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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Meniscal Tears

meniscus

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.

Meniscus tear

meniscus tear

Meniscal tear is one of the most common knee injuries in athletes. This is caused after a contact injury or a traumatic twist. The meniscus is a wedge-shaped cartilage that provides a cushion in the medial and lateral portion of the knee joint and acts as a « shock absorber ». It’s located in the area of joints contact to prevent the bones rub between them because of the bodyweight. It’s hard and rubbery to help cushion the joints and keep the knees stable.

It’s important to also know that the meniscus helps to nourish the knee by facilitating the diffusion of joint fluid. With this injury, athletes can experience acute pain with a swelling and often a catching or locking sensation.

Diagnose

A meniscus injury can be diagnosed on the basis of the story that the patient provides and a physical examination of the knee.

An orthopedic surgeon my also use other techniques to further diagnose such as magnetic resonance imaging (MRI), which gives a 3-dimensional image of the inside of the knee joint. In some cases, a surgeon can perform an arthroscopic inspection of the articulation, this is a minimally invasive surgical procedure.

Treatment

knee brace

A small meniscus tear can be treated with rest, ice and anti-inflammatory medications. When a meniscus tear causes a significant loss of movement or catching, the appropriate treatment is often a surgical operation. Depending on the location and type of tear, the treatment may be a simple arthroscopy to remove the torn fragment. Depending on how quickly the inflammation disappears, athletes can return to a full activity after a week or months.

For athletes with a repairable tear, sutures are used to sew the meniscus. In this situation, the knee is braced for 6 weeks. These athletes take at least 3-6 months to back to their activities but maintain the full cushion in their knees.

Prevention

There is not really any way to prevent a meniscus tear apart from a conditioning program to try to prevent an acromioclavicular ligament (ACL) tear and knee instability.

Stats

Women have meniscus tears more often than men and at an earlier age. These tears are often associated with an acromioclavicular ligament injury (ACL)

There are some variables of meniscus tears can be repaired and despite repair, they aren’t always heal. But arthritis can be avoided in the majority of cases when repair is successful. One study shows that 60% of patients who undergo meniscectomy (partial elimination) had some degree of progressive arthritis.

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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 .

Anterior Cruciate Ligament Injuries

anterior cruciate ligament injury tear

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.

Knee is the largest and most complex joint of the body. There are 4 primary ligaments (with their muscles and tendons) and secondary ligaments for the knee to function properly. Here are the ligaments of the knee : there are 2 ligaments on the side the medial collateral ligament (MCL) and the lateral collateral ligament (LCL) and two crossed ligaments in the center of the knee, the anterior cruciate ligament (ACL) and the posterior cruciate ligament (PCL).

Anterior cruciate ligament connects the front top part of the shine bone to the back bottom part of the thigh bone and keeps the shin bone from sliding forward.

anterior cruciate ligament

Injury

anterior cruciate ligament injury tear

There are several ways to have an injury to the anterior cruciate ligament :

  • The injury can be done because of a direct hit on the knee, which often happens in team sport.

  • The injury can be done without contact with an object in a situation where the knee forced to be in a abnormal position, which causes a tear in one or more ligaments of the knee. Or when an athlete in the race change direction. Or when an athlete make a hyperextend of the knee when landing a jump, which often happends in agility sports.

Diagnostic

In the majority of cases, the doctor is able to identify what is the injured ligament. But the knee can also be injured at the joint on the surface and in this situation, it’s more difficult to diagnose because of knee swelling. To make an accurate diagnosis, it will be necessary to use a MRI scan or arthroscopy.

Prevent

There are several fast, powerful movements that lengthen (eccentric phase) and shorten (concentric phase) a muscle. These prevention programs are for injuries without contact. These exercises are to improve the nerves/muscle control of the knee. These prevention programs use plymetrics, balance and strength/stability exercises.

Plymetrics

It’s a fast, powerful movement that lengthens (eccentric phase) and shortens (concentric phase) a muscle. The concentric phase increases the muscle power. Here is an example, an athlete who jumps from a box and immediately jumps into the air after touching the floor.

Balance

Balance exercices are done with the wobble or balance board. It’s also possible to perfom exercices by throwing a ball with a partner while balancing on one leg.

Strength/stability

To improve single-leg core strength and stability, there are excellent exercices such as jumping and landing on one leg with the knee flexed and momentarily maintaining this position.

