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Movement Science – Breaking Down Movements in Young Baseball Players

Movement Science – Breaking Down Movements in Young Baseball Players

by | Oct 27, 2023 | Sports Medicine

As part of SAFE (Sports-specific Assessment and Functional Evaluation), our team is developing sport-specific protocols for the use of motion capture technology in sports medicine that are being used across the country. There are only a handful of sports that have received attention in the motion capture world, and those are typically performance-based models. The models that our team are creating evaluate foundational movements to help us predict injuries and improve return to play protocols. To do this, we will need to record a great deal of data from a large number of athletes.

For the past two summers, our Movement Science Lab team in Frisco has collected data sets on our baseball program participants and some other volunteers. Though we are just getting started on the total number of athletes to test, we are making great progress on tweaking the protocol and looking at preliminary results to understand where to go next. Here are a few things that we are looking at in the study:

Trunk mobility – specifically in the thoracic spine. We’ve identified the best way to capture the mobility of the upper spine. We believe that tightness there may affect the stress on the shoulder during throwing.

 
Motion throughout the body while throwing. Because our movement science lab is spacious, with 14-camera motion capture system, we can monitor joint angles, speed and forces throughout the body during high velocity pitching. We believe some movements are directly related to the development of elbow and shoulder injuries, particularly when there is a high volume of throws without rest.

 
Single leg stability with motion. Most sports require movement of the legs, and most of the time, only one leg is in contact with the ground. We are measuring the differences from side to side and between athletes to identify asymmetry in static and dynamic single leg movements. We believe asymmetry is a factor for increased injury risk in all athletes.

 
Leader of the project and assistant director of the Movement Science Lab in Frisco, Sophia Ulman, Ph.D., says, “Early results from this study are helping us to establish an evidence-based return to play decision-making model.” Many have heard of functional testing or return to play testing for athletes returning to sport after a significant knee surgery, such as an ACL reconstruction. This new upper extremity program is much needed in the pediatric sports medicine community. As we continue to collect information about healthy athletes, we will use the results to continue to modify the upper extremity return to play program. This is an example of where our clinical teams of physicians, physician assistants and physical therapists collaborate with our research team to make changes that impact athletes today.

We are continuing to work on this baseball project and invite healthy young athletes to help us. We schedule testing dates periodically and would be happy to send you the calendar to sign up or work with your team to find a date to do testing together.

To learn more about Movement Science, please call 469-515-7160 or email MSL.Frisco@tsrh.org. 

A Shared Passion to Protect and Serve

A Shared Passion to Protect and Serve

by | Oct 25, 2023 | Scoliosis & Spine

Published in Rite Up, 2023 – Issue 3. 
 
Last summer, the Inpatient Unit at Scottish Rite for Children had extra security and cuteness overload in the form of a 4-year-old patient lovingly referred to as Policeman Joseph. Donning a police vest, badge, walkie-talkie and binoculars, Joseph, of Gonzales, Louisiana, made daily rounds to keep his fellow patients safe. “He’s got a huge personality stuffed inside a little body,” says Randi, his mother.
 
Joseph has congenital kyphoscoliosis. In utero, his vertebrae formed differently, which caused both kyphosis, or an outward spinal curve, and scoliosis, a sideways curve. At age 2, Joseph was referred to Scottish Rite for Children where he received expert care from pediatric orthopedic surgeon Amy L. McIntosh, M.D.

When Dr. McIntosh evaluated Joseph, his curve measured more than 80°, which was beyond the point when surgery is recommended. “For young children who have severe congenital curves, bracing or casting doesn’t help because of the abnormal vertebrae,” Dr. McIntosh says. “You have to wait until they’re big enough to surgically fit an implant in them.” Dr. McIntosh monitored Joseph until he was 4. When his curve reached 100°, she recommended six weeks of halo-gravity traction followed by surgery.

Halo-gravity traction gently stretches and straightens a significantly curved spine in a slow, safe manner. “It’s like taking a spring that’s coiled up and slowly uncoiling it over time,” Dr. McIntosh says. While Joseph was under anesthesia, Dr. McIntosh applied the halo by attaching it to his skull. “I didn’t even feel it,” Joseph says. “It was super magic!” With the help of his care team, Joseph could fasten his halo to a traction device on a pulley system that connected to his walker, wheelchair or bed.
 
While in traction, Joseph participated in therapeutic recreation, physical therapy (PT) and fun activities in Child Life. “He made friends with everyone, especially the security officers,” Randi says, “and he loved growing his muscles in PT, so he could keep his new friends safe. Scottish Rite became our second family, a home away from home.”
 
When traction was complete, Joseph underwent surgery. Dr. McIntosh inserted a magnetic growing rod, also known as the MAGEC® System, on one side of his spine and a sliding traditional growing rod on the other side. After a successful procedure, his curve measured 42° — a correction of almost 60%. “He got almost two inches taller,” Dr. McIntosh says.

