Back Pain From Throwing?

• Dull, achy back pain?
• Does it hurt when hitting?
• How about throwing?

Low Back Injuries are common in baseball, but probably not for the reasons you may think. More than half of players will experience back pain when pitching or hitting.

You don’t have to play in pain any longer.

I can tell you, in all honesty, my very first injury was a low back condition. I was out for the last 75% of my sophomore year, but I learned a lot about rehab.

After I found the right treatment plan for my condition, I was better within a month.

You can find the right treatment as well, but you have to know what condition you have first.

Here are the most common conditions causing low back pain that you can have as a baseball player.

• Facet Syndrome
• Disc Herniation
• Sacroiliac Joint Sprain
• Muscle Spasm

FACET SYNDROME

• Painful when you bend backwards
• Gets better when you stretch?
• Painful to sit?
• Hurt to pitch?

Facet Syndrome is one of the top three reasons for low back pain in baseball.

But it is one of the simplest ones to rehab, so stop dealing with back pain, and make it better.

However, the presentation (especially in youth athletes) requires us to rule out a stress fracture of the back called a pars fracture. If you have a pars fracture, you will not be playing this season.

In this article, I will teach you about Facet Syndrome and how it is rehabbed in our clinic.

What is Facet Syndrome?

The facets are small joints of the back. Each segment of the back is directly connected to four facets (two on each side).

When they become jammed, they often hurt too. Compaction is the mechanics of Facet Syndrome.

What causes Facet Syndrome back pain when pitching and hitting?

Compaction or jamming of the small joints of the back happens with repeated and prolonged extension.

Extension of the back (bending backward) often occurs over and over again in baseball. Pitchers are especially prone to have Facet Syndrome because they commonly have a forward tilling pelvis.

A forward-tilting pelvis (imaging a sway backed horse) jams the back by changing its base…the sacrum.

By the way, it is normal for a thrower to have a forward-tilting pelvis. Pitchers live in extension. They need this if they are to throw hard. This is all explained in the mechanics of pitching infographic below.

Facet Syndrome Rehab

To control Facet Syndrome, we need to attain a softer jamming.

What? Why don’t we get rid of the lumbar extension altogether?

If you are a pitcher, you lose velocity if you do not keep the lumbar extension.

So, the answer is keep the extension, but teach the player how to control it. It is that last, little bit of extension that creates the issue.

How can we do this?

The anterior abdominal wall resists extension and needs to be trained to work better through the wind-up.

I’ll say that another way: we need to get better at “anti-extension.”

Actually, we have a whole online program coming on this theory, but here are a few starting points that I can share.

To relieve pain, we often start with bouts of decompressive stretches.

Facet Stretches

Stretching is okay for a short period of time but one thing you MUST know about facet syndrome is it occurs because your spine is not being protected against extreme ranges of motion… in this case extension backward.

The facets become irritated when they are compacted.

They are compacted in a few situations:

1. When the abdominal cavity doesn’t have high intra-abdominal pressure
2. When the diaphragm is not holding position
3. When the trunk wall muscles aren’t doing their job

Or it could be a combination of all of the above.

Don’t understand any of this?

It’s ok. I have a whole article on it HERE you should read after you watch the video below.

To control excessive motion of the trunk, Pallof Press variations are a good go-to. I apologize this is not the exact video I wanted. We haven’t filmed it yet.

This is an Anti-rotational Pallof Press we use to combat back pain when pitching and hitting.

Facet Syndrome Treatment Options

Hands-on treatment often cannot train the body to resist extension, but they can help to decompress the area.

• Stretching
• Chiropractic adjustments
• Hip mobilization
• Thoracic spine mobilization
• Deep tissue work
• Active Release Technique
• Traction
• Acupuncture
• Injections
• Oral medication

DISC HERNIATION

• Unbearable pain as you get up from bed?
• Can’t bend over to tie your shoes?
• Lost your flexibility over night?
• Loss of sensation in your hip, thigh, calf or foot?
• Back pain when pitching and hitting?

These are all signs of a possible disc injury and/or possible nerve root irritation.

Disc injuries can be extremely painful. They can take months to improve if you are not taking the right rehab steps to make them better.

Disc injuries can get worse, and the loss of sensation can get worse as well.

Read through this article and understand this injury.

What Is Disc Herniation?

A spinal disc is a cartilage-based “jelly donut” located between the vertebrae of the back.

They are softer than bone, and as such, can be ripped resulting in pain.

Disc injuries come in four types (best to worst):

• Protrusion
• Prolapse
• Extrusion
• Prolapse

If we say “herniation”, we are talking about extrusion where there is a “disruption of the annular fibers” of the disc. An analogy would be the “jelly” coming out of the “donut”.

If you deteriorate to a prolapse, you become a surgical case, so it’s best to deal with it sooner rather than later.

What causes Disc Herniation?

Disc injuries occur with and without major trauma. You don’t have to be in a car accident or fall off a roof to have a disc injury.

A majority of them happen over time due to poor mechanics and posture.

The spine is designed to take a compressive load well, but it does not take shear. Here is a picture to better understand.

Disc injuries happen when the spine is subjected to a load under flexion and rotation.

Sounds a lot like what baseball players do, right?

Fielding a throw and throwing across the body are great examples.

Do this over and over again without the protection of the supporting hips, pelvis, and trunk, and the disc will become damaged.

