Repetitive Sports Injuries in Young Athletes by: Laura Copaken, M.D.

As a pediatric orthopaedic surgeon, the most common complaints I am asked to evaluate involve overuse syndromes.  Theses syndromes cause pain in many areas of the body including the knee, foot, heel, hip, elbow and shoulder--commonly where muscle and tendon units attach to bone via growth centers.  Often there is no specific trauma, just progressively worsening pain with activity which usually improves with rest.  

These kinds of injuries stem from our children doing more sports, at a higher intensity with fewer or no breaks between seasons.  Our society has placed an increased emphasis on competition over recreation and I think this is largely to blame.  Little league, youth soccer, football, cheerleading and dance, are all now associated with regional, state and national competitions, rather than just exercise and fun.  The kids feel an increased pressure to perform when they are hurting to not miss the big event, or let the team down.

Even in gym class, with new programs to combat childhood obesity and the ever growing tendency for our children to sit in front of a computer or play video games, kids are being asked more frequently to run the mile, the pacer, and lift weights.  Often these activities are without the appropriate shoe wear, stretching, safety and individualizing of what is most appropriate for each particular child.

It is important to note that most of these overuse/repetitive stress injuries carry little to no long term detriments to the child.  To some degree, they can “play through the pain” but it is not going to go away and if the child is truly limping, it has gone too far.  Not to mention that a child “playing through the pain” often changes their mechanics and can risk another injury.  It is always important to differentiate between minor achiness that progresses over time and the acute onset of pain.

So you may ask, what is the best way for a parent to help their child avoid or minimize the chance of getting these types of injuries?  First encourage and teach appropriate stretching both before and after activities of all major muscle groups.  Next encourage light off season training, stretching, light running and swimming.  Don’t go from no running, to soccer tryouts where kids are running several miles a practice.

The best advice for parents is to know that each child is different.  Participating through pain is okay in some, but not all circumstances and it is hard to know as a parent how to differentiate.  It is also sometimes impossible to convince your child to take a break when not coming from the voice of someone other than the parent.  Any pain that is persistent, does not go away with a few days rest, is associated with swelling or bruising or starts fairly abruptly should be evaluated.  There are no specific time frames for these injuries to go away.  The longer the symptoms have been around, the longer they take to go away.  Your child can safely return to sports when they can do light jogging, demonstrate equal strength and improved flexibility – all without pain.  This can be 3 weeks, it can be 6 weeks or it can be 12.

My best advice to the athlete, “No pain no gain” is not always okay.  Be honest with yourself and your coaches/teachers when you are hurting.  Often a brief break or avoidance of only certain activities for a short while will help.  Every visit to the doctor does not necessarily mean a complete break from sports.  Often we can just help ease the symptoms until the big game is over.  STRETCH!  And remember, performing on an injured or painful limb can often leave you at risk for worse injuries that could be season or even career ending.

Saddle up! Theraputic Horseback Riding by: Beverly Kornides, PT

Both Washington and Frederick Counties offer opportunities to teach riding skills to people with disabilities.  Therapeutic riding is a very beneficial means of exercise and/or rehab for children and adults with a wide range of cognitive, physical and emotional conditions.  Currently, the two centers in Washington and Frederick counties are, Star Community Inc. in Hagerstown, Maryland, and Silverado Farm, in Thurmont, Maryland.

Licensed and specialized professionals perform equine assisted activities, often called hippotherapy.  Physical, occupational and speech/language therapy treatment strategies utilize equine movements as part of an integrated intervention program to achieve functional outcomes.  Equine movements provide multi-dimensional movement, which is valuable due to its rhythmic and repetitive nature.  The horse provides a dynamic base of support, making it an excellent tool for increasing trunk strength, balance, overall postural strength and motor planning.

Currently, Star Community Inc. offers equine activities and welcomes their clients’ physical and occupational therapists on site to assist with rehab programs.  Their long-range goal is to employ a licensed physical/occupational therapist, who is accredited through the American Horseback Riding Association, to offer full-time therapeutic riding sessions to people with physical and mental challenges.

For more information regarding equine activity programs in your area, contact Ginny Gaylor at Star Community Inc., 301-791-6222, or Debbie Endlich at Silverado Farm, 301-898-3587.

Help With Shoulder Pain - by: Donna Pendleton, PT, CHT

Shoulder problems become increasingly common in mid-life. Caused by different structural problems, most shoulder complaints can be solved with good orthopedic care including physical therapy.

Most shoulder problems, whether associated with rotator cuff tears, impingement, or sprain can be treated early in physical therapy to work on reducing pain and getting full movement back to the area.

Generally, shoulder problems include stiffness and pain, and patients report the pain limiting their ability to lift their arm overhead. It is common for patients to express concern with painful motion, worry that if they lift their arm overhead it will create further damage, and they avoid moving the arm in painful directions.

