Throwing Injuries In Children

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

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Shoulder Instability Or Dislocations

shoulder instability anatomy

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.

Shoulder is the most mobile joint of the body. This allows you to lift your arm, rotate your arm and lift your arm over your head. It’s possible to have a greater range of motion with less stability.

How

Shoulder instability

This happens when the humerus head (the upper arm bone) is forced out of the shoulder’s cavity. Usually this happens as a result of a sudden traumatic injury.

Once the shoulder is dislocated, the shoulder is vulnerable to repeat. When the shoulder is loose and slips several times, it’s called a chronic shoulder instability.

The shoulder is made of 3 bones : humerus (upper arm bone), scapula (shoulder blade) and clavicle (collarbone).

Dislocation shoulder

shoulder dislocation anatomy

This may be partial, which means that the arm’s ball partially comes out from the cavity. This is called a subluxation. This can be complete which means that the arm’s ball comes out completely from the cavity.

Symptoms

Symptoms of chronic shoulder instability are :

  • Pain caused by the shoulder injury

  • Repeated shoulder’s dislocation

  • Repeated instance of the shoulder giving out

  • A persistent sensation of the shoulder that is loose, slipping out of the joint or hanging.

Diagnosis

Specific tests help assess shoulder instability (including general relaxation of ligaments). A doctor may prescribe imaging tests such as X-rays, CT Scan or MRI to confirm the diagnosis and identify other problems.

Treatment

First, chronic shoulder instability treated with nonsurgical options. If these options don’t relieve pain and instability, surgery may be needed.

Nonsurgical treatment

shoulder dislocation treatment non surgical

Generally, it often takes several months of nonsurgical treatment before success can be assessed. Nonsurgical treatments includes :

  • Activity modification

  • Non-steroidal anti-inflammatory medication

  • Physical therapy

Surgical treatment

shoulder dislocation treatment surgery bankart repair

Often, surgery is often required to repair torn or stretched ligaments so that they can maintain the shoulder joint in place.

Bankart lesions (tearing of the front labrum from the cavity) can be repaired surgically using suture anchors to reattach the ligaments to the bone.

Arthroscopy => Soft tissues of the shoulder can be repaired using tiny instruments and small incisions. It’s a procedure that is done the same day or outpatient. Arthroscopy is a minimally invasive surgery. The surgeon examines the inside of the shoulder with a small camera and performs the operation with special instruments.

Open surgery => These are patients who require open surgical intervention. This involves making a wider incision on the shoulder and performing the repair under direct visualization.

Rehabilitation

After surgery, the shoulder can be temporarily immobilized with a sling. When the sling is removed, it’s essential to do ligament rehabilitation exercises. These exercises improve the range of motion of the shoulder and avoid scarring during ligament healing. Thereafter, exercises for strengthening the shoulder will be added in the rehabilitation program.

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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 .

Rotator Cuff Tears

rotator cuff tear anatomy shoulder

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.

Rotator cuff is a group of 4 muscles and their tendons that together form a « cuff » around the head of the humerus (upper end of the arm). The 4 muscle, originate from the scapula (shoulder blade), are upraspinatus, infraspinatus, subscapularis and teres minor. Tendons of each muscle fit on the humerus tuberosity.

Rotator cuff’s functions :

  • Lift the arm

  • Turn the arm

  • Stabilize the humerus in the joint

Causes

rotator cuff tear anatomy

The causes of a rotator cuff tear can be an acute injury such as a fall or because of chronic wear with tendon degeneration. For people over 40 years old, the pinching of the tendon on the underside of the scapula may participate in tearing.

Diagnosis

Diagnosis of rotator cuff tears is based on an examination and/or diagnosis study such as a MRI (magnetic resonance imaging) to confirm the diagnosis. Diagnosis early on in the first symptoms and rotator cuff’s treatment can help to boost the treatment’s results.

Treatment

Goals treatment are to relieve pain and restore strength to the injured shoulder. Several tears in rotator cuff can be treated without surgery. Anti-inflammatory drugs, steroid injections and physical therapy can all be beneficial in treating the symptoms of a tear in the cuff.

Even though a full-thickness tear needs to be cured with surgery, it’s possible to use non-surgical treatments to have a satisfactory function in some cases.

Surgery

rotator cuff tear anatomy surgery

Surgery is recommended if there is persistent pain or shoulder weakness that doesn’t improve with non-surgical treatment. Often patients who have surgery indicate nocturnal pain and difficulty using the arm for lifting and reaching. Many will indicate persistent symptoms despite several months of treatment and limited use of the arm.

Surgery is also recommended for active people who use the arm for overhead work or sports.

Surgical options

The type of repair performed is based on the findings at surgery. A partial tear my necessarily only a trimming or smoothing procedure called a debridment. A full-thickness tear with the tendon torn from its insertion on the humerus is repaired directly on the bone.

