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Archives: April 2015

Hip Injuries in Baseball & Softball

Added on April 29, 2015 by DrJAllen

Hip Injuries in Baseball & Softball

When we talk about overuse injuries in baseball and softball, we generally discuss upper extremity conditions. Although those injuries are the most common, we are seeing more awareness and discussion of injuries to the hip.

How Do Injuries to the Hip Happen?

The activities of batting and throwing place high demands on the hips and put them at risk for injury. For instance with overhand pitching, during the wind up phase, a flexion and rotational force is placed on the hip. During the cocking phase, the hips are further apart and more loading stress is placed on them. As the pitcher moves from acceleration through the follow-through phases, the hips go through additional loading and rotational stresses. With Softball pitching, rotational forces occur in both the hips as the pitcher moves from a static standing position through the follow-through phase.

With Batting, during the stance or coiling phase, torque is placed on the back hip. As the batter moves through acceleration and follow-through, additional rotational forces are placed on the hips.

These are all normally occurring stresses that are just part of the games of baseball and softball. With normal stresses, there is a potential for injury. The potential for injury increases with the following risk factors:

1) Poor Biomechanics- Improper technique with any of the phases of batting, throwing or pitching can cause increase pressures and torque in the hip

2) Deficits in Mobility or Functional Movement- limitation in movement in any of the joints of the Lower body or Spine can contribute to increased problems in the hips

3) Deficits in Strength & Endurance- Weakness in the muscles of the hips or general "core" muscles can cause instability and result in increased pressures in the hips with activity. Fatigue can also play a part in these types of injuries- Arm fatigue is monitored for pitchers to alleviate the possibility of upper extremity problems, but we should also be monitoring lower body fatigue. If the lower body is weak or starts to break down, pitching accuracy will suffer and may be the first sign of fatigue.

4) Deficits in Proprioception/Balance- strength and flexibility are important, but being able to have balance on one leg and being able to shift weight and control motion is an important aspect in injury prevention. With poor balance, or awareness of body position, joints may move beyond their limits or may place undue strain on soft tissues that support them

5) Joint Abnormalities: abnormalities inside the joint may predispose players to certain types of joint "impingement" or pinching with movement. Repeated strain at these end ranges of motion can create pain and inflammation

Symptoms of Hip Injury

Symptoms of hip problems may be subtle at first and may just be tightness in the hip or buttock area. Other symptoms may include groin pain or aching into the thigh. As symptoms worsen, pain may be experienced at night or with the first few steps after sitting for a prolonged period. These symptoms are a sign that something is wrong in the area- the player should seek medical advice at the onset of these symptoms.

 

Screening for Risk Factors

A comprehensive baseball or softball program should include Pre-season screening, followed by preseason and off-season corrective actions to address any problems or deficits found during the screening process.

An ideal screen should include the following:

1) A regular pre-season Physical

2) Biomechanics Assessment- video assessment in slow motion during hitting/throwing or pitching

3) Flexibility & Strength screening

4) Screens of Specific Functional Movement Patterns

5) Balance & Stability Screens

The best injury treatment advice is to Avoid injury in the first place. Prevention strategies are the Key to keeping players healthy during their careers- if that is Little League Baseball...or all the way through the Majors.

Treatment for Hip Related Injuries

There are many conservative Physical Therapy treatments available for these types of hip injuries. Hands-on techniques, or manual therapy are an important part of rehabilitation as well as specific exercises to fix any muscle imbalances that may exist. Prior to returning to play, video biomechanical analysis is vital to look at throwing, pitching and hitting. This will help identify any mechanical or technique issues that could be causing problems in the hips.

Dr. Jennifer Allen is a Physical Therapist, Board Certified Clinical Specialist in the Areas of Orthopaedic and Sports Physical Therapy, as well as a Certified Hand Therapist. Sports Programming at Bodycentral Physical Therapy includes Biomechanics assessment, video movement assessment, Injury Prevention, and individual and team performance enhancement. For more information visit www.BodycentralPT.netor call 520-325-4002.


 

 

 

 


 

Fastpitch Softball Injury Treatment and Prevention

Added on April 1, 2015 by DrJAllen

Fastpitch Softball Injury Treatment and Prevention

Fastpitch Softball Injury Treatment and Prevention

Spring is in full swing and we are right in the middle of Fastpitch softball season, one of my favorite times of the year. Along with the good, we sometimes as healthcare practitioners see the bad. This time of year, particularly in the early season, we begin to see the overuse injuries that are common with the sport.

