Side strain in sport: a narrative review of pathomechanics, diagnosis, imaging and management for the clinician

Swinging injuries in competitive baseball players

Injuries are common in competitive baseball players and can occur in all facets of the game. The majority of the existing literature on injuries in baseball players has focused on injuries secondary to the overhead throw with very little attention given to injuries sustained while batting. The baseball swing is a complex, often violent, motion that predisposes batters to a variety of injuries affecting the spine, trunk, pelvis, and extremities. Knowledge of injury patterns that commonly occur during the baseball swing and radiologic findings important to the treating physician can help radiologists provide accurate imaging interpretations that appropriately guide patient management.

Characteristics of internal oblique muscle strain in professional baseball players: a case series

Background

Internal oblique muscle strains can develop in professional baseball players, rendering the players unable to continue playing for a certain period. However, the characteristics of this injury are not well known. The purpose of the present study was to investigate the details of the injury and the post injury course of internal oblique muscle strain in professional baseball players.

Methods

The subjects were members of a single Japanese professional baseball team with a total of 188 players (81 fielders and 107 pitchers) who developed internal oblique muscle strains from January 2012 to December 2021. The diagnosis of muscle strain was made on the basis of local pain and magnetic resonance imaging findings. The incidence of internal oblique muscle strain, the details of the site of the injury, and the time to return to play were examined.

Results

There were 28 cases in 23 players (12.2%) of internal oblique muscle strain. The players were 16 fielders (24.7%) and 7 pitchers (7.5%), with a significantly greater incidence in fielders (p = 0.001). Although internal oblique muscle strain was more common on the side contralateral to the batting or pitching side, it occurred on either side. Most of the injury sites were at the region of the muscle insertion to the lower ribs. At a mean time of 36.5 months after the initial injury, 5 players (21.7%) developed another internal oblique muscle strain. The mean time to return to play was 27.7 ± 9.7 days (range, 4–53 days).

Conclusions

Baseball players who have symptoms at the side of the trunk should be regarded as having possible internal oblique muscle strain, and proactive examination should be considered.

Side Strain and Impact Injuries at the Iliac Crest Attachment of Lateral Abdominal Wall Musculature in Cricketers: An Uncommon Injury Pattern

Side strains refer to injuries of the internal/external oblique or the transversus abdominis, commonly at their attachment to the lower four ribs and rarely at their pelvic attachments. Injuries at the rib attachments are well-described while literature on iliac crest attachment injuries is sparse. We report four cricketers who had side strain and direct impact injuries with varying degrees of severity at the iliac crest attachment. The purpose of this article is to describe the anatomy, possible mechanism of injury, and imaging findings in the lateral abdominal wall muscle injuries at the iliac crest, which have not been described previously.

Assessment of trunk lateral flexion range of movement using a novel method in first class cricket players

OBJECTIVES

Lateral flexion range of movement (LF ROM) is used to assess and monitor recovery of side strain injury in athletes. This study established a reliable and pragmatic measure of LF ROM and investigated the stability of the measure over time in athletes.

DESIGN

1) Cross-sectional reliability study and 2) Cohort longitudinal study.

SETTING

Elite cricket teams in COUNTRY-AAA and COUNTRY-BBB Participants: Cricket players Methods: 1) The intra- and inter-rater reliability of two methods of measuring LF ROM were assessed (distance to the floor or distance to fibular head). Ten healthy first-class cricket bowlers were tested by three experienced physiotherapists. Intra-class correlations (2,1) were calculated for absolute agreement for all 3 testers. 2) Professional cricket fast bowlers were recruited from COUNTRY-AAA and COUNTRY-BBB domestic and international competitions. Lateral flexion range of movement was measured monthly during the pre- and competitive season. A one-way repeated measures analysis of variance was performed to identify difference within the pre-season, within the competitive season, and between competitive seasons.

MAIN OUTCOME MEASURES

Lateral flexion range of movement towards and away from the bowling arm.

RESULTS

Both methods had good intra- and inter-test reliability (ICC>0.84). As LF ROM to the floor was easier for clinicians it was used for the longitudinal study. Lateral flexion range of movement did not significantly alter throughout the pre- and competitive season or between seasons (p>0.05).

