The piercing twinge Minnesota Twins reliever Glen Perkins experienced each time he threw to the plate almost felt like a knife being plunged into his ribcage and twisted.
What started as mild discomfort in his right side as he warmed up in the bullpen had exploded into full fury after a few pitches on the mound.
Finally, Perkins couldnt stand the agony and motioned to the dugout to be taken out of the game at Arizona in May.
I couldnt breathe. It hurt to walk. I couldnt sit down, Perkins said. It was as bad of pain as Ive ever been in.
Plenty of players know exactly what he went through.
Theres been an outbreak of oblique strains this season that has landed some of the games most familiar names on the disabled list, including Evan Longoria, Brian Wilson, Rafael Furcal, Travis Hafner and Jim Thome.
The oblique muscles run along the ribs and allow the torso to bend and twist. Pitchers usually injure the side opposite their throwing arm, possibly as a result of the torque created from the coil of the delivery. For hitters, its the side they lead with through their swing, the one that generates the extreme trunk rotation.
Oblique injuries have been around for years, but before the arrival of MRI exams they frequently were listed on injury reports as abdominal, ribcage, intercostal or side strain.
Theyre tricky to prevent and even tougher to treat, mostly requiring old-fashioned rest.
So far this season, 40 players have gone on the disabled list for a strained oblique or other injuries related to the core, which are the muscles located deep within the abs and back.
In comparison, there were a total of 26 in 2010.
Most oblique strains happen in innocuous situations or on routine plays that players have made throughout their careers. Longoria and Hafner aggravated their oblique injuries in batting practice, while Furcal hurt his making a quick throw to third base while he was leaning in the opposite direction.
Coughing or sneezing, thats the tough part, the Dodgers shortstop said of the pain that shot through his body with any sudden movement. You cant move or lay down in bed sometimes because it hurts.
Ty Wigginton knows the feeling. The Rockies third baseman strained his left oblique simply by lifting his left hand to protect his face on a steal attempt in late April.
I did absolutely nothing for two weeks, basically. I rode a bike some, but even early on when I went to ride a bike, I couldnt really even ride the bike without feeling it, Wigginton said. They told me as long as its not a knife-going-into-you sensation, then youre fine.
Dr. Joshua Dines has been looking into the recent rash of core injuries. An orthopedic surgeon specializing in sports medicine and a consultant for the Dodgers, Dines just submitted a paper to the American Journal of Sports Medicine that examines all things associated with the oblique.
Partnering with Dodgers trainer Stan Conte and another doctor, Matt Thompson, they had a few primary questions they were hoping to answer:
Was it occurring more frequently?
Were players likely to reinjure the oblique?
The medical team pored through the data on disabled lists dating to 1991, trying to detect patterns.
They discovered there were 393 abdominal muscle strains, comprising 5 percent of all injuries to major leaguers over the 20-year span. The high mark for one year was 29 in 2007.
That was until this season.
And its not just the average player being sidelined, either. The list also includes the likes of Angel Pagan, Marco Scutaro, Jon Garland, Derrek Lee and Ivan Rodriguez.
The 25th man (on the club) gets it, nobody really cares, Conte said. But if a star gets it, then it gets the headlines. Theres no question that 2011 is going to be the biggest number of oblique or core injuries that weve seen in baseball.
The core just may hold the key to solving the puzzle. The tighter the core muscles, the tougher it may be to tweak. But thats a delicate balance, Dines said, because an athlete doesnt want those muscles to lose elasticity.
There are multiple reasons to explain the same outcome, said Dines, whose study concluded there was an increase of abdominal muscle strains over the last two decades. Thats why we dont know what the cause is.
Typically, position players average about 26.7 days on the disabled list with the injury, while pitchers need 35.4 days to recover. Most of the down time involves rest since the injury is so sensitive to movement.
Once cleared, players slowly start a battery of stretching exercises, careful to not overdo it.
The things you gauge it on are if it hurts when youre coughing, getting out of bed or moving certain ways, Hafner said. If it hurts when you sneeze ... you got a long way to go.
In its study, the medical team found that about 12 percent of the players reinjured their oblique within the first year.
That was the case for Kansas City Royals lefty Bruce Chen. He pulled his oblique in January 2009 during offseason workouts. Nearly eight months later, he suffered a three-centimeter tear to his oblique.
Chen is convinced dehydration played a role the second time. So now he constantly keeps a bottle of water with him, even producing one from his back pocket and taking a swig.
One potential way to cut a players time on the DL may be using platelet-rich plasma treatments, a therapy that Kobe Bryant reportedly had in Germany this spring to try to strengthen his right knee.
In the PRP procedure, a small amount of blood is drawn from the patient and spun in a centrifuge for about 20 minutes to isolate platelets. The platelets then are injected into the injured area to try to stimulate tissue repair.
So far, Dines hasnt witnessed any significant breakthroughs with the approach. But hes not dismissing it just yet.
Maybe if we do PRP, maybe athletes will heal with better tissue as opposed to scar tissue and the reinjury rate will decrease, Dines said. I think there might be some long-term benefit to it that we havent seen. Maybe it will save them a day.
Every little bit helps.
Ive had arm injuries, and at least then you know you cant do anything, Perkins said. That was the hardest part with the oblique. You felt fine, but then you go try to do something, and you couldnt do anything yet.
You dont realize how much you actually (use the oblique) until you hurt it.
AP Baseball Writer Jon Krawczynski in Minneapolis and AP Sports Writer Tom Withers in Cleveland contributed to this report.