Throwing Injuries In Children

2019-03-242019-01-31 by Steph

children baseball throwing injury Little Leaguer Youth Pitcher Elbow

What’s up ? This is THE stephane ANDRE. With my training, I’m interested in biomechanics to avoid injuries. I read « Sport Medicine Media Guide » and I learned some good stuff.

In baseball, especially at the beginning of the season, there is an increase in elbow problems amoung young players. The most common elbow problem is the medial apophysitis named « Little Leaguer or Youth Pitcher Elbow ».

The elbow joint is composed of 3 bones : upper arm bone (humerus) and 2 bones in the forearms (radius and ulna). Muscles, ligaments and tendons keep the elbow joints together.

Little Leaguer Elbow

little leaguer Youth Pitcher Elbow humerus ulna radius medial apophysis epicondyle

This injury occurs when repetitive throwing creates an extremely strong pull on the tendons and ligaments of the elbow. The pain felt to prominence inside the elbow.

« Pitcher’s elbow » can become serious if the case gets worse. Repeated pull can tear ligaments and tendons of the bones. The tear can take tiny pieces of bone like when a plant takes piece of the soil when it uprooted. This can destabilize bone growth, which can create a deformity.

Symptoms

« Pitcher’s elbow » can cause pain in the elbow. If any of these symptoms occur, it’s recommended to stop the throws :

Elbow pain
Decreased movement amplitude
Locking or snagging in the elbow joint

Treatment

Elbow injuries by lanching movements can become complicated cases, if they’aren’t treated.

Non-surgical treatment

Younger children respond better to non-surgical treatment :

Stop throwing because continuing to do this can create major complications and may reduce a child’s ability to remain active in a throwing sport.
Use an ice bag to decrease swelling
If the pain continues after a few days of complete rest in the affected area or if the pain reoccurs when the throwing starts, stop the activity again until the child is treated.
Improve the technique of launched

Surgical treatment

Surgery is sometimes necessary for serious injuries, mainly for girls older than 12 years old and boys older than 14 years old.

Depending on the child’s injury, surgery may includes bone fragment removal, bone grafting or reattaching a ligament back to the bone.

Recovery time

The recovery time depends on the age of the athlete and the severity of the injury. If the injury detected early and the modification of the activity begins, there will be little time required for the athlete to start the sport again.

However, if the athlete continues to play despite the pain and other symptoms, it will take several months to heal the injury. Or it’s possible that the injury becomes permanent.

Prevent

The recommendation for a child to be safe is 15 for 8-10 years old, 100 for 11-12 years old and 125 for 13-14 years old. This involves training and competitions. To avoid pitching injury, young pitchers should play 3-4 inning each game.

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-Steph

P.S. If you’re in Miami and you like Caribbean food, go to my cousin’s bistro to eat Haitian food, click here .

Stress Fractures

2019-03-242019-01-04 by Steph

What’s up ? This is THE stephane ANDRE. With my training, I’m interested in biomechanics to avoid injuries. I read « Sport Medicine Media Guide » and I learned some good stuff.

A stress fracture is an overuse injury. Human body creates a new bone to replace a bone that has been broken due to the stress of everyday life. This process is done every day to keep the balance. Unfortunately, this balance can be disrupted because of excessive physical training. There are several factors that can prevent the body from creating enough bone and this make microcracking, called « fracture stress ».

The most common factor of fracture stress is an excessive increase in the intensitiy or frequency of physical activity without adequate rest period. Other factors are nutritional deficiencies, mechanical influences, lack of sleep, systemic factors (hormonal imbalance, etc.) and metabolic bone disorders.

There are case of development of eating disorders and/or amenorrhea (infrequent menstrual periods) for some female athletes who are preparing for a competition. These 2 conditions can create a decrease in estrogen that can decrease bone mineral density. This increase the risk of stress fractures.

Stress fractures are often seen in athletes (especially runners) or military recruiting. For an athlete, 1.6km run is 110 tons of force absorbed by the legs. Bones aren’t made to resist this force (energy) so it’s the muscles that have the function of absorbing shocks.

