One More Reason Why Vitamin D Is Important...

Vitamin D is important for bone, cartilage, and muscle function. A recent study demonstrated that Vitamin D deficiency may play a role in the worsening of knee and hip pain. The study concluded that perhaps correcting Vitamin D deficiency in the elderly may improve knee and hip pain.

Barefoot Running...

Experts have proposed that running barefoot can lead to improved strength and proprioception. A recent study examined the changes seen after an 8 week training program involving barefoot running. The study did not show statistically significant changes in strength and proprioception after 8 weeks of barefoot training. However, the authors argued it may take months or years to observe these changes.

Tip: Remember barefoot running can be a valuable training tool, however when utilized improperly, it can lead to an increase in injury, such as stress fractures.

Runners Beware...

Achilles tendon insertional tendinopathy is a common condition in runners and sports needing short bursts or push-off. The average age of presentation is 44 years of age. This is a degenerative condition of the Achilles tendon insertion on the heel bone. The posterior heel pain is often worse after activity, but can become constant. Initial treatment often includes: activity modification, anti-inflammatories, shoe modifications, a heel lift, or a brief period of immobilization. 85-90% of patients improve with conservative care. For severe and chronic cases, surgical debridement may be considered.

NJF

Pediatric Sports Injuries...

A Comparison of Males Versus Females...

A recent study compared the amount of pediatric sports injuries in males versus females. The findings were interesting...

-female athletes had a higher percentage of overuse injuries (62.5%) compared with traumatic injuries (37.5%); the opposite was seen in male athletes (41.9% vs 58.2%, respectively; P < .001)

-female athletes sustained more injuries to the lower extremity (65.8%) and spine (11.3%) as compared with male athletes (53.7% and 8.2%, respectively)

-the percentage of females with patellofemoral knee pain was approximately 3 times greater than that of males (14.3% vs 4.0%, respectively;P < .001)

-the percentage of males and females who sustained an anterior cruciate ligament injury was almost equal (10.0% and 8.9%, respectively; P= .369)

Little League Overuse Throwing Injuries

As youth participation in baseball continues to remain popular, the occurrence of upper extremity overuse injuries continues to increase.  Further, there is an increasing trend for youngsters to specialize in and train year round for a single sport at an early age.  Such a high level of intensity and demand for advanced athletic skills throughout the years of skeletal growth have raised concerns about risk and severity of injury in young athletes.

Young athletes are risk for unique types of overuse injuries due to the presence of multiple growth plates throughout the entire skeleton.  These growth plates are composed of cartilage, which is softer and more vulnerable to injury than more mature bones.  In the upper extremity, both the upper arm bone called the humerus and the bones of the forearm called the radius and ulna have multiple growth plates close to the shoulder and elbow joints that are prone to overuse injuries in overhead athletes, such as baseball players. Repetitive activities, such as throwing baseballs, can overload the susceptible growth plates of the immature upper extremity and result in growth plate irritation, inflammation, and pain.  If improperly treated, growth plate disturbance as a result of overuse injury may lead to irreversible alterations in normal bone growth patterns, which can lead to altered joint mechanics.  This can ultimately lead to significant long-term pain and disability.

Young baseball players participating in repetitive overhead throwing, such as pitchers, are at risk for growth plate injuries around the shoulder and elbow.  The overuse condition called “Little League Shoulder”, also know as proximal humeral epiphysitis, results in pain in the upper arm or shoulder.  While the overuse condition call “Little League Elbow” results in pain in the elbow.  Children with these injuries will have shoulder or elbow pain when throwing.  These athletes may also be sore for a few days after participation and may notice loss of throwing velocity or control.  Further, swelling and tenderness around the shoulder or elbow may be present.  Such injuries may be a source of discomfort and time lost from training or competition.

Severe pain around a joint may be a symptom of growth plate injury, which may require prompt evaluation and treatment by a physician.  Orthopedic physicians diagnose these injuries by listening to the history and performing a physical examination.  Further, x-rays may be helpful to demonstrate widening or a break in the growth plate.  The most effective treatment for “Little League Shoulder” and “Little League Elbow” is rest from throwing so the growth plate can heal.  The addition of physical therapy may also help improve the strength of the shoulder and elbow and prevent re-injury. A young athlete should never be expected to or allowed to “throw through the pain,” as such mistreatment may lead to a limited throwing career and chronic pain as an adult.  An athlete typically can return throwing again once they have full strength and full range of motion of the shoulder or elbow.

Often times, many coaches of youth sports are enthusiastic and well meaning volunteers, yet they are also typically uninformed about the growth and development of children and appropriate injury preventative strategies.  Therefore, it is critical for the caregivers of youth participating in athletics to educate themselves and the athlete about potential growth plate injury and precautionary tactics.  Ultimately, the best way to prevent “Little League Shoulder” and “Little League Elbow” is to follow recommended guidelines for appropriate pitch count limits and proper rest between pitching appearances.  Please refer below for further preventative tips and pitch count recommendations.

Tips for Parents:

-emphasize the benefits of year-round physical fitness, while also emphasizing the importance of appropriate rest and training variety

-allow your child to pitch in only one league in a single season and play baseball only two seasons of the year

-do not allow your child to play through pain

-consult an orthopedic physician if your child’s throwing injuries are not relieved by four days of rest and ice

Tips for Pitchers:

-appropriately warm up before all athletic participation and throwing

-remain physically fit all year and incorporate a supervised resistance training program that focuses on total body fitness, including leg and core strengthening

-do not practice pitching after the game

-rest your arm for at least 24 hours after pitching

Pitch Count Recommendations:

9- to 10-Year Old Pitcher:

50 pitches a game

75 pitches a week

1,000 pitches a season

2,000 pitches a year

11- to 12-Year Old Pitcher:

75 pitches a game

 100 pitches a week

 1,000 pitches a season

 3,000 pitches a year

13- to 15-Year Old Pitcher:

 75 pitches a game

 125 pitches a week

 1,000 pitches a season

 3,000 pitches a year

16-Year Old or Older Pitcher:

Needs an individualized program based on skill level and input from trainers, coaches, and an orthopaedic physician

Early Spring Fitness Tips...

As spring nears, you might be tempted to get outside and train as soon as the weather improves. You may also be tempted to exercise at the same level you did at the end of the last season. However, such enthusiasm can lead to preventable injuries. Here are some tips for avoiding sports injuries as you increase your activity this spring.

-increase training session duration and frequency slowly

-do not exercise in pain

-vary your mode of exercise through cross training

Good Luck...

Dr. Fanter