CONCLUSIONS

This new method of describing LF ROM demonstrates good intra- and inter-rater reliability and stability over time and can be used as an outcome measure in side-strain injury.

Trunk Injuries in Athletes

ABSTRACT

Trunk pain is a common cause of performance limitation and time away from sport in athletes. However, atraumatic trunk injuries are underrepresented in medical literature and underrecognized clinically. Delays in diagnosis and initiation of appropriate treatment can increase injury morbidity and return-to-play time. Currently, evidence-based guidelines for diagnosis and treatment of trunk pain in athletes are limited. Thus, we provide an overview of atraumatic sport-related injuries to the thoracic spine (disc herniation, scoliosis, kyphosis), ribcage (bone stress injury, costochondritis, Tietze syndrome, slipping rib syndrome, costovertebral or costotransverse joint dysfunction), and chest and abdominal wall musculature (intercostal, serratus anterior, oblique strains, regional myofascial pain), highlighting sport-specific biomechanical considerations. We aim to increase awareness of these causes of trunk pain among sports medicine providers in an effort to guide diagnostic and treatment recommendations that will ultimately improve overall musculoskeletal health in athletes.

MRI findings are associated with time to return to play in first class cricket fast bowlers with side strain in Australia and England

OBJECTIVES

To investigate the reliability of reporting and relationship between MRI parameters at injury and time to return to play (RTP) in first class cricket fast bowlers with side strain in Australia and England.

DESIGN

Cohort study.

METHODS

Eighty MRI scans of side strain injuries to 57 fast bowlers were sourced. Ten scans were reported by three experienced radiologists to determine intra- and inter-rater reliability. The relationship between six MRI parameters (muscle injured, presence of a muscle tear, rib level of injury, presence of blood fluid products/haematoma, periosteal stripping, rib oedema) and time to RTP was investigated with 39 scans reported by a single radiologist with known intra-rater reliability. The association between parameters and time to RTP was analysed with an ordinal logistic regression model.

RESULTS

Recovery time was prolonged with a mean of 39days (standard deviation: 14days) and 44% of bowlers requiring more than 6weeks to RTP. Reliability levels between parameters varied widely. The presence or absence of a muscle tear was the only MRI parameter associated with time to RTP. Players with a muscle tear were 8 times more likely to take more than 6weeks to RTP. The multifactorial model was predictive of recovery time in only 53% of this cohort, leaving 47% of total variance in time to RTP unexplained.

CONCLUSIONS

The presence of a muscle tear was associated with time to RTP in cricket fast bowlers with side strain injury in first class cricket in Australia and England.

Trunk Side Strain Has a High Incidence in First-Class Cricket Fast Bowlers in Australia and England

OBJECTIVE

To investigate the past incidence of side strain injury and its associated factors in first-class cricket fast bowlers in Australia and England.

DESIGN

Retrospective case series.

SETTING

Professional cricket.

PARTICIPANTS

Cricket fast bowlers who were professionally contracted full time at first-class level in Australia and England in 2011. All bowlers were male and aged 18 or older. A bowler was defined as a fast bowler if the wicketkeeper would take their stance back from the stumps. There were 207 participants.

INTERVENTIONS

Not applicable.

MAIN OUTCOME MEASURES

The association between bowling arm, player height, active trunk lateral flexion range of motion, side bridge endurance, volume of first-class cricket played, and the history of injury was determined.

RESULTS

Over half of the bowlers had sustained at least 1 side strain in their career. Seventy-seven percent of primary injuries occurred in bowlers aged 24 or under. A higher proportion of injured bowlers had reached first-class volume in their career. Recurrence occurred in 30% of bowlers, with over 30% of these bowlers sustaining at least 1 further recurrence. Nearly half of all recurrences occurred within 2 years with a further quarter in the next year. The injury was not associated with any measured factors.

CONCLUSIONS

Side strain is a common injury among first-class cricket fast bowlers, especially at younger ages. It was associated with the volume of first-class cricket played. Recurrence was common and occurred most frequently in the first 2 years after primary injury.