High School Pitcher With Low Back and Rib Pain

Athlete is a 15 y/o female softball pitcher who c/o L back and rib pain with pitching. Pain at the onset of the season (2 months ago) and has progressively increased over time. Patient has had physical therapy (with another provider) which included cupping, dry needling and icing without relief. At onset, she experienced pain only at the conclusion of practice, which has since progressed to bothering her while pitching. Pain best 0/10 and pain worse 7-8/10. Cupping and needling does provide some relief but it has been progressing to bothering her with daily activities outside of pitching and will bother her for up to 48 hours post pitching. Pain starts in the low back and progresses to the thoracic spine and rib cage. Currently she is not able to pitch more than 5-10 pitches before needing to quit secondary to pain.

 

Objective

Posture – Winged scapula B with L greater than R, tipping L scapula. Notable scoliosis thoracic and lumbar with slight right rib hump.

AROM – WFLs all planes shoulder and lumbar spine, TSM (total shoulder motion) R=171; L=167 CKC SA Test – +B with L > R

 

* Denotes pain

Palpation – pain with palpation of the L SI joint & L QL

 

 

 

ViMove+ AMI Results – Most significant findings listed below.

Squat Test – Significant lateral shift to the left with average greater than 11 degrees.

Core Testing – Notable difficulty with stability of lateral side bending and rotation with the R > L.

LSI Report – 82% LSI with notable LQI variances in the side plank, single leg hop, and the hop plant.

Single Leg Squat Report – R – Fair amount of valgus and speeds that are above recommended. Significant instability noted at the hip ranging from 15 to 34 degrees over normative values. L – Similar results although magnitude of valgus and speed is less. Pelvic motion L is within 2 of the right.

Single Leg Hop Plant Report – R – Significant amount of valgus, tremendously high speeds of valgus and again noting high degrees of pelvic instability. L – Similar results although pelvic motion is greater.

Pitching Assessment – Simply looking at biomechanics, we note that her right side is her driving side. When looking at her between the 9 o’clock (Phase 5) and ball release, she demonstrates:

      • Severe ankle eversion

      • Significant valgus at the knee, femoral adduction to mid-line

      • R lateral trunk lean

    Clinical Interpretation & Treatment:

    With a history of scoliosis, this young athlete is susceptible to shoulder and low back pain, especially as a softball pitcher.

    Her movement assessment and pitching assessment done pre-season is representative of what was evaluated in the clinic 5 months later. During the pre-season testing, she presented with significant instability at the knee and hip with single limb loading. Her pitching cycle demonstrated similar results under explosive dynamic loading. At the time of the ViMove+ AMI and pitching analysis, the athlete was not complaining of any pain or injuries. However, the results would have indicated a need to add some single limb, gluteus medius targeted and single limb rotational and anti-rotational training. This lack of stability combined with the shoulder weakness and history of scoliosis would definitely lead to the current complaints of pain.

    Working with her team ATC and strength coach, she was put on a program which targeted these areas. Within 4 weeks, the athlete had returned to full pitching without restriction and was able to pitch in a weekend long tournament without any increase in pain.

    In this case, the ViMove+ AMI identified the majority of issues that ultimately led to resolution of the athlete’s symptoms and performance issues. It is my firm belief that had a program been developed based on the initial clinical recommendations from the ViMove+ AMI, this athlete would have competed this entire season without an injury related to pathokinematics that were identified here.

    Trent Nessler, PT, MPT, DPT – The Athlete Lab

    Reach out to Trent Nessler to explore the AMI assessment further or to schedule your testing today!

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