Movement Medicine

Oblique Strains in Baseball Players: A Deep Dive into One of the Game’s Most Frustrating Injuries

Eric Nichols
Apr 24, 2025By Eric Nichols

Oblique strains have become an increasingly recognized soft tissue injury in baseball, particularly among professional and high-level amateur athletes. These injuries can be deceptively limiting—causing prolonged time away from the field and high rates of recurrence if not properly managed. Whether you’re a player, coach, or medical provider, understanding the nature of oblique strains is critical for both treatment and prevention.

What Is an Oblique Strain?

The obliques are the external and internal muscles on the sides of the abdomen. They play a key role in:

  • Trunk rotation
  • Lateral flexion
  • Core stabilization
  • Transfer of power between the lower and upper body
  • An oblique strain occurs when these muscles are overstretched or torn—usually during explosive rotational movements, such as swinging a bat, pitching, or quick side-to-side fielding actions.

Frequency and Impact in Baseball

Oblique strains account for approximately 9–12% of all injuries in Major League Baseball (MLB), according to multiple epidemiological studies. A study by Camp et al. (2015) found that from 2011 to 2015, oblique injuries were one of the top causes of injury-related days missed, with an average of 27 days lost per injury.

These injuries are particularly prevalent in:

  • Pitchers: Due to rapid trunk rotation and side-bending during the delivery
  • Batters: From explosive, rotational swings under high torque
  • Fielders: During sudden, forceful movements or awkward throws

Signs and Symptoms

Oblique injuries can be tricky to diagnose early, especially since mild strains may initially feel like a "side stitch" or mild soreness. Typical symptoms include:

  • Sharp or pulling pain in the side or lower ribs
  • Pain with rotation, coughing, or deep breathing
  • Tenderness to palpation over the lateral abdominal wall
  • Decreased throwing or swinging velocity
  • Guarding or stiffness during trunk motion
  • Athletes often report a “pop” or tearing sensation during the moment of injury, followed by immediate pain and loss of power.

Diagnosis and Imaging

Diagnosis is based on clinical evaluation, including a detailed history and physical examination focusing on trunk rotation, resisted abdominal contractions, and palpation.

MRI is the gold standard imaging modality, helping to confirm the diagnosis
Grade the severity (Grade I–III)
Identify the exact location (e.g., internal vs. external oblique, or insertion vs. muscle belly)
Ultrasound can also be used, particularly for dynamic assessment or in settings without MRI access.

Treatment Options

Conservative Management (Physical Therapy) Is the First-Line Approach:

Phase 1: Acute Management (0–7 Days)
Rest and activity modification
Ice and NSAIDs as needed for pain and inflammation
Avoid trunk rotation, coughing strain, or heavy breathing

Phase 2: Controlled Mobility and Strength (7–21 Days)
Gentle trunk range of motion
Isometric abdominal activation (e.g., bracing, diaphragmatic breathing)
Begin core stabilization exercises, avoiding rotation early on

Phase 3: Dynamic Reintegration (3–5 Weeks)
Progressive rotation-based core strengthening
Integrate medicine ball drills, resisted rotation, and plyometrics
Address underlying deficits (e.g., hip mobility, thoracic spine mobility, throwing mechanics)
Phase 4: Sport-Specific Return (5–8 Weeks)
Hitting/pitching progression, often guided by pain response and functional capacity
Reintegrate full-speed movements with controlled intensity
 
Return to Sport Timelines
Recovery varies based on injury severity and position demands. On average:

Grade I strain: 2–3 weeks
Grade II strain: 4–6 weeks
Grade III (partial tear or significant involvement): 6–8+ weeks
A 2020 study in Orthopaedic Journal of Sports Medicine showed average time lost in professional baseball was 27.3 days, and recurrence rates can be as high as 12–20%, especially if return is rushed or rehab is incomplete.

 
Prevention Strategies 
Reinjury is common, especially in athletes who:

Return too early
Don’t restore full trunk strength and rotation control
Have asymmetries in hip or thoracic mobility
Experience high rotational demand without adequate offseason rest
 
Prevention Strategies
Rotational strength training (medicine ball throws, resisted chops/lifts)
Comprehensive core program (anti-rotation, bracing, flexion/extension balance)
Hip mobility and stability work
Monitor swing and pitch workloads, especially during preseason ramp-ups
Integrate trunk endurance training (planks, carries, oblique isometrics)
 
Summary
Oblique strains are among the most debilitating soft tissue injuries in baseball due to the central role of core rotation in both throwing and hitting. With early recognition, targeted rehab, and proper return-to-play protocols, most athletes can recover fully—but patience and precision are essential.

Understanding the demands of baseball’s rotational mechanics allows us to build stronger, more resilient athletes and reduce the toll these injuries take on their careers.

 
References
1. Camp CL, et al. (2015). Epidemiology and return-to-play data of oblique injuries in Major and Minor League Baseball: a 10-year analysis. The American Journal of Sports Medicine, 43(2): 466–471.
2. Conte S, et al. (2012). Epidemiology of injuries in professional baseball players. The American Journal of Sports Medicine, 40(10): 2436–2441.
3. Hirase T, et al. (2020). Oblique abdominal injuries in baseball: a review of current literature and treatment strategies. Orthopaedic Journal of Sports Medicine, 8(3): 2325967120908043.
4. Schueller-Weidekamm C, et al. (2006). Imaging of abdominal wall injuries. European Journal of Radiology, 58(3): 418–429.
5. Laudner KG, et al. (2010). Trunk rotation flexibility in baseball players with and without history of abdominal injury. Journal of Sport Rehabilitation, 19(3): 305–314.