It’s No Fish Tale – These Uncommon Hand & Upper Extremity Fishing Injuries Can Really Happen!

Located on the Gulf of Mexico and home to hundreds of lakes, it’s no wonder that the Texas coast is the playground to fishing enthusiasts far and wide.

Barracuda

unhook stingray2But even the seasoned sportsman can fall victim to some unlikely fishing injuries affecting the hand and upper extremity. In fact, fishermen (and women) put themselves in danger every time they come into contact with marine life – unpredictable behavior/aggressive and often forceful nature of a catch, prevalence of less commonly treated bacteria, unsanitary tools/equipment, poor wound care – all contributing to some common and not so common injuries that hand specialists see in a region like the Texas Gulf Coast.

Some common fishing injuries and conditions with which a Texas hand surgeon is all too familiar include:

fillet_2Many of these common injuries and conditions are treated non surgically and follow the same treatment protocol as any other patient with the same diagnosis – regardless of the cause.

Uncommon Hand & Upper Extremity Fishing Injuries and Conditions

Though there is very little that surprises a hand specialist practicing in “sportsman’s paradise,” an unusual injury associated with fishing will occasionally make its way to a Texas medical clinic.

Some of these uncommon injuries and conditions include:

  • Sting Ray Laceration
  • Fish Bite / Impalement
  • Fish Handler’s Disease / Bacterial Infection
  • Lodged Fish Bones, Fin Spine 

Unlike other injuries that break the skin, these types of fishing injuries are particularly concerning.  Fish and other marine life carry bacterial infections within their bodies, as well as on their skin, which can affect humans if certain precautions are not taken immediately. Some types of bacteria found in marine life are not commonly seen and do not respond to conventional antibiotics frequently used for infections.

Additionally, some marine life such as the Sting Ray utilize defense mechanisms that require special attention when used against a fisherman.

Sting Ray Laceration
While many sting ray injuries involve an inadvertent encounter between a foot or other lower extremity and a sting ray’s barb, some have occurred to the hand or wrist while trying to remove a sting ray from a fishing net or line.

These types of lacerations require more than bandaging.  Not only do sting ray barbs pierce like a weapon, all sting rays are armed with at least one serrated venomous spine at the base of their whip-like tail.  Short-tail sting rays have two tail spines: a slender spike in front of a large, jagged bayonet (1).

In addition to possible damage to muscle, tendons and nerves that can occur from the physical impalement of a sting ray barb, its venom is comprised of many different substances that can cause tissue to break down and die.
Some of the symptoms that Sting Ray venom can cause include:

 

  • Immediate and severe pain radiating up the affected limb
  • Bleeding and swelling in the affected area
  • Sweating
  • Faintness, dizziness and weakness
  • Low blood pressure
  • Salivation, nausea, vomiting, diarrhea
  • Headache
  • Shortness of breath (2)

 

Medical attention is recommended for all sting ray injuries.  Minimally, the wound will be cleaned with warm water to remove the venom and a tetanus booster given if it has been more than five years since the last tetanus booster. Tetanus prevention is required if the patient has never had a tetanus vaccination.  Antibiotics may also be required, and depending on the severity of the injury and amount of damage sustained (often the result of the delay in seeking treatment), surgical intervention to repair soft tissue damage and/or a period of rehabilitation may be required to restore strength to the injured limb (2).

Fish Bite and Impalement
While not every fish injury comes with a venomous double blow, the high risk of bacterial infection and soft tissue damage can be just as serious.  Many fish have sharp teeth, tails and pointed features that can easily break the skin.  Wrestling the unwilling catch onto the boat or beach can leave some sportsmen a bit worse for the wear.

 

Aside from the bacterial concerns that come with marine life, the forceful impact from a sharp feature of the fish can result in soft tissue damage that may require surgical repair and/or months of rehabilitation to restore hand and upper extremity function – as the hand alone is comprised of approximately 34 muscles, 120 known ligaments, and 50 nerves!

