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.

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.