Key members of the Milwaukee Brewers and Green Bay Packers have suffered oblique injuries this year, but it has affected each differently. OnMilwaukee.com caught up with Dr. Omar J. Darr of Aurora Health Care to explain what those injuries mean and how they can affect the two sports (and positions therein) differently.

Dr. Darrspecializes in Orthopaedic Sports Medicine, and was a high-level athlete himself before pursuing his medical career as a member of the Tufts University football program.
The Brewers are hoping starter Matt Garza can return from the disabled list after suffering a strain to his left oblique, while Ryan Braun spent time on the disabled list due to a strain in his right oblique earlier in the year.

Packers safety Morgan Burnett suffered an oblique strain in early August as well and missed the team’s first preseason game in Tennessee on Aug. 9. He was cleared to play by the middle of last week and started the second preseason game on the 16th.

It seems like such a nebulous injury for someone who is a fan, or just an observer of a sport, because it’s not the result of anything traumatic.

"It was just a different feeling, like a muscle thing – it was no different than hurting any other muscle in your body," Burnett said simply. "It just takes time healing and eventually you’ll be all right."

So, we called up Dr. Darr to enlighten us*.

OnMilwaukee.com: We hear a lot about oblique issues in sports, so let’s first start by defining what they are.

Dr. Omar Darr: They’re muscles that are on both sides of the abdomen, and there’s an internal oblique and an external oblique muscle. The external obliques are in the outer, frontal parts of the abdomen and they connect to the bottom rib and the pelvis. Then the internal obliques are a little deeper down and run from the pelvis to the bottom ribs as well. So, the torso rotation motion is created by the oblique muscles and because the muscles kind of span the entire torso from the ribs to the pelvis, they rotate and stabilize the pelvis and are critical in hitting or pitching.

OMC: Wow – that’s a bigger muscle than I initially thought. Because it spans such a big area of the body, is that why it can be such a troublesome injury for an athlete?

OD: Right. Because they span the abdomen, they’re critical in any sport that involves rotation, so with baseball – with pitchers – the obliques fire during the acceleration and deceleration phases of throwing. And in hitting, that powerful rotation that occurs in the torso provides power to the swing. So that basically means the obliques are responsible for transferring power generation by the hips to the arms. Any attempt to win go throw with an injured oblique can be very painful. And even when you injure your oblique, it can be painful just to sneeze or get out of bed. You can imagine if you need to throw a 90-mile-an-hour fastball or take a hard swing it would be very difficult to do.

OMC: Because there is an external and internal oblique, and because both are so large, is that why an athlete can strain the same side over and over again but perhaps feel different pain?

OD: That could be one factor. There are also different severities of the injuries. Some are more minor where you wouldn’t expect to be out as much without as much pain, then there are other ones where you could actually have some of the muscle tearing off bone which would be painful and have al longer rehab. It’s not too uncommon to have an re-injury. They looked at about 20 years of oblique injuries in a study of Major League Baseball players and there is about a 12 percent re-injury rate in that study. It is one of those things that can recur.

OMC: On the football side of things, Burnett told me "You can’t compare the two sports. I mean, baseball, that’s a lot of twisting. I’m pretty sure they torque way harder than we do." How accurate was that thought – I mean, you’re seeing how quickly they move and how hard they hit, do they really torque differently than a baseball player?

OD: Morgan Burnett’s a defensive back, so if he doesn’t have too severe an injury his main trunk rotation would occur when he’s back pedaling or venturing to get a receiver, which certainly can be painful with a bad oblique injury but the obliques are probably more needed in baseball where you’re pitching and generating that high amount of torque from the hips to the arm, and that’s the link between the hips and the arm; and in a hitter the same way, linking the pelvis to the arm with a powerful swing.

So, yeah, it is surprising how long people can be out in baseball with these obliques. Usually, on average, with an average oblique injury, pitchers miss about five weeks. Position players are maybe a little less, a little less than four weeks, but usually it’s something that you’re missing a good amount of time with it.

OMC: Both Garza and Burnett said the recovery process is just that – a process, that really just involves rest and waiting it out.

OD: It really is. So, how do you rehab it? Really, you want to kind of control pain and inflammation, that’s with ice and anti-inflammatory medications. The rehab is really designed to maintain your general fitness and overall muscle strength until you can do some of those critical rotation movements. As the oblique heals up, you can add those back into the exercise program. Then, sometimes with some of the more significant injuries, we can treat with blood platelet injections and sometimes even a cortisone injection to get it to speed up the healing. But even mild injuries in baseball players, players can miss three to four weeks and the more severe ones six to eight weeks to get back from.

OMC: Finally, how important is it for an athlete to not rush back from this kind of injury – especially a baseball player?

OD: The more twisting involved would be the problem. The (other) problem is if you get a pitcher back too soon that’s still having a problem with a painful oblique that isn’t functioning well, that will transfer stress to other parts of his body like his arm, which could lead, potentially, to an arm injury. So you’ve got to be careful that before you get a pitcher back, kind of like when a pitcher gets a blister on their finger you don’t want to have them go back too soon. It sounds like a minor thing but even something like that can affect the throwing motion and that could lead to a bigger problem.