Disc Herniation Rehab

The first thing we have to do is take the pressure off of the disc and allow it to “center.” To be clear, if you start reading more on the Internet about treatment for disc herniation, things get pretty scary pretty fast. Understand, most of these articles were written before we knew better.

Most (95%) of disc herniations, regardless of pain level, WILL NOT REQUIRE SURGERY, INJECTIONS OR MEDICATIONS. Using effective treatment, you should be up and walking within a few days and performing all of the daily tasks you recently couldn’t within a week. With effective care, you should be practicing again within 2 weeks (at least in some fashion).

If you have received therapy for a disc herniation and you have not gotten these types of results your therapist was not skilled enough or up to date in recent exercise science treatment updates.

The McKenzie Protocol is a great one to use to do this.

McKenzie Extension

Normally, if it is a disc injury, this will feel good and take the person out of pain…until they bend forward again.

Bending forward will re-aggravate it, or as I like to describe it: “ripping off the scab.”

Also long as you keep ripping off the scab, it will never heal.

How can we stop the scab from re-injuring?

Don’t bend forward from the back. Learn to hip hinge and keep a rigid trunk. Learning and utilizing this principle is mind blowing. Understanding that the hips move independently from the back is the second step in recovery.

Here is a good exercise we use to create a rigid trunk to combat back pain when pitching and hitting.

Lewit Exercise

Disc Herniation Treatment Options

I prefer to work on stabilization of the trunk with my clients with disc injuries. I don’t even adjust them and I am a chiropractor by education. Stabilization and modification of daily activities seems to greatly assist in pain.

Here are some other treatments you can test out for pain:

• Stretching
• Chiropractic adjustments
• Hip mobilization
• Thoracic spine mobilization
• Deep tissue work
• Active Release Technique
• Traction
• Acupuncture
• Injections
• Oral medication

SACROILIAC JOINT SPRAIN

• Low back pain?
• Extending to the buttocks?
• Down the thigh but not past the knee?
• Worse with sitting?

I know this sounds like the other injuries in this section, right?

A sacroiliac joint sprain is often misdiagnosed as a different type of back condition and rightly so. It has been shown to refer pain down both buttocks and legs. This type of presentation can also be seen in more severe back injuries.

Before you assume you have a sacroiliac joint sprain, you should be examined to rule out the other conditions…seriously. This is not one you should attempt to budget on.

When diagnosed correctly, rehab can actually go very quickly… so you’re in luck!

What Is A Sacroiliac Joint Sprain?

The sacroiliac joint is a joint located where your low back and pelvis connect. Everyone has two of them.

The joints are held together and in good composure via bony structure, cartilage, ligaments, tendons and muscles.

In a “sprain”, the ligament has been damaged to some degree.

What causes a Sacroiliac Joint Sprain?

Strain to a joint can occur with trauma, a fall, or repeated insult to its stability. Sitting can even cause a strain over the years.

After sprain, the joint can become irritated and even “sloppy.”

Sacroiliac Joint Sprain Rehab Options

Rehab of a sacroiliac joint sprain centers around two goals:

• Decreasing pain
• Increasing stabilization around the joint

To decrease pain, we often use passive therapies that I will list in the next section.

As for stabilization of the joint, this can be done with core work, pelvic strengthening and posture exercises.

Here’s one we start our player back pain when pitching and hitting.

Sacroiliac Joint Sprain Treatment Options

• Stretching
• Chiropractic adjustments
• Hip mobilization
• Thoracic spine mobilization
• Deep tissue work
• Active Release Technique
• Traction
• Acupuncture
• Injections
• Oral medication

MUSCLE SPASM

• Stabbing back pain?
• Better after stretching?
• No leg or buttock pain?

This type of back pain could just be a muscle spasm.

Muscles spasms can be extremely painful and keep you on the DL as well, so don’t underestimate them.

Muscles spasms can be treated, and you don’t have to be in pain every time you swing or throw.

What Is A Muscle Spasm?

A muscle spasm is when a muscle becomes tight.

It becomes tight to protect itself from another injury. The body is pretty smart. It knows how to prevent further damage.

A muscle can spasm to protect from a muscle strain (new or old), disc injury, a joint sprain and more.

What causes a muscle spasm?

Muscles and joints have receptors.

Receptors for chemicals and mechanical stretch.

Receptors on muscles can tell it to contract if they have been stimulated by a stretch response or chemicals (inflammation).

For this reason, it is not always a good idea to attempt to get rid of a new muscle spasm… they could be protecting you from further damage.

Muscle Spasm Rehab

When muscle spasms become chronic (longer than 3 months), they can be addressed safely without risking further damage to what they were protecting.

Wondering if they can be treated sooner?

Sure, but we would need to make sure that there was no major, impending injury .

When we know that it is safe, we will suggest that some players use a ball to roll out the problematic muscles to decrease back pain when pitching and hitting.

Lacrosse Ball for Low Back Pain

Early in the injury, we often recommend trunk stabilization exercise under light load. The Lewit exercise was mentioned earlier. It is just one of our go-to exercises in this scenario.

Muscle Spasm Treatment Options

• Stretching
• Chiropractic adjustments
• Hip mobilization
• Thoracic spine mobilization
• Deep tissue work
• Active Release Technique
• Traction
• Acupuncture
• Injections
• Oral medication