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.

Ice Hockey Injury Awareness and Prevention

By Brian Rog and Katie Christopherson, ATC for ATI Physical Therapy

Ice Hockey Injury Awareness and Prevention from ATI Physical Therapy

Behind any sport’s glory lies a complex algorithm so delicate that even the slightest miscalculation in training or performance can cut a practice, game or season short. High-intensity, year-long sports like ice hockey, adhere to a very complex set of rules due to the on-ice demands and endless fitness requisites. In keeping up with these standards, as a player, coach or parent, it’s important to be educated on gear safety, strength & conditioning, skating technique and return to play rehab protocols.

With the help of ATI Physical Therapy athletic trainer and seasoned hockey player, Katie Christopherson, we’ll take an inside look into common hockey injuries, injury prevention tips and stretching recommendations to help you relish the game and all its glory. Adding to this, our friends at ProStockHockey supplied us with an insightful upper body injury infographic , which underscores the importance of choosing the right equipment.

What are the more common hockey injuries treated in the clinics?

When it comes to hockey injuries, regardless of age and skill level, we commonly see injuries to the head, shoulders, hips, knees, feet, and ankles. Injuries linked to the body parts mentioned above can be assessed and rehabbed in a physical therapy clinic. Head injuries are an exception to this as most rehab clinics are not staffed with head injury specialists. However, at select ATI locations, we have specialists credentialed to treat head injuries and their accompanying hindrances.

Within the sport, hockey injuries are traditionally classified as either chronic (overuse) or acute (more traumatic). So when you hear of a player suffering ‘an acute concussion’, you’ll know the level of injury the athlete is dealing with. Looking deeper into these common hockey injuries, here’s a breakdown of the top-4 and their contributors:

Shoulder injuries

It is common to find rotator cuff and glenohumeral (ball and socket joint) injuries being treated in clinics.  The rotator cuff is a group of stabilizing muscles that are frequently used with stick handling in hockey.  Shoulder dislocations and AC joint sprains are common due to checking in hockey as well and require physical therapy to correct.

Hip injuries

In the hip, you will find a lot of groin muscle strains due to a misstep in skating or getting caught up in the boards or another person’s leg or stick.

Knee injuries

In the knee, our clinics more commonly see MCL sprains and/or meniscus tears, which result from twisting of the knee or direct impact to the outer side of the knee.

Head injuries

Given the full-contact nature of hockey, it’s no surprise we see a steady stream of head injuries such as concussions. Head injuries can have very serious consequences and require immediate medical attention, so don’t ignore the warning signs.

How can a hockey player lessen the risk of injury? 

To help lessen the risk of injury, a player must undergo proper training, wear sized-appropriate protective gear, and follow proper rehab protocols when returning from an injury.  Before tackling this checklist, it’s important to know that roles will vary according to a player’s position on the ice, whether it be a forward, defensemen or goalie.  These roles vary by position, so following position-designated strengthening, skating technique, gear, and return-to-play rehab protocols will help you better adapt to role-specific scenarios.

For instance, if you are a forward, the position does not demand as much backwards skating as a defensive position, however both positions utilize forward-skating crossover techniques, so in some cases you’ll borrow tactics from other positions.

Irrespective of position assignment, it’s strongly suggested that as players move through the ranks they should work towards a versatile role, meaning they can assume the duties of a defenseman (or forward), if needed. Doing this helps a player better adapt to varying on-ice challenges, both physically and mentally. The anomaly to this versatility rule is, of course, the goalie, since this position will never assume the role of a d-man or forward. On the flip side, you won’t see a skater step into the crease, unless of course you are Kris Russel of the Edmonton Oilers who holds the record for most blocked shots in one game at 15.

Since we are talking goalies, which is by far the most unique and laborious position on the ice, let’s take a look at what we know and have seen as far as injuries and conditioning strategy. Given the dynamic duties of a goaltender, we most commonly treat hip injuries resulting from squatting positions, quick side-to-side transitions and knee-to-ice movements that necessitate major hip rotations.

Similar to a forward or defenseman, a goalie must also understand the mechanics of the position and the levels of mobility needed to meet the grueling demands of the position. What makes this position even more unique is that on top of recognizing one’s own mechanics and strategies, a netminder must also learn the mechanics and strategies of a skater to better prepare their physical responses.

Once you’ve identified your role on the ice and importance of training and rehabilitation guidelines for each position, it comes time to establish a more thorough, role-specific training and injury-prevention program. For a forward or defenseman, this program must combine a focus on strength, speed, flexibility and endurance. With a goalie, their program should be similar to their teammates, however, he/she must follow a program that has an increased focus on flexibility, strength and endurance.