Surgical treatment

In the past, there was a technique that consisted of stitching the ligament together but it was rarely successful. Currently, the technique involves reconstructing the anterior cruciate ligament by building a new ligament from tissue taken from one of the other tendons around the knee or from on organ donation. This tissue passed through drill holes in the thigh bone and the shin bone, and then ancored in place to create a new anterior cruciate ligament. Over time, this transplant becomes mature and becomes a new living ligament in your knee.

Recovery

recovery

Rheabilitation of the knee after the reconstruction of the anterior cruciate ligament requires time and work. To have a complete function, this can last between 6 weeks and 6 months depending on the severity and level of activity. Rehabilitation rate may take time depending on the specific requirements of the sport/physical activity of the individual.

The overall success rate of the anterior cruciate ligament surgery is very good. A lot of study show that more than 90% of patients are able to return to sport without symptoms of knee instability. It’s true that some patients complain of stiffness and pain after surgery, that is why it’s necessary to make an aggressive rehabilitation until the new surgical technique to reduce these problems.

Statistics

  • One of the most commonly injured ligament in the knee

  • Female athletes participating in basketball and soccer are 2-8 times more likely to suffer anterior cruciate ligament injury.

  • Athlete who suffer anterior cruciate ligament injury at increased risk of arthritis development later in life.

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-Steph

Standing Calf Raise Machine

standing calf raise machine

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

Stand with your back straight and your shoulders under the pads. The front of your feet on the step with your ankles in passive flexion :

  • Do an extension of your feet with of your knees joints in extension.

This exercise works the triceps surae composed of 2 gastrocnemius and soleus. It’s really important to do each repetition with a full flexion to really stretch the muscles.

muscle triceps surae

insertions muscle triceps surae

In theory, it’s possible to locate the work on gastrocnemius medial (toes outward) or gastrocnemius lateral (toes inward) but, in reality it’s very difficult. However, you can easily shift the emphasis from the gastronemius to the soleus by flexing your knees to relax the gastrocnemius.

gastrocnemius medial lateral

Variant

standing barbell calf raise

It’s possible to do this movement with the Smith machine and a step under your feet.

Note

Triceps surae is a very powerful muscle that is used to lifting your bodyweight all day. It’s for this reason why it’s important to use heavyweights to work it.

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-Steph

Adapt Your Training To Your Morphology (Part 2)

anatomy body squat morphology knee big belly

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

If you didn’t read Part 1, click here.

Legs

Improve your squat position

anatomy body squat morphology knee big belly

To reduce the lower back’s effort and limit the hamstrings tension, it’s possible to do like powerlifters by putting the barbell on posterior deltoids.

This technique decreases the cantilever and increases the power of lifting from the back. This allows you to lift heavier weights.

By using powerlifter of weightlifting shoes (solid raised heel) or a wedge under the heels, this reduces the cantilever by having the buttocks not too back by the advancing knees. This allows for greater amplitudes with the thighs flexion.

With that, we feel better the quadriceps work by limiting the torso’s inclinaison and the work of the gluteus maximus and spinal erectors.

The low barbell and raised heel combination allows you to lift heavier weights. This technique is recommended for rangy people and people with stiff ankles to correct their positioning at squat.

Front squat to target quadriceps

anatomy body squat morphology knee big belly

Front squat limits the torso’s inclinaison. This has the effect of reducing the work of the lower back, decrease the tension of hamstrings muscles and adductor magnus muscle.

On the other hand, front squat increases the cantilever, which forces quadriceps to make more effort to extend the thigh on the leg.

Which means it’s the perfect squat for thighs. But it’s not possible to lift heavyweights like the classic squat and it’s recommended to do it with heels elevated for better stability.

For rangy people, front squat is very hard to do. The torso of rangy people is more inclined, which make it more difficult to hold the barbell which may fall forward during the execution of the movement.

Spread the legs to less incline the torso

anatomy body squat morphology knee big belly

There is a squat’s technique to limit the torso’s inclination. This involves spreading the legs with the feet outward. Some powerlifters do this technique with the legs almost wide apart. With the legs apart, this limits the legs flexion.

To be able to squat with the legs apart, it’s necessary to have an adequate bone conformation of the hip joint and to be flexible of the thighs adductor muscle. Which means, it’s a technique that can’t be used by everyone.

