Help For Elbow Injuries In Pitchers? A Prevention Program Offers Hope

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

Key Points:

  • Overuse injuries to the elbow are common in young baseball players, and prevention programs are needed to reduce injury risk
  • A recently published scientific study highlighted the potential benefit of a stretching program called the Yokohama Baseball-9, showing a significant reduction in elbow injuries for players who used the program compared to those who didn’t
  • The program has the potential to be a useful tool in reducing numbers of elbow injuries for young baseball players

I’m a big believer in prevention programs for sports injury risk reduction and this week we’ll discuss a program to reduce elbow injury risk in baseball.

I’ve written before about the usefulness of the 11+ warmup program for lower extremity risk reduction in soccer. That program is highly effective. Prevention programs are great in theory but actually proving the usefulness can be difficult. What are required are often lengthy scientific studies with large numbers of individuals. Those types of studies have been done with the 11+ but are lacking for elbow injury prevention programs in baseball. But a recently published study from Japan offers some hope.

The study authors devised the Yokohama Baseball-9 (YB9) program, which consists of 9 flexibility exercises focused on the wrist, elbow, shoulder, and hips.

There were 275 players age 8 to 11 divided into a non-YB9 group and a YB9 group. Players were asked to complete the program at least once a week.

At 1-year, the YB9 exercise group had significantly lower rates of elbow injury and significantly better total range of motion at the shoulder. In a statistical analysis, increased shoulder total rotation, increased nondominant hip internal rotation and improved spine posture predicted lower rates of elbow injury.

This is a good study but there are some weaknesses. 28% of the original group was excluded due to prior shoulder or elbow pain and an additional 15% were lost to follow up. And it is a relatively small number of players who participated.

We need more studies like this so I hope it can be repeated by others, and with larger numbers of players. The fact that 28% of the young players in the original group of potential players were excluded because they already had pain in pretty alarming, and good evidence that we need some solutions to the problem of overuse injuries in baseball pitchers.Logo

Overall, the study is encouraging and provides an interesting new potential avenue for injury prevention.

The Importance of Strengthening the Gymnast’s Elbow

By Tara Hackney, PT, DPT, OCS, KTTP for Atletico Physical Therapy

strengthening gymnasts elbowGymnastics offers a unique perspective, even allowing some athletes to see the world upside down!

Very few sports involve supporting the entire body weight with the arms like gymnastics. Due to these special considerations, gymnasts are more prone to certain injuries, such as Osteochondritis Dissecans of the elbow (OCD), and should take care to strengthen the entire arm to decrease injury risk.

What is OCD Elbow?

Osteochondritis Dissecans (OCD) lesions can be found in the elbows of adolescent athletes. The exact cause of OCD in the elbow is unknown, but repetitive microtrauma and decreased blood flow to the subchondral bone are believed to play a role. As the underlying bone weakens, a segment of the articular cartilage separates from the subchondral bone, forming a lesion. OCD lesions in gymnasts may be caused by repetitive weight bearing on the hands with the elbow in extension.

Presentation of elbow OCD is very vague. A patient can have pain, tenderness and swelling over the lateral aspect of the elbow. There may be limitation in how straight the elbow can go and there may be locking or catching if the injury has progressed. However, tendinitis of the elbow can have a similar presentation. More often OCD is suspected in specific patient populations including pre-teen and teenage gymnasts as well as young baseball pitchers with elbow pain. Diagnosis is through imaging such as x-ray or MRI.

Treatment for OCD Elbow

Non-operative treatment for elbow OCD consists of rest and sports restriction. For a gymnast that means no weight bearing on arms and no hanging from bars or rings as the latter puts traction stress through the elbow. Muscle strengthening exercises and possibly a short period of immobilization are also usually a part of treatment.

There are some cases where the lesion is unstable and surgery is the best option. After surgery, physical therapy is performed to reduce pain, swelling and restore range of motion. Resistance strengthening is also incorporated into the rehabilitation after bone healing has occurred, usually around 8 weeks after surgery.

What Can Athletes Do While Resting Their Elbow?

If a gymnast has been diagnosed with an OCD lesion, they are not allowed to do any weight bearing on the arm, which includes performing skills on the bars. So what can the gymnast do as they allow their elbow to heal? Core strengthening is one option, as core strength is vital to a gymnast and is important during all events. Leg strengthening can also be performed while adhering to the restrictions on the elbow. An overall conditioning program can be designed for the athlete that will incorporate cardio, core strengthening, leg strengthening, shoulder and wrist strengthening, and flexibility stretching. Staying active and in shape is vital to the gymnast during this time to assist in returning to the sport when the elbow restrictions are lifted.

Arm Strengthening for Gymnasts

The elbow is the middle joint of the arm with the shoulder and wrist on either side. While the gymnast’s elbow is healing, it is important to strengthen both of the surrounding joints to provide extra stability for the arm for when return to weight bearing is allowed. Prior to initiating any activities, ensure the gymnasts’ physician has cleared them for return to these exercises.