 Going forward, the rods in Joseph’s back will be lengthened as he grows. Rather than undergoing multiple surgeries, an external magnetic device will be used to locate the magnet inside the rod to lengthen it. “The magnetic rod acts as a motor to drive the traditional rod that will slide,” Dr. McIntosh says. This hybrid construct will control the correction of Joseph’s spine until he stops growing and ultimately receives a definitive spinal surgery. “Joseph’s care has been top-notch,” Randi says. “Dr. McIntosh is absolutely the best, a true godsend.”
 
On his last day at Scottish Rite, Policeman Joseph made his final rounds, protecting the kids and doing a celebratory safety dance on his way out.
 
Read the full issue.

Megan E. Johnson, M.D., Appointed Program Director for Pediatric Orthopedic Surgery Fellowship

Megan E. Johnson, M.D., Appointed Program Director for Pediatric Orthopedic Surgery Fellowship

by | Oct 24, 2023 | Scoliosis & Spine

We are honored to announce the appointment of Megan E. Johnson, M.D., as program director for the Dorothy & Bryant Edwards Fellowship in Pediatric Orthopedics and Scoliosis at Scottish Rite for Children. The Edwards fellowship is one of the oldest and largest fellowships in the country and has an alumni of nearly 200 surgeons.  
 
With this new appointment, Dr. Johnson will be responsible for attracting outstanding candidates from diverse backgrounds and training them to be skilled clinicians and surgeons. Dr. Johnson will ensure ongoing maintenance of a high-quality educational curriculum for our fellows and provide leadership and direction to our orthopedic faculty who take part in education. She will have a key role in ensuring our curriculum is undergoing needed innovation through regular program evaluation and quality improvement.
 
Dr. Johnson received her medical degree and completed residency training at Vanderbilt University in Nashville, Tennessee. She completed her pediatric orthopedic fellowship at Scottish Rite for Children in 2015, and following her fellowship, she returned to Vanderbilt University Medical Center. She joined the Scottish Rite for Children staff in 2020 as a pediatric orthopedic surgeon. Her clinical practice focuses on spine deformity in the pediatric population. She also treats patients with spina bifida, not only for their spine conditions but also for lower extremity issues. Dr. Johnson also serves as the Medical Director of Ambulatory Care and is an assistant professor of Orthopaedic Surgery at UT Southwestern Medical Center. 
 
“Dr. Johnson is an excellent clinician in the outpatient, inpatient and surgical setting and is an extremely talented surgeon who takes on both the straightforward as well as the complex deformities,” says Chief of Staff Daniel J. Sucato, M.D., M.S. “Not only is she a great leader, but she also has a natural ability to educate and is one of the favorites of our fellows to work with in the operating room and clinics.”
 
Dr. Johnson succeeds Dr. Sucato, who has served as program director of the Pediatric Orthopedic Surgery Fellowship program for the past 10 years. Dr. Sucato will remain Chief of Staff of Scottish Rite for Children as well as the director of Scottish Rite for Children’s Center for Excellence in Spine.

Get to Know our Staff: Judy Sneed, Center for Dyslexia

Get to Know our Staff: Judy Sneed, Center for Dyslexia

by | Oct 23, 2023 | Dyslexia & Learning Disorders

What is your job title/your role at Scottish Rite for Children? 
I am a department assistant within the Luke Waites Center for Dyslexia and Learning Disorders.

What do you do on a daily basis or what sort of duties do you have at work?
My duties include handling patient check-ins, managing the digital platform for center applications, monitoring the approved patient file process and phone coverage.

What was your first job? What path did you take to get here or what led you to Scottish Rite? How long have you worked here?
My first job was working for Cigna Healthcare filing medical records as a teenager. My dad helped me get the job.

The path that led me Scottish Rite was after I worked in Student Discipline at a local high school. This gave me a unique perspective on how unchecked academic learning disorders affected older children daily in an educational environment. A friend reached out that had been recently hired within the department regarding an opportunity to join the center, and the rest is history. I will have worked here for three years in January 2024.

What do you enjoy most about Scottish Rite?
I enjoy assisting parents, guardians and their children with navigating our evaluation process. I am here to listen to their stories regarding their fears and anxiety about their children’s educational future and see them realizing there is help and hope to help further their children’s academic success.

Tell us something about your job that others might not already know?
I am also certified to conduct vision and hearing screening.

Where is the most interesting place you’ve been?
In 2022, I was able to spend 12 amazing days in Australia visiting Sydney, Melbourne and Port Douglas (where the Great Barrier Reef is located). More destinations soon to come.

