“Throwing injuries in baseball: what causes them and how to treat them”

The extreme biomechanics of fast throwing often lead to injuries.

Baseball is a popular and growing sport in Australia. It not only represents a pathway to Olympic representation or a professional contract, but combines a number of skills such as hitting, throwing, sprinting and catching. However, like all sports participants, baseball players have a risk of injury.

The upper limb is by far the most common site of breakdown. One recent study found that nearly two-thirds of baseball injuries were in the shoulder or elbow, due to the extreme speeds of throwing in the sport. The risk of an elbow or shoulder injury was 2.6 times higher for a pitcher than a position player, confirming that repeatedly throwing a ball is a very challenging task for a shoulder!

This high breakdown rate is not surprising when throwing is analysed biomechanically. One recent study revealed some startling data: the shoulder rotates at approximately 12 000 degrees per second during a fast baseball pitch! Furthermore, the speed of the hand was measured at nearly 1000 metres/second! With such enormous forces, it is easy to see why baseball upper limb injuries are so common.

Baseball pitch

So how do you prevent shoulder throwing injuries?  The secret is to maintain the balance around the joint. What exactly do we mean by ‘joint balance”?

Joint balance has two main components:

(1) The passive structures.  These are the bits that hold your bones together such as ligaments and joint capsule, and

(2) The active components – the muscles – that move the joint.

If the passive structures become either too tight or too lax then your throwing movement will become unbalanced. Your joints will either grind too tightly on internal structures when the throwing action forces it into certain positions, or will move around too far during the vital acceleration phase, causing microscopic tears. In either case, the grinding or tearing slowly accumulate until they become major injuries.

The same type of imbalance can occur with your muscles: if they become weak, they will be unable to stabilise your joint during the massive acceleration involved in throwing a ball.  Similarly, if some muscles are overactive, they will pull your joint out of its normal alignment, causing accumulated damage.

So how can physio help in treating throwing injuries? First, we assess the balance of your shoulder, including all the passive structures and active components.  We then direct your treatment toward correcting any anomalies.

For example, you may have some tightness in your joint capsule that requires mobilisation, massage and stretching to loosen it, and some exercises for your rotator cuff muscles to strengthen them and increase their stability. You may need some throwing practice drills to make sure that you use your new shoulder in the most efficient way.

Shoulder stretch

Physio can restore joint balance by stretching the passive structures

Throwing a fast baseball is an extreme ‘occupational hazard’ for your shoulder, but with the right biomechanics you can perform it without undue risk of injury. Who knows, maybe an Olympic Gold Medal or a MLB contract might be yours one day … or maybe not. But in the mean time at least you’ll have a lot of fun.

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“Warming up before sport: Why you’re probably doing it all wrong!”

If you want to perform at your best — on the court, on the field or on the pitch– you need to know how to get your body ready for intense activity. Yet most people, even many high level sports people, don’t understand the basics of a good warm up. 

So how do you warm up best? With some slow, sustained general body stretches, right?

Wrong!

Most studies show little or no benefit in a generalised, non-specific stretching program to prevent injury.

Scientific evidence indicates that active warm-up, as opposed to slow passive stretching, is the best injury preventative.  In other words, get moving!  So the puppy in the photograph could probably be doing things a little better!

dog stretching

You will also need to do some core muscle activation, and some sports-specific drills.

An example of an active warm-up that focuses on the leg muscles might include the following activities:

  • A slow 400 metre jog to start the process
  • Next, do a few minutes of light movements.  These should concentrate on (a) relaxed gentle movement (b) all the way to the end of range (c)  in each direction (d) for all your joints. Make sure that you move your spine and neck  as well as your limbs.  If you have any specific muscle imbalances or physio-prescribed exercises/stretches, now is an ideal time to work on them.
  • Now perform some exercises to activate your core muscles (if you know how … if you’re unsure than please contact us directly). This is an important step to awaken them for the task ahead, which is unfortunately often omitted.
  • Now move to an active phase. Start with half a dozen 40-60m runs at 50% pace, walking back in between. Slowly increase your stride length with each repetition.  Activate your core muscles as you run.
  • Add another half a dozen “run through” sprints of 40-60 metres, beginning at 50% pace, and increasing by 10% each repetition.
  • Perform 3-5 backwards jogs over 20 metres, and then a similar set of sideways runs.
  • Finally, add sports-specific skills (e.g. kicking: start at 20m, then increase to full strength over 20 kicks.)

By the time you have completed  this warm up, your muscles and joints will be loose, your core muscles activated and ready to protect your joints, and your cardiovascular system will be ready to go.  You’ll hit the playing field in peak condition, and not only will you help to prevent injuries – both short and long term – but you’ll be ready to fire from the first whistle.

