Tag Archives: Baseball Injuries

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

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Brian Wilson – Tommy John

Its true.

Our beloved bearded wonder will not be closing this year. But long before the wonderful run in 2010 and the beard that became a San Francisco sensation, Brian Wilson’s elbow underwent significant stress to the point of a ligament rupture and the long rehabilitation of Tommy John Surgery.

I thought this would be an appropriate time to give ya’ll a run down of Tommy John surgery, what some of the main reasons for it are, why Brian Wilson may be looking at his second, and what that means for him trying to come back an All-Star closer.

First off a little about what Tommy John surgery is, and why it is used so much in baseball.  The Ulnar Collateral ligament (or medial collateral ligament) is made up of three different bundles of fibers that runs along the inner aspect of the elbow. The job of the the UCL is to provide stability at the elbow, especially when the shoulder is externally rotated like the cocking and acceleration  phases in pitching (below )

Because the UCL’s job is to protect the elbow during the throwing motion, overtime the UCL can weaken and eventually rupture, causing instability at the elbow and an inability to throw. Poor throwing mechanics and weakness in the muscles of the shoulder, trunk and even lower body, have been found to relate to a pitchers likelihood of injury at the elbow.  The number 1 factor in UCL tear is bad mechanics, and the number 2 is overuse. You put them together and you are an injury waiting to happen.

The details of poor mechanics are for another blog, but one thing that stands out and is something you can look for when watching for mechanical flaws is where the elbow and shoulder are when the lead foot makes contact. You want the arm up and in what we would call external roation, meaning it is just about ready to come forward and release the ball. When you see the arm below the shoulder it means the shoulder and elbow are behind the trunk and legs and puts a tremendous amount of stress on the shoulder and elbow. Looking at Strausburg (tore UCL in first season in the majors) and Cain ( hasn’t missed a start in his 7 years in majors) you can see a difference.

Tommy John surgery is used for a player that has significantly torn or even ruptured their UCL. The repair involves using an unimportant ligament from the  opposite forearm, threading it through the ulna and humerus of the dominant arm, and allowing the new ligament to scar down and add stability to the elbow. Many times the player may have increased velocity following the surgery secondary to the ability of the new ligament to withstand more force than the original. I learned personally in my time interning with the padres that many players view tommy john surgery as a positive, thinking that they will have the surgery and a year later will be throwing 3-5 mph harder.

Not necessarily the case.

AT BEST a player will throw off the mound for the first time a year after having TOmmy John, however it can be up to 18 months, and only 80% of pitchers that have the surgery make it back the level they were throwing at before. However over time that graft can deteriorate, and without changing the mechanics, one can find themselves right back where they started.

Brian Wilson was pitching on borrowed time. And if you look at how his release point has changed in the last three years, you can see this damage to his elbow started a while back.  The graph below represents his horizontal release point and you can see the release point continued to decrease dramatically and that puts tremendous stress on the elbow.

Now lucky for Wilson he stopped pitching before it ruptured and it sounds the the MRI is showing only grade II sprain. In a pitcher that hadn’t had the surgery yet Tommy John might be appropriate, however Brian Wilson may opt out of it and try and rehab it without surgery secondary to the much poorer outcomes of a second surgery.

Of course, all of baseball hopes he comes back.

Moral of the story though?

If it breaks and you fix it, make sure you address WHY it broke to begin with.

GO GIANTS,

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

 

 

 

 

 

 

 

 

 

 

MLB Disabled List

Hello Everyone,

I’m sure it comes to no surprise to anyone, but I’m kind of a nerd. Yes… its true.  I spend far more time than I probably should checking the MLB website to see who is hurt, and what injuries have sidelined them.

Buster Posey: photo from http://www.azgphotography.com/.... check out the website...

While mourning the loss of Buster Posey, I spent some time today looking at the current Disabled List, and I found a few things kind of interesting that I thought I’d share.

Now bare with me on the nerdy numbers…. I promise I didn’t spend too much time crunching numbers.

There are currently 171 Players on the Disabled List. Not surprisingly 23% of those are injuries to the shoulder and 20% are elbow injuries. The next most common injuries are to the leg and knee, making up 14% of all the DL. This includes things like hamstring strains and knee pain. After that, which is what I find so interesting, is that 8% of the players on the DL are there due to Oblique injuries.

Nearly HALF of major league teams have a man on the DL with an oblique strain.

Nate McLouth out with a strained Left oblique

After that about 7% are ankle and foot injuries and 6% hand and wrist injuries.  However, it is the tremendous, and seemingly increasing, amounts of players straining and tearing abdominal muscles that I find so interesting. This is in part due to the fact that pitchers are throwing harder than ever before, and this puts even more stress on the body. However the injury happens to pitchers as well as hitters and may be due to more than just the increased intensity of pitching. I chatted with my friend Matt Antonelli ( AAA for the Washington Nationals) about this very topic a few weeks ago, so if you didn’t get a chance to check it out here it is:

http://www.youtube.com/watch?v=jEtG0_k-Z3c&feature=player_embedded

 

 

 

 

 

 

 

 

I knew this was becoming an increasing problem, but didn’t realize how bad it was getting. If HALF of teams have a player out with an oblique strain, I think its something that needs to be looked at a lot closer.

Go Giants,

House