Learning the limits of overuse injuries

by Ira A. Shapiro, DC, and Edward C. Camacho, DC

Don’t let the young athlete throw it all away.

Despite the extensive and constant level of medical care they receive, many major-league baseball players have undergone ulnar collateral ligament reconstruction (UCLR) or, as it is more commonly known, “Tommy John” surgery. In fact, since its development in 1974 by an orthopedic surgeon, the procedure has been performed on more than 400 professional players.

Once only associated with the highest levels of performance, this operation is now becoming almost commonplace among our nation’s young athletes. A recent study by the American Journal of Sports Medicine found that teens between ages 15 and 19 now account for almost 60 percent of all Tommy John surgeries. This is followed by the 20-to-24-year-old age group, which accounts for 22 percent of these procedures.

Most often, these and related shoulder injuries are caused by extreme stress placed on the shoulder by overhand motions repeatedly performed at high speeds. This is especially true for young pitchers, swimmers, and athletes who are not only developing physically but are also continually overwhelmed by repetitive stress to the shoulder and surrounding ligaments, muscles, and tendons. In fact, “Little League elbow” is now a common diagnosis for many 10-to-14-year-olds.

Another problem is that baseball is no longer a seasonal sport in many areas of the country, where it is played year-round without proper recovery time taken into account. Studies have recently found that pitchers who throw more than 75 pitches a game have a 2.5 percent greater chance of experiencing pain, while those who throw more than 100 innings in a year are 3.5 times more likely to suffer injuries requiring major surgery.¹

In addition, many teens and even preteens are being funneled into one or two sports for longer periods of time at increasingly younger ages. Instead of developing well-rounded athletes, cross-trained through their participation in a wide range of activities, the results are producing one-dimensional players suffering from a multitude of overuse symptoms.

Intervention and protocols for overuse injuries

As chiropractic practitioners, our road to treating such ailments starts with a detailed history of the patient’s condition. We must examine the range of motion of the affected area and the stability or mobility of the surrounding regions.

Overuse injuries are often caused by symptomatic dysfunctions at the surrounding joints. This can result in muscle groups, tendons, and ligaments working differently to compensate for the weaker areas that fail to carry their fair share of the athletic load. It is imperative to determine the extent of the damage as well as the root cause of the problem during the examination.

The first priority is to control pain and inflammation. Various active soft-tissue therapies such as Active Release Techniques (ART), Functional and Kinetic Treatment with Rehab (FAKTR), and passive modalities like electric stimulation, ultrasound, and cold laser are ideal for helping patients regain their functional range of motion and relearn proper technique.

Depending on the severity of the problem and the athlete’s physical condition, the pain and swelling produced by most shoulder overuse injuries can be greatly reduced by restricting aggravating motions and providing consistent treatments. Make education a fundamental part of the healing process and avoid common mistakes like permitting a return to competition before the ailment is fully healed. The stress placed by parents and coaches on an athlete to succeed can be as devastating as the stress continually placed on the young player’s physically abused arm.

Proper throwing technique is also essential. Athletes need to learn how to throw correctly and take care of their bodies between sessions to avoid ongoing problems. Coaches and parents must be educated on rest and recovery.

Posture is another important variable. Never forget the body works as an interconnected tool. Shoulder issues are directly correlated with lower neck dysfunctions. Strong rotator cuffs coupled with bad posture will always result in problems.

An excellent practice for treating overuse injuries is eliminating the motions that created pain and swelling in the first place. However, this is a near impossibility in an era filled with dreams for college scholarships and lucrative professional contracts.

Homework activities

Exercise should be emphasized as an essential ingredient for preventing and overcoming ongoing shoulder pain and injury. Although it may be necessary to immobilize the affected area during the early treatment phase to reduce swelling, inflammation, and pain, prolonged disuse can result in weakening not only the injured region but also the surrounding muscle groups.

Considering this, a conditioning program entailing range of motion, stretching, and strengthening exercises should be introduced and supervised. Here are a few samples of the hundreds of exercises currently in use today:

Chest stretch: Extend both arms at right angles while standing in a doorway. Lean forward and press each forearm against the door jam. Hold for 10 seconds. Repeat by placing forearms above the shoulder and then below. This will stretch various shoulder regions.

Shoulder extension: Stand with arm behind back and back against wall. Push the pinkie side of the hand against the wall for 10 seconds.

Supraspinatus stretch: Place hand on lower back. Use the other hand to pull the extended elbow forward. Repeat five times for 30 seconds per stretch.

Anterior shoulder stretch: Grab a bar, beam, or doorway above the head. Lean forward for 20 to 30 seconds. Repeat three times.

Medicine ball alphabet: Holding a medicine ball, the patient draws the alphabet with the hand extended.

Seated pushup shoulder exercise: While sitting with hands at sides, the patient pushes down on the chair and table until his or her arms are fully extended.

While some form of challenge is virtually unavoidable during athletic performance—especially high-impact ones—the ongoing abuse of a specific body region will result in injury. The creation of thousands of microtraumas are also common long before the onset of pain or soreness.

The trick is to help young athletes listen to their bodies and understand that there are recipes for both success and failure. The ongoing overuse of any body part will not only lead to injury but also sustained problems that can last a lifetime.

Authors

Ira A. Shapiro, DC, DACBSP, ICSSD, FICC, is a two-time member of the U.S. Olympic medical staff and was previously named Sports Doctor of the Year by the American Chiropractic Association Council on Sports Injuries and Physical Fitness.

Edward C. Camacho, DC, is a competitive weightlifter specializing in rehabilitation for sports injuries, improving overall wellness, and increasing performance. The authors can be contacted at 732-723-0023 or through plazachiro.com.

Reference

¹ American Sports Medicine Institute. “Position Statement for Youth Baseball Pitchers.” http://www.asmi.org/research.php?page=researc h§ion=positionStatement. Updated April 2013. Accessed Oct. 2015.