All Posts tagged little league elbow

Warm up! Key to success

Warm up! Key to success

Okay. So you’ve decided to embark on a fitness regime in order to shed some kilo’s, get fit or just for fun. New gym membership. Check. New sparkling runners. Check. Gym gear (a bit tight at the moment). Check. Alright, let me at that treadmill/rower/crosstrainer/zumba class!
“Hold on a second – what about your warm-up!”
“Warm-up” you scoff, “you’ve got to be kidding. No time to waste on that”.
Sorry folks, but the warm-up is an important part of your exercise routine and plays a crucial role in preparing your body for exercise. Skimp on the warm-up and you run the risk of injury during exercise or sport, as well as reduced performance levels.
“But what’s so important about doing a few stretches?” I hear you ask.
A proper warm-up involves more than just standing around stretching and talking. It prepares your body for the exercise/sport it is about to undertake and should simulate the actions involved.
The benefits of a warm-up are:
1) Increase in core body temperature
2) Preparation of muscles, tendons and joints for the stresses/strains of activity
3) Increase in nerve impulse conduction to muscles
4) Increase in blood flow to muscles
5) Increase in respiratory (breathing) rate
Let’s have a closer look at each of these benefits.
1. Increased core body temperature – this is important as it prepares the body for the change in activity level from being sedentary to exercising and gets the body into a ‘ready’ state. This also results in an increase in muscle temperature which makes them more pliable, supple and loose.
2. Prepares muscles, tendons and joints for activity – each sporting activity stresses the body in different ways so it is vital to prepare in a way that simulates these activities. For example, if you are a basketballer you need to include in your warm-up the jumping, running and change of direction that occurs during the game. If you pump weights at the gym, it is vital to perform a warm-up set of each exercise at a lower weight to allow your body to adjust to each specific movement.
3. Increased nerve conduction – muscles that are in a ready or aroused state react quicker and more efficiently than muscles that aren’t prepared for activity.
4. Increased blood flow to muscles – through increased blood flow there is an increase in oxygen flow to muscles as well as nutrient flow. This increased flow allows for improved performance
5. Increased respiratory rate – prepares the lungs for an increase in activity level and improves oxygenation of the blood flowing to the muscles.
Okay, so now that we know why we are performing a warm-up, what should it involve?
One common misconception out there these days is the importance of stretching as part of a warm-up. Note I said part of a warm-up.
Stretching on its own does not constitute a warm-up – rather it forms a critical part of one.
An effective warm-up has a number of very important key elements, which work together to minimize the likelihood of sports injury and prepare the individual for physical activity.
These key elements are:
1) The general warm-up
2) Static stretching
3) Sport specific warm-up
4) Dynamic stretching
1. The general warm-up
This consists of light physical activity such as walking, jogging, easy swimming, stationary bike, skipping or easy aerobics. The intensity and duration of the general warm-up is dictated by the fitness level of the participating athlete. For the average person, this part of the warm-up should last between 5 and 10 minutes and result in a light sweat.
2. Static stretching
Yes! Static stretching. This is a very safe and effective form of basic stretching. There is a limited threat of injury and is beneficial for overall flexibility. All the major muscle groups should be included for a period of 5 to 10 minutes.
Debate has raged about whether static stretching should be part of a warm-up and some studies have shown that static stretching can have an adverse effect on muscle contraction speed and therefore performance. It is for this reason that static stretching is performed early in the warm-up and always followed by sports specific drills and dynamic stretching. It is important these first two elements are completed properly as it allows the more vigorous and specific activities of elements three and four to then be performed.
3. Sport specific warm-up
In this part, you are specifically preparing the body for the demands of your particular sport or activity. During this part of the warm-up, more vigorous activities should be employed. Activities should reflect the type of movements and actions which will be required during the activity.
4. Dynamic stretching
Finally the warm-up should finish with a series of dynamic stretches. Caution should be taken with this form of stretching as it involves controlled, soft bouncing or swinging motions to take a particular body part past it’s normal range of motion. The force or the bounce of the swing is gradually increased but should never become radical or uncontrolled. These exercises should also be specific to the sport or activity.
Another important factor to keep in mind when undertaking any new exercise regime, is the time it takes for the body to adapt to training. If you have had a period of time away from sport or activity, then your body won’t be used to the stresses and strains put on it from exercise. It can take up to 4 to 6 weeks for your muscles, tendons and joints to become adjusted to the movements involved in your sport or activity.
During this period it is advisable to start with low to moderate intensity exercise which gradually builds over time. Heading straight up the red or blue arrow as your first exercise session in 3 or 4 months isn’t a great idea. Starting out with flat walks or jogging and gradually increasing time and intensity is a better way to start. After 4 to 6 weeks you will be at the stage where you can tackle more intense sessions.
The same goes for weight training. Starting with lighter weights and more repetitions will allow your tendons and joints in particular, to adapt to lifting load. Going too heavy too soon can lead to tendon injuries or severe muscle and joint soreness.


Tennis elbow…perhaps not from Tennis!

Tennis elbow…perhaps not from Tennis!

Lateral epicondylalgia or tennis elbow is the most common cause of musculoskeletal
pain located near the elbow. It is commonly known as tennis elbow as it can be a significant problem amongst tennis players. However, you do not need to play tennis to have experienced this injury. It is reported that approximately 40% of people will experience this type of pain at some point in their life and it usually presents in males or females aged between 35 and 54. Lateral epicondylalgia is an injury to the forearm muscles that act to extend the wrist and fingers. The point of injury occurs at the site where the muscle attaches to the bone near the elbow.