 

More on bursitis: what is it, and how is it treated?

A bursa is found where muscles and tendons glide over bones.  We have more than 150 bursas in our bodies.  These small, fluid-filled sacs lubricate and cushion pressure points between our bones and the tendons and muscles near the joints.  Without the bursa between these surfaces, movements would be painful due to friction.

Swelling ion the elbow is usually due to bursitis

Swelling in the elbow is usually due to bursitis


The bursa can be thought of as a self-contained bag with a lubricant and no air inside. If you imagine rubbing this bag between your hands; movement of your hands would be smooth and effortless. That is what a bursa is meant to do; offer a smooth, slippery surface between two moving objects.

What is Bursitis?

Bursitis is a painful inflammation of a bursa, that normally cushion the bones, tendons, and muscles from rubbing against each other. When a bursa becomes inflamed, the bursa loses its gliding capabilities, and becomes more and more irritated and painful when it is moved. The added bulk of the swollen bursa causes more friction within an already confined space. 

What Causes Bursitis?

Repetitive Irritation

Bursitis usually results from a repetitive movement or due to prolonged and excessive pressure. People who have weak hip muscles and tend to sway as they walk can develop hip (trochanteric) bursitis. Similarly in other parts of the body, repetitive use or frequent pressure can irritate a bursa and cause inflammation.

Traumatic Injury

Another cause of bursitis is a traumatic injury. Following trauma, such as a car accident or fall, a patient may develop bursitis. Usually a contusion causes swelling within the bursa. The bursa, which had functioned normally up until that point, now begins to develop inflammation, and bursitis results. Once the bursa is inflamed, normal movements and activities can become painful.

Systemic Diseases

Systemic inflammatory conditions, such as rheumatoid arthritis, may also lead to bursitis. These types of conditions can make patients susceptible to developing bursitis. 

How is Bursitis Commonly Treated?

Bursitis pain usually goes away within a week or so with proper treatment, but recurrent flare-ups are common and can be frustrating.  You should apply ice, avoid activities that reproduce your pain and seek professional advice. Non-steroidal anti-inflammatory drugs are usually ineffective in the treatment of bursitis since the bursa is isolated from your blood supply. You may however try applying an anti-inflammatory gel.

Bursitis is a symptom caused by many other factors, that if you don’t solve, will render you vulnerable to recurrences. Our Physiotherapists are highly trained in identifying the biomechanical or training causes of bursitis to quickly solve your pain and stop it returning again.  We recommend that you seek the advice of one of our Physiotherapists to tailor a program to suit your specific needs and to get you back on track again.

For more information in Bursitis please see our main website, our previous post on this condition, or contact us  

“New hope for hamstring strains”

An article recently appeared in the local press (The Australian, Saturday 13 July)  on a new method of testing and predicting hamstring injuries. It reports on a new device under development that will hopefully enable sports clubs to make better decisions on player injury management. The article is reproduced in full below.

hamstring tear

A typical muscle tear

But will it work? Hamstring injuries are a very complex problem. Their incidence remains high, and in truth not much progress has been made in their treatment for many years, particularly when compared to sports medicine advances in other areas. One reason for this lack of progress in the multifactorial nature of the risk factors. Issues such as the following all contribute to the problem:

  • nerve mobility, especially the Sciatic nerve that runs down the back of the thigh
  • muscle co-ordination with the quadriceps muscle
  • Imbalances with the proximal (gluteal) muscles, leading to poor muscle recruitment pattern
  • Muscle inhibition following previous injury
  • Scar tissue from previous injury
  • Overall flexibility
  • Eccentric strength (i.e. the ability to control a movement when the muscle is lengthening)
  • Neural supply issues, which may be related to lower back problems, particularly in the L5-S1 region
  • Inappropriate technique or movement pattern

When all of these factors interplay in a high force manner such as sprinting it is easy to appreciate why hamstring muscle tears are so difficult to study.  The new device mentioned in the article seems to focus on the measurement of eccentric strength, thus addressing an important variable. However, it can’t take all of the other factors into account, and thus forms simply part of the assessment protocol when used by a skilled physio or sports doctor.

If the device makes it through all of the regulatory hoops and gets a foothold in the medical market place, hopefully its price will be within reach of an average physio so that many more patients can benefit from its development. Until then, a good physio can study your injury and make informed decisions on all of the above factors, which usually leads to a resolution of the problem.

Full newspaper article follows.

For more information on hamstring strains see this previous blog post.

For specific injury treatment advice please contact us

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ELITE sports clubs could save hundreds of millions in lost player time with the invention of an on-field hamstring tester.

