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MUSC Health Blog

Date: Jul 2014

Guest Post by:
Shane K. Woolf, M.D.
Associate Professor of Orthopaedics and
Chief of Sports Medicine

After a busy Friday in the operating room treating rotator cuff tears, among other orthopaedic injuries, I had a welcome opportunity for a fun and relaxing evening out with family. My wife and I took our daughter to her very first baseball game! We sat along the third base line watching our local minor league ball club, the Charleston Riverdogs, earn a win, and throughout the evening we enjoyed boiled peanuts, pretzels, and brats. Despite her tender young age, our baby girl seemed to really enjoy the sights, sounds, and action of the game, both on and off the field.

Yet, for me, the thrill of an exciting ballgame on a comfortable and breezy evening was punctuated by other thoughts. While I observed the players in action, I could not help but to consider the types of injuries and problems that I see every day in my orthopaedic clinic. As my family sat there taking in the ballpark experience together, I pointed out the relief pitcher warming up directly in front of us. The windup and throwing mechanism is a fascinating athletic accomplishment. Rotation of the pitcher’s shoulder during a pitch is considered the fastest motion of any human joint in sports. Remarkable! And also stressful to the bones, cartilage and tissues of the shoulder. While, certain sports can be prone to injuries of one joint or another, baseball, in particular, is known for issues with the shoulder. While injury can happen during lower velocity and distance throws, sliding into base, getting hit by a pitch, or colliding with another player, it is the repetitive action of throwing that places the majority of the high velocity throwers, like the relief pitcher we were observing, at risk for shoulder problems. This is due, in part, to the fact that the soft tissues of the shoulder have a biologic limit to the degree of force and stress they can tolerate before damage, or even rupture, occurs. Here are some important principles for the aspiring high-velocity thrower to consider:

Conditioning First:
Keeping the joint limber and muscles strong are essential to achieving optimal athletic performance. Just like a car transmission, plane engine or other high-performance device, these tissues require maintenance, proper tuning, and occasional repair. During the off-season, spring training and throughout the year, high level throwers work hard to maintain the health of their throwing mechanics. This includes focus on strengthening the core and back, hips, and shoulder musculature. The rotator cuff, a sleeve of 4 tendons responsible for actively stabilizing the shoulder joint during motion as well as initiating rotational motion of the joint, is especially important. Poor rotator cuff performance can slow velocity, but also can place the shoulder labrum, basically a gasket around the socket, at risk for injury. The biceps can be at risk as well. The muscles of the upper back that stabilize the shoulder blade also have a key role in facilitating a fast, accurate pitch. The hips and back, if neglected, can derail a pitchers mechanics. Strength training, therabands, and core exercises form the foundation for a strong pitch. Warming up before games/practice is an important part of the high level thrower’s routine as well.

Most, if not all, trainers with professional and college level teams teach shoulder specific stretches and exercises meant to maintain a limber joint and to allow the humeral head (ball) to rotate freely without constraint on the glenoid cavity (socket). The ‘sleeper stretch’ and cross body stretch are thought to help maintain a compliant and forgiving posterior shoulder joint capsule. Without some flexibility of the shoulder joint, range of motion is subtly limited, and higher stresses on the rotator cuff and labrum are seen. Stretching is prophylactic – meant to decrease the chances of injury during the season.

Optimize Technique:
Arm position, body angle during the throw, and orientation of the lead foot are each important factors in preventing injury. Failure of throwing mechanics can place significantly great stresses on the tissues around the shoulder and lead to higher risk for pain or injury. For younger athletes, another important consideration is to avoid pitches like the slider, forkball, and knuckleball until mid to late teen years given the additional stresses on growing bones and developing muscles that these complicated pitches can induce.

Respect the Value of Rest:
As you might imagine, such high stresses on the shoulder can lead to micro-tears and small areas of muscle or tendon injury. For the most part, a well-conditioned athlete can heal quickly and recover to throw at a high level again in just a short period of time. But, proper rest is the key to allowing the body a chance to mend between outings. Thus, 1-3 days of rest from throwing is recommended depending upon pitch counts. And on that topic, youth throwers need to be mindful of the number of pitches thrown, which directly correlates with injury risk. As the young body matures, an increasingly higher number of pitches can be tolerated, but still needs to be monitored. Off-season rest from throwing, and in-season limits on showcase/all-star pitching, are also considered vital to maintaining healthy shoulders. Not uncommonly, I see young pitchers with shoulder pain who enthusiastically talk about pitching in multiple leagues, playing all year, pitching showcase games, and throwing way more than the recommended number of pitches per outing. Sadly, given a higher risk of injury or burnout, it is less likely that these aspiring, over-pushed athletes will ever get a chance to warm up in front of a family like mine or take the mound at a professional ballpark.

