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%.