Oblique Strain for Danny Duffy

Danny Duffy Injury Rehab: Oblique Strain

Royals fans got some bad news over the weekend that ace pitcher Danny Duffy is going to be out for 6-8 weeks with an oblique strain.  That is definitely a blow to their pitching staff because Duffy has been consistent all year.  So what’s the deal with this oblique strain?

Royals pitcher Danny Duffy

What are the obliques?

 
The obliques are abdominal muscles that are involved primarily in rotation of the trunk.  There are internal and external obliques.  The external obliques are closer to the surface, while the internal oblique is deep to that.  The right oblique actually rotates the trunk to the left and vice versa for the left oblique.  Obviously, that’s a big deal for a pitcher since he has to rotate his trunk with so much velocity to both accelerate to the plate and to decelerate through the hips and trunk after delivery of the pitch.  According to Johnson (Curr Sports Med Rep, 2006), the abdominal muscles are injured by direct blows or by sudden or repetitive trunk movement, either rotation or flexion/extension.  Sounds like he strained it covering first on a play there, so it could have been reaching his trunk too high or twisting awkwardly.

Is Danny Duffy’s Injury common?

There is actually one study from the American Journal of Sports Medicine in 2012 by Conte et al that looked at abdominal strains in professional baseball over a 20 year period.  They found that abdominal strains accounted for 5% of all baseball injuries, and a whopping 92% of those were of the internal or external obliques.  Interestingly, there was an upward trend (20%) of these injuries in the 2000’s, especially in early season.   Clearly, Danny Duffy fits this description.  It makes sense that these injuries are on the rise too – athletes are just more explosive today than they were 20 years ago.  That said, this doesn’t sound like it was from an explosive mechanism.

Why is he out so long?

 
Like any muscle injury, whether it’s a hamstring or groin strain or an oblique strain, not only is there time required for the soft tissue to heal, but the athlete has to get the strength back and then get the velocity of contraction back too.  Collectively, these phases take time.  Obviously, Duffy has to generate a lot of power through his trunk to pitch.  It takes time for the muscle to tolerate the loading and speed of contraction that is required of it so he can do his job.  What makes any abdominal strain, and any rib/intercostal muscle injury a challenge is that it’s hard to rest these muscles.   The abdominal and oblique muscles contract when you roll over or sit up in bed and when you sneeze.  It’s hard to give these muscles rest!  Compared to a hamstring, we can easily rest those muscles – we just don’t run!
 

What’s the rehab look like?

 
First step is to get his pain under control.  Given he’s out 6-8 weeks, it sounds like it could be a nasty injury.  Given that he’s their ace and need him for the long haul, they might just be taking extra precautions, especially considering the high re-injury rate.  Nonetheless, once his pain is under control, he’ll begin a steady program of core and hip strengthening exercises.  He’ll likely start with “static” abdominal contractions (think  bracing yourself before taking a punch) while he pushes and pulls bands/tubing, squats, lunges, and similar exercises that keep the muscle active, but ones that don’t involve rotation.  As these exercises are tolerated well, he’ll begin more trunk flexion exercises and introduce rotary movements at slower speeds first.  As he is pain free with these movements, he’ll increase speed of contraction doing medicine ball chop patterns and likely get back on the field jogging and progress from there.  It’s a relatively uneventful rehab.  Just need time and gradual progression of exercises.  Of course, he’ll have things like the pool to compliment his exercises.  From a modality standpoint, other than some soft tissue work, not much else will help this injury.
We hope Danny Duffy is back on the bump soon mowing down opposing hitters!  We know he’s in good hands with the Royals training staff, so we won’t be surprised if he’s back before 6-8 weeks.
If you strain a muscle, we’re your first choice for rehab in Kansas City.  We have locations in Overland Park and Prairie Village to serve you.  Remember, you can see a PT in Kansas without a physician referral.  (913) 728-8599

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