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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SLAP Tears

slap 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.

SLAP is an acronym for superior labrum anterior to posterior. The labrum is a rim of tissue that adds depth to the bony socket of the shoulder. The superior or « top » portion or the labrum is important and frequently injured because the biceps attaches to this region.

How

SLAP tears happens because of physical activity with repetitive overhead movements or physical shock. Tears created because of overhead movements are common among athletes as basball pitchers or tennis players. Tears created due to physical shocks are often a fall on a hand stretched with the arm over the head or fall directly on the shoulder.

Diagnosis

slap tear anatomy shoulder

SLAP tears are very difficult to diagnose only with a physical exam because of different shoulder problems. Using a MRI with or without contrast helps a lot.

Treatment

The first step is to do a nonsurgical treatment. While the SLAP tear likely will not heal, a study confirmed that many have improvement of symptoms and function. If nonsurgical treatment (such as physical therapy) isn’t successful, surgery is being considered.

Surgery is usually done arthroscopically and involves reattaching the torn labrum to the top of the cavity. Generally, bone anchors loaded with sutures are inserted into the top of the cavity. The sutures are passed through the torn area of the labrum. The sutures are tied, which brings the torn labrum to the bone.

Prevention

Although it’s difficult to avoir acute SLAP tears, it’s possible to prevent chronic tears, especially with athletes who make overhead movements, maintaining balance in the shoulder.

Exercices that strengthen the muscles around the shoulder blades and exercises that stretch posterior shoulders are recommended to reduce the risk of SLAP chronic tears.

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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 .

MRSA Infections

mrsa infection 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.

Methicillin-Resistant Staphylococcus aureus (S. Aureaus), or MRSA, is a bacterium that creates skin infections and other types of infections. The first time that MRSA was seen in US hospitals during the 1970s. Recently, there is a new strain of MRSA know as Community Acquired Methicillin-Resistant Staphylococcus aureus, or CA-MRSA, has left hospitals and began to spread in the community.

This is the strain that is prevalent among athletes. The difference between CA-MRSA and Healthcare-Associated MRSA (HA-MRSA) is in their effects. CA-MRSA usually creates skin infections while HA-MRSA causes bloodstream, urinary tract and surgical site infections. This make CA-MRSA less dangerous than HA-MRSA. Another difference is that CA-MRSA is more vulnerable to antimicrobial.

Symptoms

Signs of infections are :

  • Redness

  • Warmth, Swelling

  • Pus

  • Pain at sites where there are skin wounds

  • Abrasions or cuts

MRSA has the ability to spread to other organs in the body and when that happens, symptoms are more severe.

At this stage, symptoms are :

  • Fever

  • Chills

  • Low blood pressure

  • Joint pain

  • Severe headaches

  • Shortness of breath

  • An extensive rash over the body

These more advanced systemic symptoms require immediate medical attention.

Treatment

The 1st choice for treating MRSA skin infection is to use an antibiotic that has been created to kill bacteria with mild side effects. Most early infections with no widespread symptoms can be treated with oral antibiotics. Because of the nature of this decease and antibiotic options, many patients think they’re « cured » after only a few doses and decide by themselves to stop taking the prescribed drugs. However, MRSA is able to re-infect the patient and become resistant to antibiotics used previously.

For moderate to severe infections, treatment may be with intravenous antibiotics.

These infections associated with deep abscesses or boils require open surgical drainage in addition to antibiotic therapy. Most infections resolve in 7-10 days with an adequate treatment despite the fact that a deep abscess can take up to 4 weeks to eradicate the infection by resolving the abscess cavity.

Early identification and treatment of MRSA infections decrease the amount of playing time lost and decrease the chance that the infection will become severe. Skin may be protected by protective clothing or gear designed to prevent skin abrasions or cuts.

Prevention

mrsa infection anatomy

It’s necessary that athletes have good personal hygiene but it must be added that athletes and visitors to athletes facilities must also keep their hands clean by washing them often with soap and water or using an alcohol-based hand rub. The minimum is to have clean hands before and after sports and activities. For example when we use weight training equipment that is shared by all gym members, it’s important to have clean hands after using toilette or when someone is injured taking care the wounds (including changing bandage).

Ordinary and antimicrobial soaps are effective for washing hands. It’s noted that liquid soap is a better option because it’s not possible to share this type of soap compared to bar soap. Alcohol-based hand sanitizer that contain at least 60% alcohol are the perfect choice.

Athletes should shower immediately after exercise and shouldn’t share soap and towels. Washing all uniforms and clothes after each use is important. Athlete should avoid sharing items that are in contact with the skin and avoid sharing personal items as they contact the skin. Fortunately, most surfaces don’t provoke a risk of spreading staph and MRSA.

Athletes who have had MRSA

Several high school, college and professional athletes have contracted MRSA infections. There have already been epidemics among athletes on the same team. A study published in « The New England Journal of Medicine » shows an infection MRSA among St. Louis Rams professional football franchise (USA) athletes. During a single season, MRSA infections were found among 5 of 58 Rams athletes (9 percents) that was tested. All infections developed on areas of the body that are common places for turf injury.

Stats

  • Today, MRSA accounts for about 50-70% of the S. Aureus infections that are present in healthcare facilities across the world.

