to optimize performance in young athletes. High levels of muscular strength and power are essential for maximizing sport performance in any young athlete. Muscular strength is defined as the maximum force which can be exerted during a given movement. Power is the product of force and velocity and relates more to the speed at which strength can be expressed. Strength and power can be significantly improved through properly designed, supervised, and progressed resistance training programs for athletes of any age.

When to Start Youth Resistance Training

Children as young as 10 years-old can achieve substantial performance improvements through properly supervised and progressed resistance training programs. A 2014 study1 in the Journal of Strength & Conditioning Research showed young children engaged in resistance training with free weights, Olympic weight lifting with barbells, or plyometrics significantly improved vertical jump, long jump, balance, speed, agility, strength, and power. Resistance training combined with plyometrics results in superior performance gains compared to resistance training alone3. Correct performance of each exercise with proper movement patterns is always emphasized and little importance is given to the amount of weight lifted. Pre-adolescent athletes can show substantial improvements in strength and power due to neurological adaptations. Large changes in muscle mass or body composition do not occur until puberty.

Priming the Athlete to Flourish in Adolescence

Peak height velocity, or a child’s “growth spurt”, marks the point in maturation where hormones (i.e., testosterone in boys) rise exponentially and many physiological changes occur. In boys, this is the point where muscle mass spikes and young athletes begin to show large improvements in muscular strength and power. A 2016 systematic review5 in the Journal of Sports Sciences, showed boys adaptations to resistance training are greatest during and following their peak height velocity. Ideally, these athletes should have already developed the foundational movement pattern competencies during childhood. During peak height velocity, increasing the training volume and intensity often results in profound improvements in strength, power, and performance. Athletes without prior resistance training experience, or those who have not mastered fundamental movement patterns, will be at a disadvantage compared to athletes who began training earlier in childhood.

How Much Youth Strength Training is Enough

Research shows a dose-response relationship of strength training on performance in young athletes4. In order to maximize power and strength development, high school athletes should train at relatively high intensities, 2 to 4 times per week, with multiple sets per exercise, 6 to 8 repetitions per set, and with long rest periods between sets (3 to 4 minutes). High school athletes should incorporate Olympic lifts (clean, snatch) in order to maximize power development. A 2008 study2 in the Journal of Strength & Conditioning Research showed Olympic lifts resulted in superior improvements in vertical jump compared to training with traditional power lifts (squat, dead lift, and bench press).

Conclusion

The underlying key to success with any youth strength and conditioning program is related to supervision and progression by a qualified professional. Safety and performance outcomes can only be achieved when young athletes are coached appropriately. When implemented correctly, strength training can positively alter the trajectory of any young athlete’s athletic career or life.

References

  1. Chaouachi A, Hammami R, Kaabi S, Chamari K, Drinkwater E, Behm D. Olympic weightlifting and plyometric training with children provides similar or greater performance improvements than traditional resistance training. J Strength Cond Res. 2014;28(6):1483-1496.
  2. Channell B, Barfield J. Effect of Olympic and traditional resistance training on vertical jump improvement in high school boys. J Strength Cond Res. 2008;22(5):1522-1527. doi:10.1519/JSC.0b013e318181a3d0.
  3. Faigenbaum AD, Mcfarland JE, Keiper FB, et al. Effects of a short-term plyometric and resistance training program on fitness performance in boys age 12 to 15 years. J Sport Sci Med. 2007;6:519-525.
  4. Lesinski M, Prieske O, Granacher U. Effects and dose – response relationships of resistance training on physical performance in youth athletes: A systematic review and meta-analysis. Br J Sports Med. 2016;50:781-795. doi:10.1136/bjsports-2015-095497.
  5. Moran J, Sandercock GR, Ramírez-Campillo R, Meylan C, Collison J, Parry DA. A meta-analysis of maturation-related variation in adolescent boy athletes’ adaptations to short-term resistance training. J Sport Sci. 2016;414:1-12. doi:10.1080/02640414.2016.1209306.

