Skip to main content
SpringerLink
Log in

Hip and Groin Injuries in Baseball Players

  • Injuries in Overhead Athletes (J Dines and C Camp, section editors)
  • Published:
Current Reviews in Musculoskeletal Medicine Aims and scope Submit manuscript

Abstract

Purpose of Review

To discuss the clinical significance of the most common hip and groin injuries in baseball players, as well as an algorithmic approach to diagnosis and treatment of these injuries.

Recent Findings

(a) Limitations in throwing velocity, pitch control, and bat swing speed may be secondary to decreased mobility and strength within the proximal kinetic chain, which must harness power from the lower extremities and core. (b) Approximately 5.5% of all baseball injuries per year involve the hip/groin and may lead to a significant amount of time spent on the disabled list.

Summary

Injuries involving the hip and groin are relatively common in baseball players. Our knowledge of the mechanics of overhead throwing continues to evolve, as does our understanding of the contribution of power from the lower extremities and core. It is paramount that the team physician be able to accurately diagnose and treat injuries involving the hip/groin, as they may lead to significant disability and inability to return to elite levels of play. This review focuses on hip- and groin-related injuries in the baseball player, including femoroacetabular impingement, core muscle injury, and osteitis pubis.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

Papers of particular interest, published recently, have been highlighted as: • Of importance

  1. Kibler WB, Wilkes T, Sciascia A. Mechanics and pathomechanics in the overhead athlete. Clin Sports Med. 2013;32(4):637–51. https://doi.org/10.1016/j.csm.2013.07.003.

    Article  PubMed  Google Scholar 

  2. Mlynarek RA, Lee S, Bedi A. Shoulder injuries in the overhead throwing athlete. Hand Clin. 2017;33(1):19–34. https://doi.org/10.1016/j.hcl.2016.08.014.

    Article  PubMed  Google Scholar 

  3. Zaremski JL, Wasser JG, Vincent HK. Mechanisms and treatments for shoulder injuries in overhead throwing athletes. Curr Sports Med Rep. 2017;16(3):179–88. https://doi.org/10.1249/JSR.0000000000000361.

    Article  PubMed  Google Scholar 

  4. Ciccotti MG, Pollack KM, Ciccotti MC, D'Angelo J, Ahmad CS, Altchek D, et al. Elbow injuries in professional baseball: epidemiological findings from the Major League Baseball Injury Surveillance System. Am J Sports Med. 2017;45(10):2319–28. https://doi.org/10.1177/0363546517706964.

    Article  PubMed  Google Scholar 

  5. • Chu SK, Jayabalan P, Kibler WB, Press J. The kinetic chain revisited: new concepts on throwing mechanics and injury. PM & R : the journal of injury, function, and rehabilitation. 2016;8(3 Suppl):S69–77. https://doi.org/10.1016/j.pmrj.2015.11.015. Chu et al. discuss the lower extremity and core contributions to the overhead throwing kinetic chain and the importance of proper mechanics to facilitate ball velocity and control.

    Article  Google Scholar 

  6. Kibler WB, Kuhn JE, Wilk K, Sciascia A, Moore S, Laudner K, et al. The disabled throwing shoulder: spectrum of pathology-10-year update. Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association. 2013;29(1):141–161 e26. https://doi.org/10.1016/j.arthro.2012.10.009.

    Article  Google Scholar 

  7. Wight J, Richards J, Hall S. Influence of pelvis rotation styles on baseball pitching mechanics. Sports Biomech. 2004;3(1):67–83. https://doi.org/10.1080/14763140408522831.

    Article  PubMed  Google Scholar 

  8. Robb AJ, Fleisig G, Wilk K, Macrina L, Bolt B, Pajaczkowski J. Passive ranges of motion of the hips and their relationship with pitching biomechanics and ball velocity in professional baseball pitchers. Am J Sports Med. 2010;38(12):2487–93. https://doi.org/10.1177/0363546510375535.

    Article  PubMed  Google Scholar 

  9. Li X, Ma R, Zhou H, Thompson M, Dawson C, Nguyen J, et al. Evaluation of hip internal and external rotation range of motion as an injury risk factor for hip, abdominal and groin injuries in professional baseball players. Orthop Rev (Pavia). 2015;7(4):6142. https://doi.org/10.4081/or.2015.6142.

    Article  Google Scholar 

  10. Welch CM, Banks SA, Cook FF, Draovitch P. Hitting a baseball: a biomechanical description. The Journal of orthopaedic and sports physical therapy. 1995;22(5):193–201. https://doi.org/10.2519/jospt.1995.22.5.193.

    Article  CAS  PubMed  Google Scholar 

  11. Posner M, Cameron KL, Wolf JM, Belmont PJ Jr, Owens BD. Epidemiology of Major League Baseball injuries. Am J Sports Med. 2011;39(8):1676–80. https://doi.org/10.1177/0363546511411700.