 

These types of deep puncture wounds or lacerations in the hand are also at high risk of infection and should be monitored closely.  A delay in the appropriate treatment can lead to complicated tenosynovitis and horseshoe abscess.  Additionally, marine life bacterial infections resulting from Mycobacterium marinum (M. marinum) do not respond to some conventional antibiotic treatment such as amoxicillin (3).

Fish Handler’s Disease
Not every fishing-related Mycobacterium marinum infection is the result of an obvious injury/wound.  A condition known as Fish Handler’s Disease can impact those frequently handling fish and generally affects the hands.  Any inconspicuous cut or small opening on the skin can allow the bacteria to enter the body.  The bacteria’s inability to proliferate in the warm body confines it to the affected area.

 

Common symptoms include swelling, tenderness, and bluish-purple spots. Fish Handler’s Disease is treated with special antibiotics used specifically for this type of bacterial infection.  Recovery can take months.

Lodged Fish Bones, Fin Spine
Occasionally in the handling of fish a fish bone or fin spine can lodge in the hand. Though this may not be painful or immediately worrisome to the injured party, these types of injuries are concerning.  Such injuries often leave residual fragments of foreign organic matter in the soft tissue, which can cause secondary infections such as Staphylococci and Streptococci (4).

 

Typically, x-rays are used first to try and identify a foreign body in the tissue, though are not always successful in doing so.  An MRI may be indicated to identify fine fin spines and tiny bones lodged in the body’s tissue. The surgical removal of the foreign body is important.  Failure to seek and remove the foreign body may lead to persistence of infection (4). Multiple surgical procedures may be required, and the patient is put on antibiotics to prevent infection. Physical therapy may be required after surgery to regain mobility of the hand.

 

If this type of injury goes untreated it can result in permanent disability and hospitalization for infection. Though the area may look as if it has healed, but is still tender, swollen, discolored, or abnormal in any way, individuals are urged to see a hand specialist.

 

Prevention and Precaution
Understanding the unique aspects of the marine life occupying the waters you’re sporting and utilizing protective gloves and garments while fishing can go a long way in injury prevention.  As the largest organ of the human body, our skin serves as a protective barrier.  When any area is compromised, our entire body is compromised. Individuals with other health conditions, such as diabetes or immune deficiency disorders should be particularly cautious and consult a hand specialist for proper wound care.

If not addressed properly, even seemingly minor fishing injuries can result in serious infection, lingering weakness or permanent disability – inhibiting participation in the sport you love.

 

References

 

What Spring and Summer Mean to Our Musculoskeletal Health

Spring has finally arrived and time isn’t the only thing jumping forward.  Our enthusiasm for the outdoors is renewed and our activity schedule is ramped up.  From the slopes to spring sports, new plantings and training for one of the biggest bike rides in Texas, the potential for overuse injuries is particularly high this time of year – following less active winter months.

Some of the musculoskeletal injuries and conditions most commonly seen in the spring and summer months include:

  • Skier’s Thumb
  • Friction Blisters
  • Allergy-Related Muscle Fatigue / Joint Pain
  • Carpal Tunnel Syndrome
  • Golfer’s Elbow

Skier’s Thumb

Though the skies and poles are packed away, signs of a common injury following an active ski season may linger a bit longer.  Skier’s thumb, also known as Texter’s Thumb skiers-thumb gardening cycling MLB: Oakland Athletics at Chicago White Sox golfing tennisamong millennials, refers to injury of the unlar collateral ligament (UCL) of the thumb’s metacarpal phalangeal (MP) joint.  This occurs when the abnormal pulling of the thumb, such as that from a fall or harsh pull while affixed to the ski pole/hoop, causes a forced abduction or hyperextension of the proximal phalanx of the thumb. If unaddressed, this injury is further exacerbated by the repetitive use of the injured thumb in texting.