When the muscles get tired, they stop absorbing the forces and eveything transferred to the bones. Stress fractures occur in almost all bones but are more common in lower bone, expecially the tibia. Depending on the type of sport, there’re distinctive stress fractures such as the elbow in throwing sports, the ribs in golfing and rowing, the spine in gymnastics, the lower extremity in running activities and the foot in gymnastics and bascketball.

Diagnosis

stress, fracture, foot, x-rays, metatarsal,2nd

Stress fractures create pain in a limited area directly above the tip of the bone where the fracture occurred. The pain is raw because of physical activity and relived with rest. The sensitivity of the bones is the most obvious conclusion to the physical examination.

With regard to X-rays, this isn’t a tool that actually helps to diagnose an early stress fracture because the bone often looks normal and the microcracking aren’t visible. It’s difficult because after several weeks of rest, the bone begins to repair itself and shows a healing reaction or callus on X-rays.

An early stress fracture is usually confirmed by a bone scan or magnetic resonance imaging (MRI).

Treatment

Stress fractures are generally classified as low-risk (will not become a serious fracture) or high-risk (will become a serious fracture).

Low-risk stress fractures usually require a rest period of 1-6 weeks of limited weight bearing activity progressing to full weight bearing may be necessary. Return to physical activity should be a gratual process.

Low impact activities like swimming or biking are recommended to maintain cardiovascular condition when the pain is gone. When the patient can comfortably perform low impact activities for long, pain-free periods, the patient can begin high-impact activities.

High-risk stress fracture have the danger of becoming a complete fracture. For athletes suffering from chronic pain and having normal x-rays results, it’s recommanded to use a bone scan or MRI. High-risk stress fractures should be treated as traumatic fractures (with cast or surgery) because of complications.

Prevent

food, vitamin,d, carrot, papay, meat, ,egg, chees, broccoli, fish, sweet, potato, mango, pepperoni, apricot, peach, melon, avocado

calcium, food, almond, amarant, grain, aparagus, apricot, artichoke, baked, bean, haricot, blackberry, blackstrap, molasse, blackcurrant, bok, choy, brazil, nut, bread, wholemeal, brocolly, chickpeas, cinnamon, edamame, soya, fennel, kale, kidney, olive, orange, sesame, seed, milk, spring, green, tofu, swede, walnut, watercress

Here are tips developed by AAOS to help to prevent stress fractures :

When an athete does a new sport activity, it’s necessary to program progressive goals. For example on the 1^st day, don’t run 8km but rather increase the distance gradually per week.
Cross-training => Alternate activities to achieve the same fitness goal helps to avoid stress fracture injuries. For example to achieve a cardiovascular goal, alternate cycling and running (cycling one day and riding the other day) is excellent. Adding strength training and doing flexibility exercises help improve performance.
Have and maintain a heathy diet with foods rich in calcium and vitamin D.
Use good equipment. Don’t use running shoes, gloves, etc, very old and very worn.
If during physical activity it start to swell or the pain starts, stop the activity right away. It’s essential to rest for a few days. If the pain continue, you should see an orthopedic surgeon.
It’s important to recognize early symptoms and treat them appropriately to return to the sport with a normal level of play.

Stats

Stress fractures occur less frequently in those of black African descent than in Caucasians, due to a generally higher BMD (bone mineral densitiy) in the former.
Women and highly active individuals are also at a higher risk, The incidence probably also increases with age due to age-related reductions in BMD.
Children may also be at risk because their bones have yet to reach full density and strength.
The female athlete triad also can put women at risk, as disordered eating and osteoporosis can cause the bones to be severely weakened.

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-Steph

P.S. If you’re in Miami and you like Caribbean food, go to my cousin’s bistro to eat Haitian food, click here .

Overuse Injuries

2019-04-302018-10-18 by Steph

What’s up ? This is THE stephane ANDRE. With my training, I’m interested in biomechanics to avoid injuries. I read « Sport Medicine Media Guide » and I learned some good stuff.

