Elbow Injuries in Throwing Sports

December 26, 2013 by Leave a Comment

If you have elbow injuries, then take a look at this article by Sam Hutchison NASM-CPT, CES, PES. Take care of your body when you play sports! Questions? Come see us at San Diego Sports Physical Therapy.

“In today’s highly competitive sports environment, elbow injuries are prevalent for overhead throwing athletes (i.e., baseball and football) at all levels of playing. Although this may be as mild as a sore elbow, it can further degrade into a more serious elbow injury such as a ruptured elbow ligament; in particular the ulnar collateral ligament (UCL).” Ruptures to the UCL have been seen in 1 in 9 major league baseball pitchers since 2001 and requires reconstructive surgery popularly known as Tommy John surgery (1). Tommy John surgery does offer an 85% success rate, but a daunting 12-18 month recovery process follows the surgery, which can be difficult for any athlete eager to get back into action (1, 2). As a fitness professional, it is important to understand the basic mechanisms and signs of elbow injuries and refer to a licensed physician for diagnosis and treatment if an injury is ever suspected.

Mechanism of Injuries

Throwing technique for each throwing sport differs slightly, but throwing mechanics are typically broken down into six phases (3):

Wind up: Initial movement beginning when elevating the leg contralateral (opposite) of the throwing arm allowing for greater momentum. The center of gravity and stability is kept on the stance leg.
Early cocking: The elevated leg strides forward and the throwing arm moves into the throwing position allowing for a transfer of force from the upper extremity to the lower extremity.
Late cocking: Both feet have contact on the ground and the shoulder begins to externally rotate and the elbow flexes. A greater degree of shoulder external rotation enables the athlete to take advantage of the myostatic (stretch) reflex and subsequently results in greater power and ball velocity.
Acceleration: The ball is released after the shoulder undergoes rapid internal rotation and the elbow extends.
Deceleration: The shoulder undergoes maximal internal rotation after the ball is released.
Follow through: The body continues to move forward until arm motion has stopped.
When throwing, the elbow undergoes extension and the distal (furthest away portion) of the elbow joint angulates outward (known as elbow valgus). Elbow injuries typically occur during the late cocking and acceleration phase when the UCL is unable to counteract the extreme valgus and elbow extension created (1,4). Typically the UCL alone is unable to counteract the extreme forces placed on it by throwing. The muscles involved with shoulder internal rotation and forearm pronation are responsible to help counteract these forces and stabilize the elbow. If these muscles become too fatigued or there is a preexisting shoulder injury, an excessive amount of force is placed on the UCL, thus increasing the risk of injury (5, 6).

Risk Factors

Elbows injuries can occur through both chronic and acute trauma however, they typically occur through overuse. A survey looking at 95 youth baseball pitchers (50 with elbow surgery, 45 without elbow surgery) indicated that players who underwent elbow surgery had pitched more months throughout the year, games per year, innings per game, pitches per game and pitches at a higher speed (7). It was also indicated that these injured pitchers had used more aggressive post game recovery protocol such as icing and medicating with anti-inflammatory medication (5).

Along with overuse, another risk factor for elbow injury identified through research is range of motion deficits. A study conducted amongst baseball players with and without a history of elbow, shoulder and spinal injuries measured their passive range of motion (6). Each subject underwent a battery of assessments measuring the range of motion in their throwing arm for elbow flexion, elbow extension, shoulder internal rotation, shoulder external rotation and forearm pronation and supination. Results indicated injured players exhibited decreased internal rotation of the shoulder while exhibiting no significant difference in elbow and forearm range of motion (6).

What We’ve Learned

While the advancement in treatment measures has been shown to be effective at rehabilitating elbow injuries, it isn’t a magic bullet. A well devised exercise program to help prevent such injuries will always be the most viable option for keeping athletes healthy at any level. Fitness professionals should strive to assess their client’s joint range of motion through the use of various assessments and provide a pragmatic exercise program to address any potential muscle imbalances throughout the kinetic chain. It is important not to completely hone in on just the elbow but instead the entire human kinetic chain (wrist, shoulder, spine/core, lower extremities) etc.) to build a strong and balanced athlete to withstand the rigors of any sport.