Avoiding injuries with the proper gear

The main thing to remember when outfitting yourself (or someone else), is to make sure the gear is appropriate for the position (i.e., skater vs. goalie) and that it fits properly. With this, you must also consider proper stick lengths and shape as well as the way a hockey skate fits and the skate’s blade radius. And yes, even the sharpness of the hockey skate blade can affect the player due to on-ice variables such as one’s position and softness/hardness of the ice.  Making yourself and others aware of these things and taking appropriate action can help to lessen the severity and occurrence of on-ice injuries. For helpful tips on properly outfitting your equipment, check out this hockey equipment fitting guide from the experts at Dick’s Sporting Goods.

Corrective stretches that can help to minimize injury risk 

Research has proven that including dynamic (mobility stretches) and static (stationary stretches) stretches will not only improve your endurance and balance, but will also lessen the risk of injury. While the aforementioned benefits are well known across the athletic community, the timing of the stretches (warm up/post-game) are commonly up for debate. ATI’s physical therapy experts suggest focusing on dynamic stretches before hitting the ice and static once finished, which include:

Dynamic stretches before hitting the ice

Dynamic hockey warm-ups, which are great for getting the heart rate up and enhancing range of motion and power, can be done on land (without gear) or can be done once you hit the ice.  Some beneficial flat-land warm ups include exercises such as high knees, hip swings, arm swings, butt kicks, karaoke, side steps and ankle hops. For dynamic on-ice exercises, consider hip circles, arm circles, leg swings, Cossack squats and trunk rotators.  The warm-up should take around 15 to 20 minutes all together and does not need to include static stretches as this will not help elevate your heart rate, which is an essential ingredient to priming the muscles for activity.

Static stretches after a game or practice 

Hockey players of all levels incorporate some form of static stretching after a game or practice without gear. The post-activity stretch is key in preventing injuries as it helps with maintaining flexibility and lowering recovery time. Examples of static stretches include, reaching for toes (hamstring), butterfly (groin), hollywood or secretary stretch (low back), flamingo (quads), lunge stretch (hip flexors), piriformis (hip/glutes), and IT band stretch (side of leg/hip).  These are all important in supporting flexibility and helping stay injury-free.

Preventing an overuse injury

There are multiple steps a skater can take to help prevent an overuse injury.  First off, as is the case in all sports, proper training is the cornerstone for achieving peak performance and fitness levels. In doing this, avoid going from minimal levels of activity to a high level as your chances of injury or muscle strain are significantly increased.

When training, also pay close attention to your form when doing cross-overs, skating backwards, and working on shooting technique. Over time, improper form places unnecessary loads on the muscles, causing them to break down. As a result, recovery times become lengthy and rehab programs exhausting.

This brings us to our last point on the role warm-ups and post-activity stretching play in shielding your muscles from injury. Including some form of dynamic warm-up before activity as well as static stretches afterward can be very beneficial for muscle sustainability, wellness and recovery. It’s been stated that well-structured warm-ups and stretches will get your heart rate and muscles ready to handle a heavy load while post-activity stretching allows your heart rate to decrease, causing your body to idle down into a resting state.

Managing hockey injuries, aches and pains

ATI experts strongly encourage athletes to take care of any minor aches and pains before they compound and get worse.  This can be as simple as heating for 20 minutes before activity and icing for 20 minutes after activity when the athlete feels soreness in one particular area.  If the pain persists, it might be a good idea to call your physician or visit your nearest ATI physical therapy clinic. In fact, at ATI, we offer complimentary injury screenings, so stop in and see what we can do for you.

How Stem Cells Will Shape Tomorrow’s Health Care

Experts discuss stem cell treatments for cancer, neurosurgery, orthopedics, pediatrics:

The use of stem cells in medical treatments already is yielding exciting results and may yield greater medical advances in the future. At a recent event hosted by Rush University Medical Center, experts at Rush discussed the role of stem cells in neurosurgery, orthopedics, pediatrics and oncology and how their breakthrough research may dramatically improve the lives of people afflicted by disease and severe injury. An edited transcript of that discussion appears here: https://www.rush.edu/news/how-stem-cells-will-shape-tomorrows-health-care.

Larry Goodman, MD, CEO of Rush University Medical Center and the Rush system, moderated the conversation. The panelists included Brian Cole, MD, MBA, professor in the Department of Orthopedic Surgery and section head of the Center for Cartilage Restoration at Rush; Richard G. Fessler, MD, PhD, professor in the Department of Neurological SurgeryTimothy M. Kuzel, MD, chief of the Division of Hematology, Oncology and Cell Therapy; and Anna Spagnoli, MD, the Woman’s Board Chair of the Department of Pediatrics.

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Weightlifter Gets Her “World Class” Shoulders Back

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As a four-time national masters weightlifting champion, Chicagoan Gwen Chamberlin is an athlete whose success in the sport came later in life. After starting Crossfit, Gwen slowly gravitated toward weightlifting at the age of 45. One decade later, she’s developed an impressive resume in the world of competitive weightlifting – even after overcoming a few obstacles along the way.

