Athletico’s Overhead Athlete Program

Matt Gauthier, PT, DPT, SCS from Athletico Physical Therapy talks with Steve and Dr. Cole about the unique characteristics of the Overhead Athlete, types of overhead throwing injuries: causes, prevention and treatment.

There’s more to throwing than just the motion of your arm.  There’s actually a whole science dedicated to it-and Athletico offers a comprehensive approach. Our team of physical therapists, occupational therapists, certified athletic trainers, and physical therapy assistants combine their expertise in throwing analysis with slow-motion video analysis to enhance performance and help prevent injuries.

Matt Gauthier specializes in the treatment of high-level athletes, and is the most passionate about treating shoulder and knee injuries. He is the head of Athletico’s Overhead Athlete Program,  and is a member of the USOC physical therapy volunteer program. As a sports specialist, he has experience treating athletic injuries at the youth, high school, college, professional, and Olympic levels.

Furniture Refinisher Restored After Successful PRP Treatment

bill belmonte.jpg

When asked how important having a pain-free elbow is, professional furniture refinisher Bill Belmonte, 48 of Westmont, IL replied, “on a scale from 1 to 10, it’s 100.”

Four years ago when Belmonte started having elbow pain, he feared what it might mean for his future. He worried that his affected elbow would sideline him from his recreational activities, like coaching youth baseball and skiing; but he was most concerned that his livelihood as the owner of a furniture restoration company was in jeopardy. “I didn’t know what the future was going to look like if the pain didn’t go away,” he explained.

His everyday work tasks such as sanding, painting, lifting and manipulating furniture was a struggle. Eventually, just writing at his desk hurt and the pain migrated to his shoulder. This really concerned him and he knew ignoring the problem was only making it worse. Belmonte saw a physician who diagnosed him with epicondylitis, also called ‘tennis elbow.’ His physician told him that in most cases, this condition resolves itself with rest. But, with the physical demands of his job, Belmonte didn’t consider rest an option. “I don’t have a desk job,” he explains. “In my very physical line of work I use my elbow all the time and using it is how I support my family.”

While at work one day, Belmonte became engaged in conversation with a client who noticed the band on his elbow and recommended that he see Midwest Orthopaedics at Rush sports medicine physician Dr. Nikhil Verma.

He took the advice and made an appointment with Dr. Verma who encouraged Belmonte to try platelet-rich plasma (PRP), a concentrated source of healing factors taken from a patient’s own blood. He explained that after a blood draw, platelets and liquid plasma are separated out in something called a centrifuge. Then, the platelets and plasma are re-injected into the injured area to stimulate and maximize healing.

Belmonte agreed to the treatment and afterward, he quickly saw improvement. “All of a sudden [within a week],” he explained, “I could do things without pain that I couldn’t do before.”

“I could do things without pain that I couldn’t do before.” 

Since then, he has repeated the PRP treatment to address some lingering pain and after which he has experienced even more improvement in pain reduction and mobility. “I’ve been recommending [PRP] to everyone I know,” he jokes.

He’s come a long way from taking daily pain medication and barely able to turn a steering wheel. Belmonte is now happily back fully to his daily work and passions.

Preventing Cycling Arm and Hand Injuries

By Janet Apgar, OTR/L, CHT, ASTYM-cert for Athletico Physical Therapy

preventing cycling arm and hand injuries

As spring brings warmer weather and adds daylight hours, biking fever spreads!

Although biking is fun and can be good for your health, cyclists should still keep a few things about their bodies in mind before hitting those trails to prevent injury. Given its whole body involvement, cycling can involve a few injuries including ones to the upper body. In fact, one survey found that approximately 31 percent of cyclists reported overuse hand problems. So, whether your biking dreams entail off-road adventures or long-distance road cycling, it is important to take precautions to protect your arms and hands from injury, which can arise from one or more of these three causes: improper positioning, sustained positioning or trauma from a fall or collision.

Improper Positioning

Even after buying the correct sized bike and having the seat aligned, a misfit between the cyclist and the bike can occur affecting not only the spine and legs, but also the arms. Symptoms that may signal poor positioning can include numbness and tingling in the ring and small fingers, numbness and tingling in the thumb, index, and middle fingers, clumsiness with tasks involving hand coordination and pain in the arms, wrist, hands and back.

Some common positioning mistakes that can lead to numbness, tingling and wrist and thumb/hand pain include hands being positioned wider than shoulder-width apart and the wrists being angled too far back, forward or inward. These can be addressed by changing handle bars from straight to angled or using aero bars. Wearing padded gloves can also absorb the shock and vibration of the ride as well as allow for a looser grip.

Pain in the back and hands can stem from riding with rounded back and shoulders or with elbows locked in extension and can involve handle bars that are too low or too high in relation to the seat or tight hamstrings.

What is the right position then? The ideal riding position involves a neutral back, slight elbow bend, hands shoulder width apart and wrists in mid-position. Changes in handle bar height and angle (as mentioned above) as well as addition of ergonomic grips, added bar ends, adjustable height or adjustable angle handle bars can all assist to achieve the correct positioning.