There are thousands of cancer treatment centers across the United States, but only a select few receive a designation from the National Cancer Institute (NCI). MUSC Hollings Cancer Center is among this elite group - setting us apart as one of the nation's leading cancer centers. We’re the only cancer center in South Carolina to receive this distinction and one of fewer than 70 in the United States. View full list of NCI centers.

Our NCI designation means that:

  • MUSC Hollings Cancer Center is among the best in the nation in research
  • The latest discoveries for the prevention, diagnosis and treatment of cancer are happening here
  • Additional financial support for research in our fight against cancer
  • Enhanced ability to recruit distinguished researchers and clinical leaders

The Latest in Cancer Treatments

According to the NCI, designated cancer centers like Hollings are a major source of discovery of the nature of cancer and of the development of more effective approaches to cancer prevention, diagnosis and therapy.  Patients have access to the latest cancer clinical trials, many of which are only available at NCI-designated centers. Hollings currently has over 200 open clinical trials and has seen a 40 percent increase in participation since 2009.

Learn more about cutting-edge research and cancer treatment at MUSC Hollings Cancer Center.

With the start of our new year, July 1, 2014, MUSC Health welcomes an array of new physicians. Many of these doctors will start in July while others actually begin accepting patients during August and September. MUSC Health is proud that our reputation has made us the choice of our 70 new doctors. Our new physicians are dedicated to Changing What’s Possible in Healthcare.

If you need a Primary Care physician we have several new choices for you. You may search for a doctor in our Find a Doctor tool or you can call our helpful representatives at 843-792-1414. They will assist you in finding primary care doctor close to you. We have both new Family Medicine doctors and new Internal Medicine doctors for you to choose from.

We also welcome new physicians in many specialties including:
• Nephrology
• Cardiology
• Orthopaedics
• Neurosurgery
• Ophthalmology
• Endocrinology
Use our online form to request an appointment with any of the MUSC Physicians you find on our site.

Whatever your needs, MUSC Health offers physicians in every area to assist in your diagnosis and care. For more about MUSC Health visit our web site.

Guest Post:
Michael J. Barr, PT, DPT, MSR
Sports Medicine Coordinator
MUSC Sports Medicine

Rolling around on the ground, holding an ankle or a knee, or usually both, and screaming in pain, is a common site during the 2014 Fifa World Cup; but did an injury really occur? In most cases the answer is "No", however in some cases the player really did have a serious injury. I can picture Jozy Altidore screaming in pain after tearing his hamstring in the US’s match versus Ghana, and of course the response and pain we saw when Brazil’s Neymar went down in their match last week versus Columbia.

According to the Wall Street Journal’s The Count, in the first 32 matches of the 2014 Fifa World Cup, there were 302 instances of players rolling around on the ground in pain, however after careful video critique of the “injury” and their return to play response, there were “293 cases of potential embellishment.” One professional soccer player, who asked me to not publicize his name, said that he will, at times, embellish a tackle or hit on the field for a variety of reasons which include showing the referees that a foul did occur. He also went on to say, that he will stay down on the field sometimes to give himself and his teammates a minute or two to rest and catch their breath, as well he has even used this tactic to change the speed and momentum of a game. In basketball a coach will often call a timeout to slow the game down and to break-up their opponent’s momentum, but there are not any timeouts in soccer, so some players resort to this tactic.

Arjen Robben from the Netherlands even admitted in multiple reports that he dove at the end of the game against Mexico to set up the free-kick. So many players are relying on this tactic to get a foul called; some of the biggest stars in the world cup have complained about the physical play and continual small fouls. I have watched almost every match this year, and you see teams taking the “hack-a-shaq” approach to defending players like Messi, Neymar, Muller, and James Rodriguez in order to break-up their game and slow their relentless attack.

Unfortunately, serious injuries do occur which we saw with Brazil’s Neymar who suffered an L3 vertebral fracture in the 88th minute of their match versus Columbia. Luckily, according to multiple reports, the fracture is stable and does not require surgical intervention. He will be treated with a combination of medications, physical therapy, rest and bracing. Without knowing the actual extent of his injury there is no way of knowing when he will be back on the pitch, however usually a stable third lumbar fracture takes 6-10 weeks to heal and for the athlete to return to play.

Even with the ever growing number of “flops, dives, and embellishments” and injuries to some of the biggest of stars, last week was truly an EPIC week. To the MUSC community, that may mean the system wide implementation of our “one patient, one chart” documentation system. However to the soccer community, I am talking about the outstanding play during the 2014 Fifa World Cup, including Tim Howard’s world cup record 16 saves, Argentina advancing to the semi-finals for the first time in 24 years and to having a potential European team win a World Cup on South American soil.

I, like all soccer fans, eagerly await seeing the remaining 4 matches of the 2014 Fifa World Cup; hopefully the quality of play and excitement of the games will fill the highlight films rather than injuries and boys crying wolf.


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