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When we talk about overuse injuries in baseball and softball, we generally discuss upper extremity conditions. Although those injuries are the most common, we are seeing more awareness and discussion of injuries to the hip.
How Do Injuries to the Hip Happen?
The activities of batting and throwing place high demands on the hips and put them at risk for injury. For instance with overhand pitching, during the wind up phase, a flexion and rotational force is placed on the hip. During the cocking phase, the hips are further apart and more loading stress is placed on them. As the pitcher moves from acceleration through the follow-through phases, the hips go through additional loading and rotational stresses. With Softball pitching, rotational forces occur in both the hips as the pitcher moves from a static standing position through the follow-through phase.
With Batting, during the stance or coiling phase, torque is placed on the back hip. As the batter moves through acceleration and follow-through, additional rotational forces are placed on the hips.
These are all normally occurring stresses that are just part of the games of baseball and softball. With normal stresses, there is a potential for injury. The potential for injury increases with the following risk factors:
1) Poor Biomechanics- Improper technique with any of the phases of batting, throwing or pitching can cause increase pressures and torque in the hip
2) Deficits in Mobility or Functional Movement- limitation in movement in any of the joints of the Lower body or Spine can contribute to increased problems in the hips
3) Deficits in Strength & Endurance- Weakness in the muscles of the hips or general "core" muscles can cause instability and result in increased pressures in the hips with activity. Fatigue can also play a part in these types of injuries- Arm fatigue is monitored for pitchers to alleviate the possibility of upper extremity problems, but we should also be monitoring lower body fatigue. If the lower body is weak or starts to break down, pitching accuracy will suffer and may be the first sign of fatigue.
4) Deficits in Proprioception/Balance- strength and flexibility are important, but being able to have balance on one leg and being able to shift weight and control motion is an important aspect in injury prevention. With poor balance, or awareness of body position, joints may move beyond their limits or may place undue strain on soft tissues that support them
5) Joint Abnormalities: abnormalities inside the joint may predispose players to certain types of joint "impingement" or pinching with movement. Repeated strain at these end ranges of motion can create pain and inflammation
Symptoms of Hip Injury
Symptoms of hip problems may be subtle at first and may just be tightness in the hip or buttock area. Other symptoms may include groin pain or aching into the thigh. As symptoms worsen, pain may be experienced at night or with the first few steps after sitting for a prolonged period. These symptoms are a sign that something is wrong in the area- the player should seek medical advice at the onset of these symptoms.
Screening for Risk Factors
A comprehensive baseball or softball program should include Pre-season screening, followed by preseason and off-season corrective actions to address any problems or deficits found during the screening process.
An ideal screen should include the following:
1) A regular pre-season Physical
2) Biomechanics Assessment- video assessment in slow motion during hitting/throwing or pitching
3) Flexibility & Strength screening
4) Screens of Specific Functional Movement Patterns
5) Balance & Stability Screens
The best injury treatment advice is to Avoid injury in the first place. Prevention strategies are the Key to keeping players healthy during their careers- if that is Little League Baseball...or all the way through the Majors.
Treatment for Hip Related Injuries
There are many conservative Physical Therapy treatments available for these types of hip injuries. Hands-on techniques, or manual therapy are an important part of rehabilitation as well as specific exercises to fix any muscle imbalances that may exist. Prior to returning to play, video biomechanical analysis is vital to look at throwing, pitching and hitting. This will help identify any mechanical or technique issues that could be causing problems in the hips.
Dr. Jennifer Allen is a Physical Therapist, Board Certified Clinical Specialist in the Areas of Orthopaedic and Sports Physical Therapy, as well as a Certified Hand Therapist. Sports Programming at Bodycentral Physical Therapy includes Biomechanics assessment, video movement assessment, Injury Prevention, and individual and team performance enhancement. For more information visit www.BodycentralPT.netor call 520-325-4002.