Friction Blisters

While the most common concerns during baseball season include pitch count and the stress that excessive pitching and throwing has on a player’s elbow and shoulder over the course of a baseball season, these generally occur mid to late season following many practices and games.

A lesser known injury often occurs as the season gets started and impacts pitchers in particular – friction blisters.   The repeated trauma created between the baseball seams and the fingers of the pitching hand, predominately at the tips of the index and long fingers, can result in friction blisters.

Friction blisters, which are the result of repetitive friction and strain forces that develop between the skin and various objects, are also common this time of year among those increasing gardening efforts and tennis players hitting the court.

Friction blisters form in areas where the “stratum corneum” and “stratum granulosum” are sufficiently robust such as the palmar and plantar surfaces of the hands and feet [1].

 

Allergy-Related Muscle Fatigue / Joint Pain

With the vibrant colors of spring come seasonal allergies and a host of symptoms that can sometimes make involvement in many of these long-awaited activities a challenge.  While pollen allergies most commonly cause nasal congestion, a runny nose, a sore/scratchy throat and itchy eyes, they can also cause hives, itchy skin, chronic cough, mood changes and body aches/muscle and joint pain. After exposure to pollen, the body reacts to it as a foreign invader by releasing antibodies and natural chemicals called histamines. Histamine is a substance that causes inflammation in the body. Sometimes allergies can advance to bronchitis and mimic flu-like symptoms, including a low-grade fever, body aches and muscle fatigue which can make everyday activity and exercise more challenging if unaddressed. Continuing to train or play while the body fights to overcome allergy challenges can predispose the musculoskeletal system to injury.

 Carpal Tunnel Syndrome

Carpal Tunnel Syndrome (CTS) is one of the most common overuse conditions seen in hand and upper extremity orthopedic care.  In the spring and summer, it is often the result of new activity excessively engaging the hand and wrist such as gardening and cycling. It is generally the result of irritation and swelling, which causes compression within the narrow carpal tunnel located at the wrist – through which one of the major nerves in the arm, the median nerve, passes.  This nerve becomes irritated in the compressed tunnel and can cause numbness, pain, tingling and weakness in the thumb, index and middle fingers.  CTS can come on quickly and command attention or linger with varying degrees of pain that becomes gradually more intense over time.

Another hand and wrist condition, Handlebar Palsy, also known medically as ulnar neuropathy, is an overuse or repetitive stress condition that affects cyclists, though generally after completion of a long, competitive ride.  It is the result of direct pressure placed on the ulnar nerve at the hand and wrist – from the grip of a cyclist’s hands on handlebars, causing stretching or hyperextension of the nerve.

 

Golfer’s Elbow

While the greens are rarely bare in Houston, golfing tournaments really ramp up in the spring and so too do one of the most common overuse conditions associated with the sport – Golfer’s Elbow.  Also known as medial epicondylitis, Golfer’s Elbow affects the muscles and tendons on the inside (medial) portion of the elbow. The repeated activity of swinging the golf club places strain on the elbow, irritating and inflaming the tendons and muscles at the elbow joint.  This inflammation can cause pain on the inside of the elbow, as well as in the forearm and wrist.

 Preventing Injury

Easing into new activity gradually and preparing appropriately can reduce risk of overuse injuries and conditions.  Strengthening muscle groups equally and stretching sufficiently both before and after activity are key, particularly after less active winter months.

Ensuring proper equipment (cycling and other ergonomic gloves and tools) and products (moisturizing to reduce calluses and blister risk) can protect the parts of the body most vulnerable to some of these spring activities and sports. Behavior/activity modification can also help to distribute stress to different parts of the body, reducing repetitive impact on one particular area.

While allergies are often unavoidable, antihistamines and corticosteroids can reduce symptoms and improve performance.  Understanding the associated muscle fatigue and joint pain will help you modify activity accordingly to avoid injury.

Periodically resting and refraining from the activity causing pain can help restore limb strength and prevent more serious injury or damage to the affected area.