3 techniques are used for rotator cuff repair :

  • Open repair (through a traditional incision)

  • Mini-open repair (partially assisted by a camera view, with a smaller incision)

  • Arthroscopic (performed with only a small camera inserted through multiple small puncture wounds)

Recovery and rehabilitation process

Whether for the treatment of non-surgical and surgical rotator cuff tear, rehabilitation has a very important role. Usually recovery is at least 6 months or more depending on the extent of the tear.

When there is a tear, there is frequently a loss of shoulder movement. An exercise or physical therapy program is needed to restore strength and improve shoulder function.

Although surgery repairs the defect of the tendon, the muscles around the arm remain weak and an important effort is necessary in the rehabilitation so that the procedure is a success. After surgery, a complete re-education can last several months.

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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 .

Biceps Tendon Rupture

biceps brachiitTendon rupture

I read a Frederic Delavier’s book « Strength Training Anatomy » and I learned good stuff.

Rupture or tear of the biceps long head is the serious injury the most frequent in sport

This injury usually appears on a muscle weakened by tendinitis caused by a sudden movement of the arm. Sudden arm movements are usually thrown like baseball, tennis, throwing sports and also Olympic weightlifting during the snatch. At this point, all tension transferred to the biceps long head which breaks most often where the tendon passes into the intertubercular sulcus of the humerus.

In bodybuilding, this injury is a little different, especially with the deadlift.

There is a technique in deadlift which consists of having a hand with a pronated grip and the other with a supinated grip to lift heavier weights and to avoid that the barbell rolls in the hands.

This simple technique is at the origin of the rupture or the disinsertion of the lower of the biceps (where the muscle is inserted on the humerus). Fortunately, this injury rarely happens.

During the positive phase of the deadlift, the muscles that work are legs, glutes, back and abs. Arms relaxed but they stretched as cranes cables.

Unfortunately, when a hand is with a supinated grip this shortens the biceps (the biceps is extremely powerful with a supinated grip). The result is that there is tremendous tension due to the heavy weights which cause the tearing or total rupture of the tendon of the radius. The biceps with a supinated grip works more than the biceps with a pronated grip.

In the deadlift, the injury is exclusively on the distal tendon of the muscle. The arms hang along the body, which causes the tension to be distributed at the top of the muscle between the tendons of the short head and the long head. For other exercises when the tension is at the bottom of the muscle, the tension is supported on a single tendon insertion.

biceps brachiitTendon rupture

The rupture of the biceps tendon causes a pain relatively moderate compared to the severity of the injury. If we compare the rupture of the biceps tendon with the major pectoralis or the adductors of the thighs, the pain is different. With a rupture of the major pectoralis tendon or adductors of the thighs, the suffering is so strong that the athlete must stop the effort.

It often happens that during a powerlifting competition, athletes who have a rupture of the biceps tendon during the deadlift, continue until the end of the movement.

When this injury occurs, there is swelling in the forearm because of hemorrhaging. But the most surprising thing is the retraction of the biceps which forms a ball at the top of the arm near to the pectoralis major and deltoid. This biceps retraction causes the brachial muscle in the lower arm to be more exposed.

biceps brachiitTendon rupture

It’s always possible to make a flexion of the arm with the rupture of the muscle, which less powerful than before, thanks to the brachial muscle, brachioradialis, long and short radial extensor of the carpus and the pronator teres muscle. On the other hand to make a movement with a supinated grip is a problem because the end of the movement is only carried out by a single muscle, the supinator muscle.

You have to be careful because this injury should be treated quickly by surgery to restore the brachial biceps tendon to the radius. If this surgical operation is not performed in time, the ball will have a fibrous transformation and retraction will be final. The arm’s mobility will always be possible but the loss of strength in flexion and supination is inevitable.

There is a solution to avoid this type of injury with deadlift with a bicep work to have a tendinous reinforcement. This exercise is to do a flexion only with forearms with a straight barbell. This exercise reinforces the biceps distal tendon but be careful by controlling the movement.

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-Steph

Triceps Tear With Back Exercises

triceps, tear, rupture, pull, up, back, exercise

I read a Frederic Delavier’s book « Strength Training Anatomy » and I learned good stuff.

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Workout for back exercise with very heavy weights such as lat pulldowns or chin-ups with weights can create injuries to the long head of the triceps brachii.

In fact, the latissimus dorsi is a powerful muscle whose function is to bring your arms close to your rib cage and your distal tendon is anchored in your humerus.

It’s for this reason that it’s called the climber’s muscle

Your long head of triceps has the function of extending your forearm and bringing your arm nearer to your rib cage. It’s when you bring your arm closer to your rib cage that your long head of triceps and your latissimus dorsi work together.

Usually, this is when the long head of the triceps has not had a good warm up or is tired that there is a tear.

