Myofascial hydrodissection is an important tool to return athletes back to their full potential and improve sports performance. Post-leg pain can affect pitching accuracy and performance. We present a case at The Fascia Institute and Treatment Center of a pitcher with tightness at the anterior hip of his post-leg that has been going on for 2 years. Post-leg pain has affected his performance, including velocity and accuracy. The inclusion of an ultrasound evaluation and hydrodissection treatment plan can be important in the rehab process.
A 20-year-old right-handed collegiate pitcher with a history of hypermobility presents with post-leg pain and tightness at the left anterior hip for 2 years. He states that when pitching he feels excessive post-leg pain and tightness during the release of the ball. Occasionally, he has anterior hip pain during release that he describes as sharp and stabbing in nature. Pain is 7/10 and improves with rest. There is no catching or locking in the hip joint. Stretching does not improve pain. He denies numbness, weakness, or tingling. On exam, there was tenderness to palpation of the anterior hip over the tensor fascia lata (TFL) and sartorius. He did not have pain with flexion, adduction or internal rotation. An x-ray and MRI of the left hip was normal. Ultrasound imaging was performed and revealed thickened and adhered fascial tissue at the TFL and sartorius muscles that were tender upon palpation with the ultrasound unit. Because of the findings, the athlete decided to proceed with an ultrasound-guided hydrodissection. The injection site was cleaned and sterilized. Under ultrasound guidance, the TFL and sartorius fascial planes were hydrodissected without complication. The pitcher then reproduced his pitching motion, and no longer had tightness on his post leg during his wind-up. He then reproduced his pitching motion and no longer had pain. At a 2-week follow-up, he reported improvements in velocity and accuracy.
Pitchers tend to have hypermobile body types. Hypermobile athletes tend to have myofascial injuries that may linger or result in fascial adhesions. The only way to visualize a fascial adhesion is with ultrasound imaging, which requires an evaluation with a physician expert in fascia. In this case, we were able to identify a fascial restriction causing post-leg pain. A release with a hydrodissection resolved post-leg pain and returned the athlete to full function without limitation. This case stresses the importance of recognizing fascial adhesions and offering the proper treatment.