For patients who have not had surgery, therapy begins with the instructions to move the shoulder to avoid further stiffness. If stiffness is severe and movement is less than 50% of normal, the term “frozen shoulder” is used to describe the stiffness and dysfunction.

Keeping the shoulder moving to avoid stiffness is a good guideline for anyone with shoulder problems who has not had surgery. To aid in restoring motion without pain, the therapist will instruct patients to use a pulley to lift the arm, walk the wall, or lie down and use a cane to lift the arm overhead with more ease by assisting with the uninvolved limb.

Therapy is helpful for shoulder patients. Reducing pain and inflammation with ultrasound, electrical stimulation, manual and therapeutic exercise eases discomfort and movement of the shoulder.

Posture plays a particular role in shoulder comfort. Keeping shoulders back, shoulder blades pulled to the middle of the spine, and your back straight will ease pain considerably. If you sit at a computer or desk during work, try to get out of the chair every hour and move. Refresh your posture by reaching your arms behind your back, reaching overhead, and rolling your shoulders back.

If work involves overhead activities, try to position yourself higher to the work to minimize the overhead reach and take frequent breaks, lowering your arms to relieve the shoulder muscles of strain from working overhead.

Shoulder pain in some cases requires surgery, therapy and recovery time. Most shoulder irritations recover with motion, therapy and postural correction.

Early orthopedic consultation gets shoulder problems on the road to recovery with early intervention and prompt pain relief. Including therapy in the process gives patients the ability to work at home on exercises that stretch, strengthen and relieve pain.

If you have had a shoulder problem, perhaps you can share with us ideas that were helpful in your shoulder recovery. Did you find a particular exercise or home remedy to aid in restoring your shoulder function? Sharing your success story can help others with shoulder problems get on the road to recovery.

Foundations of Preparation for the Athlete by: Randall Krebs, PT

Even my calluses have blisters! The dog days of summer have my dogs barking in my shoes. I thought my “wheels” were fully inflated, but with these “three-a-day” practices I need my tires changed and balanced with a realignment.

Sharp increases in volume of sport participation or exercise intensity; combined especially with the lack of sleep, poor diet or dehydration may lead to inflammatory conditions, strains or more serious injuries taking the fun out of the fundamentals of sports and exercise.

Preparation with any endeavor, including sports and exercise, is an essential foundation often overlooked. Getting an expert to tailor a strength and conditioning program will give you an edge with both upgrading performance and preventing injury. This process starts with an evaluation that needs to include functional body mechanics. Only after an understanding of which muscle groups or joints are weak or unstable and conversely which ones are stiff or tight along with which sports movement patterns are less than mature or optimal, may a program that will maximize your time and results be effectively designed. Research has clearly demonstrated a specificity to practice and conditioning necessitating the professional designing your program needs to have an intimate understanding of the skills and demands of the activity you wish to safely improve.

Ideally, the program should be periodized over months but practically this happens most often at the more elite levels when trying to peak performance at a certain phase of the year. One of the periods in most programs is rest, but this rest sometimes includes “active rest” to speed recovery and if carefully planned by the professional can include cross training which will enhance confidence and motor success as well.

Lower body pain in children and adolescence is usually related to the growth plate of the bone, especially when growth has been recently rapid. A component of these pain syndromes, however, is that the muscles during these phases usually lag behind the bones and become in comparison, tight and weak.

Education in body awareness and self treatment is the keystone to most successful treatment of painful conditions. Massage, body work, taping and therapeutic electrical stimulation also have a place in controlling pain and facilitating return to full and active lifestyles for our children.

25 Ways To Be Fit: Donna Pendleton, PT, CHT

25 Ways to Be Fit

Being fit is a life endeavor. Some years will be more successful than others. A lifetime of practicing these few principles will have a powerful impact. You will find getting and staying fit simple and possible when you put these 25 tips into practice.

Live and get fit with everyday tools:

1. Use smaller dinner plates to control portions and calorie intake. Eat just one serving, and avoid seconds.



2. Make exercise a regular part of your life. Make friends where you exercise and use these friendships to promote accountability and increase your motivation.



3. Know what you want to accomplish and visualize the end result of your hard work.



4. Believe in yourself



5. Don’t be a wimp or a complainer – most things worth having require some work. Fitness can be fun. Keep good work ethics a part of your plan.



6. Drink water all day long.



7. Know when to ask for help.



8. Maintain your metabolism by eating a healthy snack or meal every three hours. Keep what you eat unprocessed, fresh, and low in sugar.



9. Forget “will power” – it is about WANT power! How badly do you want it?



10. Don’t eat processed foods. These foods are high in empty calories that have very little nutritional value to your body and contain chemicals that can be harmful to your health. Think: “if it comes out of a window or a box, it might not be good to eat”.



11. Make food choices that are healthy, low in fat and eat plenty of lean proteins, leafy greens, and whole grains.



12. It’s okay to be a skeptic. Watch out for products that are labeled “health food”. Always read the labels and make an informed decision.



