Hip Injuries In Baseball Pitchers And Other Throwing Athletes

      Like many sports, baseball puts asymmetrical loads on the body. In all aspects of baseball (pitching, fielding, batting, base running) the rules of the game and right or left hand dominance influence how the body takes on the physical stress of the sport.

   The core is essential for generating and transferring force during the powerful and asymmetrical movements that take place in baseball. For the purpose of this discussion we are going to define the core as: the abdominals, the erectors (muscles that run parallel to the spine), the pelvic floor, and the hips (the glutes, groin muscles, and hip flexor muscles).

   When throwing a pitch, the core muscles maintain stability of the the low back and hips allowing force generated through the legs to be transferred through the core to shoulder complex and ultimately to the ball. This transfer of force takes place in less than 0.2 seconds!1 The core is essential to maintaining proper mechanics through all phases of delivering a pitch. Any imbalances in flexibility, strength, or coordination at that high rate of speed can lead to decreased performance and injury.

     If we focus specifically at the hips as a key point connecting the powerful leg muscles to the core we find a potential area for injury and dysfunction in the pitching athlete. Up to 5% of all injuries in minor and major leaguers are due to hip problems.2 Although difficult to estimate, it could be hypothesized that other injuries to the shoulder or elbow might be avoided if function is maximized at the hip and core. Let’s forget about the steroid era in baseball for a moment and recall the crazy workouts of Roger Clemens. Sure, he focused on strengthening his arm and rotator cuff, but the main focus of his off-season training was strengthening his hips and core.

    When a hip injury in a baseball athlete does occur, physical therapy is generally the best way to treat it. The treatment of hip injuries in pitchers begins with a detailed assessment and evaluation. This includes looking at spine and hip range of motion, flexibility, soft tissue quality, strength, endurance and pitching mechanics. Treatment for these types of injuries is highly individualized depending on the specific presentation of each athlete. The four main elements we focus on when treating hip pain in a pitcher include: manual therapy, hip mobility, core stability and pitching mechanics. Let’s break each of these down:

1 - Manual therapy - This includes mobilization, manipulation, or muscle energy techniques to the hip and/or low back and pelvis complex to restore normal mobility, decrease pain, and improve muscle performance. Manual treatment can also include instrument assisted soft tissue mobilization and soft tissue techniques to relax spastic muscles, improve soft tissue mobility, and restore muscle flexibility.

2 - Hip Mobility - These are drills and exercises to restore full range of motion and flexibility to the hips. Some examples include adductor stretching, hip flexor stretching, and deep lunges for an active stretch to the hip flexors.

3 - Core Stability - These exercises are used to maintain integrity of the low back and pelvis complex and can include double and single leg bridges, glute activation drills, lunges, planks, crawling, ab roll outs, and single leg balance and stability exercises.

4 - Pitching Mechanics - Breaking down the pitching delivery step by step and practicing proper mechanics that build on the range of motion, mobility, and stability gained in the first three elements through a focused rehabilitation program.

     Recently at Performance Physical Therapy we had a patient who is a left handed pitcher with hip pain. He presented with complaints of a right hip pain that bothered him the most during his stride to deliver the ball to the plate. His history revealed no trauma or recollection of injury-just an onset of pain with throwing. On examination, serious hip pathology was ruled out through a detailed history and an in-depth orthopedic exam. There was significant tenderness to the touch over the hip flexor muscle and its attachment to the front of the hip bone, pain with stretch to the hip flexor muscle, and pain that was reproduced with contraction of the hip flexor. We also identified limited flexibility of the groin and hamstring muscle groups and weakness of the hip, glute and core. To treat this patient we utilized manual therapy targeting the low back and pelvis, hip joint and hip flexor muscles, hip mobility exercises, core stability work, and a review of his pitching mechanics.

      With  only a few sessions of physical therapy and some activity modification, our patient did not miss a single day of baseball practice or strength training with Challenger Strength and made a full return to pitching in less than 2 weeks. Early identification of the injury and a smart selection of treatment techniques was the key to such a quick recovery.

   Be on the lookout for a post from Gerry DeFilippo at Challenger Strength next week demonstrating some great ways to further develop core, rotational strength and power that helps prevent hip injuries and improve performance!

    Interested in what what we do and how we achieve our results? Stop by one of our two locations in Wayne, give us a call at 973.368.4907, email us at staff@performancePTSC.com or follow us on social media to see how we can help you!

​Dr. Anthony Falco



References:
1 - Seroyer ST, Nho SJ, Bach BR, Bush-Joseph CA, Nicholson GP, Romeo AA. The
kinetic chain in overhand pitching: its potential role for performance
enhancement and injury prevention. Sports Health. 2010 Mar;2(2):135-46.
2 - Coleman SH, Mayer SW, Tyson JJ, Pollack KM, Curriero FC. The Epidemiology of
Hip and Groin Injuries in Professional Baseball Players. Am J Orthop (Belle Mead
NJ). 2016 Mar-Apr;45(3):168-75.

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