There are 2 types of injuries : Acute injuries and overuse injuries. Acute injuries are usually caused by a single traumatic event. Here are some examples :

Wrist fractures
Ankle sprains
Shoulder dislocations

Acute injuries are less common in sport than overuse injuries. Overuse injuries are usually subtle and appear over time, making them difficult to diagnose and treat. Here is some example :

Tennis elbows
Swimmer’s shoulder
Pitcher’s elbow
Runner’s knee
Achilles tendinitis
Shin splints

Why

Human body is extraordinary to adapt to physical stress. We’re used of thinking that « stress » is bad for our emotional well-being, but physical stress is simply doing an exercise or activity. This is beneficial for our muscles, tendons, ligaments and bones. This physical stress causes an internal process called remodeling. Remodeling process involves both the breakdown and the build up of tissue. It’s necessary to have a good balance between 2, if breakdown occurs more rapidly than buildup, an overuse injury occurs.

Causes

Usually, it’s training errors that cause overuse injuries. These errors are too fast acceleration of intensity or duration or activity frequency. These injuries can also happen to people who return to the sport/activity after an injury. They try to make up for lost time as quickly as possible to reach the level they had before the injury. Doing an exercise with a good technique is important to avoid overuse injuries. When the exercise’s technique is bad, it creates overuse injuries. It’s for this reason that coaches, athletic trainers and teachers can play a preventive role so that athletes avoid overuse injures.

There are people who more easily have overuse injuries. An unbalance between strength and flexibility around certain joints predisposes some people to have this type of injury. Body alignment, such as knock-knees, bowlegs, unequal leg lengths and flat or high arched feet, also impact overuse injuries. There are also people who have weak links because of old wounds, incomplete rehabilitation of wounds or others anatomy factors.

Other factors must also be taken into account as equipment such as the type of running shoe or ballet shoe and terrain (hard versus soft surface in aerobic dance or running).

Diagnosis

Generally the diagnosis is based on the athlete’s history and physical examination. It’s recommended to make a diagnosis with a sports medicine specialist with a specific interest and knowledge of your sport. In some situations X-rays, bone scan and MRI may be necessary.

Treatment

Here are some recommendations for treating an overuse injuries :

Cutting back the intensity, duration and frequency of an activity
Adopting a hard/easy workout schedule and crosstraining with other activities to maintain fitness levels
Learning about proper training and technique from a coach or athletic trainer
Performing proper warm-up activities before and cool down after
Using ice after an activity for minor aches and pain
Using anti-inflammatory medications as necessary

If symptoms persist, a sport medicine specialist may create a more detailed treatment plan for your specific condition. This may involve an exam of your training program and an evaluation of predisposing factors.

Prevention

Majority of overuse injuries can be avoided with a proper training program, common sense and learning to listen your own body. The quote : « No pain, no gain » doesn’t apply here. The 10% rule helps a lot to get things to the next level.

In general, you should increase the training’s intensity to a maximum of 10% per week. This allows your body to have enough time for recovery and response. This rule should be used to increase pace or milestone for walkers or runners. Or for the weights amount to increase for strength training programs. In strength training, add flexibility exercises and core stability exercises help tremendously to minimize overuse injuries.

It’s recommended to seek advice from sports medicine specialist or athletic trainer to prevent chronic or recurring problems. Your training program can also be modified to maintain fitness levels safety while you recover from your injuries. You must return to the sport only if an authorization is granted by a health professional.

Remember, it’s very important to warm-up before training and cool down after training.

Stats

3.5 millions of children are treated for overuse injures every year.

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-Steph

P.S. If you’re in Miami and you like Caribbean food, go to my cousin’s bistro to eat Haitian food. Click here .

Acromioclavicular Joint Injury

2018-11-132018-08-22 by Steph

What’s up ? This is THE stephane ANDRE. With my training, I’m interested in biomechanics to avoid injuries. I read « Sport Medicine Media Guide » and I learned some good stuff.

