Oblique injuries have a reputation of being nagging and slow to heal. Lately, they seem to have been pestering players more often.
The term "oblique" is thrown around so frequently that the prescribed injury is a bit ambiguous. Four oblique muscles serve as the base of one's core, attaching the rib cage and the pelvis on each side of the body. That region is critical in baseball, a sport that demands twisting and rotating the area while throwing or swinging.
"Ultimately, that's where everything rotates around," said Greg Hauck, the Cardinals' head athletic trainer. "Quite often with players, that is the weak link. That's where you have to pivot or rotate around, whether you're throwing, hitting or anything. That creates a lot of issues when that's injured."
Hauck said oblique strains are often the result of weakness or irritation stemming from a related part of the body.
"Whether it's internal instability within the core or a rib cage that isn't mobile or some reduced mobility in the hips causing the trunk to work more," Hauck said, "I think there are a lot of underlying issues that are more the cause than just a weak oblique. You have to let it heal, but you still have to find the causation and clean that up so you don't re-injure the area."
Because of the risk of re-injury, oblique pulls or strains can often shelve players for up to six weeks. The time off can be miserable. And painful.
"Every step of my foot on the ground, it hurt," said Indians right fielder Shin-Soo Choo, who returned too early from a sore oblique last August. He missed an additional two weeks after taking four days off to initially rest the tweaked muscle.
"It affects everything: sneezing, walking, let alone baseball activities," said Royals infielder Chris Getz, who suffered oblique injuries in 2009 and '10. "You've got no shot."
"[It hurts] anytime you're turning or bending over or cough or sneeze," said Tribe reliever Joe Smith, who missed the start of the 2011 campaign with an oblique strain.
Hauck hesitated to deem oblique injuries as more common today than in the past. They might not be more frequent, but they're certainly more prevalent.
"They're more pronounced, because whenever anybody does strain an oblique, it does set them back time-wise," Hauck said. "I just think it's one of those injuries that has become more publicized because of the downtime it causes for players. They lose so much time."
Clubs will hold players out of all baseball activities at the first sign of a tweaked oblique.
"It's almost like a stabbing pain," Getz said. "Even if it's minor, you have to be really careful with it because it can become major really quickly. That's why when they find it, even if it's minor, they pretty much shut you down."
Smith said the lingering pain takes too long to dissipate.
"It's annoying because once you feel it, you're pretty much done," he said. "You can't rotate. And it's annoying because once it gets out of there, it'll just stay sore. It just constantly nags at you."
As long as pitchers repeat the unnatural motion of firing a baseball overhand at high speeds, elbow injuries will persist. As long as players run the bases with maximum effort, hamstring pulls will pop up sporadically. Similarly, oblique injuries will remain a part of a game that requires constant twisting and turning of one's core.
Hauck advised that players could be better served to balance, but not overwork, their core muscles.
"It's a unilateral activity, so you have to unwind sometimes," Hauck said. "Left-handed hitters have to swing right-handed, and vice versa. Left-handed pitchers have to work their right side. You have to counter-balance everything so you're not overdeveloping one side and making the other side more vulnerable."
Perez altered his warmup routine after straining an oblique during Spring Training in the sweltering heat of Goodyear, Ariz. He pointed to dehydration as the culprit, as he tried pitching through a cramp in his side.
The right-hander used to relax until he was summoned to throw pitches in the bullpen. Now, he rides a stationary bike in the seventh inning to stay warm. He still isn't sure of how to prevent an oblique injury, but he knows he never wants to another one.
"You don't realize how much you actually use your core until you hurt it," he said.