 References

[1] McNamara AR, Ensell S, Farley TD. Hand Blisters in Major League Baseball Pitchers: Current Concepts and Management. Am J Orthop. 2016 March;45(3):134-36.

Cowboy Casualties and the Rigors of Rodeo Life

While the Houston Livestock Show and Rodeo has come and gone, the rodeo athletes who kept us captivated as they rode, roped and wrangled their way across the arena for the duration are on to a new city – and not even half way through their rodeo season.

The life of a rodeo athlete, many true cowboys at heart, is one of unyielding dedication and physicality.

Those who have participated since youth in rodeo events have built both strengths and vulnerabilities to the ongoing rigors of rodeo life. Proper mental and physical conditioning are key in avoiding serious injury.Rodeo Quote

While many of the injuries commonly associated with these athletes include concussions and fractures, others are the result of ongoing strain placed on the same limbs, ligaments and joints day in and day out for months at a time.

Many rodeo athletes begin in their teens, tie-down roping calves before progressing to adult wrangler, bull or bare back rider.  The years of hand and upper extremity strain predisposes this athlete to tendonitis in the hand, wrist, elbow and shoulder. Known as a repetitive stress or overuse condition, without proper treatment it can cause chronic inflammation, joint instability and eventually the early onset of arthritis.

Recognizing early signs of tendinopathic injuries and conditions and establishing an effective treatment program is key.

Tendonitis

Tendonitis (also spelled Tendinitis) is the inflammation of the tendons and other soft tissue connecting muscle to bone.  It is most often caused by repetitive movement, placing strain on the tendon and negatively impacting the affected area over time.  It may also occur following a sudden more serious injury such as a fracture or dislocation.

Tendonitis can affect different parts of the body.  Some of the commonly diagnosed upper extremity tendinopathies include Tennis Elbow, Golfer’s Elbow, deQuervain’s Tenosynovitis, Pitcher’s Shoulder and Swimmer’s Shoulder – named after the repetitive motion and sport implicated.  Though, many other activities and types of sports can result in one of these types of tendinopathies as well.

Among rodeo athletes, wrist tendonitis and tendon damage is particularly common, both as a result of the repetitive stress on the wrist and fractures and other trauma this athlearthritis_tendinitis_elbow_strainte sustains.

Symptoms

Symptoms of tendonitis may include;

  • Pain and swelling
  • A feeling of friction as the tendon moves
  • Warmth and redness about the affected area
  • A lump that develops along the tendon
  • Difficulty moving

A tendon rupture may result in a gap felt in the line of the tendon and would manifest with weakness or lack of function of that muscle.

 

Tendinosis

Tendinosis is often referred to as “chronic tendonitis” and is damage to a tendon at a cellular level.  In fact, “osis” represents a pathology of “chronic degeneration” without inflammation.  Key identifiers include disrupted collagen fibers within the tendon, increased cellularity and neovascularization.  This condition is thought to develop from micro tears, repeated injury and increases the risk of tendon rupture. While pain associated with this condition may be addressed similarly to that of tendonitis, emphasis is on stimulating collagen synthesis and breaking the cycle of tendon injury.

Extensor Carpi Ulnaris (ECU) InstabilityWrist Tendonitis

The ECU tendon of the wrist attaches the ECU muscle to the bone and is responsible for straightening and rotating as well as gripping and pulling movement in the wrist and hand. While this tendon normally slides over the forearm (near the little finger), held in place by the retinaculum (ligament-like structure), damage to the area can cause it to slip in and out of place (sublux) or dislocate completely.

Treatment

Treatment for and recovery from a tendinopathic condition will depend on the type and severity.  While minimally invasive corticosteroid injections have proven effective in relieving pain, rest from the repetitive activity contributing to the condition is also indicated.  Stretching and strengthening exercises are also proving effective.

