Baseball Injuries

Monday was Opening Day for the Brewers, which means that spring is finally here. In our physical therapy clinic, this is also about the time we start seeing an uptick in the number of high school and college baseball players who come to see us for elbow or shoulder pain.

So, why are shoulder and elbow pain so common in baseball?

Baseball pitch

 Baseball players, especially pitchers, typically have shoulders that are very flexible in external rotation (see picture to the right), which allows them to generate speed as they throw. Over time, they may develop stiffness into internal rotation (the opposite direction) due to tightness through the rotator cuff and other shoulder structures. This can lead to irritation and pain in the shoulder, as well as compensations at the elbow. In the cocking position (see picture to the right), the shoulder is stretched into maximum external rotation and there is also a lot of stress transmitted to the inside of the elbow. To tolerate this position hundreds or thousands of times over the course of a season, the arm needs a good balance of mobility of the joints and stability of the surrounding muscles. 

Overloading the arm with too many throws or throwing with poor mechanics can lead to injuries, especially in a growing athlete. Bones grow more quickly than muscles and this imbalance often leads to injuries near the growth plates of elbow or shoulder. Overuse can also lead to irritation and gradual tears of the rotator cuff muscles or labrum (cartilage) in the shoulder. Excess strain through the elbow can overstretch or tear the ligaments that stabilize the inside of the elbow. This is known as a “Tommy John” injury in baseball circles. If not caught early, some of these injuries may require surgery and a very long recovery.

How someone throws can also be a risk factor for shoulder or elbow injuries. Poor mechanics can lead to increased torque and strain through the shoulder and the inside of the elbow. A good pitching coach can identify throwing flaws and address them in order to prevent problems down the road. Learning good mechanics early on is much more effective–and safer–than waiting until there is a problem.

Preventing Injuries

Current research shows that a high number of pitches is one of the biggest predictors of having either shoulder or elbow pain. Baseball players between 9 and 14 years old were more likely to have shoulder pain if they threw more than 600 pitches throughout the course of the season and elbow pain with more than 800 pitches. In response to this research, Little League instituted pitch counts based off of the player’s age to avoid overtaxing growing joints. The following chart shows the maximum number of pitches allowed by age, as well as the recommended days of rest following a start.

Age                 Daily Max (Pitches) Required Rest (Pitches) Required Rest (Pitches) Required Rest (Pitches) Required Rest (Pitches) Required Rest (Pitches)
    0 Days 1 Day 2 Days 3 Days 4 Days
7-8 50 1-20 21-35 36-50 N/A N/A
9-10 75 1-20 21-35 36-50 51-65 66+
11-12 85 1-20 21-35 36-50 51-65 66+
13-14 95 1-20 21-35 36-50 51-65 66+
15-16 95 1-30 31-45 46-60 61-75 76+
17-18 105 1-30 31-45 46-60 61-75 76+

Information from http://www.momsteam.com/sports/baseball/safety/2014-little-league-baseball-pitch-count-limits-and-mandatory-rest-periods#ixzz4bPUpySeo

It is also important to gradually increase the amount of work the arm has to tolerate, especially at the beginning of the season, after injuries, or after time off. Gradually increasing the distance, speed, and number of throws over several weeks is important to avoid overtaxing the joints as they get used to the stress of throwing.

Along with gradually increasing the work on the arm, it is important to make sure that players, especially pitchers, have adequate rest. Pitching with a sore or tired arm is a significant risk factor for injuries. It is essential that pitchers have days off after starts to allow their arm to recover. Players that play on multiple teams may play year-round, never giving the arm sufficient time to rest and recuperate. It is recommended that athletes play their main sport a maximum of 9 months a year, as specializing in any sport year-round has been associated with a higher incidence of injuries. Players should have a 6-8 week recovery period following their season and focus on rest, off-season conditioning and injury prevention. This may also help with avoiding burnout.

Given the high demands on a baseball player’s arm, every player should have an exercise program that addresses their need for shoulder and elbow mobility and stability. A physical therapist can check for adequate range of motion and strength, take a look at the structures around the shoulder or around the elbow and develop a specific, individualized program to help keep the arm happy and healthy throughout the course of a long baseball season.

Sources:

Brotzman SB, Manske RC. Clinical Orthopaedic Rehabilitation: an Evidence-Based Approach – Expert Consult. 3rd ed. Philadelphia, PA: Elsevier Mosby; 2011.

Straus LB. 2017 Little League Pitch Count Limits and Mandatory Rest Rules. MomsTeam. http://www.momsteam.com/sports/baseball/safety/2014-little-league-baseball-pitch-count-limits-and-mandatory-rest-periods#ixzz4bPUpySeo. Published February 27, 2017. Accessed March 23, 2017.

Plantar Fasciitis – What is It & What Can You Do About It?

By: Lauren Hogan, PT, DPT, OCS, ATC

Plantar fasciitis is one of the most common foot-related conditions that we see in the clinic. Around 10% of people will experience plantar fasciitis at some point in their lives. It can be incredibly painful to put weight on the foot and walk, making it a very challenging injury for patients to deal with.Plantar fasciitis is irritation of the plantar fascia as it attaches to the calcaneal tuberosity, or heel bone. (https://en.wikipedia.org/wiki/Plantar_fasciitis)

What is Plantar Fasciitis?

The plantar fascia (or aponeurosis, as labeled in the picture above) is a thick band of connective tissue that attaches from the heel bone up through the toes. As we walk, the plantar fascia works to help support the arch, along with muscles in the foot and ankle. When we sleep or sit, our feet are often in a pointed toe, relaxed position, so the plantar fascia may be resting in a shortened for a prolonged period of time. When we get up in the morning or stand after sitting for a while, the plantar fascia is suddenly stretched as we put weight on the foot. For people that have irritation of the plantar fascia, the attachment at the heel can be painful for several steps until the tissue starts to loosen up.

Anyone can get plantar fasciitis, but there are several factors that can put someone at risk for developing pain through their heel. Tightness through the calf and limited ankle range of motion are common causes. Runners and workers that spend a lot of time on their feet on hard surfaces are more likely to be diagnosed with the condition. Patients with a higher body mass index also may be at increased risk. Poor footwear can also be a triggering factor.

There are several things you can start doing if you are experiencing heel pain.

  1. Wear supportive shoes consistently throughout the day. Adequate arch support and cushioning are necessary to help avoid irritating the plantar fascia.
  2. Stretching the calf muscles is extremely important. The more mobile the calf muscles and ankle are, the less strain there is through the plantar fascia with walking.
  3. Rolling through the bottom of your foot with a golf ball can help massage the arch and surrounding muscles.
  4. Icing or rolling the foot over a frozen water bottle can help relieve pain.
  5. Sitting with your feet flat on the ground helps to maintain a little bit of a stretch through the calf and foot, making it less painful when you first get up and start walking.

If your symptoms are not improving within a few days with self-treatment, a physical therapist can help. Treatment may consist of hands-on massage to loosen up tissues in the calf and foot, joint mobilization to improve foot and ankle mobility, as well as work on strengthening the foot and ankle muscles, balance, and working on gait. Some patients may benefit from an orthotic insert to further support the foot, or a night splint to help gently stretch the calf at night to minimize pain first thing in the morning. You can ask your PT how to use these tools to help with your recovery.

Early treatment is important, as chronic plantar fasciitis can be challenging to treat and take longer to resolve. If you are in pain for more than a few days and it is not responding to the ideas above, talk to your physical therapist to get on the road to feeling better.