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MLB Injury Report: Oblique and Rib Injuries

Nic Civale is a Doctor of Physical Therapy and former NCAA Division I Baseball player. He combines his knowledge of anatomy and physiology with that of baseball mechanics to provide expectations for injured players. Utilize The MLB Injury Report to make the most of your fantasy season.

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MLB Injury Report: Oblique and Rib Injuries

Today’s injury report will focus on what to know about oblique and rib injuries for both hitters and pitchers. We will touch on some aspects of anatomy that make the function of the muscles easier to conceptualize and visualize and apply this knowledge. Hopefully, this helps fantasy managers make more informed decisions about their lineup and roster decisions. We’ve already seen plenty of big names hit the IL for oblique and intercostal injuries, like George Springer, Adalberto Mondesi, and Jack Flaherty. So let’s take a look at the differences and similarities of these two muscles, and talk about how to handle them.


The oblique muscles are actually a combination of two muscles on either side of the abdomen. The external oblique fibers travel from the lateral rib cage, down and in, towards the area of the belly button. The internal obliques travel in the opposite direction to make an “X” shape. This setup is present on either side of the core and is responsible for the forceful rotation of the upper body. Obliques are also part of a group of core muscles that help support the spine and lower back. Clearly, rotation is a vital part of baseball, whether you are throwing, hitting, fielding, or running.

A strained or torn oblique muscle is extremely painful and difficult to play through. Not only are the obliques responsible for initiating rotation, but also slowing down pre-existing rotation. In the course of a right-handed swing, the left internal oblique and right external oblique are firing aggressively and then relaxing in time for the left external oblique and right internal oblique to eccentrically slow down the momentum of upper body rotation. The most common pathways to injuring an oblique while swinging include check swings, swing and misses, and overuse/fatigue.

Check swings require a somewhat unexpected and violent contraction of muscle to stop a motion, so the risk for injury is obvious there. Fatigue and overuse are easy enough to comprehend. Swing and misses are usually the most unexpected form of these injuries. With the swing and miss game being more prevalent than ever in today’s MLB, it’s not surprising to see so many hitters dealing with lower back and core issues.

When a player is expecting to make contact with a 97 mph fastball and they swing through what ends up being a 84 mph changeup (we’re looking at you, Devin Williams), they are missing out on the impact of the ball slowing the bat down. This creates an increased burden on the obliques to slow the rotational forces of the body. The obliques are essential to pitchers as well, for the same reasons. Although their injuries are usually more related to overuse/fatigue due to the more predictable nature of their throwing motions.

The Intercostals

Between your rib bones lie the intercostal muscles. Costas in Latin translates to ribs, and inter represents their position related to the ribs. These muscles are not much different from the ribs you would eat at a steakhouse if you want a somewhat disturbing visualization. The intercostals allow the ribs to bend and stretch so we can achieve the rotation that the obliques are trying to cause. They also stretch fairly significantly as we flex forward or extend back with our spine.

Intercostal injuries occur very similarly to those in the obliques. Rotation and overuse are prevalent, but the added factor of flexion and extension creates another opportunity for injury. Intercostal muscles are also famously injured by sneezing of all things. If you’ve had this happen in a severe enough case, you may have had to miss work for a day or two; the pain is very noticeable with nearly every movement you make.

The Rehab

Recovering from oblique and intercostal injuries is very nuanced and tedious. There are very few movements you can make without utilizing these muscles, so a severe tear may even prevent the athlete from turning to back their cars out of the driveway. Gentle and deliberate range of motion exercises comprise the early parts of rehab.  If an athlete is in this phase, they should not even be touching a bat or a ball. As they are able to progressively handle more rotational movements – WITHOUT PAIN – they progress to resisted medicine ball tosses, are resistance band training. This precedes the initiation of throwing and swinging.

Once an athlete is throwing or swinging again is when you really start to pay attention to their ETA back to the starting lineup. This will be categorized as ‘baseball activities’ in most cases. They will be swinging off a tee, jogging, throwing off flat ground surfaces, and fielding. The next step is the most crucial for both hitters and pitchers. Hitters will begin to take live AB’s vs pitchers or machines.

Once the hitter is successfully taking live swings and they don’t know if a fastball or an off-speed pitch is coming, they are in business. This is the biggest test for both oblique and intercostal muscles; the unexpected and unanticipated stopping and starting of rotation. For pitchers, the next step is throwing off of a mound, in which the obliques and intercostals need to work much harder to stabilize the body on the uneven surface.

The Decision-Making

For the reasons described above, I tend to target both pitchers and hitters with smooth, consistent deliveries and swings. This control and fluidity certainly help prevent these types of core injuries, among others. Every player and body is different of course, but if I have two players who are valued similarly and you need a tie-breaker, I’ll always lean towards the player with a smoother, more repeatable action.

I’m almost always a proponent of buying low on injured players, especially early in a redraft season, or in dynasty leagues. However, oblique injuries in particular have a way of creeping up again, and I’m not as quick to try to snatch up a player who’s on the shelf with core injuries. Look at Adalberto Mondesi the last few years. He’s spent as much time trying to heal his core muscles as he has using them in games. Oftentimes, it has to do with the fact that baseball will never, not have fast and unexpected rotation as part of the requirements to play. It’s extremely difficult as a hitter to not have to check-swing and to always make contact with pitches.

All things considered, oblique and intercostal injuries are nasty, nagging, and often re-injured. Most athletes do come back 100% healthy, but after the second or third strain/tear it’s very difficult to stay on the field.

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