Rib Fractures in Professional Baseball Pitchers: Mechanics, Epidemiology, and Management

Abstract

Pitching is a complex kinetic chain activity requiring the transfer of energy from the lower body, through the core and trunk, and finally through the arm to generate explosive acceleration of the baseball. As a result, large forces are generated in the trunk musculature and rib attachments from the late cocking phase of pitching through deceleration. The repetitive cumulative load and high pitch velocities put professional pitchers at risk of rib stress fracture. Given the potential for a prolonged recovery course and high rate of recurrence, early recognition of rib bone stress injury is critical to optimize care. Identifying torso strength imbalances, suboptimal pitching biomechanics (such as late or inadequate pelvic rotation), as well as metabolic deficiencies that may adversely affect bone health are essential to expedite safe return to play and prevent future injury. In this review, we discuss risk factors, mechanism of injury, typical clinical presentation, diagnostic imaging findings, and propose treatment and prevention strategies for rib stress fractures in overhand pitchers.

Rib stress fracture in a female athlete caused by bouncing the barbell in bench press exercise: A case report

“…Stress fractures of the rib due to repetitive contraction of trunk muscles, such as those observed in rowers, swimmers, and golfers, have previously been reported. 3 – 7 Rib stress fractures in such athletes are usually seen along the posterior axillary line, as the serratus anterior and external oblique muscles are attached in this region with callus formation usually occurring on both the chest wall and pleural sides. 4 , 7 In our case, a rib fracture was observed on the anterolateral part of the rib, which corresponded to the area where the rib cage made contact with the barbell.…”

“… 3 – 7 Rib stress fractures in such athletes are usually seen along the posterior axillary line, as the serratus anterior and external oblique muscles are attached in this region with callus formation usually occurring on both the chest wall and pleural sides. 4 , 7 In our case, a rib fracture was observed on the anterolateral part of the rib, which corresponded to the area where the rib cage made contact with the barbell. In addition, callus formation was evident predominantly on the pleural side, which may indicate repetitive compression of the rib cage.…”

“…Repetitive tensile, angular, and torsional stresses on the ribcage are the main cause of rib stress fractures. 3 – 7 Acute traumatic rib fractures induced by weight training exercises have been reported previously 8 ; however, there have been few reports of rib stress fractures caused by repetitive bench press exercises. 9…”