Acromioclavicular joint is a joint between the clavicle and the scapula. Acromion is a continuation of the scapular spine and hooks over anteriorly. It articulate with the clavicle (collar bone ) to form the acromioclavicular joint.

Problems types

The most common problems are arthritis, fracture and separation. Arthritis is characterized by a loss of joint’s cartilage. Arthritis of acromioclavicular joint is common with weight lifter, especially with bench press and a little less with shoulder press. When there is a problem with the rotator cuff, it’s possible that there is also acromioclavicular joint’s arthritis.

Acromioclavicular separation

When there is an acromioclavicular joint separation, it means that the ligament that connects the acromion and clavicle is damaged and that the 2 structures don’t align properly. Separation’s state can be weak or severe, that is why there is a system of « grade » according to which ligament is torn and the severity of the tear.

Grade I Injury – This is the weakest damage and the acromioclavicular joint is still aligned.

Grade II Injury – This is an average damage. Ligaments are only stretched but not fully torn. In case of stress (physical effort), the acromioclavicular joint becomes painful and unstable.

Grade III Inury – This is a serious damage. Ligaments are completely torn and the collar bone is no longer attached to the scapula, which creates a visible deformity.

Treatment of acromioclavicular joint arthritis

If the rest, ice, medications and change of the training program (changing the exercises) don’t work, the next step is a shot of cortisone. A shot of cortisone in the joint may have calmed the pain and may be permanently swollen. As each individual is unique, the effects may vary and it’s possible that it doesn’t swell permanently.

If non-surgical methods fail, it’s possible to perform a surgical operation. The pain is localized at the bones end that make contact with each other and the goal of the operation is to remove some of the end of the clavicle. This ambulatory surgery can be done with a small incision of 1 inch (2.5 cm) long or with the arthroscopy technique with 2-3 incisions. The results and recovery of these 2 surgical techniques are about the same. Most patients have a full movement by 6 weeks and can return to do sport by 12 weeks.

Treatment for acromioclavicular separation

Separation can create very painful injuries, so the first thing to do is to decrease the pain. Hold the arm in a sling, put ice and pack the shoulder for 20-30 minutes every 2 hours as needed. Acetaminophen and non-steroidal anti-inflammatory medications can also help calm the pain.

When the pain begins to subside, it’s important to move the fingers, wrists and elbow (and eventually the shoulders) in order to avoid having stiff or « frozen » shoulder. The length of time needed to regain complete movement and function depends on the severity or injury’s grade.

Recovery from Grade I acromioclavicular separation usually takes 10-14 days while Grade III takes 6-8 weeks.

When surgery

Grade I and II separations require very rarely surgery. With a Grade III injury, after surgery, it’s possible to have full body physical activity with some restrictions.

Statistics

More males than females suffer acromioclavicular joint injuries

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-Steph

Variant To Avoid Dumbbell Bench Press Shoulder Pain

2018-08-09 by Steph

What’s up ? This is THE stephane ANDRE ! I watched an Athlean-x’s video and I learned some good stuff.

I wrote an article about to avoid pain when you do dumbbell press or overhead shoulder press because I have a pain when I do it. Click here to read the article . I have the same problem with the dumbbell bench press. I have pain when I do it, so I write this article to continue this exercise without pain.

Bench press is one of the fundamental exercises to build muscles but with this pain, I wondered if I should continue doing this exercise because it hurt.

Problem

The reason for this pain may be a biceps tendonitis, a torn labrum, an inflammation or shoulder impingement (inflammation in rotator cuff). All these problem create instability during this exercise while we know that stability (body’s stability and dumbbell’s stability) is very important to perform the movement properly.

In the case of a torn labrum, labrum is tied to the biceps tendon or rather the biceps tendon is attached to the labrum. During the movement, it’s the tension of the biceps tendon that pulls on the torn labrum.

Solution

The solution is to change the elbows position. To do the classic bench press, the elbows are at between 45° and 90°, dumbbell held horizontally in the hands and you press up. To calm the pain, we’ll change the position. The technique is to tilt the dumbbells so that the dumbbell’s back are facing the ceiling.

