Injury Prevention: Little League Pitch Counts and Rest

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We have discussed pitch counts and injury prevention for our young athletes in the past, but with baseball season upon us, it is important to remind parents and athletes of the guidelines. Young athletes feel invincible and feel injury "won't happen to them". As a physician with over 20 years of experience in sports medicine, I can assure you that injuries can and do happen. Luckily, some simple precautions can help minimize injury risk.

It is important to mention that while the old adage “practice makes perfect” is true, our youth need guidance in order to prevent injury. Overuse injuries in school aged athletes are on the rise. The incidence of shoulder and elbow injuries among youth baseball and softball players is five times greater than it was in the year 2000.[i]

Many of these baseball injuries are preventable. In recent years, Little League Baseball has released guidelines and enforced regulations to help prevent injury in young athletes (see charts below). The league has put limits on pitch counts during games and also enforced required rest periods. All the guidelines are based on the age of the athlete.

While the guidelines from Little League Baseball are important, there are additional steps that can be taken at practices and off the field.

Here are some tips:
1. Always warm up – stretch, jog and begin with some easy, gradual throwing
2. Try different positions – different positions require the use of various muscle groups
3. REST – don’t play year round and allow rest between games
4. Focus on your form, accuracy and control
5. If you have shoulder or elbow pain, do not pitch
6. Talk to your parents and coaches about any pain – do not play through the pain!

Getting kids involved in sports at an early age is a great idea, but it is important to remember an injury can end their baseball career too soon. By following the suggestions outlined here, injury can be avoided and a lifelong love of baseball and activity can be built!

ACL Injury and Prevention

ACL injuries are common and on the rise. These injuries can cause young athletes to sit on the sidelines for months, lose out on valuable scholarship money and lead to long term osteoarthritis. It is estimated that over 50,000 high school and college age female athletes suffer from ACL injuries each year.[1] While some of these incidents cannot be prevented, there are steps that can be taken to reduce the number of injuries. 

One common misconception about ACL tears is that they are a result of player-to-player contact and little can be done to prevent occurrence. While ACLs are injured/torn in this manner, most occur as a result of the following: 

• Sudden change in direction
• Cutting maneuvers coupled with a sudden stop
• Awkward landing following a jump
• Pivoting with knee fully extended while foot is planted on the ground

Unfortunately, female athletes are more susceptible to ACL injury. Anatomical differences, such as a greater Q-angle, are primarily to blame. Other factors include weak muscle groups, bad habits, improper form and decreased range of motion. The good news is that while we cannot change the anatomy, we can identify risk factors and help reduce the chance of injury. 

A few suggestions for prevention would include: 

• Strength training – especially the smaller muscles around the knee and the hamstring 
•  Jump routine exercises emphasizing proper form and landing
• Pivoting exercises – also focusing on proper form

These tools are most successful when implemented in early adolescence. By utilizing prevention tools early in life, we can ensure that kids are learning proper form and technique from the beginning. This alleviates the need to undo risky habits in the future. 

Many organizations are implementing pre-season screening programs where professionals can assess athletes and determine if they are high risk for ACL injury. If you have access to one of these programs, take advantage of it and use the prevention tools provided. In future posts, we will also highlight exercises and routines that could be helpful.

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[1] Stopsportsinjuriesnow.org

Case Study: Hard Labor Leads to Rotator Cuff Tear

A 50 year old male laborer came to our office following an injury at work. The patient felt a sudden pain while pulling a heavy object on wheels when the injury occurred.  We suspected a rotator cuff tear based on the symptoms he described. The rotator cuff is comprised of 4 muscles and keeps the shoulder stable and in place.

The patient’s symptoms included:
-          Great difficulty raising his arm overhead.
-          Significant pain and weakness in the shoulder.
-          Intense pain at night that caused difficulty sleeping.
-          Inability to raise arm above shoulder level.

Before Surgery

Before Surgery

After a thorough examination, we sent the patient for an MRI to confirm and determine the severity of the injury.  An MRI of his shoulder revealed a very large full thickness tear involving 2 out of the 4 rotator cuff tendons. Based on these findings, we recommended the patient undergo arthroscopic surgical repair and the patient agreed.

The patient underwent a shoulder arthroscopy; which included removal of a bone spur above the tear and a rotator cuff repair. In our practice, we strive to restore the natural anatomy of the body in any surgical procedure. In this case, we used bio-absorbable anchors and sutures to re-attach the torn tendons to the anatomically correct location of the bone. Anatomic re-attachment helps promote healing and reduces the risk of subsequent injuries.

Following surgery, the patient was placed in a sling for 4 weeks and began physical therapy 3 weeks after surgery. We have seen great success in keeping the shoulder protected for 3-4 weeks following a rotator cuff repair. This allows the shoulder to heal and reduces the risk of repeat tears, shoulder weakness and decreased range of motion. In a recent study at the Center for Special Surgery, this was protocol confirmed as the preferred option to beginning physical therapy sooner. (Click to view full article from the Center for Special Surgery)

After Surgery

After Surgery

Approximately three months post-surgery, the patient was able to lift his arm above his head without difficulty or pain and was able to return to light work duty. Five months post-op, the patient returned to work full duty without restrictions; including heavy lifting and repetitive overhead activities. After completing 5 months of on-going physical therapy, the patient continued to perform strength training exercises on the rotator cuff at home and tells us he is completely healed. He has his full strength back and is very pleased with the outcome of the procedure.

It is important to note that upon the conclusion of formal physical therapy, continued strength training at home is necessary to ensure a full recovery. Most rotator cuff repairs require a full year of healing before full strength returns. By being diligent and continuing a home-based strength training routine, a patient can increase his/her chances for a full recovery without any lingering symptoms. (Click here for some simple strength training exercises for the rotator cuff)

Our office specializes in injuries of the shoulders and knee. We treat each patient as an individual and carefully evaluate the best treatment plan in each case. If you would like to make an appointment, please call 973-300-1553 or visit www.advocareorthosportsmed.com to learn more.