On Sunday, the 76ers released an update on guard Markelle Fultz’s right shoulder injury. They stated that after a visit with Dr. Ben Kibler in Lexington, KY, it was confirmed that Fultz did not have any structural impairment but he would be out indefinitely with soreness and scapular muscle imbalance.
Scapular muscle imbalance, also known as scapular dyskinesis, is an asymmetry of the shoulder blades characterized by an abnormal movement pattern of the overused side. This is often seen in baseball pitchers and tennis players due to the repetitive overuse of the throwing or hitting arm. Although typically in basketball, shoulder injuries occur when the arm is blocked during a shot or hits the rim after a dunk.
Media reports stated that Fultz had a cortisone injection earlier in October. These are typically used to reduce inflammation and pain but with Fultz’s continued symptoms, we can assume that the injection didn’t have significant benefit. This supports the scapular dyskinesis diagnosis as injections generally don’t offer relief for this problem.
Return to play can be very difficult to predict, especially with the diagnosis of scapular dyskinesis. Some athletes respond to rehab in a few weeks whereas others require months of work. Rehab focuses on improving scapular stability and movement patters, but also addressing any kinetic chain dysfunctions that may be contributing to the shoulder issue. Sometimes another injury, such as Fultz’s previous ankle sprain, can cause certain muscle groups to overcompensate, resulting in dysfunction elsewhere in the body, like Fultz’s shoulder injury. Think of it as your car’s alignment being off.
The good news in all of this is that the injury appears to be non-surgical. The Sixers will be on top of Fultz’s rehab and will have him back on the court once the scapular dyskinesis and any other movement dysfunctions are addressed. Correcting these dysfunctions will allow Fultz to return to his previous level of performance while minimizing his risk of re-injury.
Add another player to the Eagles “out for the season” list. Jordan Hicks ruptured his left pectoralis major in the final minutes of this past Sunday’s game against Dallas. The injury occurred as Hicks reached his left arm out to tackle Cowboys receiver Cole Beasley. These injuries are usually the result of an eccentric overload on an outstretched arm. The injury occurs as the player is trying to move the arm forward (ie tackle) as the arm is forcefully pushed backwards (ie player running through the tackle). This sudden eccentric load causes the tendon to either rupture near its attachment on the humerus or to pull off of the humerus itself.
The pectoralis major muscle originates on the sternum and ribs and inserts on the proximal humerus at the bicipital grove. The main function of the pectoralis major is to elevate and internally rotate the arm and is the key muscle when performing activities that require power in these planes of motion. Most athletes are unable to return sports that require pushing and tackling, such as football and wrestling, without surgical repair.
A 2014 study by Tarity et al looked at pectoralis major ruptures in the NFL from 200-2010. They found 10 complete ruptures during this period. 5 of 10 were in defensive players and 9 of 10 occurred during games. All 10 occurred on the football field with none occurring in the weight room. The authors were able to obtain the mechanism of injury for 6 of 10, with all of the reported mechanisms involving either tackling or blocking. The incidence of pectoralis major ruptures during the 11-year study was 0.004 showing that it is a rare injury in professional football. All 10 athletes returned to play in the NFL but the study was unable to obtain data to further investigate the long term effect the injury may or may not have had on their careers. Previous studies have shown a much higher success rate with surgical repair versus non-operative treatment with 70% of athletes having excellent results.
The results of the NFL study are very promising for return to play after pectoralis major injuries. This is great news for Jordan Hicks. I’m sure we’ll see him back on the practice field sometime this summer and in the starting lineup come August.
Philly.com Sports Doc
POSTED: TUESDAY, NOVEMBER 25, 2014
If you’re a power lifter or body builder, please stop reading. If you’re a high level athlete, please read with an open mind. Now for the rest of us… My patients ask me all of the time, “What can I do in the gym?” For me, it’s not what you can and can’t do but what you should or shouldn't do.
Why do I say that? Here are just a few of the injuries we've seen in the office from doing the wrong things in the gym: a middle aged women who tore her ACL doing jumping jacks onto a plyometric box, a 60 year old who tore his meniscus when he was forced into deep knee flexion during yoga, and a broken tibia from the bar hitting her leg during Olympic lifting. It’s not that some people can’t do these things; it’s just that most of us shouldn't be doing them.
