A client of mine has pain in two areas when swinging a bat. She is a right handed batter who gets pain in the right hip flexor and left glute area (right around the ischial tuberosity). This occurs upon the completion of the swing and the first step out of the batter's box. The pain is recurring and no warm up or stretch will prevent it. It is quite incapacitating and prevents her from playing. Here is some background: She has had a couple of MRI's and extensive physical therapy with no relief. The MRI showed only an inflammation near the pirformis. However, she completed therapy for hamstring, hip and low back areas. She initially suffered a "pulling" type injury approximately ago when her foot slipped on water while playing volleyball. This caused her left leg to go forward and the right to go back - into the splits (she had never been that flexible though).
As you know, we (personal trainers) should always refer to the proper medical practitioner regarding ANY pain issue. What we can do is explore some possibilities that may help your client function, prevent further injury and possibly alleviate her discomfort.
To start, assess your client statically, transitionally and dynamically to gather as much information as possible. This information will lead you to the appropriate program.
Statically assess the position of your clients ASIS (Anterior Superior Iliac Spine), PSIS (Posterior Superior Iliac Spine, Greater Trochanter and Medial Malleolus. This static palpation of bony structures can be performed standing and lying supine. Note if, your client MAY have a right.
Next move to the transitional Overhead Squat Assessment (please see PTontheNet article A Simple Guide to Stretching for the how to & correction strategy). Watch her foot and ankle to see if it is pronating excessively and/or externally rotating. Next watch her knees, are they adducting and/or abducting out of alignment? Watch the lumbo-pelvic-hip complex to see if she is hyper-extending the low back or rounding the low back during the descent. Are her arms moving forward relative to the assessment position? Does her head protrude forward on the descent? If there a weight shift? Is the weight shift left or right? Once again, the corrective strategy for all above mentioned deviations are explained in the article A Simple Guide to Stretching.
Last but not least is the dynamic assessment. With baseball/softball being the emphasis and bat swinging causing discomfort, we suggest getting a video analysis of her swing for a slow and closer observation. This observation may show similar deviations at faster speeds when compared to the static and transitional assessment already performed. Other dynamic assessments used for baseball/softball: Vertical Jump, Overhead Medicine Ball (not exceed 5 % of bodyweight), LEFT Test for agility & Home to first base for speed. Please note: You can obtain all of the assessment descriptions by exploring various educational products listed on the National Academy of Sports Medicine's web-site www.nasm.org
It seems your client has gained some insight from therapy with little to no functional success. Our advise; progress to assessing the kinetic chain as opposed to isolated areas for an overall impression of what might be CAUSING your clients discomfort. By utilizing a static, transitional and dynamic process you will be observing multi-planes, various speeds, functional flexibility, core control, etc. This integrated process will help you to unravel your clients complaints and most importantly lead you to the appropriate program implementation. Please see the Optimum Performance Training Textbook for program strategies.