Oblique Injury Treatment & Hydrofascia Release™

01 · Why This Injury Is Different

The external and internal obliques drive trunk rotation, lateral flexion, and the core stability behind nearly every explosive athletic movement. When they strain or tear, even ordinary motion becomes painful — and conventional recovery commonly stretches from three to six weeks, with a stubbornly high recurrence rate. We built a faster, more precise path. Using ultrasound-guided Hydrofascia Release™, we treat the injured muscle-fascia interface directly and return athletes at every level — from weekend competitors to professionals — to their sport in a matter of days.

This injury is best known in throwing and rotational sports, but the mechanism shows up far more broadly. A baseball pitcher or hitter loads the internal oblique on the side opposite the throwing or lead arm. A professional defensive end generates enormous rotational torque driving through the trunk to shove a blocker aside. A pro boxer loads and unloads the obliques on every hook and cross. Golfers, tennis players, rowers, and hockey players place the same high-velocity demand on these muscles. Any athlete who rotates hard and fast through the core is a candidate — and every one of them benefits from getting the injury treated correctly the first time.

02 · Safety First

Patients should understand this before choosing a provider: injections around the obliques and lower ribs are not routine. Because the target tissue sits directly over the rib cage and lung, a needle placed even slightly off course can puncture the lining of the lung and cause a pneumothorax — a dropped, or collapsed, lung. This is a real and serious complication, and it is exactly why these procedures should only ever be performed by an expert using real-time ultrasound guidance.

Ultrasound is not optional here, and it does two jobs at once. First, it lets us see the lung, the pleura, the ribs, and every layer of muscle and fascia in real time, so the needle stays exactly where it belongs and never crosses into dangerous territory. Second, it lets us find the precise spot — the exact injured muscle-fascia interface or insertion near the rib — so treatment goes where the healing is actually needed instead of somewhere approximate. Dr. Jacques Courseault and our team have performed thousands of ultrasound-guided procedures. That combination of expertise and imaging is what turns a high-risk injection into a safe, remarkably effective one.

03 · How We Treat It

Our primary treatment for oblique injuries is Hydrofascia Release™ (HFR), our advanced, ultrasound-guided evolution of hydrodissection. The procedure involves precisely injecting a fluid solution — typically saline or dextrose combined with anesthetic — into the injured fascial planes under continuous ultrasound imaging.

HFR works by separating and rehydrating the tissue layers that have become adhered, inflamed, or scarred after a strain. This releases adhesions, reduces scar-tissue formation, relieves nerve entrapment and muscle tightness, and restores the gliding surfaces that let the obliques move freely again. The result is less pain, better range of motion, and a healing response that starts immediately — rather than the slow, passive timeline of rest and physical therapy alone. Because we treat both the muscle and the surrounding fascia, athletes recover faster and are less likely to re-injure — a major concern given the high recurrence rate reported for oblique strains. You can read more about the patient experience with fascial hydrodissection here.

Patient Result · Professional Boxing

Professional boxer Victor Hernandez came to us with an oblique injury that was robbing his right hook of its snap and power. After ultrasound-guided Hydrofascia Release™, he was back to training quickly — and the improvement in his rotational power was immediate.

“My right hook is stronger and faster than it’s ever been. I can rotate through the punch with full power and no pain. Dr. Courseault and the team got me back in the ring when I thought I’d be out for weeks.”

— Victor Hernandez, Professional Boxer

His experience reflects what we see across sports: when the obliques are treated precisely at the source, athletes don’t just heal — they often come back moving better than before.

05 · What The Research Shows

The literature underscores both how common these injuries are and how long traditional recovery can take — the exact timelines our ultrasound-guided approach is designed to shorten:

Professional soccer player, external oblique injury. A 28-year-old player felt a popping sensation with pain between the left 11th and 12th ribs; ultrasound confirmed fluid collection consistent with a muscle injury. He returned to full competition 21 days after platelet-rich plasma treatment (2).

Internal oblique strains in professional baseball players. A study of Japanese professional players found a 12.2% incidence of internal oblique strains, most often at the muscle insertion near the lower ribs, with a mean return time of 27.7 days and a high recurrence rate (3).

Professional handball player, internal oblique strain. A 26-year-old player with a grade III injury confirmed on MRI and ultrasound recovered over six weeks with conservative care — analgesic injections, anti-inflammatories, activity modification, and progressive strengthening (1).

As Seen On WWL-TV

In the segment below, Dr. Jacques Courseault discusses muscle and fascia injuries in athletes — including the kind of oblique strain that made headlines when it sidelined an NFL quarterback — and our clinic’s specialized, minimally invasive approach to accelerating recovery and return to play.

▶ Read the WWL-TV report: MRI confirms Saints QB oblique injury →

Author, References & Related Reading

Author: Orsula Staka  ·  Editor: Jacques Courseault, MD, CAQSM, FAAPMR

1. Asai K, Nakase J, Shimozaki K, et al. Internal oblique muscle strain on the left side of the dominant arm in a representative handball player. ACSM, 2019;18(10):358–360.
2. Dauty M, Menu P, Dubois C. Uncommon external abdominal oblique muscle strain in a professional soccer player: a case report. BMC Res Notes. 2014;7:684. — BioMed Central
3. Komatsu S, Kaneko H, Nagashima M. Characteristics of internal oblique muscle strain in professional baseball players: a case series. BMC Sports Sci Med Rehabil. 2022;14:118. — DOI
4. Nealon A, Kountouris A, Cook J. Side strain in sport: a narrative review of pathomechanics, diagnosis, imaging, and management. J Sci Med Sport. 2017;20:261–266. — DOI
5. WWL-TV: MRI confirms Saints QB oblique injury. — wwltv.com

Related: Hydrodissection / Hydrofascia Release™  ·  A Patient’s Experience  ·  About Dr. Courseault

This page is for general education and is not medical advice, nor does it create a physician–patient relationship. Oblique injections carry real risks, including pneumothorax, and should only be performed by a qualified physician under ultrasound guidance. Individual results vary; return-to-play timelines depend on injury grade and the individual, and some cases require more than one treatment. The Fascia Institute and Treatment Center® · 2520 Harvard Ave, Ste 2B, Metairie, LA 70001 · (504) 704-1254.