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MUSC Health Blog

Keyword: injury prevention

Guest post by:

Kathleen Choate, ATC, CSCS, CEAS
Athletic Trainer
MUSC Health Sports Medicine

No one likes being injured.  It's painful, expensive, takes time away from the sports we love, affects our daily life, and can even lead to pain and disability later in life.  Wouldn't it be nice if we could enjoy the sports we love without this risk?  While it isn't possible to completely eliminate the risk, there are ways to prevent them.

Stretch

            Before participating in physical activity, a good warm-up should be in order.  Both static and dynamic stretches are acceptable prior to participation, but you may choose one or the other depending what your goal is. Stratching on track

            Static stretches involve holding a muscle in a lengthened position for an extended period of time.  For example, a static stretch could include sitting on the ground in a pike position with legs fully extended, reach for your toes, and hold it for 30 seconds.  If you choose to primarily use static stretching prior to physical activity, try to incorporate things like jogging, jumping jacks, or squats to increase your body temperature.

            Dynamic stretches involve bringing a muscle through a full range of motion; it comes with an active movement that should be slow and controlled.  One benefit of using dynamic stretching over static stretching is that it also increases your body temperature, which helps to increase elasticity of the muscles right before physical activity.  An example of a dynamic stretch would include slow and controlled lunges with a straight instead of bent back knee. 

            Ballistic stretches involves a bouncing motion at the end range of a stretch and should not be used as a way to warm-up since it is likely to lead to a muscle strain.  Regardless of your warm-up, remember that it should never be painful.

Equipment

            Proper equipment should be a no-brainer with any sport.  Runners need shoes, football players need helmets, pads, and mouth guards, and wrestlers need headgear.  Not only are these pieces of equipment necessary to be worn, but they should also be fitted correctly.

            Shoes are especially important for sports with a high volume of running including cross country, track and field, soccer, field hockey, and basketball.  While quality shoes are pricey, they are the only piece of equipment a runner needs.  Running is a fairly straightforward movement compared to other sports.  It involves a series of repetitive movements over the course of several miles.  If your feet hit the pavement 1,000 times in one mile, then a faulty running gait or a worn out pair of shoes can cause injuries anywhere from your feet to your back.  It can be difficult to spend our hard earned money on a pair of running shoes; however this investment can prevent you from having to spend hundreds or thousands of dollars at the doctor’s office.  Since shoe needs are going to vary from person to person, consult with your Athletic Trainer for guidance prior to making this purchase.  Also, plan to replace your shoes every 300-500 miles.

Technique

            Have your coaches ever sounded like a broken record?  Maybe they told you ten times in one practice to follow through, keep your head up, or to bend your knees more.  Good technique doesn't just make you a throw a ball better, score more points, or run faster; it prevents injury.  The more obvious injuries are the ones that happen when a movement is performed incorrectly one time and sudden pain is felt.  The injuries that creep up on you are ones that arise from consistently flawed technique.  Next time your coach tells you to correct a motion, do everything in your power to fix it the first time!

Rest

            Rest is the word athletes never want to hear, but it's vital to preventing injury.  Give yourself at least one day off a week to let your body recover.  This may seem like slacking to some, but it will prevent overuse injuries and burnout. 

            As athletes, it’s tempting to play through pain, especially during a game.  The pain level may feel tolerable, and you don’t want to let your teammates down.  Choosing to continue to participate with a possible injury will most likely make the injury worse and recovery time longer.

Strength and Conditioning

            Condition your body for the sport you are participating in.  A great strength and conditioning program will vary depending on your age, level of training, sport, and time of year.  A strength and conditioning specialist is your best resource to put a conditioning program together with all factors considered.

Athletic Trainers

            Athletic Trainers are often thought of as the person that runs onto the field when a player gets hurt.  That may be when we are viewed most publicly; however we have many other roles with regards to injury management, including (but not limited to) preventing the injury from happening in the first place.  Consult with your Athletic Trainer about injury prevention to identify a plan that is specific to you as an individual.

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

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.

Flexibility:
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.

 

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