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Easy Ways to Prevent Serious Injuries in Pitchers

Hello All,

I know normally I talk about how certain mechanical or muscular flaws can be a cause of injury in pitchers. Today however I wanted to give some really quick and easy ways to prevent injuries. Too many highly talented and well paid major league pitchers have been placed on the DL secondary to these types of easily preventable injuries. So I came up with 5 quick tips of things I see all the time and I wish guys would just stop doing.

Ok here we go.

#1 – DON’T BAT  LEFT HANDED IF YOU ARE A RIGHT HANDED PITCHER

Tim Lincecum bats left handed, exposing his $12M /year arm to a 95 mph fastball. Why would you do this? Its not like his bat is a great contributing factor to the giants offense. This really makes no sense to me. You can’t be that much better left handed than you are right handed. Bat righty Timmy, don’t take that chance.

#2 – RAILINGS ARE NOT FOR JUMPING OVER

Ryan Dempster found himself with a broken toe that put him on the DL after casually trying to jump over the dugout railing. It takes two seconds to go around buddy.

# 3 – DON’T GET ANGRY

We all know Brian Wilson has a crazy streak in him, and that’s why we all love him. But last year when he took his rage out on an innocent Gatorade tub with a bat, we all cringed. The last thing giants fans needed was Wilson to be out with a strained shoulder from swinging that bat in rage.

Other pitchers have broken hands from punching walls when upset. Bottom line – don’t get angry you’ll just get hurt.

# 4 – WATCH YOUR STEP

We have seen this so many times; pitchers or position players running in from the field into the slippery dugout and down those oh-so-difficult steps. One slip and fall later and they are on the DL for a sprained ankle or back injury. Just read the sign boys and watch your step.

# 5 – DON’T WARM UP 100 FEET FROM THE PLATE

I love ATT&T park. It is my favorite place on the planet. However, I’m waiting for the day someone warming up in the bullpen gets nailed by a foul line drive down the line. Its unnecessary; build our boys a pen !!

So five simple ways to prevent injuries in pitchers.

Don’t worry next week I’ll be back to writing the nerdy stuff.

Happy Friday everyone, and GO GIANTS.

House

Tim Lincecum vs Trevor Bauer

This blog could be very extensive, however I’m going to try and keep it short and sweet. If you do not know who Trevor Bauer is yet, you will.  He was the 3rd overall draft pick by the Arizona Dbacks  in the 2011 draft from UCLA ( go bruins!). Bauer may have gone number 1, except he does not fit the typical build of a major league pitcher.

Sounds a little like someone I know 😉

Tim Lincecum is 5’11” on a good day and a whopping 165 lbs soaking wet. And although Trevor Bauer is a more typical 6’2″ he only weighs in at 185 lbs. Both pitchers overcome their physical disadvantages with mechanical advantages, and although Trevor admits to utilizing many of Tims mechanics they do differ in a few ways.

Both pitchers have a long stride length, although Trevor can be deceiving because is is quite a bit taller so its not quite as much as Tim’s 127% stride length.  Looking at the two pictures below , both pitchers are just about to strike the ground  their lead foot.

If you look at their right arm it doesn’t take a physical therapist or pitching coach  to see the difference. Tim is still very early in his motion; meaning he has to get his arm from this position into the full external rotation position very rapidly. The disadvantage is the force on the shoulder, the advantage is the hitter will see the ball very late. With Trevor you can see how far his arm is behind him as his foot comes down, meaning his shoulder and arm will have to catch up to his body and put a lot of force on the shoulder.
When you look a little later in the motion, now both their chests and hips are facing the batter.  What I notice most in this phase of their motion is the differences in elbow flexion. When you see more flexion in this position I worry about how much force the elbow is taking. The ligament that protects the elbow in this position is strongest at 80 degrees. So anything more or less puts more stress on the elbow.
Lastly is the difference in follow through.
Tim has the iconic high leg lift, while Bauer uses more of this arm to follow through. Most people will say the follow through doesn’t really matter as far as mechanics, however as a physical therapist I think it does. When Tim lifts his leg, he uses his lower body to help decelerate his arm. Without the leg lift the muscles in the back of the shoulder and back must work harder to slow the arm down, and those muscles can be then prone to fatigue and injury.
So those are a couple of my thoughts on the two. Both are excellent at using mechanical advantages to succeed. I do worry about the longevity of Bauer, so we’ll see how that plays out. People worried about Tim too and he seems to be doing just fine for now.
Just about 1 week until the season starts and I couldn’t be more ready!
House