            Shoulder strengthening examples:

  • Resistance band exercises including rows, shoulder extension, diagonals, internal/external rotation
  • Sidelying shoulder external rotation
  • Tricep extension with band or hand weight
  • Bicep curls with band or hand weight
  • Prone I, T, Y exercises – exercises can be performed using a swiss ball for added core activation, hand weights can be added for resistance
  • Gradual return to weight bearing exercises, like push-ups, planks and handstands, can be added when the athlete is cleared from restrictions

            Wrist strengthening examples:

  • Wrist curls in both directions with a weight or resistance band
  • Gripping exercises for the hands
  • Wrist rotation exercises, such as hand weight rolling
  • Supination/Pronation with a hand weight

Arm Stretching for Gymnasts

  • Wrist flexor stretch
  • Wrist extensor stretch
  • Cross body shoulder stretch
  • Tricep stretch
  • Shoulder flexion stretch on foam roller, wall, or mats
  • Shoulder circles – lie on your side on the floor and draw a circle on the floor with your top arm by rotating your upper body
  • Doorway stretch

Strengthening the Upper Body

Gymnasts have special considerations due to the nature of their sport with weight bearing on the arms. This can lead to injuries of the elbow such as OCD lesions. Strengthening of the entire upper body, including shoulder and wrists, should be incorporated into a conditioning program for both healthy gymnasts and gymnasts recovering from an elbow injury.

For more information, contact an Athletico clinic close to you for a complimentary injury screening.

Schedule a Complimentary Injury Screen

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/.

10 Reasons To Go For A Walk Right Now

On an average day, 30 percent of American adults walk for exercise and with good reason. Walking doesn’t require special equipment or athletic skills, yet it offers a host of health benefits — from helping you lose weight and lifting your mood to controlling diabetes and lowering your blood pressure. In fact, a study published in the journal PLoS Medicine showed that adding 150 minutes of brisk walking to your routine each week can add 3.4 years to your lifespan.

Here are 10 surprising ways to use walking to boost your health, along with tips to make starting and sticking to a walking routine more fun.

1. Walk to Manage Your Weight
Avoiding weight gain might be as simple as taking a walk. Researchers at Harvard University and Brigham and Women’s Hospital in Boston followed more than 34,000 normal-weight women for more than 13 years. They found that, over time, the women who ate a standard diet and walked for an hour a day (or did some other similar moderate-activity exercise) were able to successfully maintain their weight.

Fun fitness tip: Buddy up for fitness — walk with a friend, neighbor, or a four-legged pal. A study published in the Journal of Physical Activity & Health found that dog-owners walked more each week and were more likely to reach the recommended levels of physical activity than those who do not own dogs.

2. Walk to Get Blood Pressure in Line
A heart-pumping walking routine can help lower your blood pressure, studies show. A study conducted at Lawrence Berkeley National Laboratory found that moderate-intensity walking was just as effective as jogging at lowering risk of high blood pressure.

Fun fitness tip: Can’t find a full 30 minutes to walk? Spread it out throughout your day — 10 minutes here and 10 minutes there will add up if you stick with it. According to the Center for Disease Control and Prevention, breaking your workout into several shorter workouts throughout the day is just as effective as one longer workout session, while also making it easier to fit exercise into your schedule.

3. Walk to Protect Against Dementia
Walking, which improves cerebral blood flow and lowers the risk of vascular disease, may help you stave off dementia, the cognitive loss that often comes with old age. According to the 2014 World Alzheimer’s Report, regular exercise is one of the best ways to combat the onset and advancement of the disease. In addition, researchers at the University of Pittsburgh conducted brain scans on seniors and found that walking at least six miles a week was linked to less brain shrinkage.

Fun fitness tip: Download upbeat music you love to listen to on your iPod, and take it with you while you walk. An analysis conducted by the American Council on Exercise found that music not only makes exercise more enjoyable, but it can also boost endurance and intensity.

4. Walk to Prevent Osteoarthritis
Walking is a great form of weight-bearing exercise, which helps prevent the bone-thinning condition osteoporosis, as well as osteoarthritis, the degenerative disease that causes joint pain, swelling and stiffness. Researchers from the University of California, San Francisco, found that people who participated in moderate aerobic activities such as walking have the healthiest knees because walking can help maintain healthy cartilage.

Fun fitness tip: Reward yourself. After you stick to your new walking routine for a few weeks, treat yourself to a new pair of shoes, a manicure, or something else that will keep you motivated.

5. Walk to Reduce Cancer Risk
Walking may reduce your chances of developing some cancers. Research published in Cancer Epidemiology, Biomarkers & Prevention found that women who walked at least seven hours per week were 14 percent less likely to develop breast cancer. Similarly, a study conducted by scientists at the University of California, San Francisco and Harvard University, found that men who were treated for prostate cancer and who walked briskly at least three hours a week reduced their chances of a recurrence.

Fun fitness tip: Explore. Try a new route around the neighborhood, pick a different trail at the park, or go walking in a new location altogether to keep it interesting.