The advantage of the big belly

anatomy body squat morphology knee big belly

Having a big belly for squat and deadlift allow to compress it against the thighs. This helps to limit the inclination of the torso and the back’s rounding. This has the effect of protecting the lower back and limiting the risk of herniated disc.

It’s for this reason that we can see a lot of heavyweight champion of powerlifting or weightlifting with a big belly. They take care to keep their belly fat with an excessively rich diet.

Different forms of knees

anatomy body squat morphology knee big belly

In bodybuilding, it’s important to take into account the different morphologies of the individual and especially for the knees.

Arched legs (genu varum) are not more risky than normal legs. For people with X legs (genu varum) or people who can overly extend the thighs (genu recurvatum), it’s often recommanded to not do leg exercises with very heavy weights.

Cases of genu valgum are often :

  • In people who were overweight during their youth when leg bones weren’t fully developed and still « malleable ». Legs are deformed because of the overload. Now, they have this X shape.

  • In women. The fact that women have wider hips to have children, this influences the femurs direction which are generally more inclined.

For people with genu valgum. If the genu valgum is to excessive, the joint would be overused. The medial collateral ligament would be extremely tense. The lateral meniscus, the articular surfaces coated with cartilage of the external condyle of the femur, and the external lateral tuberosity of the tibia would be subjected to excessive friction, which would cause pathologies of wear.

For people with genu recurvatum. These are people who are essentially very flexible named hyperlaxes or women whose muscular and ligamentous hyperlaxity is related to reproductive function.

Rarely pathological, knees with genu recurvatum can sometimes have some problems like the meniscus pinching. This can happen when the knees are rapidly expanding and the meniscus haven’t had enough time to slip, or during an exercise with a heavy weight that has forced the hyperextension of the thigh.

It’s for this reason that it’s recommended to people suffering from a genu recuvatum pathological never to totally block the knees at the end of extension to the squat or to the leg press.

Note

For 2 people who are the same size, it’s important to consider the torso-leg ratio.

anatomy body squat morphology knee big belly

Type A :

People with proportionally long legs and a short torso will have trouble doing a proper squat without tilting their torso excessively forward.

On the other hand, the short torso (which limits the cantilever) facilitates the execution of the good-morning, classic deadlift and Romanian deadlift.

Type B :

People with proportionally short legs and a long torso will have the facility to squat safety without tilting their torso excessively forward. It’s for this reason that the great champions of powerlifting squat specialist have this type of morphology.

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

-Steph

Triceps Extension

triceps extension anatomy version

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

Lying on the bench, you take the barbell with a pronated grip with your arms in vertical :

  • Inhale and flex your arms. Taking care to not spread too much your elbows to go down the barbell at your forehead or behind your head.

  • Back to the start position and exhale at the end of the movement

Variant

triceps extension anatomy version

  1. Barbell at your forehead level: Works mainly your medial head and lateral head of triceps muscle.
  2. Barbell behind your head: Works mainly your long head of triceps muscle.

triceps extension anatomy version

To make this movement easier, you can use an overhead triceps machine. This allows for greater concentration on the triceps long head. 

triceps muscles long head medial lateral

Note : Like we have each different morphology like have shoulders more or less wide, valgus of the elbows more or less pronounced, wrist more or less flexible, hands may be more or less outspread and elbows more or less open during the movement execution.

ez bar

Use the EZ-bar allow you to do this exercise by avoiding excessive tension on your wrist joints.

-Steph

Reverse Pushdowns

reverse pushdown anatomy

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

Standing in front of the machine with your hand on the bar with a supinated grip. Your elbows are along of your body. Your arm must be do a « L » :

  • Inhale and make an extension of your arms and be sure not to spread your elbows of your body.

  • Exhale at the end of the movement

The supinated grip  doesn’t allow you to work with heavy weights then this exercice is done with light weights.

This exercise  work triceps and the medial head.

When you do the extension of your arms, you work also anconeus muscle and wrist’s extensors.

reverse pushdown anatomy arm

The wrist’s exensors ( extensor carpi ulnaris, extensor digitorum, extensor digiti minimi, extensor carpi radialis longus and extensor carpi radialis brevis) keep your wrist straight by an isometric contraction during the movement’s execution.

-Steph