Here are my top 5 things you should avoid at the gym.
1. Deep squats
I always have this debate with strength and conditioning coaches. Why do they have their athletes squat past 90 with resistance? It’s not functional except for maybe wrestlers and football lineman, and even with them, is it worth the risk of injury? For the rest of us who are just trying to stay in shape it is a recipe for knee pain and meniscus tears. Deep squats put significant strain on the knee ligaments, significant pressure on your patellofemoral joint (knee cap), and it puts your meniscus at significant risk for tearing.
Let’s talk about the meniscus tear more specifically. As we squat down, the knee not only flexes but the femur glides posteriorly on the tibia. From about 90 degrees and beyond, we are putting almost all of the pressure on the posterior horn of the meniscus. Now just add a little rotation and pop, there goes your meniscus. And we know that our menisci start to degenerate over time (starting at about 35-40) placing us at even greater risk for a meniscus tear. Do the theoretical benefits of deep squatting out weigh the risks, absolutely not! So let’s please stop at 90 degrees.
2. Dead lifts
This is another exercise where I also debate people on the risk/benefit of the exercise. Yes, it’s a great exercise to strengthen your hip extensors (glutes and hamstrings) but it’s an even better way to injure your back. Repetitive flexion activities have been shown to be a significant factor in back injuries, specifically bulging and herniated disks. Even if you perform the exercise with perfect mechanics, which none of us do all the time, you’re still setting yourself up for a problem. Just like the meniscus in the knee, the discs in the spine start to degenerate with age. Combine this with an exercise that puts significant strain on the posterior annulus of the disc and you’re in for a lifetime of intermittent back pain. Instead of dead lifts, let’s focus on exercises that will still strengthen your hip extensors with less risk of injury. Lunges, step ups, bridging, and squats above 90 can all accomplish this while limiting the risk of low back injury.
3. Overhead presses
Overhead military press, dumbbell shoulder press, etc., all put your rotator cuff at risk for injury. Every time we lift our arms over head we have the potential for some impingement of our rotator cuff under our acromion. Now add weight and we’re just tempting fate. There is also a common theme with all these problematic exercises I’m writing about: our tissue starts to wear down and degenerate with age.
This is once again true for the rotator cuff. So why do an exercise to strengthen our shoulders that puts our rotator cuff at significant risk for injury? If you want to strengthen your deltoid you just need to do some pushing and pulling exercises. Overhead exercises aren't functional and the risk of injury just isn't worth it. Don’t try to “isolate” your shoulders and instead strengthen them functionally with pushing and pulling exercises such as push-ups and incline pull-ups on the smith press or TRX.
4. Bench press to your chest
I don’t like the bench press because it’s not a functional exercise, but that’s another discussion. The risk with bench press is that when your elbows break the plane of your chest, you’re putting significant strain on the stabilizing structures of the shoulder, specifically the labrum and capsule. Now add heavy weight and it’s a labral tear waiting to happen. And like everything else, the labrum degenerates over time. Clicking in your shoulder? It’s probably a labral tear. If you have to bench, keep the weight reasonable and don’t let your elbows break the plane of your chest. Better yet, do a standing cable column press as it is a much more functional position; just don’t go too deep and your shoulders will thank you.
5. Anything with heavy weights
I’ll be the first to admit that I loved lifting heavy weights when I wrestled in college. It was always a competition of who could bench and squat more. Looking back, bench pressing did nothing for me as a wrestler as I should have been doing more pulling exercises. After two shoulder surgeries, a hip labral tear which has likely progressed to arthritis (no MRI as I don’t want to know), focal arthritis in my knee as well numerous other chronic injuries, my joints wish I had focused on functional training and not weight lifting.
There is starting to be a paradigm shift in the strength and conditioning world. People are turning away from weight lifting and focusing on functional training and injury prevention. Stanford University’s director of football sports performance Shannon Turley is on the forefront of this movement. Instead of having freshman players hit the weight room when they get to school, they focus on regaining flexibility, improving core stability, and relearning correct movement patterns. He has had to write letters to NFL scouts about his program and why his players don’t have a record setting combine bench press but excel on the field and are injury free.
