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%.
Justin Shaginaw, M.P.T., A.T.C.
POSTED: WEDNESDAY, FEBRUARY 5, 2014, 6:00 AM
This is the last blog of a three part series on winter scholastic sports. Let’s head to the mat.
Sprains and strains account for nearly half of all wrestling injuries with the shoulder being more common in high school wrestlers and the knee more common in college. About 40 percent of those injured return to the mat within 1 week.
These injuries should be evaluated by your team’s athletic trainer and appropriate treatment plan developed. This usually includes some time off the mat, rehabilitation exercises (strengthening, stretching, balance, etc), and modalities (heat, ice, etc). For more serious injuries, schedule an appointment with a sports medicine physician for further work up (x-rays, MRI, etc) and other treatment options .
Dislocations/subluxations account for approximately 10% of all wrestling injuries. These are urgent and often times emergent injuries requiring immediate care from an athletic trainer followed by a referral to a sports medicine physician or the emergency room. These injuries most commonly occur to the shoulder, elbow, and patella and require a prolonged period off the mat and rehabilitation.
Lacerations are much more common in college wrestling and account for approximately 10 percent of collegiate injuries. These injuries vary in severity with some being managed by your athletic trainer with an immediate return to practice or the match while others require physician referral for sutures. Suturing may require a period of time off the mat depending on the location.
Fractures are the second most common injury in high school wrestlers accounting for approximately 15 percent of all injuries. These are emergent injuries requiring immediate care from an athletic trainer and referral to a sports medicine physician or the emergency room. Fractures require a significant period of time off the mat and are often season-ending.
Concussions account for approximately 5 percent of injuries for both high school and college wrestlers. The majority of concussions resolve within a week. A small portion will require a prolonged recovery period and may require a significant amount of time away from the sport. All concussions should be taken seriously and evaluated initially by the team’s athletic trainer with a referral to s sports medicine physician trained in evaluation and management of athletic concussions.
Skin infections represented 8.5% and 20.3% of all reported high school and college adverse events respectively.
All wrestlers with a skin infection should be evaluated by a physician for appropriate medical treatment as dictated by National Federation of State High School Associations (NFHS) and the National Collegiate Athletic Association (NCAA). Wrestlers will also need a clearance letter from their physician clearing them to return to practice and competition. There are also prophylactic treatment options for some dermatologic conditions such as herpes which can be prescribed by a physician.
Wrestling injuries are usually due to the combative nature of the sport. As you can see, sprains and strains account for the majority of wrestling injuries. Most of these are minor and can be managed conservatively with a quick return to sports. 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.
Philly.com Sports Doc
POSTED: Saturday, June 8, 2013, 6:00 AM
Justin Shaginaw, MPT, ATC, Aria 3B Orthopaedic Institute, Athletic Trainer - US Soccer Federation
With the outdoor tennis season comes sprains and strains, aching knees and shoulders. Today, we will focus on common tennis injuries, how to prevent them, and how to treat them when they occur:
This seems to be the bane of tennis players as it can be very difficult to treat. Not all tennis players get tennis elbow as some get golfer’s elbow and vice versa. Tennis elbow starts with pain in the lateral elbow where the wrist extensor muscles attach. Golfer’s elbow presents with medial elbow pain where the wrist flexors attach.
There can be many causes of elbow pain including acute soreness from getting back on the court, overuse from playing too much, incorrect grip size, and inappropriate string tension to name a few. One thing that is often a major contributor and is usually overlooked is the shoulder. A loss of internal rotation known as glenohumeral internal rotation deficit (GIRD) and scapular dyskinesis are often times the underlying causes of elbow pain in tennis.
Once symptoms have occurred, rest and ice can help with acute pain. If symptoms persist, it is best to see a sports medicine physician, athletic trainer, or physical therapist that specializes in overhead athletes for an evaluation and treatment recommendations.