If the above necessary positioning modifications are made and the affected body part is rested early enough, the symptoms should resolve within a couple of days. However, if symptoms involve coordination problems with the fingers or have been longstanding, it may take weeks to months to recover and may possibly require seeing a physician that is a hand specialist and/or an Occupational Therapist.

Sustained Positioning

Even with the best bike fit, sustained positioning while riding has the inherent risk of continuous pressure and requires constant shock absorption on the part of vital structures including: blood vessels, nerves, joints and muscles. This can lead to tissue breakdown and inflammation.

This can be especially prevalent with road bikes as their speed and aerodynamics require the trunk to be angled 60-75 degrees forward toward the bars (i.e., the cyclist is not as upright as the off road mountain biker or hybrid biker). This position requires strong overall core and upper body conditioning to go faster and/or longer distances. Addressing these areas as part of an overall fitness regimen can help prevent issues while riding.

Another way to counteract pain from sustained positioning is frequently moving the body parts that are typically static during a ride. This can be achieved by changing hand holds every three to five minutes and stretching on breaks or after the ride.

Here are a couple examples of stretches. Perform each stretch for five to ten seconds, repeating five to ten times during each break from riding. Notice that while both stretches involve the hands, they are stretched in opposite directions during each one.

  

Trauma

While the injuries that occur with bike falls and collisions are as varied as the impacts, two common bones broken are the clavicle (collar bone) and the scaphoid (wrist bone near the thumb). Extending the arm to break a fall focuses forces on these bones leading to injury during impact. Along with potential fractures, the clavicle is also prone to sprain or separation, which could require at a minimum sling usage or surgery depending on severity.

A scaphoid fracture can be easily missed as the telltale sign of this fracture, pain in the thumb side of the wrist, might not be felt as severely initially as other injuries. It is important to be vigilant of an injury in this area, however, as a design flaw in the blood supply to the scaphoid can lead to serious issues including avascular necrosis (failure of bone to heal) and long term functional impairment if not treated early. This is why it is important to not ignore wrist pain after a bike fall.

While prevention of falls and broken bones may not be entirely possible, if the biker holds on to the handle bars while falling, the entire body can absorb the blow of the impact rather than focusing the impact on these two bones in the outstretched arm. Wearing a helmet can also make the need to protect the head less of an issue during a fall.

Enjoying the Ride

By being aware of some of the most common arm and hand-related bike injuries, you can take the necessary steps to prevent these injuries from occurring during your rides. Should an injury occur, schedule an appointment at a nearby Athletico location so that our Occupational Therapists can help you heal in time for the next ride.

REQUEST AN APPOINTMENT

There’s A Lot We Don’t Know About Baseball and Softball Injuries

By Dev Mishra, M.D., President, Sideline Sports Doc, Clinical Assistant Professor of Orthopedic Surgery, Stanford University

Key Points:

  • There are likely many factors involved in shoulder and elbow injuries for young throwers
  • The available data suggests that there are steps a young thrower can take now to minimize risk.
  • These steps include: play less than 8 months out of the year; play more than one sport; maintain shoulder motion as close to the non-throwing shoulder as possible; and improve lower extremity and core strength

I’m still thinking back on a recently published study of MRI abnormalities in young baseball players. I wrote about this in a blog post and noted that in this small study 100% of the players had an abnormal shoulder MRI scan if they were single sport athletes and played more than 8 months out of the year. Sure, a larger study will likely show a different percentage but it still should give us all reason to ask: why does this happen?  And why did 74% of young players report some arm pain during play in another study? Is this just the new normal, the physical price paid to play the sport? The data are compelling and a bit scary, but still it’s not easy to connect the dots and identify specific causes of problems. There’s a lot we still don’t know.

There is a lot of outstanding research taking place now, attempting to answer the question: “why”. We’ll likely find that there are several factors that can conspire together to create injury risk, loss of performance, and loss of sport enjoyment. I’d like to highlight a few excellent studies recently published in the journal Sports Health.

Here’s an excellent study that starts to define what the normal pitching motion should look like in a young pitcher. The authors defined ranges for the normal shoulder rotation and elbow load and found interestingly that loads are actually less for curveballs compared to fastballs, and yet current pitching recommendations suggest avoidance of curveballs until around age 14. The culprit may actually be abnormal lower extremity and trunk mechanics in the young pitcher. Possible solutions: lower extremity and core strength should be a conditioning focus for the young thrower.

In another study the authors did a retrospective analysis of previously published data and found that shoulder rotational deficits correlated with risk of shoulder and elbow injuries in early adulthood. These authors feel that with the onset of puberty and the accelerated growth in the young body, it seems that repetitive overhead activity leads to changes in bone shape. Once the young thrower is finished growing the continued repetitive stress in throwing is transmitted to the soft tissues. Possible solution: improve shoulder, elbow, and trunk range of motion with a program such as the Yokohama Baseball-9.Sideline Sports Doc Logo

These and other studies point to the fact that there are multiple factors involved in creating the recipe for upper extremity injury. There’s a lot we still don’t fully understand. But there are reasonable steps any young thrower can take right now to reduce injury risk and maximize sport performance and enjoyment. Play less than 8 months in a year and play more than one sport. Keep shoulder motion as close to the non-throwing shoulder as possible, and keep lower extremity and core strength up.