In severe cases, or when the tendon becomes displaced and nonsurgical treatment fails to resolve the problem, surgical intervention may be indicated.  Surgical intervention may include repair of the retinaculum, tendon lining (tendon sheath), or tendon – or to replace the tendon if it is torn.

Prevention

While many injuries in the life of a rodeo athlete cannot be avoided, damage can be reduced by staying fit and strong overall.  Strength and flexibility, combined with periods of rest and other activities involving different muscle groups will help reduce risk of injury and the impact of a tendinopathic condition.

According to long time rodeo professional and bareback rider Cody Goodwin, “every ride is like getting in a car wreck.”

“You have to be in pretty darn good shape, which is why I jog four miles every other day and lift weights every other day – to develop lean muscle mass,” said Goodwin.

“I take good care of my body, so that I can, at my age, continue to compete with 20 and 25-year-old riders,” added the 41-year-old rodeo veteran.

Dr. Korsh Jafarnia is the hand and upper extremity specialist at UT Physicians / Memorial Hermann IRONMAN Sports Medicine Institute (Memorial City and Texas Medical Center locations), 713.486.1700.

Defending Against Turf Trauma

Football is now more than half way through the season, and we’ve seen our share of sprains, fractures, and concussions.  Many of these injuries have been discussed at length, so we thought we would talk about a growing concern; injuries occurring from or made worse as a result of the synthetic turf our kids are playing on today. Turf Concerns in Sports

Synthetic Turf Concerns

At the professional level, there is concern that the difference in buoyancy and other  attributes of synthetic infilled turf may contribute to increased risk of ligament injuries and overall musculoskeletal wear, resulting in prolonged fatigue and recovery between games. While studies continue to assess these concerns without conclusion, debates grow in women’s soccer and are capturing the attention of parents of young athletes playing on artificial turf across the United States [1,2].

There have also been a number of studies assessing increased risk of infection in football associated with playing on synthetic turf.  While studies are ongoing, there are currently no scientific findings to conclude that synthetic turf results in a higher number of infections than natural turf.  The abrasive nature of this artificial turf, though, has certainly resulted in an increased number of severe abrasions and lacerations of the skin, leaving players more vulnerable to infection.

The surface temperatures of synthetic turf are also significantly higher than that of natural grass turf when exposed to sunlight (Buskirk et al., 1971; Koon et al., 1971; and Kandelin et al. 1976, Devitt et al., 2007, McNitt et al., 2007).  This may contribute to increased bacteria growth.

Turf concerns have been noted as early as 2003 when Connecticut’s Department of Public Health launched an investigation into infections in a Connecticut college football team [3]. Of the 100 players studied, those with turf burns had an infection risk seven times higher than their scraped teammates. Cornerbacks and wide receivers, who frequently come into contact with other players, accounted for most cases. Improperly treated whirlpools could also have helped spread the bacteria.

When these bacteria become resistant to antibiotics they can spread and cause pneumonia, bone infections, or life-threatening infections of the bloodstream that are difficult to treat.

Reducing Risk for Turf Related Skin Infections

Each football season, we see a growing number of skin infections related to synthetic turf burns, abrasions and lacerations.  While many of these infections can be treated with antibiotics, those more resistant require special attention.  Parents and coaches are encouraged to educate their athletes on preventive practices to avoid the dangers of a serious skin infection.

Signs of a Turf-Related Skin Infection

Two of the most common skin infections associated with turf, both natural and synthetic, are Staph (staphylococcus bacteria) and MRSA (resistant staph).

Staph is one of the most common forms of infections that can develop from a turf wound.  This type of skin infection, also referred to as cellulitis, may or may not result from an open sore/wound.

Possible Symptoms of a Skin Staph Infection include: 

  • An area of tenderness, swelling, and redness
  • Inflammation — redness, warmth, swelling, and pain
  • Fever and sweats, as well as swelling in the area (if the infection has spread)

MRSA is a more serious type of staph infection resistant to many of the antibiotics used to treat staph and other common infections.  These types of infections require special antibiotic therapy.

