“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.

Arthritis: do I have it? What can I do about it?

What is Arthritis?

Arthritis is a group of musculoskeletal conditions in which there is wearing and inflammation of the joints causing chronic pain, swelling and stiffness.  Nearly 3.3 million Australians have a disability due to arthritis and related conditions, and more than half of these have chronic or recurrent pain. Even though many different conditions are labeled as arthritis,they each have very different causes and so require different treatments. The most common forms of arthritis are:

  • Osteoarthritis (OA). This is by far the most common type. It is caused by wear-and-tear that grinds away at the smooth lining of cartilage that covers the joint surfaces, exposing the rougher bone underneath. This process causes pain, stiffness, creaking and sometimes swelling. osteoarthritis_diag
  • Rheumatoid arthritis (RA) This is an inflammatory disease that primarily attacks the small joints in the hands and feet. It is caused by a dysfunctional immune system in which your own cells attack the joint linings.

    rhematoid arthritis

    rhematoid arthritis

  • Gout is usually found in the big toe joint. It is caused by a build up of crystals within the joint.
  • gout

    gout

  • There are many other different but rarer types of arthritis such as Ankylosing Spondylitis, Juvenile arthritis and Systemic lupus erythematosus (lupus), just to name a few!

Is my sore joint arthritis?

There are many different reasons why your joints may be sore. Not all pain in your joints is caused by arthritis. It could be from an injury or using your joints and muscles in an unusual way (for example, playing a new sport or lifting heavy boxes). Talk to your physio if you have pain and stiffness that:

• starts for no clear reason

• lasts for more than a few days

• comes on with swelling, redness and warmth of your joints.

How can I find out if I have arthritis?

Your physio will ask you about your symptoms and examine your joints. They may do some tests or x-rays, but these can be normal in the early stages of arthritis.  Your physio may also send you to a doctor for blood tests, or to a specialist for a surgical opinion, if either is warranted.

The Role of Exercise

Moderate, regular exercise has been proven to aid in the prevention of arthritis, and offers you a host of side benefits.  Exercise can reduce your joint pain and stiffness, build strong muscles around your joints and increase your flexibility and endurance.

The Role of Physiotherapy

If you have OA you could benefit from physio work to loosen your joints, and electrotherapy to ease your pain and inflammation. We can also give you muscle strengthening exercises to realign your joints—almost like giving your car tyres a wheel alignment. Localized, specific massage techniques can also break up the ’rust’ from your affected joints, greatly reducing your pain.

hip stretch

Loosening a hip joint to lessen the effects of arthritis

Physiotherapy can reduce arthritic pain and reliance on drug therapy. Unlike pharmaceuticals, physiotherapy has few side effects or contraindications. So although arthritis is a chronic disease, treatment and management techniques can control and reduce the effects of the condition, and prevent further deterioration.

Almost like a miracle cure!

 

 

 

“How to get rid of joint pain that is bought on by cold and rainy weather.”

With autumn now approaching and the temperature starting to drop, you may hear a lot of people complain that their bone and joint discomfort worsens. This is a common statement around this time of year. This change can be due to a drop in barometric pressure.

rainy day

How does air pressure relate to joint pain? When there is less pressure on the outside of the joint it allows the swelling inside to increase just a tiny bit. This extra swelling can be the difference between a good day and a bad one.  Air pressure tends to drop even more when it is raining, so cold wet days often feel the worst.  

A hot bath or heat pack married with a good anti-inflammatory cream is often enough to ease the symptoms, but if you find your aches and pains are overstaying their  welcome then your best  treatment is, of course, a few sessions of physiotherapy.

The Role of Physiotherapy

Patients with arthritic or wear-and-tear  disorders may benefit from joint mobilization, electrotherapy,  hydrotherapy and muscle strengthening exercises. Localized, specific massage techniques can also break up the ’rust’ from the joint, greatly reducing the pain.  When done together, these techniques not only reduce the swelling and inflammation in a joint but they loosen it up, giving everything more room to move. This extra space means that the joint does not ache as much, even if the weather outside is cold or rainy.

The Role of Exercise

Moderate, regular exercise has been proven to aid in the prevention of arthritis and joint stiffness, and offers a host of benefits to  sufferers.  Exercise can reduce joint pain and stiffness, builds strong muscles around the joints and increases flexibility and endurance.

What type of exercise should I be doing?

  • Water exercise- such as aqua aerobics or swimming laps—especially if done in a warm pool. This non-weight bearing exercise provides the fitness without the joint pounding associated with land-based activities.
  • Tai chi, yoga, and stretching will help to get you looser if done on a  regular basis
  • Pilates will help to strengthen your core muscles and make sure that you are balanced. When your muscles are balanced your joints will move properly, minimizing the wear and tear.
  • Walking or light jogging, depending on your body’s general condition and specific problems such as knee or hip wear-and-tear.

Please contact us if you have any queries, especially aches that appear as the weather cools.

“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  

RSI – upper limb pain explained

RSI – Repetitive Strain Injury – is a term that refers to pain in the upper limbs – the shoulders, elbows and wrists – usually as a result of frequent typing or other highly repetitive actions. It is an often misdiagnosed condition. A few decades ago a lot of unwarranted suspicion arose about this painful injury simply because it was misunderstood by the vast majority of doctors and physiotherapists alike. Thankfully some recent research has uncovered the real reason that we suffer from RSI. Not only that, but we now know how to cure it!

The most common cause of RSI is inflammation of the nerves that run from the neck, down through the shoulders, and into the wrists and hands. These nerves pass by many other structures, most notably the discs the neck and various muscle groups. If the discs or muscles become damaged or tight – often due to a poor posture – then the nerves cannot move freely in the arm.

If these tight nerves are then used repetitively, such as when typing or process working, they naturally become sore and inflamed. If this process is repeated before the nerve has recovered, the problem worsens. Before long it can be difficult to perform any task, even lifting a coffee cup, without feeling pain.

Most people picture their nerves as a fine, delicate structure, like thin pieces of string or strands of a spider’s web. In reality, your nerves are tough, fibrous structures, some of which are as thick as your little finger!

Many different nerves course through your arms. The diagram below illustrates some areas covered by the main branches. If you think that it looks complicated – you’re right!

The nerves of the upper limb

By assessing both the nerves and the structures that they cross, your physio can usually determine the exact cause of nerve-related RSI. This much-maligned problem is no longer a mystery. A cure is close at hand.