This happens very simply. Imagine that during an exercise such as lat pulldowns or chin-ups with a very heavy weight, you release for a few seconds your muscle of the latissimus dorsi. The result is that at the tension will go on your long head of triceps.

In a few thousandths of a second, this may partially tear your triceps long head and usually, it’s located near of the connection of your triceps long head and the scapula. Fortunately, it’s rare to have a total tendinous tear.

This type of injury doesn’t have the same consequences as shoulder injuries because, with a shoulder injury, you’re almost forced to stop to train the upper body.

Despite the injury, it’s possible to do exercise with light weights. You can do exercise for the back like low cable row, t-bar row and triceps pushdowns with the elbows along the body for the triceps.

It’s recommended to have a rest period before to restart the upper body training.

Note

triceps stretching

It’s possible a triceps long head tear with the barbell lying extension. To avoid this, it’s advisable to do some stretching exercises before training.

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-Steph

Dumbbell Pullovers

dumbbell pullovers

I read a Frederic Delavier’s book « Strength Training Anatomy » and I learned good stuff.

Lying on a bench with your feet on the ground. You take a dumbbell with both hands and your arms outstretched. The dumbbell is on your palms and your thumbs and forefingers encircling the handle:

  • Inhale and lower the dumbbell behind your head by slightly bending your elbows

  • Exhale returning to the starting position

This exercise work pectoralis major, triceps long head, teres major, lats and a little bit serratus anterior, rhomboids and pectoralis minor. The serratus anterior, rhomboids and pectoralis minor have the function to stabilize the scapulae (shoulder blades) and to allow the humerus to tilt over a stable support.

It’s possible to do this exercise only to open the rib cage. To do this, work with lightweights and be careful to not bend your elbows too much. And it’s necessary to use a bench in a transverse position so that your pelvis is lower than your shoulder girdles. It’s important to inhale as much as possible at the beginning of the movement and to exhale only at the end of the movement.

dumbbell pullovers

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-Steph

Bench Press And Morphology

bench press morphology

I read a Frederic Delavier’s book « Strength Training Anatomy » and I learned good stuff.

I think you’ve noticed that the bench press is the most practiced exercise in a gym. And as this is the most practiced exercise, it’s also the exercise that create the most injury per year. This is why, it’s important to have basic morphology’s notions to be able to do this exercise correctly.

Arms length

bench press morphology

The majority of injuries with the bench press are muscle tears or rupture of the pectoralis major tendon (during the descent of the barbell).

The pectoralis major inserted on the humerus. As a result, during the descent of the barbell, more the arm go down and more the pectoralis major is stretched and vulnerable.

But the descent of the arm and the stretching of the pectoralis major vary from one individual to another. More the arm is long, more the humerus will go down, which causes the pectoralis major to be stretched. It’s for this reason that willowy people (a person with long body members) often have this type of injury.

Rib cage thickness

bench press morphology

More rib cage is thick and less the barbell can go down. This means a limited strech of the pectoralis major therefore less risk of injury.

It’s for this reason that the majority of great bench press champions are brevilineal type (a person with short body’s members). Having a thick rib cage and short members allow to achieve a record with a morphological safety that limits the risk of muscle tearing or rupture of pectoralis major.

Morphology has a fundamental place in sport success and it’s injuries that limit the progression. Sport progression isn’t only based on mental (mindset), diet and workout type.

It’s fundamental to adjust the training program with the morphology. Let couple things be clear : what’s good for the person next to you, is not automatically good for you.

Limit the injury risk

bench press morphology

There is a bench press variant and it’s close-grip bench press. This variant limits the arm’s descent and this reduces the pectoralis major’s stretch thus limits the injuries risks.

This variant used by bench press champions with willowy type but the disadvantages are reduced performances, triceps work more and the movement’s amplitude is more important.

There is also another variant, the partial bench press. The concept is to decrease the barbell’s descent for it doesn’t touch the chest. This avoids excessive pectoralis major’s stretching.

Muscle predominance

Depending on the muscular strength of a person, there are 2 ways to do bench press :

  • Elbows spread to make more work the pectoralis major

  • Elbows close (to close arm/chest angle) to make more work deltoids.

Regardless morphology, these techniques can be used to specifically target a muscle (elbows spread => pectoralis major or elbows close => deltoids).

Attention : for bench press, it’s necessary to adjust the technique according to the different morphologies

bench press morphology

Image A

A thin rib cage with long arms when the barbell approaches the chest during the descent dangerously stretch the pectoralis major. The risk of muscle tears or tendon rupture are increased with the weight on the barbell.

Image B

A thick rib cage with short arms when the barbell approaches the chest during the descent limits the movement’s amplitude and the pectorlis major’s stretching. It’s for this reason that there are many bench press champons with this morphology.

Share this article if you think it can help someone you know. Thank you.

-Steph