Resistance Training Reduces Injury in Youth Athletes

In our last article, we discussed the safety of youth resistance training. In addition to being safe for youth athletes, resistance training can also reduce injury and improve athletic performance. Resistance training has been shown to reduce injuries in adolescents who participate in football, soccer, basketball, and various other sports1-2. Adolescent females are especially vulnerable to knee injuries. Preseason conditioning programs that include plyometric training, resistance training, and jump training significantly reduce knee injuries in female athletes. Also, youth athletes who engage in regular resistance training recover quicker from injuries when they do occur.

When to Incorporate Resistance Training for Children

Youth athletes can benefit from developing fundamental movement skills (e.g., jumping, landing, and throwing) through appropriate fitness conditioning at early ages (6-10 years old). Once fundamental movement skills are mastered, appropriately supervised strength training programs can be initiated to reduce the likelihood of overuse injuries occurring during sport. Resistance training addressing specific risk factors associated with youth-sport injuries (e.g., low fitness, muscle imbalances, and training errors) reduce overuse injuries by as much as 50%1, 3. With early exposure to resistance training, young athletes may be able to prevent the development of deficits which predispose them to injury later in life.

Resistance Training for Youth Non-Athletes

Free-time physical activity among children and adolescents is on the decline. Strength training is beneficial for athletes and children who are not engaged in competitive sports. Physical inactivity is a risk factor for activity-related injuries in children. Youth who participate regularly in age-appropriate fitness programs, which include resistance training, may be less likely to suffer an injury.

Conclusion

Although the total elimination of injuries is unrealistic, appropriately designed conditioning programs that include strength training can help reduce the likelihood of sports- related injuries.  Clearly, incorporating resistance training supervised by qualified professionals is in the best interest of any young athlete looking to minimize risk for injury and improve performance. Our next article will discuss the role of resistance training for improving athletic performance.

References

  1. Faigenbaum, A., Kraemer, W., Blimkie, C., Jeffreys, I., Micheli, L., Nitka, M., & Rowland, T. (2009). Youth resistance training: Updated position statement paper from the National Strength and Conditioning Association. Journal of Strength and Conditioning Research, 23(5), S60–S79.
  2. Faigenbaum, A. D., & Myer, G. D. (2010). Resistance training among young athletes: safety, efficacy and injury prevention effects. British Journal of Sports Medicine, 44, 56–63. http://doi.org/10.1136/bjsm.2009.068098
  3. Lloyd, R. S., Faigenbaum, A. D., Stone, M. H., Oliver, J. L., Jeffreys, I., Moody, J. A., … Myer, G. D. (2014). Position statement on youth resistance training: The 2014 international consensus. British Journal of Sports Medicine, 48, 498–505. http://doi.org/10.1136/bjsports-2013-092952

Early Sports Specialization in Young Athletes

In the United States, it is estimated that 72% of school-aged youth (8 to 17 years old) participate in at least one organized sport. Sports participation has many benefits, including living a healthy lifestyle, having a positive self-image, and building social relationships. It is also estimated that nearly 30% of school-aged athletes specialize in a single sport year-round6.  Early sports specialization has been defined as intensive year-round training in a single sport at the exclusion of other sports4. This may include athletes who:

  1. Choose one main sport,
  2. Participate for greater than eight months per year in one main sport, and
  3. Quit all other sports to focus on one sport.

Young athletes who engage in year-round intense training programs in a single sport are prone to overuse injuries, burnout, and dropping out of sports. Sports believed to be most susceptible to these negative consequences are baseball (pitchers especially), cheerleading, gymnastics, soccer, swimming, tennis, and volleyball.