Platelet Rich Plasma Injections – Treating chronic injuries in top athletes

In the recent years, elite athletes like Alex Rodriguez, Closer Joe Nathan and golfer Tiger Woods have undergone the new fad in rehabilitation called Platelet Rich Plasma Therapy. Rodriguez underwent a treatment of these injections last month in Germany for chronic problems in his knee and shoulder. In Europe, and now recently in the United states, an increased trend has emerged of using  the PRP injection because its promising alternative to surgery and decreases time on the DL. So I thought I’d write a quick little note about it since you’ll start to hear more and more about this treatment in baseball and other sports.

So first of all lets start with what the heck are platelets?

Basically blood has 3 components: red blood cells, white blood cells and platelets. Plasma is the liquid component of the blood, mostly its made of water (which is why you should drink it more!) Platelets are mostly thought of as clotting agents…they help form the scab sick people like to pick. However they do so much more than that by removing dead tissue, promoting healing, and regenerating healthy tissue.  Normally 6% of blood is made of platelets, however PRP works by increasing the percentage to 94%.

The idea is that if you put a concentrated amount of the good stuff into an area thats not healing, good things will happen.

In the baseball world, the injection is being used for players with chronic tendonitis in the knee, shoulder, wrist, elbow and ankle. When tendons have to overwork ( like throwing 90 miles an hour over a hundred times) time and time again, they can thicken and become injured. The injured tendons heal by scarring down, which actually makes the tendon less able to perform a task like throwing a baseball. Tendons have very poor blood supply and therefore don’t heal well. So what sports medicine doctors are doing is drawing blood from the player, spinning the blood and removing all the red and white blood cells, and injecting the platelets into the specific tendon that has scarred down. This then jump starts healing.

Players that have the injection are usually then instructed to not move or use the joint for up to 6 weeks. After that they are freed to go back to baseball activities. The benefits are that you are using your own blood, and it can be a much quicker recovery than having surgery. Of course PHYSICAL THERAPY is a very important step before and after the injections to prevent the problem from coming back.

Keep your eye out this season for the PRP injection….

HOUSE

How Effective is Internal Rotation Stretching?

 

I ask myself this question a lot when putting someone on a stretching program.

The most common injuries in baseball players involve the shoulder and elbow, and pitchers are more prone to these injuries than positions players (1). These injuries include SLAP tears, shoulder impingement syndrome, rotator cuff pathology, and Ulnar collateral ligament tears. Researchers that specialize in baseball injuries have found that it is common for pitchers to display a loss of internal rotation and a gain of external rotation in their dominant arm (2). This loss of internal rotation, or GIRD, has been proven to put a player at a much higher risk for injury that can sideline them and possibly require surgery (2,3). There have been several studies with both major league and collegiate players that have shown how beneficial stretching the shoulder can be in reducing the amount of shoulder internal rotation loss for a  (4, 5). However I often wonder if players can actual make changes to their range of motion that are significant and will last.

A significant study came out in 2008 that demonstrated the effects of the “sleeper stretch” immediately on shoulder mobility, however were unable to determine whether or not this would have lasting effects on injury prevention.

The Sleeper Stretch

There is much debate about what causes the change in shoulder mobility, however most people agree there is some component of soft tissue changes, and the defecit can be improved with stretching. A recent study looked at what the long term effects of stretching was on professional baseball players (5) They looked at players after 3 years of being in a stretching program and found them to have better shoulder mobility than those that had been stretching for less than 3 years. Those players were performing a few stretches DAILY for 3 years. Seems like a lot, I know. Their program was the following:1) passive internal rotation stretching 2) cross body stretch

Passive Internal Rotation Stretching

Cross Body Stretch with Scapula Stabilize

 

The most recent study demonstrated that the loss of internal rotation is neither permanent or necessary, and that ideally with stretching the player will maintain the gained external rotation with no loss of internal rotation. Although it may take up to years for these changes to become permanent.

Interesting.

Stick with the stretching boys.

