Philly.com Sports Doc
Posted: Monday, April 28, 2014
A 2007 study by Dick et al in the Journal of Athletic Training looked at injury rates for the women’s lacrosse using the NCAA injury surveillance system from 1988-2004.
The results show the game injury rate was twice the rate for practice (7.15 versus 3.30 injuries per 1000 athlete-exposures [A-Es]). Preseason practice injury rates were almost twice as high as regular-season practice rates. More than 60% of all game and practice injuries were to the lower extremity.
Approximately 22 percent of all game injuries and 12 percent of all practice injuries involved the head and neck. In games, ankle ligament sprains (22.6%), knee internal derangement (14.0%), concussions (9.8%), and upper leg muscle strains (7.2%) accounted for the majority of injuries.
In practices, ankle ligament sprains accounted for the largest proportion of all injuries (15.5%), followed by upper leg muscle strains (11.7%) and knee internal derangements (6.1%).
Participants had almost 5 times the risk of sustaining a concussion or a knee internal derangement during a game compared with practice and 3 times the risk of sustaining an ankle ligament sprain during a game. The greatest proportion of game injuries (44.3%) resulted from no direct contact. A total of 35.9 percent of game injuries were associated with other contact (primarily stick or ball) and 18.6 percent with player contact. The majority of practice injuries (62.0%) involved a non-contact mechanism. A total of 22 percent of game and 24 percent of practice injuries were severe enough to restrict participation for at least 10 days. In games, knee internal derangements accounted for almost half of all severe injuries, followed by ankle ligament sprains. Head injuries represented 7 percent of the severe game injuries. In practices, lower leg stress fractures, knee internal derangements, and ankle ligament sprains were the primary severe injuries.
Lower extremity injuries account for over 60 percent of all collegiate women’s lacrosse injuries. The majority of these injuries can be divided into the following diagnoses: ankle sprains, knee internal derangements, upper leg strains, and lower leg stress injuries.
Ankle sprains account for 22.6 percent of game and 15.5 percent of practice injuries. These are primarily lateral ankle sprains which are caused by the ankle rolling inward during cutting and pivoting. Most ankle sprains are minor and players can return quickly to practice and competition. These injuries should initially be evaluated by your team’s athletic trainer. Depending on the severity, players with minor injuries may return immediately with taping or bracing. More severe injuries may require time away from the sport and more substantial treatment including evaluation by a sports medicine physician and subsequent rehab. There may be a period of immobilization and limited weight bearing depending on the extent of the injury. Rehab involves regaining range of motion and flexibility, strength, and balance with a gradual progression to full sports activities.
Knee internal derangements account for 14 percent of game and 6.1 percent of practice injuries. The two most common diagnoses are ACL tears and meniscal tears. In women’s lacrosse, ACL injuries account for a great number of knee internal derangement due to the significantly higher rate of ACL injury in female athletes compared to males. Both meniscus tears and ACL tears are serious injuries and should be evaluated by a sports medicine physician. Although most of these injuries require surgery, there are some players who can finish the season. If an athlete is to finish the season with one of these injuries, she needs to undergo a structured rehabilitation program and meet specific objective goals before being cleared to return to sports.
Upper leg strains account for 7.2 percent of games; 11.7 percent of practice injuries. These injuries are primarily hamstring strains. Hamstring injuries can be difficult to treat and there is still debate on the best course of treatment. In my experience, the initial phase of treatment focuses on reducing pain and inflammation while regaining flexibility. The second phase involves regaining strength in the injured and initiating lower level sport specific activities. The final phase involves higher level sport specific activities and a structured return to sport progression.
6.5 percent of practice injuries involve lower extremity stress injuries. These can include stress reaction or exertional compartment syndrome, which combined are commonly called shin splints, as well as stress fractures. Lower extremity stress injuries are almost always due to repetitive overload stress. This can be caused by increased training loads in under conditioned athletes, overtraining, lower extremity biomechanical issues, or a combination of all three. The first treatment is to reduce the volume and/or intensity of training. At times, athletes need to be shut down depending on the severity of symptoms.
These injuries should be evaluated by both the athlete’s athletic trainer and a sports medicine physician to rule out more serious diagnoses such as a stress fracture. The athlete should also have a biomechanical analysis performed to help correct any underlying dysfunction that may be contributing to the problem such as over pronation or weak gluteus medius.
Concussions are the 3rd most common game injury and 6th most common practice injury in collegiate women’s lacrosse. In this study, concussions resulted in 7 percent of all injuries requiring greater than 10 days of missed time. This correlates with concussion research showing that that most concussions resolve within that time frame. 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.
Upper Extremity Injuries
Upper extremity injuries in women’s lacrosse account for less than 1 percent of all injuries and therefore were not tabulated in this study. This is likely due to the rules that prohibit checking in women’s lacrosse.
As you can see, ankle sprains and knee internal derangements (ACL tears and meniscus tears) are the two most common injuries followed by upper leg muscle-tendon strains (hamstrings) and concussions. Upper extremity injuries are uncommon in women’s lacrosse. Any injury should be evaluated by your athletic trainer to assess the severity of the injury and determine the appropriate plan of care.