    Article  PubMed  Google Scholar 

  12. • Coleman SH, Mayer SW, Tyson JJ, Pollack KM, Curriero FC. The epidemiology of hip and groin injuries in professional baseball players. Am J Orthop. 2016;45(3):168–75. Coleman et al. presents the most recent update on the epidemiology of baseball injuries from 2011–2014. During this period, approximately 5.5% of injuries among MLB and MiLB players involved the hip and/or groin, and 96% of these injuries were extra-articular.

    PubMed  Google Scholar 

  13. Poultsides LA, Bedi A, Kelly BT. An algorithmic approach to mechanical hip pain. HSS J. 2012;8(3):213–24. https://doi.org/10.1007/s11420-012-9304-x.

    Article  PubMed  PubMed Central  Google Scholar 

  14. Byrd JW. Hip arthroscopy. The Journal of the American Academy of Orthopaedic Surgeons. 2006;14(7):433–44. https://doi.org/10.5435/00124635-200607000-00006.

    Article  PubMed  Google Scholar 

  15. Trofa DP, Mayeux SE, Parisien RL, Ahmad CS, Lynch TS. Mastering the physical examination of the Athlete’s hip. Am J Orthop. 2017;46(1):10–6.

    PubMed  Google Scholar 

  16. Martin HD, Palmer IJ. History and physical examination of the hip: the basics. Current reviews in musculoskeletal medicine. 2013;6(3):219–25. https://doi.org/10.1007/s12178-013-9175-x.

    Article  PubMed  PubMed Central  Google Scholar 

  17. Byrd JW. Evaluation of the hip: history and physical examination. N Am J Sports Phys Ther. 2007;2(4):231–40.

    PubMed  PubMed Central  Google Scholar 

  18. Lynch TS, Bedi A, Larson CM. Athletic hip injuries. The Journal of the American Academy of Orthopaedic Surgeons. 2017;25(4):269–79. https://doi.org/10.5435/JAAOS-D-16-00171.

    Article  PubMed  Google Scholar 

  19. Hernando MF, Cerezal L, Perez-Carro L, Abascal F, Canga A. Deep gluteal syndrome: anatomy, imaging, and management of sciatic nerve entrapments in the subgluteal space. Skelet Radiol. 2015;44(7):919–34. https://doi.org/10.1007/s00256-015-2124-6.

    Article  Google Scholar 

  20. Cheatham SW, Kolber MJ, Salamh PA. Meralgia paresthetica: a review of the literature. Int J Sports Phys Ther. 2013;8(6):883–93.

    PubMed  PubMed Central  Google Scholar 

  21. Ganz R, Parvizi J, Beck M, Leunig M, Notzli H, Siebenrock KA. Femoroacetabular impingement: a cause for osteoarthritis of the hip. Clin Orthop Relat Res. 2003;417:112–20. https://doi.org/10.1097/01.blo.0000096804.78689.c2.

    Google Scholar 

  22. Beck M, Kalhor M, Leunig M, Ganz R. Hip morphology influences the pattern of damage to the acetabular cartilage: femoroacetabular impingement as a cause of early osteoarthritis of the hip. The Journal of bone and joint surgery British volume. 2005;87(7):1012–8. https://doi.org/10.1302/0301-620X.87B7.15203.

    Article  CAS  PubMed  Google Scholar 

  23. Nepple JJ, Clohisy JC, Members ASG. Evolution of Femoroacetabular impingement treatment: the ANCHOR experience. Am J Orthop. 2017;46(1):28–34.

    PubMed  Google Scholar 

  24. • Siebenrock KA, Ferner F, Noble PC, Santore RF, Werlen S, Mamisch TC. The cam-type deformity of the proximal femur arises in childhood in response to vigorous sporting activity. Clin Orthop Relat Res. 2011;469(11):3229–40. https://doi.org/10.1007/s11999-011-1945-4. Siebenrock et al. present a landmark article suggesting a correlation between high-intensity sport activities during adolescence with a substantial increase in the risk of cam-type femoroacetabular impingement.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  25. Ito K, Leunig M, Ganz R. Histopathologic features of the acetabular labrum in femoroacetabular impingement. Clin Orthop Relat Res. 2004;429:262–71. https://doi.org/10.1097/01.blo.0000144861.11193.17.

    Article  Google Scholar 

  26. Hetsroni I, Larson CM, Dela Torre K, Zbeda RM, Magennis E, Kelly BT. Anterior inferior iliac spine deformity as an extra-articular source for hip impingement: a series of 10 patients treated with arthroscopic decompression. Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association. 2012;28(11):1644–53. https://doi.org/10.1016/j.arthro.2012.05.882.

