David Wright, Daniel Murphy And The Year Of The Intercostal Injury

daniel murphyThis spring has been rocked by injuries for the Mets thus far. Maybe it’s because we live in New York, and hear about the injuries more, but it doesn’t seem like as many teams have suffered the amount of injuries that the two New York teams have this spring.

While injuries are sometimes unpreventable and part of the game, the injuries this spring that really made me scratch my head were the intercostal injuries suffered by the Mets’ infielders Daniel Murphy and David Wright. I scratched my head because while this injury is caused by twisting the torso, which baseball players do for a living, many people can go a lifetime and never experience an intercostal injury, or even know where their intercostal muscles are. It seems preventable.

When I saw two players suffer from the same preventable injury, on the same team, a giant question mark appeared over my head. Were these two prominent players not properly warming up before action? Is it something in the off-season program that needs to be tweaked or added to avoid these injuries in coming years?

I decided to call on an expert to give an idea on what causes intercostal injuries and how they can be avoided. Ken Stabler, of Ropestone Fitness, specializes in the Training for Warriors system which is primarily used by MMA fighters, but more and more athletes outside of the MMA world are using the system due to its benefits, especially with rehabbing injuries. I asked Ken to weigh in on this intercostal confusion, and give us a better idea of what Wright and Murphy are doing to try and get back on the field…

Thoughts from Ken

The intercostal muscles or “rib cage muscles” lie in-between and around your ribs. There are 2 types of intercostal muscles: the internal intercostals and the external intercostals consisting of 11 of each. These muscles are primarily used to aid in respiration by reacting to the diaphragm.

Strains in the intercostal muscles are caused in sports by a quick and forceful transverse contraction of the torso. This means that a sharp twisting motion can cause the strain. The injury can cause anywhere from minor to severe pain upon inhalation (breathing in) or reactive actions such as hitting or fielding the ball. When these muscles are strained they also become tight and difficult to stretch. This especially affects baseball players because their whole game revolves around twisting the torso. Whether they are at bat or throwing the ball, there is generally some act of twisting involved.

The origin of the injury doesn’t just lie with the twisting motion. In my experience, the more probable cause of the injury is from weakness in the intercostal muscles as well as in the diaphragm. Chronic motion in the transverse plane (twisting) coupled with weak deep core muscles will cause the injury rather than just the twisting component alone. This is why more and more athletes are adding in Pilates and Yoga to their program, and practicing proper breathing.

Unfortunately, there is no set time frame for recovery. There are generally 3 levels of severity for the strain but every person is different and has a different recovery time. However, there are certain activities to engage in to not only rehab the injury but also prevent future occurrences. I don’t like to place value tags on fitness techniques but I always tell my students that if you can master your breath, you can master your body. I have outlined below some basic techniques to be performed, preferably by a licensed PT or fitness professional but can be done on your own. I will begin by explaining some stretches to be done prior to the exercises.

  1. Kneeling latissimus stretch (AKA “children’s pose”). Start by kneeling on the floor. Place your hands, palms down in front of you and reach as far as you can out in front of you. Keep the elbows flexed and lower your head and chest to the floor without compromising your flexed elbows and place the stretch in your lats. Perform 3 times for 30 seconds.
  2. Abdominal stretch. Lie Face down with your hands at your sides, next to your chest. Push your upper body and leave your hips and thighs down. DON’T FORGET to keep the core engaged on this one so you don’t compress the lumbar spine. Keep a neutral pelvic tilt. Perform 3 times for 30 seconds.
  3. Swiss ball stretch. Lie on your back over a Swiss ball. Begin at the shoulder blades. Let your arms go overhead to your end range of motion. Do not overreach the arms back because then your erector muscles of the spine will start to become engaged. Think of your arms just falling behind you. From that point, roll slightly down on the ball towards your low back and then roll back up towards your shoulder blades (in a rocking motion). Relax on the ball and let your abs stretch out. Breathe in slowly through the nose and exhale slowly and completely. Perform for 5 deep breaths.

Ribcage breathing: this breathing technique is most notably seen in Pilates and Yoga but it is also implemented by many of the top fitness professionals because of its ability to strengthen the core from the inside out and minimize recovery time from a high intensity exercise. This technique is vital to the rest of the program and to an effective strength and conditioning program. Diaphragmatic breathing and ribcage breathing should be done during all activities to keep the deep core muscles strong which in turn, prevents injury.

First lie on your back and pull your feet in as you would in a bridge position. Next, find a neutral pelvic position by activating your core until you feel your lower back against the ground (this position may vary from athlete to athlete depending on the state of which you live in extension). Once you find a neutral pelvis, place your thumbs on the posterior rib cage (in back) on both sides and wrap your fingers along the front of the ribs but do not squeeze. Your hands serve as your marker to see where the ribs are moving but do not apply resistance. Next, inhale into the ribs but do not let the stomach rise by keeping a tight core. This will force the intercostals to expand and contract much more than normal and thus, create a stronger core to prevent future injury.

Release technique: Once you are comfortable expanding the ribs laterally with ribcage breathing, find the same position stated above. Take your thumb and find the injured area or trigger point. Next, slowly expand the ribs with a breath and gently apply pressure to the area. The amount of pressure is subjective to the individual but I would apply it generously if you can tolerate it. Release the applied pressure gradually as you slowly exhale. After each rep, massage along the muscle with your palm to promote blood flow for 15 seconds. Repeat for 5-10 reps.

After this “therapy” session:

  1. Ice the area. Icing will decrease inflammation.
  2. Compress. A compression shirt is really handy to have around for multiple reasons but especially for an injury like this one. If you do not have a compression shirt then wrap the ribs snuggly.
  3. Rest. Do not engage in regular activity until you are pain free. There is a rule I follow. Once you wake up pain free, wait an extra week before attempting more demanding exercises.

Rehabbing an injury is all about diligence and patience. Don’t harp on the injury. It will heal. Take the time to evaluate what you may be missing in your program that caused the injury. You might not have had enough quality sleep, or you haven’t been practicing good form, maybe you have a muscular imbalance that needs to be addressed. Reflection and evaluation are critical if you want to prevent future injuries.

We already know both Wright and Murphy had cortisone shots to try and speed up the recovery process, but Ken lays out a very in depth analysis of the rehab process that the two athletes are also probably going through. Wright seems to be on pace to be in the lineup on Opening Day, and Murphy thinks he can be ready, but only time will tell if one, both, or neither of the two Mets stars start the season on the disabled list. It looks like they’re both making progress with their rehab now, so any time that may have to be spent on the DL will hopefully be minimal.