Possible Symptoms of a MRSA Infection include:

  • General feeling of poor health (malaise)
  • Skin rash
  • Headaches
  • Muscle aches
  • Chills / Fever
  • Fatigue
  • Cough
  • Shortness of breath
  • Chest pains

Treatment of Staph and MRSA Infections

Treatment for Staph infection generally entails a course of antibiotics.  Treatment for MRSA requires a special class of antibiotics or a combination of multiple antibiotics – depending on the patient’s response and the severity of the infection.

Reducing Risks of Skin Infections

The Center for Disease Control (CDC) has outlined the five primary conditions for contracting and spreading MRSA and Staph infection.  Referred to as the Five “C’s”:

  1. Crowding
  2. Contact – frequent skin to skin
  3. Compromised Skin (cuts, scrapes, abrasions)
  4. Contaminated Items (sweaty towels, clothes, mats, synthetic turf)
  5. Cleanliness

For the prevention of skin infections, it is important that athletes:

  • Keep wounds covered and contained
  • Shower immediately after participation
  • Shower before using whirlpools
  • Wash and dry uniforms after each use
  • Report possible infections to coach, athletic trainer, school nurse, other healthcare providers, or parents

Other CDC recommendations addressing MRSA and Staph infection in sports can be found on their website: http://www.cdc.gov/mrsa/community/team-hc-providers/index.html .

References

1.) Meyers MC, Barnhill BS.  Incidence, causes and severity of high school football injuries on FieldTurf versus natural grass:  a 5-year prospective study. Am J Sports Med. 2004 Oct-Nov;32(7):1626-38.

2.) http://www.usatoday.com/story/sports/soccer/2014/10/15/alex-morgan-us-women-artificial-turf-world-cup/17295011/

3.) Begier et al. 2004. A High-Morbidity Outbreak of Methicillin-Resistant Staphylococcus aureus among Players on a College Football Team, Facilitated by Cosmetic Body Shaving and Turf Burns. Clin Inf Dis. 2004;39:1446-53.

(Keywords:  synthetic turf, artificial turf injuries, lacerations, Staph infection, MRSA, sports injuries, skin infections)

STRIKE!

Looking behind the baseball at UCL injuries … and the role former Los Angeles Dodgers pitcher Tommy John plays

 

The goal of every great baseball pitcher is to strike out the batter.  To do this requires not only talent but extreme power every…single…pitch.

Few other athletes are required to throw with this kind of power as frequently as a pitcher.

Over the course of a baseball career, particularly if begun at a young age and played competitively, this high speed force repeatedly placed on the elbow can take a toll.

Often beginning with Little Leaguer’s Elbow, a condition affecting young pitchers who do not allow adequate rest between pitches, a baseball player’s elbow joint absorbs a tremendous amount of repetitive stress over the seasons.  The impact of this type of overhead throwing irritates the tendons and ligaments supporting the elbow joint, predisposing pitchers to more serious problems.  One such injury is an Ulnar Collateral Ligament (UCL) injury.

Once seen primarily in adult athletes, the dramatic increase in more serious overuse injuries like UCL damage, Flexor Tendinitis and Valgus Extension Overload (VEO) in young players prompted the American Sports Medicine Institute (ASMI) and the USA Baseball, Little League Baseball and Major League Baseball organizations to establish Pitch Count Guidelines.

While these changes and educational efforts are expected to reduce the number of overuse injuries seen in young players, competitive league players remain at risk.

Ulnar Collateral Ligament (UCL) Injury

Elbow Anatomy and UCL Injury

The Elbow Joint and location of the Ulnar Collateral Ligament

The ulnar collateral ligament (UCL) is among the most commonly injured ligament in throwing athletes.  To accommodate the high speed throwing motions, the ligament stretches and lengthens until it can no longer hold the elbow bones tightly enough. Severity of the injury can range from a sprain with minor damage and inflammation to a complete tear.