What causes tennis elbow?
Lateral epicondylalgia is usually caused by an overload of the forearm extensor muscles where the load is more than what normal muscle tissue can handle. Associated neck or shoulder pain may also contribute to the presentation. Common causes or activities can include:

Poor technique during sports or other activities i.e. racquet sports
Manual workers with jobs involving repetitive gripping and hand tasks
Office workers with jobs involving repetitive use of the keyboard and mouse

Symptoms of lateral epicondylalgia include tenderness over the side of the elbow and pain with activities involving gripping or wrist extension. There may also be areas of tightness through the forearms and pain when the involved muscles are stretched. Your physiotherapist will be able to diagnose this condition based on physical examination and gathering a complete history of your injury. Your physiotherapist may also send you for medical imaging scans to assist in ruling out other causes of elbow pain including muscle tears, ligament injury and elbow instability or pain that is originating from the neck.

The goals of treatment are to reduce pain, promote healing and decrease the amount of stress applied to the elbow. Also, to restore full strength and movement of the elbow and wrist. Early treatment may include:
Rest from aggravating activities
Exercise programs involving gradual strengthening and stretching
Massage and other soft tissue techniques
Taping to reduce load on the muscle and tendon
Acupuncture or dry needling
Once pain levels have decreased, physiotherapy will involve prescription of more difficult or specific strengthening exercises and correction of any predisposing biomechanical or technique problems. These are essential to prevent future aggravation and shorten recovery time.

Braces are available which are designed to assist in alleviating pain by reducing the amount of stress on the tendon. However, not all people will benefit from using a brace. Your physiotherapist will be able to guide you through all stages of rehabilitation.


Baseball Injuries: How to prevent.

Baseball Injuries: How to prevent.

Crucial Tips for Parents of Little League Players

–Angela Gordon, PT, DSc, MPT, COMT, OCS, ATC, FMS Lead physical therapist for the Washington Nationals Baseball team & NAIOMT Guest Faculty Member

As the little league season is upon us, there is quite a buzz these days on injury prevention and year round throwing in the youth baseball player. Over the last couple of years, I have seen quite an increase in youth injuries in the 10 to 13-year-old range from kids playing baseball either year round, playing in two leagues at the same time or both.

At this age injuries manifest in the elbow mostly due to overuse, improper throwing mechanics and also because of skeletal immaturity. Injuries such as medical epicondyle avulsion fractures and UCL strains are amongst the most common for this age range. The severity of these injuries are on the rise and what most parents and kids do not understand is that while we as a medical community have evolved and are great at helping to correctly these injuries, it still does not negate the fact that if these kids continue to play year round and in multiple leagues at the same time, their chances of making it beyond high school in baseball decrease to a generous 10%. I am a huge advocate for the STOP program that Dr. Andrews has begun to spread awareness of the potential hazards associated with overuse in youth sports. There is also a program started by MLB called Pitch Smart and an app developed by Dr. Andrews and Kevin Wilk out of ASMI called Throw Like a Pro, all to help promote following pitch counts and smart baseball habits. I make sure parents and athletes that I am treating are well versed in the pitch count and throwing regulations for youth baseball. I want parents and kids to understand that until they have a skeletally mature system, there are several things they should and should not be doing:

Do not play year round. I advocate 4-6 months off from baseball for 10-12 year olds and 4 months on for 13-14 yr old, and 3 month off for 15-18 yr olds. However with all the camps and showcases for high school athletes this can be nearly impossible.

Do not play on multiple teams. One team per season, do not cross over end of one season and beginning of another. If you have a break in between seasons (1 week to 4 weeks) take the time and proper steps to progress back into throwing and hitting.

Do not play pitcher and catcher in the same game or same day if playing multiple games. Be an advocate for your child, do not let coaches over utilize the kids during games and tournaments even if they are short on players. Nothing good ever comes out of this tactic for the athlete.

Avoid the training programs that require exercises and weighted ball activities that their system is not strong enough to handle. Volume, distances, weights, and exercises all need to be modified and reduced for the 10 to 13-year-old group.

Develop basic scapular stability. Most 10 to 13-year-olds have some baseline scapular dyskinesis due to skeletal immaturity and you can not develop full stability until you age. Focus on basic stability and only perform what bodies can handle until they mature.

The Thrower’s Ten program is a great program for this age range with no weights and light resistance bands. It is easy to perform with little to no equipment, compliance is high and it is not overtaxing on their system.
There are also some good basic throwing mechanics as described by Davis JT et al* that I review with this age group. Davis describes, for the youth these basic checkpoints are useful to help develop more efficient throwing until they achieve proper sequence of motion as they age:

Leading with the hips

Hand on top position

Arm in throwing position: elbow max height when lead foot contacts

Closed shoulder position

Stride foot towards home plate

This study by Davis et al concluded that hand on top and closed shoulder position are 2 parameters the pitcher should achieve to reduce humeral internal rotation torque and elbow valgus loads. A basic arm prevention program, volume control and basic mechanics instruction can have a positive impact in reducing the injury epidemic in the young baseball player.

*Davis JT, Lumpisvasti O et al. The Effect of Pitching Biomechanics on the Upper Exremity in Youth and Adolescent Baseball Pitchers. Am J Sports Med. 2009:37:1484-1489.