String of Pearls: Sports Specificforms.acsm.org/2014ATPC/PDFs/52 String of Pearls.pdf ·...
Transcript of String of Pearls: Sports Specificforms.acsm.org/2014ATPC/PDFs/52 String of Pearls.pdf ·...
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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