A comprehensive corrective exercise strategy following NASM’s Corrective Exercise Continuum includes:

Inhibitory techniques (i.e., self-myofascial release) to decrease tightness and alleviate trigger points found in overactive muscles.
Lengthening (i.e., static and neuromuscular stretching) techniques to restore optimal range of motion of overactive (tight) muscles.
Isolated strengthening exercises to improve neuromuscular activation of underactive muscles through a controlled range of motion.
Integrated (total-body) exercises to integrate the entire kinetic chain through multijoint, compound movements.
Figure 1 provides an example a corrective exercise strategy for the elbow. Please refer to NASM’s Corrective Exercise Specialist (CES) course for a comprehensive list of movement assessments and corrective exercise strategies for the elbow.

References

1. Langer P, Fadale P, M Hulstyn. Evolution of the treatment options of ulnar collateral ligament injuries of the elbow. Br J Sport Med. 2006; 40:499-506.

2. Wilk KE, Reinold MM, Andrews JR. Rehabilitation of the thrower’s elbow. Clin Sports Med. 2004; 23: 765-801.

3. Seroyer ST, Nho SJ, Bach BR, Bush-Joseph CA, Nicholson GP, Romeo AA. The Kinetic Chain in Overhand Pitching. Sports Health. 2010; 2(2):135-146.

4. Cain EL, Dugas JR, Wolf RS, Andrews JR. Elbow Injuries in Throwing Athletes. Am J Sport Med. 2003; 31(4): 621-635.

5. Olsen SJ, Fleisig GS, Dun S, Loftice J, Andrews JR. Risk Factors for Shoulder and Elbow Injuries in Adolescent Baseball Pitchers. Am J Sport Med. 2006; 34(6):905-912.

6. Dines JS, Frank JB, Akerman M, Yocum LA. Glenohumeral Internal Rotation Deficits in Baseball Players With Ulnar Collateral Ligament Insufficiency. Am J Sport Med. 2009; 37(3): 566-570.

7. Bernas GA, Thiele RA, Kinnaman KA, Hughes RE, Miller BS, Carpenter JE. Defining Safe Rehabilitation for Ulnar Collateral Ligament Reconstruction of the Elbow. Am J Sport Med. 2009;37(12) 2392-2400.

– See more at: http://blog.nasm.org/cex/elbow-injuries-throwing-sports/#sthash.YCDLpBmm.dpuf

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Reducing Workplace Stress

December 17, 2013 by Leave a Comment

Times can be tough and stressful, especially during the holiday season. Things pile up, but don’t fret! Here are some ways to manage your stress at work from ACE Fitness.

Do you have a demanding boss or difficult co-workers? Stacks of work to get done and not enough time? Everyone encounters job stress sooner or later — but that doesn’t make it easier. There are many aspects of your work environment that you have no control over — but you can take action to manage stress so that work doesn’t take a toll on your well-being.

Stress Matters

Workplace stress has been linked to serious health problems — including heart attack. Your body releases greater amounts of the hormone cortisol in response to stress — stimulating an increased appetite for high-fat, high-sugar foods, and increasing fat storage in the abdomen. A study of workers coping with corporate restructuring and layoffs revealed that chronic job stress led to weight gain. Not surprisingly, consumption of high-fat, high-calorie vending machine snacks went way up during the most stressful periods. Research also shows that intense job stress is an independent risk factor for high blood pressure at work, home, and even while sleeping.

Work Mindfully

Mindfulness is a way of zeroing in on the here and now instead of ruminating over the past, mulling over the future, or doing several things at once. Give your full attention to the task at hand, whether it’s a call, a meeting, or a project. Scrolling through your messages while on a phone conference may feel productive — but in the long run, multitasking will only add to your stress and drain your energy.

Be Nice

Get to know your co-workers by asking about their weekends, inviting their opinions, and eating lunch together. Collegial co-worker relationships make the workplace more pleasant for everyone —and studies even show that a positive outlook is contagious. Offer genuine compliments. Smile frequently — it’ll boost your mood and encourage those around you to lighten up.