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 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.
The 3 main lower extremity injuries in baseball are:
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.
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%.
Philly.com Sports Doc
Justin Shaginaw, MPT, ATC, Aria 3B Orthopaedic Institute, Athletic Trainer - US Soccer Federation
Robert Senior, Sports Doc blog Editor
Posted: Monday, January 13, 2014, 6:00 AM
The winter sports season is in full swing. In gyms everywhere the squeak of basketball shoes on the court can be heard. Along with the layups and 3 pointers, there are common injuries that occur. Let’s talk about some of these common basketball injuries and the appropriate treatment.
This is the most common injury in basketball, accounting for 24.6 percent of women’s game injuries and 26.2 percent for men. It occurs when the foot rolls inward spraining the ligaments on the outside of the ankle. Swelling and bruising often occur with the severity of the injury dictating the athlete’s ability to return to play.
Mild ankle sprains can return fairly quickly, sometimes even in the same game with taping or a brace. More serve injuries can take weeks to months to recover. Immediate treatment involves immobilization and ice followed by range of motion, strengthening, and balance/proprioceptive exercises. For athletes that cannot bear weight on their foot, they should be put on crutches and see a physician to rule out a fracture as well as assess the extent of the injury. For prevention, taping and bracing has been shown to reduce the rate of ankle injuries in sports.
Stress injuries (shin splints, stress fracture, etc) are another common basketball injury, usually seen during preseason as athletes transition from softer outdoor fields in fall sports to the hard indoor courts. Initially, symptoms are only with activity. As the problem worsens, pain can occur with walking and even at rest. If not addressed early, it can lead to a stress fracture requiring the patient to stop sports for a prolonged period of time.
The common locations of these injuries are the tibia, medial malleolus, fifth metatarsal, and navicular. Initial treatment involves decreasing impact activities until symptoms resolve and assessing the athlete’s feet for appropriate shoes and possibly supportive inserts. It’s also a good idea to progress practice intensity gradually to allow players to acclimate to the new playing surface. Players that do not respond to conservative measures should be seen by a sports medicine physician for further evaluation.
Knee injuries are the second most common injury in basketball, with ACL injuries being more common in female players. Both meniscal tears and ACL injuries are caused by deceleration and pivoting on a planted foot. The common signs of an internal knee injury include swelling and a feeling of a “pop” or “catching and locking.” Immediate treatment should include ice and crutches if the athlete cannot walk normally followed by a referral to a sports medicine doctor to diagnose the injury.
Research has shown that ACL prevention programs have been effective in reducing the incidence of injury. Some well-known programs are the PEP program (http://smsmf.org/smsf-programs/pep-program), Sportsmetrics (http://sportsmetrics.org/), and the FIFA 11+ program (http://f-marc.com/11plus/home/) . Although some of these are sports specific, they can be easily modified for basketball.
Commonly known as patellar tendonitis or jumper’s knee, this injury presents as pain and tenderness of the patellar tendon. The mechanism of injury is believed to be due to repetitive strain to the tendon from jumping, cutting, and deceleration activities involved in basketball. Treatment includes limiting activity until symptoms improve, as well as ice, quad stretching, eccentric quadriceps exercises, and soft tissue treatments. Patellar tendon straps can also be beneficial. In more chronic cases, medications, injection therapies, and surgery are other options.
In younger patients whose growth plates are not closed, usually under 15, Osgood-Schlatter syndrome is more common. This is an injury to the attachment of the patellar tendon to the tibia. The tendon actually pulls away from the bone causing a boney protuberance that can become painful and tender. The treatment for Osgood-Schlatter syndrome is rest and ice as it is almost always self-limiting.
Finger injuries are fairly common in basketball and occur when players “jam” their fingers on the ball. The injuries are usually simple sprains that can be treated symptomatically with ice and buddy taping. Occasionally these injuries can be more serious such a fracture and tendon rupture. If the player’s finger looks deformed or if they are unable to move it, they should be evaluated by a sports medicine physician to accurately diagnose the injury.
Shoulder injuries are relatively rare in basketball with the most common being dislocations and labral tears. These injuries usually occur when a player is blocked during a shot forcing the arm backwards. For a dislocation, urgent treatment should be sought from the team’s athletic trainer and a physician if necessary. Labral tears should be considered for players with chronic shoulder pain with overhead activities such as shooting, and an appointment with a sports medicine physician should be schedule to accurately diagnose the injury.
The other upper extremity injury seen in basketball is a fracture. These usually occur from falling on an outstretched arm. As with dislocations, the player should be evaluated by the team’s athletic trainer and referred to a physician for urgent care.
As you can see, lower extremity injuries account for the majority of basketball injuries. Many of these are minor and can be managed conservatively with a quick return to sports. With more serious injuries such as ligament/tendon ruptures and fractures, urgent care by a sports medicine physician is advised. The above treatment recommendations are just a guideline and any injury should be evaluated by your team’s athletic trainer or a sports medicine physician to accurately diagnose the injury and provide appropriate care.