EXOS, formerly Athlete’s Performance, is the provider for strength and conditioning for the Men’s U.S. National Soccer team. Their approach to sports performance is to fix an athlete’s problems/weaknesses. There is little return in trying to improve quad strength in soccer players who already have super strong quads. Instead, you’ll see more gains by focusing on correcting their weaknesses such as limited hip mobility and glute med weakness. Even though we’re not professional athletes, let’s take a page out of their training programs and try to fix our deficits such as flexibility, core strength, and movement patterns and leave the heavy weights on the rack.
As I’m writing this, I’m envisioning the comments that I’ll be getting. But as I always tell my patients, “Is it better to look good or to feel good?” Let’s move away from working out the way we always have and start thinking about our long term health, as many of the exercises we do are counterproductive to our overall goal of living a healthy, happy, and pain free life.
Philly.com Sports Doc
Posted: Monday, May 12, 2014, 9:37 AM
Unlike other collegiate sports, there have been no studies published on track and field injuries using the NCAA injury surveillance system. Therefore, we will look at the few studies that analyze injury prevalence in track and field.
A 2005 article published by Zemper in the journal Medicine and Sports Science suggested that 70-80 percent of all track and field injuries are the result of running events. 75 percent of all injuries are to the lower extremity and the overwhelming majority of injuries occur during practice. A 2011 article by Jacobsson et al in the American Journal of Sports Medicine showed a strong dominance of overuse-related conditions such as tendinopathies and stress fractures in track and field athletes.
These overuse injuries account from 60-90 percent of injuries in various published papers. An article by Alonso et al in 2012’s British Journal of Sports Medicine looked at track and field injuries during the period of the Daegu 2011 IAAF World Championships. Sprint events accounted for 27.7% of all injuries followed by long distance at 17.3%, and jump events at 14.1%.
Let’s look at the some of the different events and the injuries that go along with them.
Sprints and Relays
The most common injury in sprint events is muscle strain, specifically hamstring strain. The mechanism of hamstring injuries is still being debated. These include neuromuscular inhibition, eccentric overload, over-striding, and decreased muscular endurance to name a few. To simplify hamstring injuries, these can be broken down into acute and chronic injuries.
Acute hamstring injuries are the result of a distinct injury such as a sprinter pulling out of a race. These usually involved a tear of the hamstring muscle. These can be minor or more serve where bruising, swelling, and a defect are noted. Hamstring injuries can result in significant time away from training and competition, and early return frequently results in re-injury. Treatment involves management of pain in the acute phase of injury followed by rehabilitation to regain ROM, strength, and eccentric control prior to initiating a running program.
Chronic hamstring pain can be due to a variety of underlying causes. These include incomplete rehabilitation from a previous hamstring injury, overuse injury, and referred pain from other areas such as the lumbar spine. A thorough evaluation from an athletic trainer or physical therapist is needed to determine the underlying cause and to develop an appropriate rehab program.
Middle distance injuries are a combination of sprint injuries and distance injuries. The event distance and the training methods will dictate which type of injury is more likely to occur. As with any injury, the athlete should be evaluated by the team’s athletic trainer in order to develop an appropriate rehab program.
Unlike sprints, long distance injuries are primarily overuse and repetitive stress injuries. These include sprains, strains, and tendinopathies as well as stress fractures, shin splints, and exertional compartment syndrome. Treatment should not only focus on resolving the symptoms but also include a thorough biomechanical evaluation to correct the underlying cause. This should include assessment of footwear, lower extremity alignment, and lower extremity flexibility and strength. This may also include modification of the athletes training program with decreases in frequency, intensity, and/or duration.
Hurdles and Steeple Chase
Hurdles and steeple chase have injuries similar to the above running events but also include more traumatic injuries. With hurdles, injuries can occur from hitting the hurdle or from catching a hurdle resulting in a fall or awkward landing. Steeple chase injuries can occur from stepping onto the obstacle, not clearing the obstacle, or landing from/over the obstacle.