Symptoms Include:

baseball bullet

Pain on the inside of the elbow

baseball bulletA feeling of instability in the elbow

baseball bulletLoss of strength in throwing

baseball bulletIrritation of the ulnar nerve (funny bone) causing numbness in the small and ring fingers

Diagnosis and Treatment

A UCL injury is diagnosed based on the results of a physical examination, X-ray and MRI.  Depending on the severity of the damage, rest and refrain from play along with rehabilitative exercises and anti inflammatory medication may be indicated. Work with an athletic trainer may also be helpful, to assess throwing mechanics and improve body positioning which can reduce excessive stress on the elbow.

If there is a complete tear of the ligament and patients fail to improve with conservative treatment, surgery may be indicated.

The UCL reconstruction procedure, which was performed on former Los Angeles Dodgers pitcher Tommy John and is more commonly known as Tommy John surgery today, has dramatically changed the outcome for athletes.  In fact, his results were so impressive, it is reported that young players not actually suffering from a UCL injury have sought Tommy John surgery in hope that it would improve their performance [1]!  The procedure, though, is performed only when necessary to repair a severely torn UCL.

Tommy John surgery is a surgical graft procedure in which the injured UCL is replaced with a tendon graft taken from the forearm or the hamstring tendons.  This procedure is followed by an intense rehabilitation program that lasts from six months to a year, depending on the position an athlete plays.  Throwing exercises can begin in about 16 weeks.

The Role Tommy John Continues to Play

In the medical community, Tommy John remains credited with the shift in how athletes view UCL injuries. Once career ending, today UCL reconstruction has become a common procedure – returning most athletes to their sport at a pre injury level of play.

In the sports world, Tommy John is still revered for the excellent athlete he was, choosing baseball as his sport of choice and playing in all three of the Yankees vs Dodgers World Series in his era (1977, 1978 and 1981).

Undergoing the procedure in 1974 and spending his entire 1975 season in recovery, he learned to pitch in a way that relieved the stress he was placing on his arm and leg.  He returned to the Dodgers in 1976. His 10-10 record that year was considered “miraculous.”  But, he went on to pitch until 1989 winning 164 games after his surgery – just one game shy of baseball great Sandy Koufax.

The recognition he received for his unexpected success following the procedure now donning his name became the launching pad for other endeavors benefiting young baseball players.

His “Let’s Do It” foundation, which umbrellas the Tommy John Pitching Academy, is today dedicated to research in preventing such injuries and teaching pitching techniques that minimize the physical impact. The foundation also supports the efforts of the American Orthopedic Society for Sports Medicine (AOSSM) and its collaborators’ STOP Sports Injuries Campaign as well as the American Foundation of Suicide Prevention (AFSP).  AFSP and its outreach effort is an important component in the foundation’s efforts in memory of his son.

 References

  1. Longman, Jere. Fit young pitchers see elbow repair as cure-all. 2007 Jul.

 

 

Baseball Fit – Preventive Exercises for a Winning Season

As weather warms and winter sports wind down, attention turns to the promise of a new baseball season and the championships ahead.

Now is the time to begin preparing.High School baseball

At the core of a successful team are strong players – physically strong, well rested and well conditioned.

Baseball is one of the few sports played almost daily throughout the entire season.  For young players beginning in little league, this amounts to a lot of plays by high school.  The frequency of repetitive stress injuries in youth baseball have increased over the years, particularly with the rise in special “elite” teams and extended seasons. This is most evident in young pitchers, on which much research has focused and for which Pitch Count guidelines have been developed.

Although baseball is not considered a contact sport, injuries can result from contact with the ball and other players, as well as poor form/technique, or an awkward movement during a play.