    Article  Google Scholar 

  27. Ryan JM, Harris JD, Graham WC, Virk SS, Ellis TJ. Origin of the direct and reflected head of the rectus femoris: an anatomic study. Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association. 2014;30(7):796–802. https://doi.org/10.1016/j.arthro.2014.03.003.

    Article  Google Scholar 

  28. Byrd JW, Jones KS. Hip arthroscopy in high-level baseball players. Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association. 2015;31(8):1507–10. https://doi.org/10.1016/j.arthro.2015.03.002.

    Article  Google Scholar 

  29. Klingenstein GG, Martin R, Kivlan B, Kelly BT. Hip injuries in the overhead athlete. Clin Orthop Relat Res. 2012;470(6):1579–85. https://doi.org/10.1007/s11999-012-2245-3.

    Article  PubMed  PubMed Central  Google Scholar 

  30. Gilmore O. Gilmore’s Groin. Sports Med Soft Tissue Trauma. 1992;3(3).

  31. Palisch A, Zoga AC, Meyers WC. Imaging of athletic pubalgia and core muscle injuries: clinical and therapeutic correlations. Clin Sports Med. 2013;32(3):427–47. https://doi.org/10.1016/j.csm.2013.03.002.

    Article  PubMed  Google Scholar 

  32. Knapik DM, Gebhart JJ, Nho SJ, Tanenbaum JE, Voos JE, Salata MJ. Prevalence of surgical repair for athletic pubalgia and impact on performance in football athletes participating in the National Football League Combine. Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association. 2017;33(5):1044–9. https://doi.org/10.1016/j.arthro.2017.01.024.

    Article  Google Scholar 

  33. Zoga AC, Kavanagh EC, Omar IM, Morrison WB, Koulouris G, Lopez H, et al. Athletic pubalgia and the “sports hernia”: MR imaging findings. Radiology. 2008;247(3):797–807. https://doi.org/10.1148/radiol.2473070049.

    Article  PubMed  Google Scholar 

  34. McCarthy E, Hegazi TM, Zoga AC, Morrison WB, Meyers WC, Poor AE, et al. Ultrasound-guided interventions for core and hip injuries in athletes. Radiol Clin N Am. 2016;54(5):875–92. https://doi.org/10.1016/j.rcl.2016.04.008.

    Article  PubMed  Google Scholar 

  35. Meyers WC, McKechnie A, Philippon MJ, Horner MA, Zoga AC, Devon ON. Experience with “sports hernia” spanning two decades. Ann Surg. 2008;248(4):656–65. https://doi.org/10.1097/SLA.0b013e318187a770.

    PubMed  Google Scholar 

  36. • Hammoud S, Bedi A, Magennis E, Meyers WC, Kelly BT. High incidence of athletic pubalgia symptoms in professional athletes with symptomatic femoroacetabular impingement. Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association. 2012;28(10):1388–95. https://doi.org/10.1016/j.arthro.2012.02.024. Hammoud et al. describe a high incidence of symptoms consistent with core muscle injury (athletic pubalgia) in elite-level athletes with femoroacetabular impingement, highlighting the significant overlap of these diagnoses.

    Article  Google Scholar 

  37. Gaudino F, Spira D, Bangert Y, Ott H, Beomonte Zobel B, Kauczor HU, et al. Osteitis pubis in professional football players: MRI findings and correlation with clinical outcome. Eur J Radiol. 2017;94:46–52. https://doi.org/10.1016/j.ejrad.2017.07.009.

    Article  PubMed  Google Scholar 

  38. Hopp SJ, Culemann U, Kelm J, Pohlemann T, Pizanis A. Osteitis pubis and adductor tendinopathy in athletes: a novel arthroscopic pubic symphysis curettage and adductor reattachment. Arch Orthop Trauma Surg. 2013;133(7):1003–9. https://doi.org/10.1007/s00402-013-1777-7.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Sports Medicine and Hip Preservation, Hospital for Special Surgery, New York, NY, USA

    Ryan A. Mlynarek & Struan H. Coleman

  2. Sports Medicine and Shoulder Service, Hospital for Special Surgery, 535 E. 70th Street, New York, NY, 10021, USA

    Ryan A. Mlynarek

Authors
  1. Ryan A. Mlynarek
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Struan H. Coleman
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Ryan A. Mlynarek.

Ethics declarations

Conflict of Interest

Both authors declare that they have no conflict of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Additional information

This article is part of the Topical Collection on Injuries in Overhead Athletes

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Mlynarek, R.A., Coleman, S.H. Hip and Groin Injuries in Baseball Players. Curr Rev Musculoskelet Med 11, 19–25 (2018). https://doi.org/10.1007/s12178-018-9455-6

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12178-018-9455-6

Keywords

Search

Navigation