Traumatic injuries can include contusions, ligament sprains, knee internal derangements (meniscus tear, ACL injury) and fractures. These injuries should be evaluated by the team’s athletic trainer and treated accordingly or referred to a sports medicine physician for more serious injuries. These more serious injuries usually require significant time away from training and competition.
Long jump and triple jump
Long jump and triple jump are horizontal jumping events with specific associated injuries. These injuries can be broken down into overuse and traumatic. Overuse injures include tendinopathies and repetitive stress injuries as seen in other events and should be treated as noted previously. Traumatic injuries occur either at takeoff or landing and can include fractures, acute muscle tears, dislocations, serious ligament sprains (such as ankle sprains), tendon ruptures, and knee internal derangements. These more serious injuries should be evaluated by your team’s athletic trainer and referred to a sports medicine physician for appropriate care. These more serious injuries usually require significant time away from training and competition.
High Jump and Pole Vault
High jump and pole vault are vertical jumping events with similar injuries to horizontal jumping events. These injuries can also be broken down into overuse and traumatic. Besides the traumatic injuries noted for long and triple jump, pole vault accounts for almost all of the catastrophic injuries (fatal, non-fatal but causing permanent severe functional disability) and serious (no permanent disability, but a severe injury). These more serious injuries should be evaluated by your athletic trainer and referred to a sports medicine physician for appropriate care. These injuries usually require significant time away from training and competition.
Javelin, shot put, hammer, and discus
Throwing events account for the vast majority of upper extremity injuries in track and field. These include injuries to the rotator cuff and shoulder labrum as well as abdominal injuries from the rotational throws, and lower extremity injuries from planting during a throw. One injury specific to the javelin is an ulnar collateral ligament tear (Tommy John injury).
UCL injuries in javelin are due to the throwing motion and the stress incurred at the elbow, similar to baseball. Throwing injuries need to be evaluated by the team’s athletic trainer and either treated conservatively through rest and rehabilitation or referred to a sports medicine physician when more a more serious injury occurs such as an ulnar collateral ligament tear.
Exertional heat illness
Lastly, environmental factors can cause heat related illness in track and field athletes. Athletes, coaches, and medical staff need to be aware of the environmental conditions (heat and humidity) and monitor athletes for any signs or symptoms of heat illness. Heat illness is an urgent and sometimes emergent issue and needs to be address by the event’s medical staff. Signs and symptoms can include finding it hard or impossible to keep playing, loss of coordination, dizziness or fainting, profuse sweating or pale skin, headache, nausea, vomiting or diarrhea, and stomach/intestinal cramps or persistent muscle cramps.
To truly evaluate an athlete for heat related injury, an accurate core body temperature needs to be assessed by a trained medical professional such as an athletic trainer. Cooling measures should be implemented with the best method being ice immersion. For those athletes with a core temperature over 104° and showing signs or symptoms of heat illness, immediate cooling should be implemented and emergency response should be initiated as heat stroke is likely.
The National Athletic Trainers Association has an excellent web page on How to recognize, prevent, & treat exertional heat illness: http://www.nata.org/nr072606
As you can see, not only do we see lower extremity injuries in track and field, we also see upper extremity injuries and environment injuries such as exertional heat illness. Although most of the injuries are minor, there are urgent and emergent injuries in track and field and these are best managed by the team’s athletic trainer and medical staff.
(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.
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 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.
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.
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.
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.
Justin Shaginaw, M.P.T., A.T.C.
POSTED: WEDNESDAY, FEBRUARY 5, 2014, 6:00 AM
A 2008 article by Yard et al in The American Journal of Sports Medicine calculated rates of injury among high school and college wrestlers during the 2005-2006 season using the High School Reporting Information Online (RIOTM) and the NCAA Injury Surveillance System (ISS). It also characterized the incidence and type injuries and compared risk factors for high school and college wrestling injuries.
There were 387 injuries among participating high school wrestlers during 166,279 athlete-exposures, for an injury rate of 2.33 injuries per 1000 athlete-exposures (AE).
258 injuries occurred among college wrestlers during 35,599 athlete-exposures, for an injury rate of 7.25 injuries per 1000 AE. The injury rate was higher in college than in high school.
