String of Pearls: Sports Specific

Baseball :

Who is up the tree?

Lumberjack Tracy up a tree

Risk Factors

Comparing common practices of injured throwers to uninjured throwers, Olsen et al, found…

• > 80 pitches/game 4 times

• > 8 months/year 5 times

• Pitched fatigued 36 times

Ask About and Discourage Multiple Leagues

• Travel Ball • Overlaps ↔ Arm Pain, Tired • Showcases USA Baseball Study

ASMI Position Statement(2009) 1. Watch and respond to signs of fatigue. 2. No overhead throwing of any kind for at least 2-3 months

per year (4 months is preferred). No competitive baseball pitching for at least 4 months per year.

3. Follow limits for pitch counts and days rest. 4. Avoid pitching on multiple teams with overlapping seasons. 5. Learn good throwing mechanics as soon as possible. Learn,

in order: basic throwing fastball pitching change-up pitching.

ASMI Position Statement (2009)

6. Avoid using radar guns. 7. Avoid pitcher-catcher combination. 8. If elbow or shoulder pain, see a sports medicine physician. 9. Inspire youth pitchers to have fun playing baseball and other

sports. Participation and enjoyment of various physical activities will increase the youth's athleticism and interest .

Sources

• Olsen et al, Risk Factors for Shoulder and

Elbow Injuries in Adolescent Baseball Pitchers. Am J Sports Med Vol. 34, No. 6

Football:

John Kelly on stage at a Comedy

Club

Soccer: Matt Gammons

Tennis:

Mark Hutchinson on mission trips

with his kids

Tennis: Mark Hutchinson

• Four injuries with Tennis eponyms –Tennis Shoulder –Tennis Elbow –Tennis Leg –Tennis Toe

Tennis Shoulder

• Hypertrophic muscles • Protracted & depressed

scapula • Scapular dyskinesia

leads to inability to clear acromion with overheads and impingement

Tennis Elbow

• Tendinopathy of the ECRB • More common in Masters

athletes than younger elites • Broad range of treatment options:

– Eccentric stretch, deep friction massage, counterforce straps

– Steroid? Vs PRP injections? – Radiofrequency, percutaneous release,

arthroscopic vs open debridement

Tennis Leg

• Partial rupture of medial gastroc

• More common in older, weekend warrior

• Treatment is conservative with boot immobilization till comfortable the progressive range of motion

• ?PRP to speed healing

Tennis toe

• Injury to great or 2nd toe related to charging net in loose fitting shoe.

• Foot slides forward in shoe impacting toe on toe box leading to subungual hematoma of nail bed or hyperflexion injury of IP joint

Volleyball: Liza Arendt

Liza’s Pearls Volleyball

Blockers/ middle position most vulnerable •Side blockers land w/ 2 legs but need fast transition back to 10 foot line •Middle Blockers have significant side to side motion as they block in all 3 net positions •Middle Hitters learn “slide attack” which focuses on landing with 1 leg; fast transition back to middle

Tibial / leg pain

Focus on Middle Hitters • Middles position: increase in PMTSS and tibial stress fxs.

• Rx: Long leg U splints for practice and play

Consider injection along periosteum if (-) for stress fx. Emphasize technique, reduce # of reps (?NNH?)

High school : poor footwork patterns and landing mechanics due to poor instruction and undeveloped techniques

Debate? - should adolescent females be running relatively complicated routes when they are not physically ready to perform it correctly? Should we be limiting # of blocks and attacks for adolescents? (aka baseball?)

Gymnastics: Suzanne Hecht

WALKING ON YOUR HANDS…

• Injuries from using UE for wt bearing • Forces (x body weight)

– Back handspring 2.4-3.6 – Round-off 2-3 – Yurchenko vault (round-off) 2.4 – Pommel horse 1.5-1.6 – Running 1.7-2.3

• Wrist Hyperextension (90° or >)

Markolf 1990, Koh 1992, Seeley 2004

EXAM TIPS

• Test w/ wrist in hyperextension w/ axial loading – 1st: Elbows straight w/90 degrees shoulder flexion – 2nd: Elbows straight & 180 degrees shoulder flexion – 3rd: Push up position – 4th: Handstand against the wall or w/ a spot

• Check shoulder flexibility!

Scaphoid Stress Fractures • Case reports in literature • Remember to think of this in a gymnast

with no acute trauma but +ttp over scaphoid – Repetitive FOOSH mechanism

• Usually need MRI • Treatment

– Immobilization 2-4 months – Long arm vs short thumb spica cast/splint – Surgical intervention

Cheerleading:

Mark Hutchinson on mission trips

with his kids

Cheerleading: Mark Hutchinson

• Its all a matter of potential energy…… • The greater the height, the greater the risk of

catastrophic injury • Basket tosses • Pyramids • Gymnastics • Diving • Horseback riding

Cheerleading

• Highest risk of catastrophic head and neck injuries for females (gymnastics #2)

• American football is #1 for men • Actual injury incidence risk is relatively low

compared to other female sports; however when injured more time loss from sports than all sports.

Cheerleading

• Injury prevention – Preseason screening on all ATHLETES! – Progressive skill building in tricks and maneuvers – Practice on safety mats when possible – Limit pyramids to 2.5 person height – All tosses and pyramids must have front and back

spotters

Cycling: Liza Arendt

Liza’s Pearls: Cycling

Limb Version: Exam / Imaging Tips

• Beware of AKP w/ External Tibial Torsion

• PE: ‘Squinting patella’ ‘Walks like a Duck’

• Standing Alignment XRS:

– hidden lesser trochs – rotated knees – overlapping fibulas

Limb Version: Exam / Imaging Tips

• Beware of AKP w/ External Tibial Torsion

• PE: ‘Squinting patella’ ‘Walks like a Duck’

• Standing Alignment XRS:

– hidden lesser trochs – rotated knees – ankles forward

Fixed Foot vs. Degree of ‘Float’

• Why cleats: to have hamstrings and hip flexors (posterior muscles) help with upward pedal cycle rotation

• Always : use cleat system that allows “Float” (typically @ 6-8 degrees total)

• ‘Fit’ cleat system to have “neutral” foot/cleat position that matches the cyclist’s externally rotated foot position

• Consider pedal extender if medial heel hits chain system

• Consider 'adjusting float' to favor lateral heel motion

Ice Hockey: Matt Gammons

Ice Hockey Pearls

• STOP program to reduce catastrophic injuries from blind-side blows into the boards

• Collegiate facemask requirements significantly reduced risk of eye and dental injruies as well as facial lacerations

• Beware butterfly position for skeletal immature goalies may lead to FAI later in life

• Don’t tie boot tongue down for mobility, increases the risk of severe laceration to dorsal foot

Dance: Craig Young

Craig cycling in Austria

Evaluate other risk factors • Dance floor - especially in overuse

injuries. – Sprung floors – Class area vs. performance areas – Smaller programs & folk dancers often

not on sprung floors.

• Non-dance footwear worn

Courtesy of Milwaukee Ballet

Snapping hip syndrome

• External (ITB) - with jump landings • Internal - usually in non-weight bearing

gesture – May be reproduce with resisted straight knee

sit-up

Courtesy of Milwaukee Ballet

Treating dancers

• Get to know the terminology – If you don’t know, ask…

• Determine their dance philosophy – Artist – Athlete – Athlete-artist

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