Shoulder pain accounts for the majority of tennis injuries. In younger players (under 40) the common culprit is a labral tear. In older players (over 40) we start suspecting rotator cuff involvement. There are numerous causes of shoulder injuries such as overuse, incorrect racket and string tension, and poor form/hitting mechanics. But just as with elbow pain, GIRD and scapular dyskinesis are often times the root of the problem.
This is a problem that we really only see in our high level youth and professional players. In a closed or neutral hitting stance, the majority of power is created from the legs. An open stance limits the legs ability to develop power and instead it is produced through the abdominals via trunk rotation.
With the open hitting stance becoming the norm, we are treating more and more of these injuries. In the past we would usually saw a few rectus abdominus injuries from serves per season. Now, we are seeing a dramatic increase in oblique injuries due to the rotational force with the open stance. Two ways to prevent this injury are to change your stance back to a neutral/closed position and the other is to develop a strong core. If you do experience an abdominal injury, make sure to see a sports medicine specialist as these injuries need to be evaluated and treated appropriately.
There are 3 main injuries to the knee in tennis. The first is an ACL injury, which rarely occurs in tennis due to the mainly linear movement patterns as compared to cutting and pivoting sports such as soccer and football. When an ACL injury does occur, one should see an orthopedic surgeon who specializes in ACL reconstruction to discuss surgical and non-surgical options.
The second and more common knee injury is a meniscal tear. These can be acute in nature in our younger players (under 40) or chronic and degenerative in our older players (over 40). As with ACL injuries, one should see a sports medicine physician to discuss treatment options.
The third and most common knee injury in everyday tennis players is an aggravation to underlying arthritis. This occurs from either overuse or an acute irritation to a pre-existing arthritic condition. The best treatment for these injuries is the old RICE method (rest, ice, elevation, and compression).
Please click on the link to view these exercises. http://www.justinshaginawptatc.com/exercise-programs.html
As with any exercise program, please consult a medical professional if you have any questions or concerns.
There are a few simple exercises that will help keep you in the game. They should be performed 2-4 times a week at the recommended number of sets and repetitions. When in doubt, see an athletic trainer or physical therapist for an individualized program specific to you.
Sleeper stretch: this stretch helps to improve shoulder internal range of motion. Stretches should be pain free. Perform 3-5 repetitions holding for 30 seconds.
No moneys: Will help to improve scapular strength and control. Key is to squeeze your shoulders down and back. Only rotate arms out in a pain free range of motion. Do 2 sets to fatigue.
Timothy Tyler, PT, ATC from the Nicholas Institute of Sports Medicine and Athletic Trauma at Lenox Hill Hospital in New York City has developed an eccentric exercise program for tennis elbow using a rubber bar. His program has been validated by research and has been able to reduce symptoms fairly quickly.
Plank exercises are probably the best and simplest exercises for core strengthening. Key is to contact not only your rectus abdominus (your 6 pack abs) but also your rotators and deep stabilizers (obliques, quadratus lumborum, and multifidus). To do this, suck in your belly button like you are trying to get into a tight pair of pants. Don’t hold your breath. You should feel your abs tight above and below your belly button and more importantly around your sides in your love handle region. Make sure to have good form with the planks (straight as an arrow through your ankles, knees, hips, shoulder and head) and only hold the position as long as you can maintain good form and tightened abs.
Flexibility is important in your thoracic and lumbar spine with extension and rotation being the key factors. Prone press ups or the cobra yoga pose is an excellent way to improve extension. Supine trunk rotation stretches will help maintain and improve rotational range of motion. These should be performed for 3-5 repetitions with 30 second hold. Do not work through pain with stretching.
Flexibility is also key in the lower extremities. Quad, hamstring, and calf stretches should be performed for 3-5 repetitions holding 30 seconds on each side. Once again, stretching should be pain free.
Justin Shaginaw, MPT, ATC is lead therapist and coordinator of sports medicine at Aria 3B Orthopaedic institute.