Communicate Well

Miscommunication is the root of many workplace conflicts. Clarify details and expectations for every job task. Check for understanding if you’re the one dishing out assignments.

Annoying co-workers are best dealt with immediately and directly — or the behavior may get worse. If your co-worker distracts you with loud, lengthy personal calls, talk with her privately instead of just getting frustrated. If it continues, speak with your manager.

Shake It Off

You can let yourself get wound up and upset about things that happen at work — or you can respond differently. Instead of stewing about a project that was dumped on you, could you view it as an opportunity to showcase your skills, talent, and teamwork — or speak with your supervisor? Instead of letting one grumpy customer get you down, can you focus on the 50 grateful customers you helped today? Take a few full, deep breaths to clear your mind and proceed down a more positive path.

Practice Smart Self-Care

Regular exercise and good nutrition — along with time for fun and relaxation —boosts your ability to cope with stress. And when you’re well-rested, stressors are more manageable. Consider taking a walk at break time, or meeting a friend for lunch. Learn relaxation breathing and stretching exercises to do at your desk. Choose high-energy, nutritious foods for meals and snacks. Cultivate a healthy sense of humor; look for the laughable moments in everyday life at work.

Get Help

If your best efforts don’t reduce your stress and talking with your manager doesn’t help, seek advice from your human resources department or employee relations representative. Some employers offer employee assistance programs (EAP) that provide confidential, 24/7 phone consultation with professional counselors for personal matters and workplace issues. If your employer offers this benefit, don’t hesitate to use it.

Make a Change

Life is too short to spend it in a toxic workplace — and living with chronic stress isn’t a long-term solution. No job is stress-free, but if your current job isn’t a good match for your interests, talents, and goals, create a plan to move on. Paint a realistic picture of your dream job by talking with others in your desired line of work before you make the leap.

Additional Resources

The American Institute of Stress Job Stress Self-Test

UCLA Mindful Awareness Research Center Mindful Meditations

University of Pittsburgh Medical Center -Stress Coping: Relaxation Techniques

References:

Clays, Els Leynen, Francoise De Bacquer, Dirk Kornitzer, Marcel Kittel, France Karasek, Robert PhD; De Backer, Guy, High job strain and ambulatory blood pressure in middle-aged men and women from the Belgian job stress study, JOEM April 2007, Vol. 49, Issue 4, pp.360-367. Abstract.http://journals.lww.com/joem/Abstract/2007/04000/High_Job_Strain_and_Ambulatory_Blood_Pressure_in.5.aspx

Fowler J, Christaki, J, Dynamic spread of happiness in al arge social network, BMJ 2008; 337(2338), posted 12/16/2008, retrieved May 18, 2008 from: http://www.medscape.com/viewarticle/584834

Maglione-Garves, C, Kravitz, L, Schneider, S, Cortisol connection: tips on managing stress and weight, retrieved May 18, 2010 from: http://www.unm.edu/~lkravitz/Article%20folder/stresscortisol.html

Nauert, R, Workplace stress linked to obesity, retrieved on May 18, 2010 from: http://psychcentral.com/news/2010/03/25/workplace-stress-linked-to-obesity/12382.html

Fernandez, I, Su, H, Winter, P, Liang, H, Association of workplace chronic and acute stressors with employee weight status: data from worksites in turmoil, JOEM, Jan 2010, v.52, Issue 1S, pp. S34-S41.Abstract. http://journals.lww.com/joem/Abstract/2010/01001/Association_of_Workplace_Chronic_and_Acute.7.aspx

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EXERCISING WITH OSTEOPOROSIS: BUILD BONES, STAY STRONG

November 12, 2013 by Leave a Comment

It’s still possible to train even if you have osteoporosis. Read this article from Fitness Together to see how you should train with this condition safely. Then come see us at San Diego Sports Physical Therapy for all of your training and therapy needs! 619-756-7500

When you think about what your body’s bone structure looks like, flashbacks of the lanky skeleton hanging lifelessly in your science class are probably the first thoughts that come to mind. The bones in your body, however, are much livelier than their classroom counterparts as they are made up of living and growing tissue that continues to get denser as you become a young adult. As you age into adulthood, you can begin to lose more bone mass than your body produces, putting you at a higher risk of bone breakage and osteoporosis.