The Queensland University of Technology (QUT) is working with a portable prototype that can help determine which players are most likely to hurt their hamstring.

The University says it has already caught the eye of English premier league soccer clubs such as Manchester United, Liverpool and Chelsea.

Hamstring tears are the most common sports injury in the world, with injured players typically missing three to six weeks of competition and training.

And players are likely to reinjure the tendons within a year, says QUT Faculty of Health lecturer and researcher Dr Tony Shield.

The device is currently being trialled by six AFL clubs, the Queensland Reds and a number of track and field athletes including long jump Olympic silver medallist Mitchell Watt.

Dr Shield said the device aims to provide almost immediate and accurate measures of athletes’ hamstring strength to compare strength between limbs and monitor the progress that players make across the pre-season or in rehabilitation.

“Armed with this information, a trainer can make a more informed decision on what types of strength training need to be employed and whether a player is fit to take the field,” he said in a statement on Friday.

Until now, the best measure of hamstring strength and injury risk had been via an isokinetic dynamometer – a large, heavy and immobile machine found in only a few dozen university exercise science facilities around the country.

Despite providing excellent data, dynamometers cost up to $100,000, making them accessible to only the wealthiest sporting clubs.

They also need at least two full days to test a squad of 40 or more AFL players, whereas 44 were tested in two hours using the QUT prototype, Dr Shield said.

With worldwide interest already high, he said the device will hopefully be available within a year at a cost of around $10,000.

“”How do I treat a recent injury? Some aspects you might not have considered.”

Most people know the pain of an acute sprain, whether it be a twisted ankle or a torn back muscle. However, the information on how to treat such inju-ries is inconsistent; some practitioners advise heat and rest, while others suggest ice and exercise. So, you are entitled to ask: What do I do in the first few days post-Injury?

Rest or movement?

Rest from painful exercise is essential in the early injury stage.”No pain. No gain” does not apply. How-ever, complete immobilisation is rarely necessary. We call this active rest. A rule of thumb is that gentle movement of the injured area is usually beneficial as long as it does not reproduce your pain. You can also move the joints that are distal to your injury (e.g. move your ankle for a knee sprain) to encourage circulation. Stick to these hints for the initial two or three days. After that, you’ll need specific exercises to promote healing and prevent other problems from developing.

Ice or Heat?

Most practitioners agree that ice is preferable to heat for an acute sprain. Yet sometimes, particularly for back or neck sprains, heat is recommended. Why the difference?

A few guidelines will help you choose.

1. If the injury is swollen or bruised, ice is better.

2. If the injury happened as a result of high force, such as a fall, or high speed, such as a muscle tear, then ice is better.

3. If the injury started by itself, or came on gradu-ally, then it is harder to be definite. In this case, stick with ice if you can feel tender areas around the injury site. If not, try the test below.

4. Perform some gentle movement of the injury site, and note how far you move before it hurts. Then apply an ice pack for 30 minutes, and re-peat the test. If you can move further without pain, then stick with ice. If the movement was stiffer, then repeat the test with a warm heat pack.

Apply the heat or ice for about 30 minutes every two to three hours. If the injury is large or deep (e.g. a back injury) then apply the treatment for about one hour.

Should I elevate the injured area?

If your injury is swollen, then elevation in the first few days is very helpful. It will also help it to ache less. Think where your injury is compared to your heart. Gravity will encourage swelling to settle at the lowest point, so try to rest your injury above your heart.

knee sprain treatment

A well-treated knee sprain

Should I use a Bandage or Support?

If the injury is swollen or bruised, then, yes, apply a compressive bandage or elastic support to the injury. This will help to control swelling and bleeding in the first few days. Some injuries, particularly those with instability, will benefit from more support such as a brace or rigid strapping tape. However, some injuries immobilisation can result in increased stiffness and weakness. In this case, check with your physio.

Correct initial management can make a big difference to your recovery, so please contact us at Bulimba  or Mansfield if you are uncertain, and we’ll set you on the right track.

Please see here to learn more about ligament sprains.

What has a Mythical War Hero got to do with Heel Pain?

In Greek mythology, Achilles was a Greek hero of the Trojan War. Achilles was the greatest warrior of Homer’s Iliad. Legend states that Achilles was invulnerable in all of his body except for his heel. He even died because of a wound on his heel. The term Achilles’ heel has come to mean a point of weakness.

However, most runners and athletes who need to run or jump will know that Achilles heel is better known as Achilles Tendinitis and it is both painful and effects your sporting performance.
Achilles Tendonitis
What is Achilles Tendinitis?

