 (AP Photo/The Oregonian, Ross William Hamilton) Philly.com Sports Doc POSTED: MONDAY, MARCH 24, 2014, 9:40 AM Baseball and softball may be similar sports, but the injury data differs quite a bit. Let’s see what the research says. Injury statistics A 2007 paper in the Journal of Athletic Training looked at softball injuries from 1988-2004 using the NCAA injury surveillance system. Over the 16 years of data collection, the rate of injury was 1.6 times higher in games than in practices (4.3 versus 2.7 injuries per 1000 athlete-exposures). Preseason injury rates were more than double the regular season injury rates. Postseason injury rates were lower than preseason and in-season rates. 43% of injuries occurred to the lower extremity while 33% were to the upper extremity. For game injuries, ankle sprains and knee internal derangements accounted for 19% of all injuries. Concussions accounted for 6% of all game injuries and players were 3 times more likely to sustain a concussion and 2 times more likely to suffer a knee internal derangement in a game versus practice. Of the three mechanisms of injury, contact with something other than another player accounted for 51% of all game injuries followed by non-contact at 27%. Sliding was the highest mechanism for game injuries at 27% while only accounting for a small percentage of practice injuries. Non-contact injuries accounted for 55% of all practice injuries. When looking at injury severity, more than 22% of all game and practice injuries required time missed from participation of 10 days or more. Knee internal derangements and ankle ligament sprains accounted for the majority of injuries requiring time away from sports (30.4%). In games, the base runner, batter, pitcher, and catcher were the positions with the highest risk of injury. (62.3%) Upper Extremity Upper extremity injuries are significantly less common in softball than baseball. This is likely due to the underhand pitching motion for softball which places less stress on the shoulder and elbow. Although injuries such as rotator cuff and labral tears do occur, they are not common in softball. The majority of upper extremity injuries are traumatic injuries to the shoulder wrist and hand such as fractures and dislocations. These traumatic injuries should be evaluated by your athletic trainer who will refer to a sports medicine physician for more server injuries such as dislocations and fractures. Minor injuries such as sprains and strains are usually treated with rest, rehabilitation, and taping/bracing if needed. Lower Extremity Ankle sprains and knee internal derangements are the most common softball injuries. Combined, they account for more than 22% of all injuries requiring 10+ days away from participation. Ankle sprains are the most common injury in softball and are usually the result of sliding into a base. The majority of ankle sprains are minor injuries and can be treated conservatively. Treatment can involve a short time off from play (if needed) with rehabilitation consisting of regaining range of motion/flexibility, strength, and balance. All of this should be done under the guidance of an athletic trainer or physical therapist. Knee internal derangements are the second most common injury and consist primarily of meniscal tears and ACL tears. Whereas ACL injuries require a surgical consult and are almost always season ending, some athletes are able to finish their season with meniscal tears if they are only mildly symptomatic. Once again, a consultation with an orthopedic surgeon should be made to discuss the severity of the injury and treatment options. Other injuries Softball has almost twice as many concussions during games as baseball. This is likely due to the shorter distance to the pitching mound and the smaller infield. The shorter pitching distances may place batters at increased risk of being hit by a pitch. The smaller infield places the players closer to the batter giving less time to react in order to avoid being hit by a batted ball. The smaller infield may also increase the risk of contact with another player. As we have learned from contact sports such as football and hockey, concussions are serious injuries and should be treated as such. An evaluation by a sports medicine clinician trained in concussion assessment should be performed in order to develop an appropriate treatment plan. This may include time away from the classroom as well as from the playing field. Unlike baseball, lower extremity injuries account for the majority of both minor and severe injuries in softball. As with any injury, players should be evaluated by a sports medicine specialist and an appropriate plan of care should be developed.
