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.

Overthrowing: Abnormal Shoulder MRIs In Young Baseball Players Without Shoulder Pain

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

Key Points:

  • A recent medical study showed that more than 50% of throwing shoulders in young baseball players without shoulder pain had MRI abnormalities
  • These MRI issues have the potential to cause long term issues for the shoulder
  • Players who played more than 8 months out of the year and were baseball-only athletes had a 100% chance of an abnormal MRI, regardless of playing position

At least once a week I’ll see a young athlete in the clinic with shoulder pain and at theYouth Pitchers end of a careful discussion, physical exam, and further discussion with the parents I’ll hear “that’s great, now can he have his MRI this afternoon”. The desire for an MRI is normal and natural on the part of the parents, after all this is what the media tells us will happen in a professional athlete.

(And btw the truth of that interaction with a pro athlete is frequently very different than what’s reported). But this study, published about a month ago in the Orthopaedic Journal of Sports Medicine provides valuable insight. An alarmingly high number of non-painful throwing shoulders in young athletes will have MRI abnormalities compared to the athlete’s own non-throwing shoulder.

The shoulder is frequently injured in young baseball players. Sports medicine doctors will often treat these athletes for overuse injuries and structural problems. Many of these diagnoses have long-term implications, sometimes requiring surgery and putting young athletes at risk for future problems. You’d be far better off not having any of these conditions.

Author Andrew Pennock and colleagues from UC San Diego orthopaedic surgery performed the study. They performed MRI evaluations on 23 young male baseball players aged 10-12 with no reported shoulder issues, and did MRI scans on the throwing and non-throwing shoulder.

Here were some of their key findings from the MRI portion of the study:

  • 52% of the throwing shoulders had MRI abnormalities that were not present in the non-throwing shoulder
  • They identified 2 key risk factors: year round play (defined as 8 or more months of baseball play per year) and single sport specialization
  • If a player had 1 of the 2 risk factors there was a 71% chance of an abnormal MRI; and with 2 of 2 risk factors there was a 100% chance of an abnormal MRI
  • Player position did NOT correlate with an abnormal MRI, meaning that fielders could also have an abnormal MRI

There were also some interesting observations about player behavior and knowledge of rules and recommendations for shoulder safety. 83% of the players were aware of pitch count restrictions, innings restrictions, and PitchSmart recommendations, and yet it appears that the number of players who actually followed the recommendations was small. In this study, 43% played baseball more than 8 months per year, 22% were single-sport athletes, and 80% of pitchers threw curveballs, sliders, and sinkers.

There are some limitations to this study that require additional investigation. It’s a fairly small number of players, and we don’t actually know what happens down the line to the shoulders with abnormal MRI scans.Sideline Sports Doc Logo

If you’re parents or coaches of young baseball players please have a look at the guidelines and rules in place from Little League Baseball and PitchSmart, and then make a commitment to actually follow the rules. A healthy arm is much better for long-term health and near term performance.

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.

5 Ways Movement Enhances A Parkinson’s Disease Diagnosis

By Erica Hornthal, MA, LCPC, BC-DMT; CEO Chicago Dance Therapy

Related image

I’m not here to tell you why exercise or a certain type of activity like dance or yoga, is beneficial.  Anyone can type “PD and exercise” into Google and read one of 63 million results. What I would like to share are the psychosocial implications that arise from engaging in movement.  How movement enhances our emotional, social, and cognitive well-being is imperative following a diagnosis of Parkinson’s disease.

Movement, our earliest form of communication, seems to be taken for granted only until we see it deteriorate or are faced with a degenerative disease that reminds us that our movements are so much more.  They are a connection to ourselves and our environment. Engaging in movement is not just about maintaining our physicality, but about preserving our existence.


Assists in symptom management: Research has shown that movement can help manage problems with gait, balance, tremors, flexibility, and coordination.  Improved mobility has been shown to decrease the risk of falling as well as other complications from PD. This often occurs because the brain is learning to use dopamine more efficiently.  