Achilles Tendinitis is a term that commonly refers to an inflammation of the Achilles tendon.  It is an overuse injury that is common in sports that require running or jumping. Most experts now use the term Achilles tendinopathy to include both inflammation and micro-tears. But many doctors may still use the term tendonitis, tendinitis or tendinosis out of habit.

What are Tendons?
Tendons are the tough fibres that connect muscle to bone. Most tendon injuries occur near joints, such as the shoulder, elbow, knee, and ankle. A tendon injury may seem to happen suddenly, but usually it is the result of many tiny tears to the tendon that have happened over time.

What Causes Achilles Tendonitis?

Most tendon injuries are the result of gradual wear and tear to the tendon from overuse or ageing. Anyone can have a tendon injury, but people who make the same motions over and over in their jobs, sports, or daily activities are more likely to damage a tendon.

Sometimes a tendon injury can happen suddenly. You are more likely to have a sudden injury if the tendon has been weakened over time.

Common Causes of Achilles Tendonitis

  • Over-training or unaccustomed use – “too much too soon”
  • Sudden change in training surface – e.g. grass to bitumen. Soft sand works your calves and achilles very hard
  • Flat (over-pronated) feet
  • High foot arch with tight Achilles tendon
  • Tight hamstring (back of thigh) and calf muscles
  • Toe walking (or constantly wearing high heels)
  • Poorly supportive footwear, or changing from shoes with a high heel cup to a lower one, which puts more stretch and strain on the achilles.
  • Hill running.
  • Poor eccentric strength

What are the Symptoms of Achilles Tendonitis?

  • Achilles tendonitis may be felt as a burning pain at the beginning of activity, which gets less during activity and then worsens following activity. The tendon may feel stiff first thing in the morning or at the beginning of exercise.
  • Achilles tendonitis usually causes pain, stiffness, and loss of strength in the affected area.
  • You may have more pain and stiffness during the night or when you get up in the morning.
  • The area may be tender, red, warm, or swollen if there is inflammation.
  • You may notice a crunchy sound or feeling when you use the tendon.
How is Achilles Tendonitis Diagnosed?
Your physiotherapist can usually confirm the diagnosis of Achilles tendonitis in the clinic. They will base their diagnosis on your history, symptom behaviour and clinical tests.
Achilles tendons will often have a painful and prominent lump within the tendon.
Achilles tendinitis Further investigations include US scan or MRI. X-rays are of no use in the diagnosis.

What are the Aims of Achilles Tendonitis Treatment?

Achilles tendonitis is one of the most common problems that we see at PhysioWorks and it is unfortunately an injury that often recurs if you return to sport too quickly – especially if your rehabilitation program is not completed.
Your calf muscle is a large powerful group of muscles that can produce sufficient force to run, jump and hop. Your achilles tendon attaches your calf muscle to your heel bone. It is a tendon or non-contractile soft tissue structure, which does have a different level of blood supply and function, which does alter the rehabilitation from a calf tear.
Researchers have concluded that there are essentially 7 stages that need to be covered to effectively rehabilitate these injuries and prevent recurrence.

Phase 1 – Early Injury Protection: Pain Reduction & Anti-inflammatory Phase

As with most soft tissue injuries the initial treatment is RICE – Rest, Ice, Compression and Elevation.
In the early phase you may be unable to walk without a limp, so your Achilles tendon needs some active rest from weight-bearing loads. You may need to be partial-weight-bearing, and use crutches, a wedged achilles walking boot or heel wedges to temporarily relieve some of the pressure on the Achilles tendon. Your physiotherapist will advise you on what they feel is best for you.
Ice is a simple and effective modality to reduce your pain and swelling. Please apply for 20-30 minutes each 2 to 4 hours during the initial phase or when you notice that your injury is warm or hot. Anti-inflammatory medication (if tolerated) may help reduce your pain and swelling. However, it is best to avoid anti-inflammatory drugs during the initial 48 to 72 hours when they may encourage additional bleeding. Most people can tolerate paracetamol as a pain reducing medication.
As you improve a kinesio (stetchy) style supportive taping will help to support the injured soft tissue.

Phase 2: Regain Full Range of Motion

If you protect your injured Achilles tendon appropriately the torn tendon fibre will successfully reattach. Mature scar formation takes at least six weeks. During this time period you should be aiming to optimally remould your scar tissue to prevent a poorly formed scar that will re-tear in the future.
It is important to lengthen and orientate your healing scar tissue via massage, muscle stretches, neurodynamic mobilisations and eccentric exercises. Signs that your have full soft tissue extensibility includes being able to walk without a limp and able to perform Achilles tendon stretches with a similar end of range stretch feeling.