  • Statistics fro the Kaiser foundation in 2007 indicated that approximately 1.2 million hospitalized patients contract MRSA infections.

  • Serious MRSA infection is still predominantly related to exposure in the healthcare setting, where approximately 85 percent of all serious MRSA infections occur.

  • Fortunately, in children under 18 years old, mortality rates are much lower (1%), even though the number of hospitalized children with MRSA has almost tripled since 2002.

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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

acromioclavicular joint injury

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

acromioclavicular joint injury type grade

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

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

Knee Instability

knee anatomy

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

When the knee extended, external and internal lateral ligaments stretched and prevent rotation of the joint. Standing on one foot, knee wedged in extension, which means that there is no need for muscle action to stabilize the joint.

knee anatomy extension flexion

When the knee flexed, external and internal lateral ligaments relaxed. In this position, the joint only stabilized by the action of the muscles.

knee anatomy meniscus

In flexion-rotation of knee, meniscus moves forward on the side of rotation If the extension of the articulation which follow is poorly controlled, it may happen that meniscus doesn’t back in its place quickly enough. In this case, meniscus pinched between condyles and there may be a meniscal lesion. If during pinching, a small piece of meniscus has been cut, a surgical operation may be necessary to remove it.

knee anatomy meniscus ligament

During asymmetical exercise such as lunges (lunges and dumbbell lunges), it’s important to preserve the knee joint to control movement in speed and straightness to avoid any injuries.

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-Steph

Spinal Disc Herniation

disc herniation

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

First we can say : « disc herniation » or « herniated disc » but I prefer use « disc herniation » in my article.

Disc herniation is a common pathology in bodybuilding. This often occurs because of poor back placement during exercises such as squat, deadlift and rows (barbell bent row, seated row, etc).

During the execution of theses exercises, the main defect observed is the rounding of the back or a flexion of the spine. Because of that discs are pinched forward and loosened backward.

disc herniation

If an intervertebral disc cracked or aged, the gelatinous fluid of the nucleus pulposus moves backwards and can compress the spinal cord or roots of the spinal nerves. The symptoms of a disc herniation depends on the nature of the lesion, the amount of nucleus displaced and the surface that nucleus compresses.

The disc may have a bump or even worse, the nucleus may explode through the surrounding annulus fibrosus. It’s also possible that the posterior ligament that joins the vertebrae to each other is broken. The compressions caused by the rupture of the annulus fibrosus are always painful and incapacitating.

In bodybuilding, disc herniation are mainly at the lumbar level. Often between the 3rd and 4th lumbar vertebrae or between the 4th and 5th lumbar vertebrae. The pain is dull and deep and sometimes with numbness and tingling. Often the pain is in the middle of the back or on one side. The pain extends onto the glutes, pelvis and pubis. Sometimes pain can be felt throughout the leg following the path of the sciatic nerve because the sciatic nerve is compressed at the root (hence the name of sciatic to define this type of pain).

disc herniation sciatic nerve

Usually disc herniation resolve spontaneously and the pain gradually disappears. But in some cases the bump on a vertebral disc doesn’t disappear and can continue to painfully pres on the nerves or it’s a loose piece of intervertebral cartilage that compresses the nervous elements.

In these 2 cases, the doctor will think of doing a surgical operation to remove the part that compresses the nerves.

To avoid having a disc herniation, it’s essential to do squat, deadlift, « good morning » and rows (rows, barbell bent row, seated row) with excellent positioning technique.

Attention

For all exercises done with very heavy weight, it’s necessary to perform a « blocking » :

  1. Take a deep breath and block the breathing to fill the lungs like a balloon. This stiffens the ribcage and prevents the top of the torso form tilting forward.

  2. Squeeze abs stiffens the belly, This increases the intra-abdominal pressure and prevents the torso from sagging forward.

  3. By slightly arching the lower back with lumbar squeeze, this allows to have the spine’s bottom in extension.

These 3 simultaneous actions is what we call « blocking ». This « blocking » has the function of avoiding the rounding or bending of the spine because with very heavy weights, it can create disc herniations .

Note

After a training session with very heavy weights, it’s advisable to do stretching for the spine. There is an excellent exercise to relax the back muscles and rebalance the pressure inside the intervertebral discs. Click here .

Bad position

disc herniation bad positon squat deadlift

For exercises such as deadlift or squat, it’s important not to round your back to avoid lower back injuries.

Disc herniation

disc herniation

Flexion of the spine with heavy weights can create disc herniations at the level of the lumbar vertebrae.

These disc herniations are common at squat and deadlift. This is caused by a bad back position during exercise. That’s why it’s important to work the technique for these exercises.

Disc herniation according to the age

disc herniation intervertebral

From the age of 30 years old, intervertebral discs degenerate and don’t worry, it’s normal, The annulus can crack and the nucleus pulposus dries progressively.

Vertebral discs of people over 30 years old are more rigid, less elastic and the mobility of the spine is more limited. But as the viscous gel of the nucleus pulposus deacreases due to drying, the risk of the vertebral discs moving and compressing the nerves diminished.

Vertebral discs of people under 30 years old are more flexible, more elastic and there is more mobility with the spine. There is a greater amount of viscous gel in the nucleus pulposus which increases the risk that vertebral discs will move and compress the nerves. Disc herniation is very common among young athletes.

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

-Steph