If you could only eat one meal for the rest of your life, what would it be?
Some kind of potato meal. If anyone knows me personally, I have loved french fries or any kind of potatoes for as long as I can remember, except for yams or sweet potatoes. Not a fan!

If you could go back in time, what year would you travel to?

The late ‘80s, 1989 – 1990. I had just completed high school and was wide-eyed about my future and was just about to meet someone that would make a tremendous impact on my life then and now.

What three items would you take with you on a deserted island?
I hate making assumptions, however, assuming there would be no electricity, I guess my Bible, some seeds and some fabric. No one in their right mind would be anywhere without food or clothing, plus if I was alone, what an amazing book to let me know I really wasn’t and to provide me with hope of a change in my situation.

What’s one fun fact about yourself?
I worked to replace an engine fan assembly on a classic convertible truck I once owned. Go YouTube University!

Progression from “Pop” Back to Pitching

Progression from “Pop” Back to Pitching

by | Oct 20, 2023 | Sports Medicine

A young baseball player hears a pop and immediately feels pain in his throwing elbow while playing club baseball. At his first visit to Scottish Rite for Children’s Fracture Clinic, Parker and his family were told that surgery was necessary to reattach a separated piece of bone in his elbow. That was tough news for this young pitcher nearing his 12th birthday.

A Note About Sport-Related Overuse Injuries in the Elbow in Baseball

Though a completely displaced fracture in this area is uncommon, pain and injury on the middle side of the elbow is common in young throwers. There are immense stresses placed on the elbow during throwing.

Many pitchers and others perform many throws during practice, private training and year-round games and tournaments, and the damage continues and worsens. For many young athletes, early recognition and rest can prevent the condition from worsening to the point of an acute injury, like a medial epicondyle avulsion fracture, that needs surgery. Learn more about preventing elbow overuse injuries in young athletes in this article, Injury Prevention Tips for Young Baseball Players and Parents.

“This area of the elbow is weak in young throwing athletes around Parker’s age, he was 11 at the time of this injury,” occupational therapist Savana Ashton says. The area is an epiphysis, a growth center, where the bone fragment is connected to the humerus by cartilage that will become bone when growth is complete. With or without a history of overuse, a sudden and forceful injury causes the muscle tendon attached to the fragment to pull it off the humerus completely, this is called an avulsion fracture. Like Parker, an athlete often describes hearing a “pop” and instantly feeling severe pain with this injury.

Parker was in good hands. Pediatric hand surgeon, Chris Stutz, M.D., performed the ORIF surgery where he used a screw to reattach the piece of bone. The procedure is called an open reduction and internal fixation (ORIF) of the medial epicondyle. After surgery to secure the bone fragment back in place, patients require intensive rehabilitation to return to activities and sports that are meaningful to them. In occupational therapy (OT), Ashton provided many therapeutic interventions including skin care and scar management as well as exercises to regain motion in the elbow and strength in the entire arm.

“From the beginning of Parker’s journey, he was eager to return to baseball, so a strategic path through postsurgical rehabilitation including safely reintroducing throwing was critical,” Ashton says. “Once Dr. Stutz cleared him for throwing, I advanced Parker’s plan to include evidence-based throwing programs, which include general baseball strengthening exercises and a multiphase guide to gradually return-to-pitching.”

Similar to other young athletes recovering from a serious sport-related injury, Parker was ready to be discharged from formal rehabilitation, but he was not quite ready to return to full activity, including baseball. In September, Parker transitioned from OT to the Bridge Program, a group training option offered by our Therapy Services team at Scottish Rite for Children. The program provides athletes like Parker a safe “bridge” to maintain progress made in therapy and continue strengthening in the previously injured area. Simultaneously, the coaches emphasize proper body mechanics and total body strength and conditioning, which will likely help reduce the risk of reinjury. “We were grateful Scottish Rite had an environment for him to continue his recovery,” Parker’s mom, Michele, says. She has entrusted Scottish Rite to care for several of her children now.

The program is not baseball-specific, but it is beneficial for baseball players and many others. Certified strength and conditioning coach Justin Haser, M.S., CSCS, says, “The kids that consistently come in, give a good effort and are coachable see great improvements in their movement economy and improvements in their overall strength outputs.” When athletes enroll in the Bridge Program or Athlete Development Program, they can attend up to three times each week.

In pediatric orthopedics, follow-up visits are particularly important when a growth area was involved in the treatment. Complications with this treatment are rare, but monitoring periodically and confirming recovery is on the right path ensures there won’t be surprises later.

Parker is now 13 and has been happily back on the mound and hitting home runs. “Parker is thrilled to be back playing baseball after his full recovery from surgery,” Michele says. To help other young throwers like himself have a safe season, Parker helped us create instructions for evidence-based exercises for all throwers. These are designed to be performed before practice or a game and can help to reduce elbow injuries.

Download the Thrower’s Program PDF (English | Spanish)