Some of the most common baseball injuries include:

  • Injuries in the shoulder and elbow (Little Leaguer’s Shoulder, Little Leaguer’s Elbow)
  • Knee injuries
  • Muscle pulls
  • Ligament injuries
  • Fractures (Finger, Distal Radius/Wrist)
  • Concussions 

While some injuries resulting from collision with another player are getting hit by the ball cannot be avoided, exercise can aid in reducing risks or preventing many repetitive stress related injuries.

Repetitive injuries are the result of repetitive use, stress and trauma to the soft tissues of the body (muscles, tendons, bones and joints), which are not given adequate time for proper healing. They are sometimes called cumulative trauma, repetitive stress or overuse injuries.

To avoid such repetitive stress conditions and muscle fatigue, players should have a dedicated fitness program – ideally one that is also specific to the position they play.  This should include overall strengthening and endurance, along with specific exercises to equally strengthen the muscles of the limb(s) most used. Such fitness programs should also include stretching and rest between play.

Exercise programs should also be age appropriate. Young, developing players are encouraged to build strength through resistance rather than weights. Involvement in other seasonal sports such as swimming and running can also provide excellent overall strengthening and endurance.

Strength and Conditioning Exercises – Upper Body

As a throwing sport, exercises for baseball concentrate heavily on the upper body – arms and shoulder. Core strength is also essential for pitching velocity, hitting power and running speed.

The key to any exercise program is the balanced/equal strengthening of muscle groups. For the upper body, this includes triceps/biceps, trapezius, rotator group, and deltoids.

Some Effective Arm, Shoulder and Core Exercises Include:

  • Resistance bands – These can be effective in building arm and shoulder strength. (View video on how these bands are used in exercise programs.)
  • Push ups – Traditional push ups are very effective in building upper body strength (arms, shoulders, back and core/abdominal muscles).
  • Pull ups – Using your own body weight/strength these work on the biceps, upper shoulder and back, upper abdominals and obliques.
  • The Plank – strengthens the core, lower back and oblique muscles. (View video demonstration of the Plank.)

Exercises to Improve Leg Strength

Lower body strength and conditioning is as important as upper body training for young athletes. Leg strength impacts throwing velocity, bat speed/force and running speed.

Squats, lunges and running are among the most effective ways to strengthen the lower body.

Stretching

Stretching is a very important part of an exercise program for athletes in any sport. During exercise and play muscles contract. When muscles contract, they produce tension at the point where the muscle is connected to the tendon. Stretching helps lengthen, relax and restore muscles to their natural state.

Stretching following activity is as important as stretching while warming up before practice and play.

Some easy, yet effective stretches include:

  • Elbow Pulls – Raise the right arm as though asking a question and drop the forearm behind the head though leaving the elbow in the air. Pull the elbow to the left with the left arm until you feel the stretch, hold briefly then repeat several times. Do the same on the opposite side.
  • Cross Body Arm Pulls – Straighten your right arm and pull it across the front of your body, cradling the forearm and elbow with the left hand, pull the arm towards the left across the body until you feel the stretch. Hold the stretch briefly, then repeat on the opposite side.
  • Shoulder Stretch – Lay face down on a floor mat and stretch arms overhead to form a “Y,” with palms facing down on the floor. With forehead on the ground, retract shoulder blades while lifting arms off the ground (still outstretched). Hold for a couple of seconds while squeezing the shoulder blades together. Be careful not to “shrug” the shoulders up. Return to starting position and perform several sets of 10 repetitions. To work the back a little differently, perform this same exercise with the arms straight out to your sides, forming the shape of a “T.”
  • Runner’s Lunge – Position into a deep lunge on your right leg, drop the knee of your left leg and lean forward over the right quad until you feel the stretch, hold for several seconds. Repeat on opposite leg.
  • Hamstring Stretch – Stand flat on the floor with feet a little less than hip width apart. Lean forward and place palm of your hands flat on the floor just in front of your feet, hold for several seconds.

TOP PREVENTION TIP

Resting is as important as any of the components in a successful training program.