Promotes self-awareness and identity: Every person has a different way of moving and certain affinities toward movement.  It is those differences that promote a capacity for introspection and the ability to stand out as an individual.  Muscle memory even has the ability to tap into memories stored in the brain. Movement has the ability to retain our memories and create new ones.  

Maintains a sense of control: Connection to our breath, the most primitive form of movement, enables us to control our pulse rate, circulation, and even our thoughts.  This is so important for when we feel like things are out of our control or when our body is not functioning the way we would like, we have the power through our own breath to take back a sense of control.  

Builds psychological resilience: Movement has the ability to actually increase our adaptability to stress and adversity.  Reinforcing our own connection to the body empowers our psyche and encourages inner core strength.  This core I’m referring to isn’t your abdominals, but rather your identity. Connecting to the muscles in your chest, torso, and pelvis tap into your belief system, identity formation, and personality.

Maintains social connections: From early on in human existence, there is documentation of celebration and rejoicing through song and movement.  Movement has the ability to connect us with others without verbal communication. We can join in someone’s experience just by witnessing and empathically embracing their body language.


These 5 ways in which movement enhances our mind body connection are just the tip of the iceberg.  Movement is more than just exercise and physical fitness. Movement is body language, expression, and creativity.  Movement is an innate part of being human and just because that ability changes when diagnosed with PD, that does not mean that we should give up all that it entails.  It is even more imperative that we engage in movement to preserve that very part of who we.

Erica Hornthal is a licensed professional clinical counselor and board certified dance/movement therapist. She received her MA in Dance/Movement Therapy and Counseling from Columbia College Chicago and her BS in psychology from University of Illinois Champaign-Urbana.  

Erica is the founder and president of North Shore Dance Therapy and Chicago Dance Therapy. As a psychotherapist in private practice, Erica specializes in working with older adults who are diagnosed with dementia and movement disorders. Her work has been highlighted nationally in Social Work Magazine, Natural Awakenings, and locally in the Chicago Tribune as well as on WCIU and WGN.  


Parkinson’s Awareness Month: #StartAConversation

Every April, the Parkinson’s Foundation engages the global Parkinson’s community to support Parkinson’s Awareness Month. When we raise awareness about Parkinson’s and how the Foundation helps make lives better for people with PD, we can do more together to improve care and advance research toward a cure.

TISSUE BANK EMPLOYEE BECOMES TISSUE RECIPIENT

RECIPIENT OF: PATELLA LIGAMENT ALLOGRAFT

H.C. Martensen works in the AlloSource tissue processing core where he is faced with the powerful realities and possibilities of tissue donation and transplantation every day. He also has the utmost confidence in the allografts that he and his tissue bank colleagues produce, so much so that he recently requested one for his own transplant.

Over the summer H.C. returned to his former university, Colorado College in Colorado Springs, for an alumni soccer game. He played on the team in college, and since then remained very athletic, participating in triathlons and skiing. However, at the time of the game, it had been a while since he’d played soccer. Following a cutting motion on the field he felt his leg let go below the knee. H.C. instantly knew what had occurred, not only because of his work, but also because a close friend had sustained a torn ACL just
three days prior.

Shortly thereafter a surgeon confirmed it – H.C.’s ACL and lateral meniscus were torn
and he needed surgery and an allograft transplant. Although the surgeon did not
historically use allografts from AlloSource, H.C. made a special request to have his
graft come from the tissue bank. His surgery required a patella ligament bone-tendon-bone graft, which he received from a 33-year-old male donor.


“Just a few years older than me,” H.C. said. “It added to the perspective that I’ve had.

I’m presented with the reality of the business we’re in everyday. Seeing young donors come in is hard. Now that I’ve personally benefitted I’m further grateful for the gift of donation and even more aware of what we do.”


Since his surgery in June, H.C.’s recovery has been progressing very well and he just
completed his final functional evaluation in physical therapy. Although his knee isn’t yet 100%, he knows it shouldn’t be back to normal this soon after the injury, and his road to recovery has been swifter than other patients with similar injuries. Of course, H.C. intends to make the most of his gift of life – he will be training for triathlons.