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 Philly Sports Doc
Justin Shaginaw, M.P.T., A.T.C. Posted: Monday, March 10, 2014 It’s that time of year. Spring sports are in the air, even if the spring weather isn’t. Let’s head to the ballpark and start with baseball. Upper Extremity Upper extremity injuries are the most common area injured for both college and pro baseball players. Shoulder injuries account for approximately 20 percent of all injuries in both pro and college players. These injuries include dislocations, sprains and strains, labral injuries, and rotator cuff injuries. Stats and facts about baseball injuries Dislocations are an emergent injury and immediate medical attention should be sought. In the above research studies, injuries diagnosed as sprains and strains were likely either misdiagnosed or players were given this diagnosis to down play the severity of the injury. Sprains and strains are more likely an underlying rotator cuff or labral injury. Both of these are usually the result of a kinetic chain dysfunction, which is like having your car’s steering out of alignment. By correcting the alignment issues, most shoulder problems can be resolved as long as they haven’t passed the point of no return. Once this happens, surgery is usually the only option to truly fix the problem. Elbow injuries account for approximately 16 percent of pro and 8 percent of college injuries. These injuries include sprains and strains, contusions, and more severe injuries such as ulnar collateral ligament injuries (Tommy John) and posterior impingement. As with the shoulder, elbow injuries diagnosed as sprains and strains were either misdiagnosed or players were given this diagnosis to down play the severity of the injury. Elbow sprains and strains are more likely the precursor to an ulnar collateral injury. And just as in the shoulder, by correcting alignment issues, most elbow problems can be resolved as long as they haven’t passed the point of no return. Pediatric and early adolescent shoulder and elbow injuries need to be assessed by a physician who specializes in pediatric sports medicine. These injuries can be different than the adult injuries due to open growth plates. Two such examples are little leaguer’s elbow and osteochondritis dissecans (OCD). These injuries are the result of throwing too much and overloading the elbow. This is why pitch counts are so important in little league through high school aged players. The first step in treating upper extremity problems in a throwing athlete is to be evaluated by a sports medicine clinician who specializes in the assessment of the kinetic chain. These problems include loss of shoulder range of motion (specifically internal rotation), scapular dyskinesia (shoulder blade weakness/abnormal movement), trunk and hip range of motion, core strength/stability, balance, and lower extremity flexibility and strength (specifically hip rotation range of motion and gluteus medius strength). Rehabilitation is the first step in correcting the underlying kinetic chain issues. Please be aware that not all rehab is the same. An athlete that did rehab and did not get better may not have done the correct rehab. Players should not throw until significant improvement has been made with rehab. In cases where players do not improve with the correct rehab, surgical consultation is the next step if the athlete wants to continue to play. Lower Extremity The 3 main lower extremity injuries in baseball are:
Hand/wrist Hand and wrist injuries account for approximately 10 percent of baseball injuries. These can be minor such as contusions to more serious injuries such as fractures and dislocations. The majority of these injuries are from being hit by a pitch or from sliding. Hand and wrist injuries should be evaluated by your athletic trainer who will refer to a sports medicine physician for more server injuries such as dislocations and fractures. Minor injuries are usually treated with rest, rehabilitation, and taping/bracing if needed. Other injuries Facial injuries are rare in baseball. When they occur, they are usually the result of being hit by a pitch. Examples of these injuries include facial fractures and eye injuries. These can be very serious and need immediate medical attention. Other less common injuries seen in baseball include core injuries/sports hernia, back/neck pain, and foot injuries. All of these should be initially evaluated by your athletic trainer who can develop an appropriate rehab plan as these injuries are usually minor and resolve with conservative treatment. As you can see, upper extremity injuries in baseball are the most common and tend to be the ones that will cause significant time missed from play. The cause of most shoulder and elbow injuries is an underlying kinetic chain problem. Brian Cammarota, MEd, ATC, CSCS, CES, another contributor to the Sports Doc blog, has some great posts on kinetic chain problems, throwing programs, and injury prevention for throwers. Please review some of his posts for further insight into upper extremity injuries in throwers. Philly Sports Doc
Justin Shaginaw, M.P.T., A.T.C. POSTED: MONDAY, MARCH 10, 2014 A 2007 study by Dick et al in the Journal of Athletic Training looked at injury rates for the men’s baseball using the NCAA injury surveillance system from 1988-2004.
Upper leg strains (11%) Ankle sprains (7.4%) Shoulder strains (6.5%). The most common practice injuries were: Shoulder strains (10%) Ankle sprain (8.5%) Upper leg strain (8.3%) Regarding mechanisms of injury, contact with something other than another player accounted for 45% of injuries while 42% of injuries were non-contact. For game injuries resulting in 10 or more days off, lower extremity injuries accounted for 19.7% followed by shoulder and elbow injuries at 4.3%. For practice, shoulder injuries were the major cause of significant time off. Of all shoulder and elbow injuries, pitching accounted for 73.0% and 78.4% respectively. When looking at injuries by position:
A 2011 study in the American Journal of Sports Medicine by Posner et al looked at Major League Baseball injuries from 2002-2008 using information obtained from the MLB disabled list since there is no injury surveillance system in place. They found the general rate of injury was 3.61 per 1000 A-Es. Pitchers had 34% higher injury rate then fielders. Among all player injuries, upper extremity injuries accounted for 51.4%, while lower extremity injuries were 30.6%.
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