On Tuesday against the Detroit Tigers, Corey Kluber left his start after only pitching three innings and having surrendered five earned runs. The 31-year-old right-hander was forced to exit the game with what was initially termed low back “tightness.” However, following the game it was diagnosed as a low back strain. Kluber was placed on the 10-day disabled list a day later; in a corresponding move, the Indians recalled RHP Joe Colon from Triple-A Columbus.
What is it? The low back is compromised of muscles, bones, and ligaments that are at the bottom of the spine. Five lumbar vertebrae (spine bones) and the sacrum, which is located just below the fifth lumbar vertebrae, comprise the bony components of the low back, while structures such as the multifidus and lumbar paraspinals, among others, comprise the muscular portion of the low back. The term “strain” refers to over stretching of a muscle and is typically used interchangeably with the phrase “a pulled muscle.” Strains are typically graded on a scale from one to three, with one being the least severe and three being the most severe. A strain of the low back could be to any number of muscles, which may manifest themselves with similar symptoms. Strains of the low back are typically not the root of a low back problem, as most individuals will have some other deficit through the low back or anterior chain (core), which causes the low back to become strained. Such deficits can include impaired mobility through joints in the low back/pelvis, inadequate muscle strength, and improper muscle firing patterns, among other things. The low back muscles attempt to compensate for these deficits, and in turn are subjected to extra stress and are more prone to injury.
How is fixed? The majority of true “low back strains” respond well to conservative, skilled, physical therapy intervention. The sooner rehab can be initiated following a low back strain, the better the outcomes in the short and long term. Rehabilitation for low back strains will involve a period of rest from activities which exacerbate or worsen the individual’s symptoms. If the individual is unable to take time off from activities which cause them problems, how can we ever expect their condition to improve? Physical therapy intervention will work to identify the root of the patient’s problem through a variety of techniques and testing. Once the source of the problem, which caused the low back strain in the first place, is identified, treatment of the low back becomes more focused. Treatment will emphasis pain control, first and foremost, as well as the maintenance of proper mobility through the lumbar spine/sacrum, proper alignment of the hips/pelvis and adequate strength through the core, hips, and other surrounding structures. Once pain has been reduced and adequate strength and mobility are achieved, functional activities are initiated. Functional activities for a major-league pitcher include throwing and catching, both of which would be performed in controlled situations first prior to performance in live game action.
My take. If Kluber’s injury is in fact just a low back strain, this is good news. However, if there is a more serious underlying problem which has not been disclosed to the public, the rehab process may become a little more drawn out. I don’t expect the team to rush Kluber back from the DL before he is ready, and I anticipate that the ballclub will be very conservative in his return to pitching. It’s tough to discern at this point how much time the righty will miss, but it would not surprise me if Kluber remains on the DL for longer than 10 days.
We will continue to monitor the status of Corey Kluber as he progresses through the rehabilitation process and will provide up-to-date injury analysis and explanation as new information becomes available.
Brandon Bowers, PT, DPT, is a graduate of the University of Toledo, Doctor of Physical Therapy Program and currently practices in Columbus, Ohio. He is an avid Cleveland sports fan and has experience rehabbing athletes of all levels and from a variety of sports. Follow Brandon on Twitter for more Cleveland Indians injury insight and analysis: @blbowers12
The information provided is the professional opinion of Brandon Bowers, PT, DPT and is based on his clinical experience and the most current clinical evidence available. This information should not be interpreted as or substituted for medical advice for a specific condition or diagnosis.