 

House

REFERENCES

  1. Wilk, KE, Meister K, Andrews JR. Current concepts in the rehabilitation of the overhead throwing athlete. Am J Sports med. 2002;30(1):136-151.
  2. Bukhart SS, Morgan CD, Kibler WB. The Disabled Throwing Shoulder: spectrum of pathology. Part 1:pathoanatomy and biomechanics. Arthroscopy. 2003; 19(4): 404-420
  3. Dines, JS, Frank JB, Akerman M, Yocum LA.. Glenohumeral Internal Rotation Deficits in Baseball Players with Ulnar Collateral Ligament Insufficiency. Am J Sports Med. 2009; 37(3): 566-570.
  4. Laudner, KG, Spines, RC, Wilson, JT.  The acute effects of sleeper stretches on shoulder ROM. Journal of Athletic Training. 2008; 43(4) 359–363.
  5. Lintner, D, Mayol, M, Obinna, U, Jones, R, Labossiere, D. Glenohumeral Internal Rotation Deficits in Professional Pitchers Enrolled in a stretching program. Am J Sports Med. 2007; 35(4): 617-62

 

 

 

 

 

 

 

 

 

 

A lesson from Residency

Every once  in a while I forget where I am. Every once in a while, I forget why I wanted to be here in the first place. Some days just blur together. Sometimes I see my patients as my work, and  I don’t even blink. Its just another day.

But its never just another day.

Its funny, and by no means coincidental, that I find myself in a rut of daily routine, and then out of nowhere something will snap me out of it and remind me just why I wanted to be doing this .

Today was one of those days.

In many ways, residency has taken over my life. I find myself more stressed, more fatigued, and less social than I ever was in PT school. There are many days I lose the joy of being able to help people to the demands of going through a program that sets high standards and expects a high level of skill. I often worry far more about myself than I do about my patients.

This last week so many things have been on my mind, and most of them have been about myself. Residency will be over in six months and my bosses, family members, and myself are all starting to ask too many questions. What are MY plans for next year? What job will I take? Where will I go? What can I get next? Life choices are coming up for me and I’ve spent so much time focusing on them lately, I’ve lost sight of why I am here.

5 years ago, I opened a phone book and called the very first physical therapy clinic listed: Agape Physical Therapy, in hopes of getting a job as an aide. I figured since “agape” means godly love, it would be a great place to start. Later that day I was at the clinic getting trained. NOT coincidence. 3 days later I watched a women take her first steps in over 3 years following a stroke, and decided right then and there that I wanted to do that for the rest of my life.  I worked at Agape for 2 years, under two of the most caring, compassionate and skilled therapists I’ve ever met. They gave me my first exposure to physical therapy. They inspired me to impact the lives of our patients. They encouraged me to apply for PT school, and supported me every step along the way. Today, on my lunch break, I received word that one of the therapist that guided and molded me so much had fallen very ill.

The news effected me greatly, and my afternoon was difficult to get through. God however, like He always does with his perfect timing, gave me a great reminder of why He has me here. I went to the waiting room this afternoon to get my patient, and nearly dropped to my knees when I saw him. You see, I’ve been seeing this patient for nearly 6 months now. He is a young kid (20 is a young kid ok) who had a bullet rip through his sciatic nerve, and leave him with the inability to walk without a brace on his paralyzed foot and a walker. When he first came to me he said the only thing he wanted was to be able to walk without a walker. He told me he was so embarrassed to walk down the street, being so young, and needing  walker. So we decided together that was the goal, to get rid of that walker and give him a chance at returning to his normal life. His mother, who comes with him to every appointment, him and myself have been working tremendously hard to make that happen for him.

6 months later, he stood up from his chair in the waiting room, no walker, and walked towards me with the biggest and best smile I’ve ever seen.

And my insides went to mush.

Indescribable.

And I thought back to 5 years ago, back at Agape physical therapy, and remembered why I was here.

To my fellow therapists, and friends that are just about to graduate and step into the field for the first time: may we never forget the opportunity we get each and every single day to impact the lives of those God has entrusted into our hands.

“Let no one ever come to you without leaving better and happier. Be the living expression of God’s kindness: kindness in your face, kindness in your eyes, kindness in your smile.”
-Mother Theresa

“Home” by Ken Burns

It’s a beautifully designed game.  Timeless, but always changing. It’s a game in which the defense always has the ball; and a game in which every player is measured by the ghosts of all who have gone before.

 

For more than 150 years, baseball has been a mirror of the complicated country that gave it birth.

 

From California to the New York islands, through good times and bad, through wars, depressions, and civil strife, it has entertained us, it has inspired us, and sometimes, it has even transformed us.

