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MLB Injuries

Cole Hamels is inching closer to a return-Dr. Morse

Photographer: Steve Nurenberg/Icon Sportswire

Veteran starting pitcher Cole Hamels, who was placed on the disabled list on May 3 with an oblique strain, is near his return to the Texas Rangers. It appears that Hamels suffered a Grade 2 oblique strain – this was MRI confirmed and has put him out about 6 weeks so far. His initial timeline to return to play was 6 to 8 weeks, so he is right in that window.

Hamels has been the definition of consistent, as he has pitched 7 straight 200+ inning-seasons between 2010 to 2016. Unfortunately, in light of this injury, I don’t believe he will be able to make that an 8th consecutive season. It appears that Hamels’ oblique injury was severe enough that it kept him out a decent amount of time and for the Rangers to be extra cautious with him because he is so important to their rotation, serving as the #2.

The issue with oblique injuries in starting pitchers is that the oblique muscles are really required to generate muscle force and power in their repetitive deliveries. Without strong oblique muscles that are fully healed, in Hamels’ case, the velocity will be down and he will be wincing with each pitch.

To help further explain exactly what an oblique injury is let me briefly talk about this, starting with the anatomy of the oblique muscles. The oblique muscles are comprised of two different parts, the external and the internal obliques, and they basically overlap each other. They make up the sides of your abdomen and are described as broad, thin and irregularly quadrilateral muscles. On each side of the abdomen the obliques arise from eight digitations, each from one of the external surfaces and the inferior borders of the fifth through twelfth ribs. The blood supply of the oblique muscles is from the lower intercostal arteries, and they are innervated by the thoracoabdominal nerves ( T7-T11) and the subcostal nerve (T12). The main purpose of the obliques is to represent the contralateral rotation of torso, essentially twisting, which is vital in not only everyday activities but they are especially important in many of the sports movements.

Unfortunately oblique injuries are notorious for taking a long time to fully recover. Oblique strains are very common injuries, especially in baseball as they are very important in both generating power on one side while helping to stabilize the other. The obliques help to transfer the energy generated in the legs and hips up to the core, chest and to the arms. Swinging the bat, throwing the ball both are require substantial amount of oblique involvement. Pitchers often depend on their obliques to generate power in their pitches, helping to create that ‘whip’ effect. In both batters and pitchers oblique strains can affect the contralateral external oblique and possibly even the same-sided internal oblique as well.

Even a simple grade one oblique strain can set either a pitcher or hitter back several weeks because these muscles are so important within baseball. Re-injuring them is quite easy to do. Adequate healing is vital in order to help prevent re-injury and longer DL stints. Sometimes MRIs are used to determine the severity of the strain. Grade 1 strains can heal in 1-3 weeks, whereas grade 2 strains can take anywhere from 2-4 weeks. Grade 3 strains often involve complete rupture of either the internal or external oblique muscle, and require 2-3 months to completely recover from.

Treatment requires rest, anti-inflammatories (NSAIDs), massage, core strengthening exercises, sometimes ice and even electrotherapy. It is important to not only target both the internal and external obliques in your rehab, but also the muscles that oppose the obliques as well. These muscles include the lats, lower traps, the serratus posterior muscles, spinal extensors, glutes as well as the hip abductor muscles.

I expect Hamels to return in the next two weeks after he gets a couple strong we have outings in him. He should be considered an SP2-3 for the rest of the season. Send a low-ball offer on him to see if you can get a reliable pitcher for a decent price to help to you go deep into the playoffs.

This was written for the @TheFantasyDRS by Dr. Jesse Morse. I am a Family Medicine trained physician, and I will be beginning a Sports Medicine Fellowship at the University of South Florida in Tampa next month. If you have any questions or comments, you can contact me directly at @DrJesseMorse or visit my website at: www.DrJesseMorse.com

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