Injury rates were higher in matches than in practices for both high school and college.
Strains/sprains accounted for approximately half of all high school (48.1%) and college (49.2%) injuries. The most common high school injury sites were the shoulder (18.6%) and knee (15.4%) while the knee (24.8%), shoulder (17.8%), and head/face (16.6%) were most common in college.
The most frequent high school injuries were:
Philly Sports Doc
Justin Shaginaw, MPT, ATC, Aria 3B Orthopaedic Institute, Athletic Trainer - US Soccer Federation
POSTED: MONDAY, JANUARY 27, 2014, 9:40 AM
My last blog was about basketball injuries. Let’s dive into the pool and talk about common swimming injuries.
Poor swimming mechanics may be a contributing factor in many swimming injuries. But assessing these mechanics is beyond the expertise of most sports medicine. Your swimming stroke should be assessed by your coach, taking into account your specific injury, in order to eliminate an underlying biomechanical cause. A team approach should be taken with swimming injuries incorporating these stroke changes along with a specific rehabilitation program from your athletic trainer or sports medicine provider.
Shoulder/upper arm injuries are the most common body area injured in swimming. These injuries can generally be categorized into two causes: flexibility and strength issues.
From a flexibility stand point, shoulder injuries are usually from being too loose (hypermobile) or too tight (hypomobile). Hypermobility allows the shoulder ball to subtly move around in socket where hypomobility stresses shoulder structures due to lack of flexibility.
Strength issues are usually seen as problems with scapular (shoulder blade) positioning and stability. Shoulder injuries should be thoroughly evaluated by your team’s athletic trainer or a sports medicine specialist to assess the underlying cause of the problem and develop an appropriate treatment plan which may include time out of the pool, rehabilitation, medications, injection, and even surgery when indicated. Common diagnoses include rotator cuff tendonitis/impingement, biceps tendonitis, rotator cuff tear, and labral tear.
Neck and back injuries are the second most common behind the shoulder. Swimming puts significant stress on the spine, specifically rotational stress on the cervical and thoracic spine. Common diagnoses include sprain/strain, spondylolysis, and disc derangement (bulge, herniation, etc).
As with the shoulder, these injuries should be evaluated thoroughly by your team’s athletic trainer or a sports medicine specialist to assess the problem and develop an appropriate treatment plan which usually includes time out of the pool, rehabilitation, and medication.
Hip pain is an uncommon problem in swimming and is more frequently associated with the breast stroke due to the rotational motion of the kick. Some common diagnoses for hip pain in swimmers include sprain/strain, femoral acetabular impingement, and labral injuries. As with the shoulder, these injuries can generally be categorized into two causes: flexibility (hyper or hypomobility) and strength issues. Your team’s athletic trainer should assess the injury and either provide an appropriate rehabilitation program or refer the athlete to a sports medicine physician for further evaluation and treatment options.
Patellofemoral pain is another uncommon problem in swimming. It is also known as anterior knee pain or chondromalacia and its main symptom is pain behind the knee cap. More common in females than males, patellofemoral pain is usually the result of overuse from the kicking motion involved in swimming.
The first line of treatment is an evaluation by your team’s athletic trainer to put together an appropriate rehabilitation program including lower extremity stretching and strengthening. It may also require some time out of the water to allow the symptoms to subside. Patellofemoral pain from swimming is of a different etiology than weight-bearing sports where the underlying problem is a biomechanical/kinetic chain dysfunction.
Hand and wrist injuries are relatively uncommon in swimming. They include finger sprains/fractures from contact with the wall and overuse injuries of the elbow and wrist such as sprains/strains and tendonitis. Finger injuries should be evaluated by your athletic trainer and referred to a sports medicine physician if a fracture is suspected. Overuse injuries are usually the result of overtraining or poor swimming mechanics. These injuries should also be evaluated by your athletic trainer. Treatment may include time out of the pool, rehabilitation, and referral to a sports medicine specialist if indicated.
As you can see, upper extremity injuries account for the majority of swimming injuries. Many 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.
Swimming injury prevention brochure from the STOP (Sports Trauma and Overuse Prevention) Sports Injuries program: