Youth Pitching Study: The Effect of a Strengthening Program

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WHAT IS THE STUDY?

This study is examining the effect of a 6-week hip and core strengthening program on shoulder and elbow motion during pitching. Participants are 13-18 years old who pitch in at least one game per week on average during the season. Players will either be assigned to the control group or the strengthening program group. In the strengthening group, players will be taught a hip and core strengthening program and will be expected to complete it daily for 6 weeks. In the control group, players will continue to train as they were before enrolling in the study.

WHY HIP AND CORE STRENGTHENING?

The forces generated by the hip muscles during throwing are vital to the initiation and transfer of power to the arm. Electromyography (EMG) has shown that the legs and trunk provide rotational momentum for the arm and create over 50% of the total force and kinetic energy in a tennis serve. Other studies have shown that as a game progresses, players first show fatigue in their hip and core muscles and then lose their correct pitching form. In order to keep the same speed of their pitch while tired, players often use poor form and place themselves at risk for injury. We hope that using this conditioning program will strengthen the hip and core muscles and allow pitchers to continue pitching with proper form, therefore decreasing injuries.

WHAT WILL THE PLAYER BE EXPECTED TO DO?

When the player and parents decide to participate, the player will have baseline measurements taken, including hip range of motion, hip strength and the single leg squat test. Next, players will pitch while there are 1-inch markers attached to their arms and legs, which help us track body movements. If assigned to the strengthening group, players will be instructed on the proper completion of 10 exercises and will be instructed to do these daily before their regular practice sessions for 6 weeks. The program takes 10-15 minutes to complete. Players will also fill out a weekly compliance log of how often they do the exercises. The same tests will be repeated after the player has finished the 6 week program and then again after 6 months.

WHERE WILL THE TESTING TAKE PLACE?

The testing will take place at the new Rush University Medical Center Sports Training Facility in Oak Brook, IL.  If you believe you or your patients might qualify for one of our clinical trials or wish to be evaluated, please contact our research administrator, Kavita Ahuja, MD at (312) 563-2214 or kavita.ahuja@rushortho.com.

WHAT ARE THE RISKS AND BENEFITS?

There is minimal risk associated with participating. Risks include injury from pitching, muscle soreness or discomfort associated with completing the hip and core strengthening program. Potential benefits include improvement in the players’ pitching mechanics and/or velocity. However, that result cannot be guaranteed.

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Research on GelrinC for the treatment of Articular Cartilage Defects in the Knee

This study evaluates the effectiveness of GelrinC in the treatment of cartilage damage in the knee. GelrinC is a synthetic material called PEG-DA combined with a natural protein called fibrinogen. Together, these materials form an implant which is inserted into the “hole” in your cartilage. As time goes on, new tissue forms around the implant and the implant gradually degrades so that eventually only the new tissue remains. This study hopes to find that the new tissue closely resembles your natural cartilage tissue, like the hole was never there in the first place.

Some patients with holes in their cartilage undergo a procedure called a microfracture, which stimulates the bone marrow within your knee bones to start the healing process. In this study, patients will have a microfracture procedure done with the additional implantation of the GelrinC. We will compare the results of the patients who received GelrinC to previous patients who only had the microfracture procedure. In an earlier clinical research study, GelrinC was shown to be safe for use and showed improvement in pain levels after surgery, symptoms and ability to do day to day activities.

Patients participating in the study answer questionnaires about their symptoms and functionality. Patients also undergo 4 MRI scans to evaluate how the knee is healing over the course of 5 years. There are 10 post-operative visits patients attend: 7 times within the first two years and then yearly at 3, 4 and 5 years.

NeoCart tissue implant for the treatment of articular cartilage injuries in the knee

This is a company-sponsored Phase 3, randomized research study evaluating an investigational treatment called NeoCart®, a tissue implant made from a patient’s own cells, aimed at repairing certain knee cartilage injuries. The study will look at damage to the knee’s hyaline articular cartilage, the smooth, white tissue that covers the ends of bones where they come together to form joints. Damage to this cartilage may be caused by an injury or repetitive motion.

It is a common problem that results in pain and symptoms, such as swelling, locking of the knee and loss of knee function. Damaged hyaline cartilage has limited capacity to repair or restore itself. Left untreated, the damage may progressively worsen and may lead to chronic conditions such as osteoarthritis. The purpose of this study is to learn about the safety and potential efficacy of the investigational cartilage tissue implant, NeoCart®, compared to microfracture, the current standard of care surgery for articular cartilage defects of the knee.

Patients who are between 18 and 59 years old and who have symptoms of pain in one knee may be candidates for this study will be screened for study recruitment. Accepted patients will have a two out of three chance of being treated with NeoCart® and a one out of three chance of receiving the microfracture procedure. Patients in each group will know their treatment group, have a specific rehabilitation program, and be evaluated periodically for three years after treatment.

The study sponsor is Histogenics, Corp. For more information, text knee1 to 87888, call (773)257-7057 or visit www.NeoCartImplant.com.

Read more about Clinical Trials and Ongoing Research Efforts under the direction of Dr. Brian Cole and the Cartilage Restoration Center Research Team at Rush.

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College Player Back in Action after Overuse Injury

By Midwest Orthopaedics at Rush

baseball player with baseball

Baseball is a huge part of life for Millikin University sophomore Ben Jacobs. And he doesn’t take his ability to play at the college level for granted.

Just a few years ago while playing in a high school summer travel league, Ben was afraid his plans for a college baseball career might be derailed. He felt a tingling sensation in his arm and pain with throwing. What he didn’t know was that he was developing a type of throwing overuse injury.

When the feeling in Ben’s arm changed from tingling to pain, he knew he had to see a specialist. Ben’s father had been a patient at Midwest Orthopaedics at Rush, so they sought help right away from that group. They were introduced to Dr. Gregory Nicholson, an expert in shoulder and elbow surgery.

Dr. Nicholson diagnosed Ben with ulnar neuritis (also known as cubital tunnel syndrome), an inflammation of the ulnar nerve, which passes behind the medial epicondyle of the elbow down through the forearm and into the hand. The ulnar nerve is more commonly thought of as the “funny bone” nerve and inflammation can cause numbness or weakness in the hand.

Because of the position of the nerve, it is stretched when the elbow is bent. Thus, with the throwing motion it can become inflamed. In some cases, a splint or brace that keeps the elbow straight can be enough to relieve the pressure on the ulnar nerve. In Ben’s case, Dr. Nicholson recommended surgery to decompress the nerve and relieve Ben’s symptoms.

“Ulnar nerve decompression and transposition (moving the nerve to the front of the bend of the elbow) is a low-risk, outpatient procedure with a relatively high success rate. If patients are diligent with their physical therapy and follow the course of treatment, most regain full function,” Dr. Nicholson explains.

Ben and his family agreed to the surgery and he completed it while still in high school. During the procedure, Dr. Nicholson made an incision along the inside of Ben’s elbow. Once the nerve was fully explored, decompressed and moved slightly, Ben’s connective tissue and skin were closed with small stitches.

The surgery was successful and Ben soared through his physical therapy. Now, a few years post-surgery, Ben says he “feels 100 percent,” and has had no pain recurrence.

However, in order to avoid another overuse injury, he has changed positions from pitcher to catcher.

“To err on the side of caution, I decided to primarily play catcher. That way, I’m not putting too much strain on my arm, but can still be involved in every pitch.”

To commemorate his positive outcome, Ben had a “smile” face tattooed over his surgery scar as a reminder to persevere and stay positive.


“At first my arm felt a bit strange after surgery and it took me awhile to adjust. But now I’m lifting weights and throwing with no problem and I feel stronger than ever.”


To schedule an appointment with Dr. Nicholson to discuss your shoulder or elbow pain or condition, call 877-MD-BONES.

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Getting Back On The Horse After Injury

marianne riding horse

When Barrington Hills, IL resident Marianne Giovenco-Pappas’ grandfather put her on a pony at age three, she was hooked, and her love for riding grew as she began lessons at age five and entered competitions at seven. Despite the physical demands and risks associated with horseback riding, Marianne, now 50, never sustained an injury.

That all changed last summer when Marianne was competing with her horse, Bocelli, at Balmoral Park in Crete, IL. During a course run, Marianne fell off Bocelli and heard two ‘snapping’ sounds come from her lower extremities. She knew immediately that she had broken her leg. She was rushed to the nearest hospital then traveled back home to create a medical plan.

Finding An Trauma Expert

Marianne did not know the extent of her leg fracture until she met with Dr. Joel Williams the following day. Dr. Williams, an orthopedic trauma specialist at Midwest Orthopaedics at Rush, explained that the CT scan and xray showed a serious injury called a tibial plateau fracture, or a break in the upper part of the shinbone and knee joint.

Her bones had shattered and her body’s natural reaction to the trauma was creating a swelling that, if left untreated, would cause her to lose her leg. Dr. Williams immediately placed her leg in a fixator, a large metal device commonly used to stabilize the leg in tibia injuries.

“Dr. Williams was very honest,” she explains. “During the first visit, he walked me through every step of wearing the fixator, the necessary surgery to repair my leg, and the recovery plan. He even gave me his number, which I actually used.”

Successful Surgery

Marianne’s successful surgery took seven hours. Afterward, she appreciated Dr. Williams’ bedside manner. “Dr. Williams is different,” she recalls.


“He not only focused on my injury, but on my total wellness. From injury, through surgery and recovery, and even pain management—he was involved in all of it.”


As directed, Marianne dedicated herself to non-weight-bearing recovery and physical therapy for three months followed by adding weight-bearing activities to her routine for another three months. As soon as she felt comfortable walking without a cane, she saw Dr. Williams again, and he cleared her to begin riding. In just a year’s time, with loving support from her husband, Marianne is back to jumping 3’3”-3’6” – the same height she performed prior to her accident – and competing with Bocelli in the Amateur Owner Hunter Division. She recently traveled to compete in Old Salem, MA and Fairfield, MA with Bocelli and his trainer.


“My muscles are strong and I don’t feel any pain when I ride,” she says. “I’m able to ride and show my horse the way I did before. I still get to do what I love and I’m so appreciative of Dr. Williams and his team for helping me get here.”


Follow Dr. Williams on Twitter: @JoelWilliams_MD

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