6. Walk to Prevent or Control Diabetes
Brisk walking can help prevent and manage diabetes. “A 20- to 30-minute walk can help lower blood sugar for 24 hours,” says Tami Ross, RD, LD, a spokesperson for the American Association of Diabetes Educators. Plus, The Diabetes Prevention Program, a major government study, found that even a small weight loss — for example, 10 to 15 pounds for a 200-pound person — can delay and possibly prevent the onset of the disease. Adding a brisk walk to your daily routine is one of the easiest ways to reach and maintain a healthy weight.

Fun fitness tip: Dress for the occasion. A good pair of walking shoes and comfortable clothes that are easy to move in are essential for a successful workout.

7. Walk to Lower Your Heart Disease Risk
Walking may help lower your cholesterol and, in turn, your risk for heart disease. According to the American Heart Association, walking just 30 minutes per day can lower your risk for heart disease and stroke. And since regular walking can keep cholesterol and blood pressure in check, it is a great way to boost your overall heart health.

Fun fitness tip: Challenge yourself to walk more steps every day and make fitness more fun, by using a pedometer or other fitness tracking device to chart your progress. You can set new step goals each week and even join challenges with friends and family to motivate yourself to get moving.

8. Walk to Improve Your Mood
A brisk walk can boost your mood and may even help you treat depression. A Portuguese study published in the Journal of Psychiatric Research found that depressed adults who walked for 30 to 45 minutes five times a week for 12 weeks showed marked improvements in their symptoms when medication alone did not help.

Fun fitness tip: Get outdoors! When the weather permits, take your walk outside, for a dose of vitamin D and an even bigger mood boost. Research published in the journal Ecopsychology revealed that group walks in nature were associated with significantly lower depression and perceived stress, as well as enhanced mental well-being.

9. Walk to Reduce Pain
It might seem counterintuitive, but to reduce pain from arthritis, start moving. Research shows that walking one hour per day can help reduce arthritis pain and prevent disability. The study, published in Arthritis Care & Research, determined that 6,000 steps was the threshold that predicted who would go on to develop disabilities or not. Plus, a recent study found that walking significantly improved mobility loss among patients with peripheral artery disease (PAD), a condition where clogged arteries in the legs can cause pain and fatigue while walking.

Fun fitness tip: Add some healthy competition to your walk. As you move down the sidewalk or trail, imagine the people in front of you are rungs on a ladder. Then, focus on walking fast enough to overtake them one by one.

10. Walk to Reduce Stroke Risk
A large, long-term study reported in Stroke, a journal of the American Heart Association, found that women who walked at a brisk pace for exercise had a much lower chance of having a stroke than those who didn’t walk. Researchers credit this to walking’s ability to help lower high blood pressure, which is a strong risk factor for stroke.

Fun fitness tip: Join or start a regular walking club with friends or coworkers and make fun fitness plans for your outings. Recent research published in the British Journal of Sports and Medicine found that participants were enthusiastic, less tense and generally more relaxed after regular, organized walking groups.

By Beth W. Orenstein for Huffington Post

The Runner’s High

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

Key Points:

  • When your body comes under stress or experiences pain, neurochemicals called endorphins and endocannabinoids are produced in the brain. This happens in all age groups.
  • Endorphins and endocannabinoids are considered natural painkillers because they activate receptors in the brain that help minimize discomfort
  • These brain chemicals are naturally produced as a result of exercise and are likely responsible for the feeling called “a runner’s high”

Whether you’re a young athlete or an adult, many of you have experienced a post-workout high. People love the feeling so much that “endorphin junkie” has even become synonymous with someone who’s constantly chasing that exercise high.

When your body experiences physical or even emotional stress, neurochemicals called endorphins are produced in the brain. Endorphins, which are structurally similar to the drug morphine, are considered natural painkillers because they activate receptors in the brain that help minimize discomfort. They can also help bring about feelings of euphoria and general well being.

The idea that exercise creates a huge endorphin rush entered popular culture soon after endorphins were discovered around 40 years ago. The legendary Dr. Jim Fixx started America’s running revolution back in the 1970’s, and there was thinking that endorphins could play a big role in the psychological benefits of running and exercise. But no one really knew for sure.

The problem with jumping to the conclusion that endorphins cause your “exercise high” is that in large-scale studies, scientists measure endorphins present in the blood — not the brain. Then, they make the assumption that if endorphin levels rise in the blood, then it must be because of an increase of endorphins in the brain. It’s a logical assumption but the reality is a bit more complex.

In fact, a German study found that, while endorphin levels are higher after a run, the real brain chemicals responsible for the runner’s high are called “endocannabinoids”. These substances are similar to the key chemical in marijuana. At least that’s true in running mice, who kindly volunteered for the study…

So if you aren’t an endorphin junkie, then what are you? You’re probably an endocannabinoid junkie! That just doesn’t have the same nice ring to it though, does it?

Regardless of what the actual reason is for the good feelings after exercise, the point is that you need to just get out and do something. It’s good for what ails you.

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