Reports from the National Osteoporosis Foundation (NOF) earlier this year indicated that 57 million Americans are affected by low bone density conditions or osteoporosis. By 2020, the NOF estimates that half of all Americans over the age of 50 are expected to have low bone density or osteoporosis. Whether you have osteoporosis now or at risk of developing this common condition, there are steps you can start taking today to help reduce the rate of bone loss in your body.

Feed Your Bones, Build Strength

If you are one of the millions of Americans suffering from osteoporosis, it’s important to be proactive about reducing the loss of bone density by adopting healthy exercise and nutrition habits. A diet rich in Vitamin D and calcium can help make bones harder and stronger, while a well-balanced nutrition approach that includes a mix of dairy, lean protein, fruits, vegetables and healthy fats can feed your body’s framework with the nutrients and minerals it needs to support weak bone areas and reduce the risk of bone loss.

To enhance the flexibility and strength of your body’s foundation, it also is important to keep the bones moving with a combination of weight-bearing cardio, muscle strengthening and core balance exercises, says Sue Teoli, personal trainer and studio owner at Fitness Together New Canaan. The NOF recommends 30 minutes of weight-bearing exercises daily (walking, elliptical, swimming, stair climbing), a combination of upper body and lower body muscle strengthening exercises (using body weight or resistance equipment) two to three days per week, and a variation of balance, posture and functional exercises each day depending on the area you are the weakest.

“It’s imperative to keep exercising if you have osteoporosis,” Teoli advises. “Anytime you improve your muscle strength, it’s good for your body. But, when you have osteoporosis, exercising can strengthen your bones first and foremost, while helping to slow down and prevent your bones from deteriorating.”

Break Out of the Cycle of Bone Loss by Getting Active Safely

Many people with osteoporosis may be reluctant to exercise as they may be afraid of getting hurt, breaking a bone or making their condition worse. While it’s recommended to consult with your doctor before starting any fitness routine, it can be very beneficial to the health of your skeletal and muscular systems when you focus on improving your physical fitness strength, balance and mobility.

“I tell all my clients, but especially my older ones, that strength in the lower back, abs and core is one of the most important things for your body,” says Teoli. “When you balance, you engage every muscle in your body. I think it’s important to focus on core strength and balance whether you have osteoporosis or not.”

It’s always important to think safety first when starting any workout routine by being aware of the inherent risks and staying in tune with how your body feels before, during and after you work out. Teoli advises her clients with osteoporosis to be aware of the following precautions before they start working out:

Refrain from high-intensity interval training as the jarring, jumping and high joint impact typically associated with these types of workouts increases the risk of bone damage and breakage.
Never flex your spine forward like when doing a traditional sit-up as this movement puts too much strain on the vulnerable sections of your spine and mid-section. Instead, opt for other less forward-bending core movements such as the plank.
Be careful with bending and twisting your body in different directions, as these movements can increase the risk of compression fractures in the spine.
“My philosophy is to start out slowly and progress slowly,” says Teoli. “If you start out with vigorous exercises, you run the risk of injury. I believe in taking baby steps with my clients and working on a movement until they master it.”

If you have osteoporosis and are ready to start an exercise program to build your bone strength and physical fitness levels, Teoli suggests going back to the basics. A sample workout plan that she would suggest for her clients with osteoporosis includes the following elements.

Upper body strength movement like a modified push up.
Lower body strength movement like a body weight squat while leaning against a fitness ball along the wall or straight leg lifts if you have knee issues.
Core exercises such as planks or balance exercises using a BOSU ball.
Weight-bearing cardio movements such as walking, stair climbing or elliptical.
You can choose to do each exercise either for a set amount of time like 30 seconds each or for a certain number of repetitions such as 10-15 reps. Either way, the focus of your fitness plan when you have osteoporosis should be on working out your body and supporting healthy bone structure.

– See more at: http://corp.fitnesstogether.com/our-solution/fitness-tips/exercising-with-osteoporosis-build-bones-stay-strong/#sthash.TDCy9CFf.dpuf

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