Classic dumbbell bench press

Variant dumbbell bench press

Tilting the dumbbell’s back does 2 things :

This brings your arms closer to your body because you use a semi pronated grip. With this position your hands and arms make your shoulders have a neutral position. It’s the equivalent of barbell corner press which helps to reduce the pain caused by dumbbell press .

You use your triceps more than your biceps during the movement. With the classic position, you use your biceps to stabilize dumbbells than your triceps. With this position, you flex your elbows so you use more triceps to stabilize dumbbells than your biceps.

Classic dumbbell bench press

Variant dumbbell bench press

Using more triceps than your biceps will seriously reduce the pain or make it disappear because there is less tension through the biceps and it will less pull on the torn labrum. If you have biceps tendonitis or inflammation, this will seriously decrease the pain. Try this technique and you’ll see that it will be the first time you’ve been doing pain-free bench press for a long time.

When I had this pain during this exercise, I thought of 2 options :

Stop doing bench press because you can’t support the pain anymore
Use lightweight

Now that I know this technique :

I can continue to do bench press
I can keep the same weights and increase them

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-Steph

Exercise To Avoid Overhead Shoulder Press Pain

2019-03-242018-06-20 by Steph

What’s up ? This is THE stephane ANDRE. I watched an Athlean-X’s video and I learned some good stuff.

I have a little pain when I do dumbbell press or overhead shoulder press, maybe you have that pain too ? As I want to avoid having surgery like the majority of professional athletes, I tried to find out if I could find an alternative exercise to work the same muscles without pain.

This shoulder pain during this exercise is a real problem, because it’s a movement that is so advised to do to develop shoulders that the majority of people continue to do despite the pain. The longer a person continues to do this exercise with the pain and the more the person, several years later, will need to do a surgery to the damaged shoulder. It’s sad because people keep doing this exercise because they don’t know (like me at the beginning) that there are alternative exercises.

Pain

For me, I felt the pain at the starting position, it means with a dumbbell in each hand, dumbbells at the level of my ears or a little above my shoulders and my elbow at the outside. It was impossible for me to keep this position for more than 5 seconds and after a few reps, I felt less pain. A few months later, I changed the starting position. I started with my arms outstretched but the pain was still there. The feeling of pain is really bizarre because sometimes, I felt that my shoulders could be dislocated with heavyweight.

Solution

The idea is to do this exercise with the elbows forward because the pain is due to instability of the rotator cuff. In fact, this pain appears on the weakest shoulder.

This exercise has no official name and has a lot of variation but the best known name is barbell corner press. You need to use a barbell and put it in a corner of the gym. If you do this at home, I advise you to put a blanket in the corner of the wall to not damage the wall. Put a plate of 10kg (22lbs) or 20kg (45lbs) on the opposite side :

Lift the barbell with your 2 hands with a squat position to protect your back. Stand up with your torso leaning forward, your back straight, one leg forward and your hands almost on your torso with your elbows forward.

Press straight up overhead and exhale

Back to the start position and inhale

You can also do this exercise with one hand. Barbell corner press is an alternative exercise to dumbbell press or overhead shoulder press to continue developing your shoulders without pain and without sacrificing your shoulders.

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-Steph

Leg Raises

2019-03-242018-06-11 by Steph

What’s up ? This is THE stephane ANDRE ! I read a Frederic Delavier’s book « Strength Training Anatomy » and I learned good stuff.

On your elbows with your back on the backrest :

Inhale and back up your knees to your torso by rounding your back to feel your abs contraction.
Exhale at the end of the movement.

This exercise works the hips flexors, mainly iliopsoas, obliques and rectus abdominis (it’s the inferior part of the rectus abdominis which works intensely).

Variant

To target the work on abs, it’s advisable to make small swings of legs with your rounded back, without ever lowering your knees below the horizontal.
To increase the intensity, the movement can be done with your legs stretched but it’s necessary to have a good hamstrings flexibility.
You can keep your knees grouped to your torso for a few seconds to have an isometric contraction.

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-Steph