Randon Hall, MD
Oblique Muscle Injury
Updated: Nov 22, 2020
Oblique Muscle Strain
Oblique muscle injuries are common in sports, especially those that involve significant twisting and rotation. Most sports fans hear about oblique muscle injuries in baseball due to the significant contraction of those muscles during the baseball swing. Here is a deeper look at the oblique injury and approach to management in sports.
The injury can occur in any sport, but baseball is the classic case. The oblique injury occurs in baseball with an aggressive swing, followed by the athlete clutching the lower abdomen on the affected side. If you look at the slow-motion clip (end of video) of Yankees’ Aaron Judge you will see after the swing he grimaces and grabs the lower-left abdominals. Typically batters are injured on the lead side of the body and as in this case he is right-handed and the injury occurs to the lead side on the left.
Anatomy of an Injury
Basically, oblique injuries occur with the abdominal muscles on the side of the toro. Their main function is to rotate the trunk. The primary muscles included in the diagnosis of an oblique strain include the internal oblique, external oblique and/or the transverse abdominal muscle. An oblique muscle strain, by definition, is a tear of the muscle fibers, but the degree of tear is what determines the severity. The mildest form of injury is a stretch of the muscle fibers which is classically referred to as a strain, however, more severe injuries can be due to a partial or complete tear. One key diagnostic feature discussed by Conte et al is the cough test, where a simple cough elicits significant pain in the abdominal muscles.
Internal Oblique Muscle
Internal Oblique Muscle
Approach to the Athlete with an Oblique Injury
In general, oblique muscle tears are treated just like any other muscle strain. Unfortunately, the mainstay of treatment is rest to prevent further bleeding and allow any torn muscle fibers to heal. In my experience, a significant factor in recurrence or prolonged injury is inadequate rest. Ice can be a helpful addition for pain control and reduction of swelling. Lastly, gentle range of motion as tolerated based on pain can help regain movement. Although there is no clear evidence of effectiveness PRP or cortisone injections can be options in the elite athlete.
Return to play can vary significantly depending on the sport. However, studies have shown that the average time to return for major league baseball players is about 24 days. In general, the average return to play is usually in the range of 2-4 weeks.