13. Act now and get the job done. Remember, talk is cheap.



14. Exercise with people who are in better shape than you. This will encourage you to push your limits.



15. Never indulge in negative self talk.



16. Don’t drink calories.



17. Pay attention to everything you eat.



18. Get enough rest



19. Be consistent with your exercise. Exercise three or four times per week for life.



20. Expect more from yourself.



21. Never eat or drink high fructose corn syrup. It will spike your blood sugar levels and encourage your body to store fat.



22. Eat plenty of whole plant foods. Vegetables, fruits, and whole grains are filled with fiber and antioxidants and great for your health and weight control.



23. Eat breakfast, always.



24. If you know you deserve better, than go get it. Challenge yourself.



25. Set specific, measurable goals and track your successful progress.

Life is over before you know it…get ready to make a change, live and eat healthy. Put these practices to the test, it is a great beginning. Print them where you can see them, strive to be focused, determined, and in control of your health. Get fit and stay fit for life.

Here at MMI, we can help you address and recover from injuries or barriers to your “fitness for life” success. We offer state of the art rehabilitation programs and our staff of rehabilitation professionals can individualize your fitness and treatment programs to reach your goals.

Are you struggling with a problem that interferes with your ability to reach your fitness level and stay healthy? Can we offer a suggestion to get you back on the path and moving again toward your goal. Let’s hear from you and let’s team up and get started on a Healthy New You.

Balance Issues Resolved Through Physical Therapy by: Bev Kornides, PT

Did you know that the #2 reason for patient visits to the primary care physician office is the complaint of dizziness?

Are you dizzy? Lightheaded? Or even tipsy? Do you have a sense of feeling “off balance”?

Pinning down these adjectives can help your physician better diagnosis the problem as it could be related to inner ear, a specific area of your brain, medication or a recent infection that may have residual effects.

For those patients who struggle with a sense of imbalance or disequilibrium, there are simple tests to evaluate one’s level of confidence in doing activities around the house without the risk of falls.

Physical therapists trained in this type of rehab called “Vestibular Rehabilitation” can help the physician with data collection toward nailing the correct cause of the imbalance. Could it be an inner ear problem, central nervous system or other?

Most common patient type in this category are those who suffer with Benign (not life threatening) Paraxysmal (recurrent sudden intensification of symptoms) Positional (related to bodily posture) Vertigo (sensation of rotation/spinning), otherwise known as BPPV.

Repositioning maneuvers, otherwise known as canalith repositioning, are done in the physical therapist’s office and offer a very effective option. Most cases of BPPV can be healed in 1-3 sessions with 80-90% resolution of all symptoms.

During the treatment sessions the patient is educated on the rationale of the canalith repositioning technique and why it works.

Approximately 50% of individuals with BPPV can experience another episode within five years. With their knowledge and understanding of their problem they often can effectively treat themselves.

So… Do you have spinning when you position change?

Does the symptom linger less than or greater than a minute?

Are you phobic about position change?

Don’t be a victim of such a correctable disorder; contact us in the physical therapy department of MMI.

So Your Young Son Wants to Pitch in the Major League. By: Dr. Mark Chilton

So your young son wants to pitch in the Major League some day. The secret to failure is burly success. No one who will make it to the big league as a pitcher was very successful pitching at Little League or in Babe Ruth.

There are 1000 ways to throw a baseball, but only one correctly. Youngsters rarely have the physical and mental aptitude to apply correct pitching mechanics. They lack balance, leg strength and shoulder deceleration, to name just a few. Inadequate follow through, throwing the ball across the body or with the hand under the ball in full cocking phase, are more frequently seen problems.

But if they are successful at striking out opponents at a young age, despite poor mechanics, then they will pitch more games and develop more habits until their shoulder and elbow fails. It happens every time. It is not just the coach over pitching the youngster, but the player himself, or parent, or teammate who encourage the youngsters malpresence because of previous success.

To be a successful pitcher at the college level or beyond, don’t pitch.

Learn proper mechanics. Learn to reproduce your release position so as to improve accuracy. Remember, pitching has three important aspects just like real estate. They are location, location, location.

When you do pitch, don’t worry about striking out every opponent. It is probably more important at the early stages of pitching to learn to play defense off the mound. When you do pitch, no curve balls before the age of 17. Just work on locating your fastball and maybe a changeup.

Never pitch more than one game per week, never more than 50 pitches per game for little league and 70 pitches per game for older Babe Ruth or high school players. When not pitching, don’t play catcher – the shoulder has only so many throws in it, save them for later.

Plus, don’t play on three different travel teams and don’t play year round. Be involved in other activates, especially your school work.

By age 17, your son should have reached the physical and mental maturity to have developed and maintain good pitching mechanics. His shoulder decelerators are strong enough to prevent shoulder and elbow problems and he is probably ready to throw a proper curve ball, not that risk twisting Little League curve.

For more information contact me, Dr. Mark Chilton or Randy Krebs, P.T. for group sessions in pitching mechanics.