A few years ago, the demands of the sport began to affect her shoulders. She sought general medical advice at first before realizing she needed more extensive care. Her physical therapist recommended Dr. Gregory Nicholson, a sports medicine shoulder specialist at Midwest Orthopaedics at Rush. After meeting him, Gwen was impressed with his experience in shoulder care and his supportive attitude. “He didn’t treat me like an old lady. He treated me like an athlete,” she shares.

Dr. Nicholson diagnosed her with a torn supraspinatus tendon and posterior cuff. The supraspinatus muscle is located on the back of the shoulder and is part of the three muscles that make up what is referred to as the rotator cuff, which helps to lift and rotate the arm. Rotator cuff repair surgery reattaches these muscles to the bones of the shoulder.

Dr. Nicholson recommended repair surgery to get her back to health and back to the gym. After undergoing surgery with Dr. Nicholson, Gwen found that the recovery time away from the gym was well worth it. In fact, she achieved her personal lifetime best weight lift.

Despite a newly repaired and thriving shoulder, she started to experience nagging pain in her other shoulder, threatening her goals. Naturally, Gwen went back to Dr. Nicholson. Almost two years to the day after her first surgery, he performed a second rotator cuff surgery on the opposite shoulder, during which he also discovered the need to repair the bicep muscles.


“I am so grateful that I’m now back to health and competing with what he calls my ‘world class shoulders.’”


Today, Gwen is showing no signs of slowing down. Within eight months of her second shoulder surgery, she was back lifting at full strength and with full range of motion. This allowed her to prepare for the Masters National Championship this month. She’s also set to compete in the Pan American Masters in June and the Masters World Championship in August.

“Dr. Nicholson is one of the best,” Gwen explains.

To schedule an appointment with Dr. Gregory P. Nicholson, call 877-MD-BONES. For more information about keeping your shoulders healthy, visit www.shouldersforlife.org or https://chicagoshoulderdoc.com/.

New 3D Animation on Reverse Total Shoulder Replacement

We are pleased to announce the latest addition to our 3D Animation Library on surgical procedures: Reverse Total Shoulder Replacement

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Introduction

Reverse Total Shoulder Replacement is a surgery performed toimprove shoulder function and decrease pain. This procedure is performed on patients who have suffered massive rotator cuff tears, which have led to a painful condition known as rotator cuff tear arthropathy, or on those patients who have undergone previously failed shoulder surgeries. The surgery removes damaged portions of the shoulder joint, and replaces them with a prosthesis.


Anatomy

There are three bones that are involved in the shoulder: the humerus, the scapula, and the clavicle. The head of the humerus rests in the socket of the scapula called the glenoid cavity.

The rotator cuff is made up of a group of four tendons from muscles that surround the shoulder joint, and together with the deltoid muscle, they work to stabilize the joint and move the arm.


Reverse Total Shoulder Replacement vs. Conventional
Shoulder Replacement

There are two types of total shoulder replacement surgery: conventional shoulder replacement and reverse shoulder replacement. The determination between which surgery should be performed is based upon the strength and functionality of the rotator cuff.

For many patients, the function of the rotator cuff has been compromised through massive tears, and the muscles and tendons do not function properly. In these cases, a conventional shoulder replacement may not be effective and reverse shoulder replacement may be an option.

In a reverse shoulder replacement prosthesis, the ball is placed on the shoulder socket while a cup and stem replace the head of the humerus. This configuration relies on the deltoid muscle instead of the rotator cuff to stabilize the shoulder and provide joint mobility. Additionally, this procedure may be recommended for individuals who have undergone previously unsuccessful conventional  shoulder replacement surgery.


Procedure

Depending upon your preference and that of the anesthesiologist, you will be put under general anesthesia and/or a nerve block. Your surgeon will make a single incision through the skin to access the shoulder joint.

Your arm is rotated and the head of the humerus is removed. Next, a space is created in the humerus and your surgeon will insert the stem portion of the prosthesis into the bone. The plastic cup then is fitted onto the humeral side.

Next, your surgeon will remove the damaged surface of the glenoid cavity. The first portion of the prosthesis is placed in the glenoid cavity and secured to the bone with screws.

Next, the “ball” portion of the implant is affixed to the previously placed glenoid prosthesis, and the arm is rotated to place the ball into the socket.

The incision is closed with internal sutures; and either external sutures, or staples. Finally, surgical tape or bandages will be placed over the incision.


Recovery and Results

Most patients return home within two to three days of the procedure. Any external staples or sutures that are present are usually removed in 10 days to two weeks. Scarring along your incision site is normal, but it is likely that your scars will fade
considerably over time.

Your arm will be in a sling after surgery and until your surgeon prescribes therapy. Depending upon your specific needs, your surgeon and physical therapist will develop an exercise routine to gradually increase your range of motion and strength. Your surgeon will recommend when you can return to work, daily activities, and driving; full recovery typically takes 6-8 months.


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