Injury, Burnout, and Dropping out of Sports

Evidence is emerging which shows specialized young athletes are at more risk for injury compared to those who engage in multiple sports. One study of 7 to 18 year old athletes, showed that those who specialized in a single sport were 2.25 more likely to sustain a serious overuse injury compared to unspecialized young athletes4. Another study of 546 high school athletes found a relationship between the development of knee injuries and single- sport training in those engaged in basketball, soccer, and volleyball3. It appears that female high school athletes who specialize in a single sport are particularly vulnerable to hip and knee overuse injuries1,3. A possible explanation for these injury trends is the lack of diversified activity which may not allow young athletes to develop the appropriate neuromuscular skills that are effective in injury prevention. Year-round training in a single sport also does not allow for the necessary rest from repetitive use of the same muscles and segments of the body. The positive transfer of skill with diversification of sport participation is important in the successful development of any young athlete2.

Young athletes are under a tremendous amount of pressure brought about by adult-driven specialized training programs, weekend tournaments, showcases, and competitions. The psychological risk of burnout, depression, and increased risk of injury is believed to result in withdrawal from sport. In the physical therapy clinic, we are faced with many young athletes who lose their desire to return to sport following injury. It is my belief that these young athletes view their injury as a means to escape from the increased pressures of youth sports.

Research has indicated that adolescents need to enjoy their sport, and that intrinsic motivators are keys to maintaining participation and goal achievement in sports. Unfortunately, this is often not the case as the temptation of collegiate scholarships and stardom causes thousands of adolescent athletes to specialize in single sports. While this may result in more highly skilled, sport-mature athletes at a younger age, it is isolating the child and has the potential to lead to increased stress and pressure. Consequently the child loses a sense of control or decision-making power over their lives. These consequences may be far-reaching with the adolescents overall maturation and development5.

Conclusion

Parents and coaches should be cautious with encouraging young athletes to engage in intense year-round training specialized in any single sport. Adults involved in instruction of youth sports should be on the alert for signs of burnout, and physical symptoms in highly specialized athletes and be prepared to take corrective action such as backing off training. A more proactive approach is the better option. Encouraging multiple sports participation has the benefits of reducing injury risk, decreasing the chance of burnout, and the promotion of basic motor skills which will enhance the young athletes overall development throughout their lifespan.

References

  1. Bell DR, Post EG, Trigsted SM, Hetzel S, Mcguine TA, Brooks MA. Prevalence of sport specialization in high school athletics: A 1-year observational study. Am J Sports Med. 2016;44(6):1469-1474. doi:10.1177/0363546516629943.
  2. Fransen J, Pion J, Vandendriessche J, et al. Differences in physical fitness and gross motor coordination in boys aged 6 – 12 years specializing in one versus sampling more than one sport. J Sports Sci. 2012;30(4):379-386.
  3. Hall R, Foss KB, Hewett TE, Myer GD. Sport specialization’s association with an increased risk of developing anterior knee pain in adolescent female athletes. J Sport Rehabil. 2015;24:31-35.
  4. Jayanthi NA, Labella CR, Fischer D, Pasulka J, Dugas LR. Sports-specialized intensive training and the risk of injury in young athletes: A clinical case-control study. Am J Sports Med. 2015;43(4):794-801. doi:10.1177/0363546514567298.
  5. Myer GD, Jayanthi N, Difiori J p, et al. Sport specialization, part I: Does early sports specialization increase negative outcomes and reduce the opportunity for success in young athletes? Sport Heal A Multidiscip Approach. 2015;7(5):437-442. doi:10.1177/1941738115598747.
  6. Myer GD, Jayanthi N, Difiori JP, et al. Sports specialization, part II: Alternative solutions to early sport specialization in youth athletes. Sport Heal A Multidiscip Approach. 2016;8(1):65-73. doi:10.1177/1941738115614811.
  7. Bell DR, Post EG, Trigsted SM, Hetzel S, Mcguine TA, Brooks MA. Prevalence of sport specialization in high school athletics: A 1-year observational study. Am J Sports Med. 2016;44(6):1469-1474. doi:10.1177/0363546516629943.