A lot of emphasis is put on the prevention of injury in baseball players, and I couldn't agree more with what we do in the field of sports medicine to prevent and treat those injuries. We are getting better at identifying risks for injury and are addressing them to a higher degree in baseball.

I do feel we can do a better job for fastpitch softball players. Pitchers in fastpitch softball have repetitive use of the pitching and throwing arm, and are at risk for injury just as our baseball players are. There is a misconception that pitching a softball is somehow "safer" and less problematic than pitching a baseball. As time goes on, we are discovering that this is really not true. Forces on the shoulder and elbow can reach up to 95% of what are experienced in baseball pitchers (1, 2). Girls and women participating in fastpitch softball are susceptible to similar injuries in the shoulder and elbow as our baseball players.

Common Injuries/Painful Areas:

Anterior shoulder pain (pain in front)        

-       During the softball pitching motion, when the arm is in the "pitch delivery phase", there are significant distraction forces on the shoulder which make the Pectoralis major and Subscapularis muscles susceptible to injury. The Pectoralis Major is a large anterior chest muscle and the Subscapularis is part of the Rotator Cuff. These forces are similar to the forces seen in baseball pitchers.(1)

Elbow Pain

-       Distraction forces at the elbow make those tissues susceptible to overuse injury

 

Posterior Shoulder pain (pain in back of shoulder)

-       The posterior shoulder muscles (deltoid, infraspinatus, and teres minor) are injured while contracting to decelerate the arm during delivery of the pitch. Shoulder joint laxity can be a problem that leads to this type of pain problem. (1)

 

Prevention & Treatment: Bullet Points to Recognize as Factors

-       Proper pitching mechanics- Many factors can affect the ability to maintain good pitching mechanics. Musculoskeletal restrictions, weakness, and problems with balance can contribute to break downs in mechanics.

-       Pitching while fatigued. There are pitch counts available for baseball for different ages to help as a guideline to prevent arm fatigue. Best advice is to stop throwing when arm fatigue starts, regardless of pitch count. Below is a recommendation for fastpitch softball pitch counts as described by S. Werner, PhD.

-       Lower Extremity and "core" strength- Hip position and lower body control is important in the ability to produce force during the pitching movement. Weakness in the lower body can result in more reliance on the arm for force generation, and can lead to injury.

-       Shoulder and Scapular stability- strength and stability in the arm is important, but in addition to that, there must be adequate strength in the muscles that stabilize the shoulder blade. If scapular stability is not present, that again results in smaller shoulder muscles generating and controlling forces.

-       Treatment of the softball athlete and return to play must consider all of these issues. Video Throwing and pitching analysis is an integral part of diagnosis and treatment of the "causes" of painful conditions. A thorough musculoskeletal and entire body functional analysis is important to identify restrictions that can lead to upper extremity overuse. Rehabilitation of the throwing athlete should include hands on treatment, video analysis and biomechanical analysis, and a progressive return to overhand throwing- followed by return to pitching. Missing any of these components can put an athlete at risk at developing another injury.

 

 

 

Fast pitch softball pitch count recommendations as suggested by SL Werner, PhD based on her research (3):

       10U – 60 Windmill pitches per day max followed by one day rest

       12U- 70 pitches per day max followed by one day rest

       14U- 80 pitches per day max followed by one day rest

       16U- 90 pitches per day max followed by one day rest

       18+- 100 pitches per day max followed by one day rest

Dr. Jennifer Allen is a Physical Therapist, Board Certified Clinical Specialist in the Areas of Orthopaedic and Sports Physical Therapy, as well as a Certified Hand Therapist. Sports Programming at Bodycentral Physical Therapy includes Biomechanics assessment, video movement assessment, Injury Prevention, and individual and team performance enhancement. For more information visit www.BodycentralPT.netor call 520-325-4002.

 

References:

1.     Barrentine SW, Feisig GS, Whiteside JA, Escamilla RF, Andrews JR. Biomechanics of windmill softball pitching with implications about injury mechanisms at the shoulder and elbow. J Orthop Sports Phys Ther 1998;28: 405-414.

2.     Werner SL, Murray TA, Levy M, Smith SL, Plancher KD, Hawkins RJ. Reports to the coaches: softball pitching at the 1996 Olympic Games (monograph on the Internet). Steadman Hawkins Sports Medicine Foundation; 2001 Available from: http://www.shsmf.org/main/olympics/olympics1.html

3.     Leland, G. (Fastpitch Softball TV Show). (2014, April 16). How to Softball Drills & Tips: Softball Pitch Counts. Retrieved from http://www.youtube.com

 

 

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