 

We pass it down from mothers to sons, fathers to daughters, as every generation invests itself in the sweet hope of springtime and endures the painful realities of fall.

Its essential dimensions never change, yet nothing ever happens the same way twice. It is a game in which the person scores, not the ball; where the objective, always, is to come home.

Home, where no asks where you come from or who you voted for.

Home, where all season long, we congregate to cheer and plead, laugh and cry in the magnificent cathedrals of our game – the places, the poet Donald Hall says, “where memory gathers.”

 

Home, where every October, baseball’s greatest stars do battle.

 

Nothing in our daily life offers more of the comfort of continuity, the powerful sense of belonging, and the freedom from time’s constraints than does our National Pastime.

 

It is the place we always come back to – home.

 

 

Thoughts on Buster Posey

Hello All,

Two nights ago, as the Giants came back with a great 4 run bottom of the 9th to extend a game against the Marlins, I lay in my bed watching the game on my Ipad, and hoping it would end soon so I could go to sleep. An hour later, the worst happened.

Scott Cousins and Buster Posey collided with the play at home, and in an instant the entire season for the SF giants changed. As a Giants fan, it was gut wrenching to watch our best offensive player, our leader behind the plate, and a genuine and tough player clinging to the dirt as he experienced excruciating pain. As a baseball fan, it was sad to see the season of the reigning rookie of the year cut short. As a physical therapist though, it was difficult knowing the long road ahead of him and the challenges he faces as he goes through rehab.

Posey and the rest of the baseball world found out the next day he would be dealing with a broken fibula and torn ligaments in his left ankle.  The fibula is the smaller of the two lower leg bones, and there are several ligaments that surround it to give the ankle joint stability. Any physical therapist will tell you they’d much rather see an athlete with just the break; the torn ligaments complicate things so much more, and prolong the injured athletes comeback. To give you a quick overview of the ankle, check out the picture below.

When looking at this picture, you can see that no matter what the direction the fibula breaks in, the chances of escaping the incident without any damage to the ligaments is very small because there are ligaments in all directions of the bone. The Anterior Talofibular ligament (ATFL) is the most commonly torn ligament in the ankle and makes up an estimated 14-33% of all sports related injuries. Judging by the mechanism of Posey’s injury, it is my guess that he tore more than just his ATFL. The specifics of which ligaments are injured doesn’t really matter at this point; whether its 1 or 4, he still has the same road ahead of him.

Although a fracture seems scary, it is actually much easier to come back from a broken bone, than ligament injuries. A broken bone takes about 6 weeks to heal. Bone has a really good blood supply, and because of that it can heal pretty quick. Unfortunately, ligaments don’t have as good a blood supply and therefore can take a lot longer to heal. Surgery is indicated, especially for athletes that need to get back faster, to jump start that ligament healing.

What can Posey and Giants fans expect? Well, depending on the specifics of his specific structural damage and surgery, Posey will be unable to bear full weight for 4-6 weeks. That’s best case scenario, but weight bearing precautions can last up to 8-12 weeks. He could continue to work on upper body and core strength through this time, and even keep his swing up if he has a sweet contraption like this.

 

From there the most important thing for Posey will be to get his full range of motion back in his ankle. After being in a cast or boot following the surgery, the ankle joint will be very stiff. For a catcher the range of motion is especially important because he needs to be able to squat for prolonged periods of time, and that range may take a while for him to get back. Without a doubt, the Giants physical therapist and trainers will be be aggressive with that. After that, the strength and balance should come pretty easily. At best, Posey would be able to play first base in rehab assignments at 12-14 weeks, which is rapidly approaching the end of the season.

If Posey simply had a broken bone, I would have said he’d be back by August. The ligaments and surgery though make me think he’s not coming back, at least not at the catcher position, until next year. Even then, 30% of people with torn ankle ligaments have persistent problems with their ankle that can last a year to forever. Now, after working with the padres rehab last year, I know there are 2 different types of rehab players. There are guys that GET though rehab, and there are guys that WORK though rehab. Posey seems like the kind that will WORK through rehab. I have no doubt that although he has a long road ahead of him, he will do everything in his power to get back to the squat; catching one of the greatest pitching staffs in baseball.

A Bend in the road is not the end of the road, unless you fail to make the turn. The giants have a little overcoming of adversity to do. They’ll get it done.

Have a great holiday weekend everyone !!!