Phase 3: Restore Eccentric Muscle Strength

Calf muscles work in two directions. They push you up (concentric) and control you down (eccentric). Most Achilles injuries occur during the controlled lengthening (eccentric) phase. Your physiotherapist will guide you on an eccentric calf strengthening program when your injury healing allows.

Phase 4: Restore Concentric Muscle Strength

Calf strength and power should be gradually progressed from non-weight bear to partial and then full weight bear and resistance loaded exercises. You may also require strengthening for other leg, gluteal and lower core muscles depending on your assessment findings. Your physiotherapist will guide you.

Phase 5: Normalise Foot Biomechanics

Achilles tendon injuries can occur from poor foot biomechanics eg flat foot. In order to prevent a recurrence, your foot will be assessed. In some instances you may require a foot orthotic (shoe insert)  Your physiotherapist will happily discuss the pros and cons with you.

Phase 6: Restore High Speed, Power, Proprioception & Agility

Most Achilles tendon injuries occur during high speed activities, which place enormous forces on your body (contractile and non-contractile). In order to prevent a recurrence as you return to sport, your physiotherapist will guide you with exercises to address these important components of rehabilitation to both prevent a recurrence and improve your sporting performance.
Depending on what your sport or lifestyle entails, a speed, agility, proprioception and power program will be customised to prepares you for light sport-specific training.

Phase 7: Return to Sport

Depending on the demands of your chosen sport, you will require specific sport-specific exercises and a progressed training regime to enable a safe and injury-free return to your chosen sport.
Your PhysioWorks physiotherapist will discuss your goals, time frames and training schedules with you to optimise you for a complete return to sport. The perfect outcome will have you performing at full speed, power, agility and function with the added knowledge that a through rehabilitation program has minimised your chance of future injury.

What Results Should You Expect?

There is no specific time frame for when to progress from each stage to the next. Your Achilles tendonitis rehabilitation status will be determined by many factors during your physiotherapist’s clinical assessment.
You’ll find that in most cases, your physiotherapist will seamlessly progress between the rehabilitation phases as your clinical assessment and function improves.
It is also important to note that each progression must be carefully monitored as attempting to progress too soon to the next level can lead to re-injury and frustration.
The severity of your tendon injury, your compliance with treatment and the workload that you need to return to will ultimately determine how long your injury takes to successfully rehabilitate.

Can Your Achilles Tendon Rupture?

The worst case scenario is a total rupture of your Achilles tendon. Treatment in this case usually requires surgery, plaster or a walking boot for at least six weeks. Most of these injuries take six months or more to adequately rehabilitate.
Achilles tendon rupture

The best advice is to seek early advice from your physiotherapist to do all you can to avoid this nasty rupture happening in the first place.

More info about Achilles tendon rupture.
Contact our clinic directly

Rugby injuries: how to prevent them.

Rugby is a fast-moving and high-intensity team sport. Most teams are now starting the competitive phase of their season. It is a sport with a high injury rate, although with physio input and sensible rule changes, that rate is dropping. Let’s have a look at some injury statistics, and discuss what can be done to help further.

rugby injuries
Rugby injuries can be serious

As many as 1 in 4 rugby players will be injured during the season. On average each player performs up to 20-40 tackles per match. Approximately half of all injuries occur while a player is tackling or being tackled.

Other factors that injury analysis shows are risk factors include:

  • A lower ranked or less skilled team within the division. Almost 25% of neck injuries occur when there is a mismatch in experience between the two opposing front rows.
  • a forward position
  • beginning of the season. This suggests that pre-season conditioning could reduce injuries. Physiotherapy can play a large role.
  • Most injuries are experienced by 10-18 year olds.
  • More injuries occur during matches (57%) than in training, and more often in the second half of the game.

Injury prevention strategies to reduce the incidence and severity of rugby injuries include coaching on defensive skills, correct tackling technique, correct falling technique and methods to minimize the absorption of impact forces.

To reduce scrummaging injuries at lower rugby levels, props should crouch, touch, and then set. This technique is called Depowering the Scrum. Another alternative is Sequential Engagement where the front rows engage first and then the second row joins in, so that a stable scrum is established.

Many injuries are those that linger through the season, or are exacerbations of previous problems. Physiotherapy can sort these injuries out now so that your chances of playing an uninterrupted season are much higher.

To read more about rugby injuries, please see http://www.physioworks.com.au/Injuries-Conditions/Activities/rugby-union-injuries or visit us directly at http://www.physioworks.com.au/Bulimba/bulimba.htm or http://www.physioworks.com.au/Mansfield/mansfield.htm