Back Pain in Pitchers

A few days ago I got an email form a concerned Dad. His name Jeff, and his son is having low back pain on the landing side when he pitches. We spend a lot of time studying and talking about arm pain, but this is something I’ve seen seen enough that I though it might be worth sharing.

Here is my response to Jeff’s question.

Hi Jeff,

I can’t say that I see this frequently, but it does come up from time to time, and when it does, it usually appears on the left side for right handed pitchers and on the right side for left handed pitchers.

Low back pain on the landing side is more prevalent in guys with postural disconnections that cause them to lurch to the glove side when they land.

The biggest thing I worry about in cases like this is something called spondlylolysis.

It’s a stress fracture in an area on the vertebra called the Pars Interarticularis (see below).
You can’t see it on a traditional front to back view or side view of an X-ray.
You have to ask for an oblique view. Typically, that would not be ordered by a primary doctor, but if you ask for it they’ll usually do it.

It’s not catastrophic and usually improves with rest and the right kind of rehab.

However, It can become a more significant problem if you ignore it and it becomes displaced like this:

Keep in mind, I’m not saying that is what is going on with your son. There is no need for alarm.
But whenever I see a pitcher with low back pain on the landing side, I always try to rule out spondylolysis.
When that is out of the picture, I know we can be more aggressive with the rehab.

In pitchers with back pain this is usually our progression.

Once we are over the acute pain, I conduct a total body assessment and video analysis to try to identify the variables that contributed to the injury.

Here are a few of the possible contributors to back pain on the landing side:

Physical constraints: deficits in hip mobility (internal rotation of lead hip, tight hamstrings, lead leg lateral hip tightness, trail leg hip flexor or quad tightness), decreased thoracic mobility (rotation and extension), and ankle mobility (dorsiflexion and eversion on either leg).

Mechanical constraints: Postural disconnect, lead leg disconnect, early torso rotation, poor glute activation, and a poor deceleration pattern.

It’s usually not one thing that “causes” the injury. Instead, a confluence of variables merge at just the right time to create the perfect environment for it to evolve.That’s whey we look at everything.

The results of the assessment set the template for training. Once we have identified the physical and mechanical contributors, it is simply a matter of assigning and executing the appropriate corrective exercises and drills, and progressing just below the pain threshold until he’s back in action.

Hope that helps.

Randy