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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)

Strength and Conditioning Training: It Is Not Just About Getting Strong

by | Oct 10, 2023 | Therapy Services

What is strength and conditioning?
Strength and conditioning may better be referred to as “physical preparation.” An athlete needs to be physically capable of accomplishing the goals set by the coach to compete in the game. Benefits of strength training go beyond just getting an athlete bigger, stronger and faster. Proper training improves an athlete’s resiliency and confidence in their performance as well. Though preventing injuries may not be directly related to movement and strength training, there are studies that suggest that overuse injuries may be reduced by as much as one-half with appropriate training.

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Ideally, an athlete participating in a strength and conditioning program is:

  • At a developmentally appropriate level.
  • At a physically appropriate level.
  • Receiving proper instruction and supervision.
  • In a setting with equipment that is appropriate for both the athlete and the sport.

KEISER YOUTH TRAINING CLASSES KE 0000000 D 10 10 45 St PB 48KG. A group of young boys squatting in a gym

What is training age?
An athlete’s training age may vary across skills or activity. The “training age” is typically much lower than the chronological age. A soccer player may have started playing soccer at age 4 but didn’t start resistance training until age 12. Therefore, that athlete should not begin a strength and condition program at the level of an athlete with five years of resistance training who may be lifting weights and using other forms of resistance.

How should goals be set for a young athlete?
The goals of the program should also be individualized and progress should be tracked. Measures for strength, power, endurance and speed are commonly used. More importantly, an assessment of movement quality should be integrated in the progression. Proper form in fundamental movements should always precede increased resistance or other challenging elements of an exercise.

Younger athletes should learn that “bulking up” is not an appropriate goal for them. These changes will not occur until developmental stages where hormones are present to create those visual changes. What is more likely to occur with movement and strength training in this population are neurological changes that lead to improved neuromuscular control, which is believed to reduce the risk of knee and ankle injuries common in young athletes.

What happens after an injury?
After proper diagnosis, a transition to a supervised strength and conditioning program is ideal only after treatment and rehabilitation for a musculoskeletal injury. An athlete often completes formal physical or occupational therapy before they are ready to return to sport. Therefore, a continued progression of sport-related and other activities help the athlete to complete recovery and prepare for realistic sport environments. Complex movements and distractions that are common during competitions can be integrated into training sessions where variables are controlled.
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In a recent program for medical professionals, strength and conditioning coach Justin Haser, M.S., CSCS, and physical therapist Daniel Stokes, P.T., D.P.T., CSCS., explained how strength and conditioning is integrated in the continuum of care for healthy and injured athletes. Watch now on YouTube.

Four Tips to Prevent Injuries in Youth Lacrosse

Four Tips to Prevent Injuries in Youth Lacrosse

by | Apr 28, 2023 | Sports Medicine

Lacrosse is one of the oldest sports in North America and is also one of the fastest growing sports in the United States. In 2021, there were more than 40,000 collegiate and more than 450,000 youth lacrosse players. Boys’ and girls’ lacrosse follow different rules and require different equipment, which may impact the types of injuries seen in these young athletes.

“Lacrosse is an intense and demanding sport,” orthopedic surgeon John E. Arvesen, M.D., says. “Athletes who are prepared can dramatically reduce the risk of injury.” Coaches and parents can use these tips to guide young athletes in the right direction.

FOUR WAYS TO REDUCE INJURY RISK IN LACROSSE

Wear proper equipment. Protective gear that meets standards and fits correctly will provide the most benefit. Poor-fitting equipment may not offer the same protection or support.

Perform a dynamic warm-up. This involves continuous movement to raise the body’s core temperature in preparation for training or competition. Perform this before each practice or game to increase elasticity in the muscles, tendons and ligaments around the joints.

Learn and implement effective hydration strategies. Mild dehydration can worsen performance. Ideally, players should drink water every 15 to 20 minutes. Add a sports drink during intense activities lasting longer than one hour or in very hot environments to replace electrolytes lost through sweat.

Plan for rest and cross-training. Early sport specialization increases an athlete’s risk of injury and inhibits their athletic development. Focusing on one sport at an early age may lead to movement imbalances, an increased risk of injury and overtraining. A one- or two-month break between seasons and a day or two of rest each week in-season is recommended.

Some injuries in lacrosse are more difficult to prevent, such as those that occur from sticks, collisions and falls. Non-contact injuries are considered to be more preventable. As a sports physical therapist and youth lacrosse parent and coach, Michael Losito teaches young athletes the importance of learning fundamental movements to prepare their bodies for non-contact injuries. “When an athlete has control over the trunk and lower extremities, he or she can produce more power, which may help to protect the joints from minor and serious injuries,” Losito says.

Common Injuries in Lacrosse

Despite efforts to reduce the risk of injury, some accidents are going to happen. Make sure you recognize and respond to injuries promptly. Many conditions can be treated with rest and a short round of rehabilitation if they are recognized early.

SPORT-RELATED CONCUSSIONS
Concussions in girls’ lacrosse players are often the result of stick contact, or a blow with a stick to the head. Boys’ lacrosse has a higher risk for concussion due to player-to-player contact. An athlete with any concussion symptoms, including change in behavior, thinking or performance after a collision or a blow to the head, neck or body, should be removed from play immediately and not return to play the same day. A medical professional with experience managing concussions should determine when it is safe to return to play.

KNEE AND ANKLE INJURIES
Sudden changes in direction, stopping and jumping can place a lot of stress on the knee.  This can stretch and tear ligaments, such as the anterior cruciate ligament (ACL) and medial collateral ligament (MCL). A swollen knee is a sign of a joint injury that needs to be evaluated.

In lacrosse, sudden direction changes, stepping on another player’s foot or landing from a jump can result in an ankle injury. Ankle sprains and injuries to the growth plate are common in growing athletes and should be evaluated to optimize treatment and return to sport.

BACK AND CHEST INJURIES
Player-to-player collisions or falls may cause back injuries. Powerful and repetitive rotation while running, cradling, shooting and passing is more likely to cause activity-related pain in lacrosse. Overuse injuries, such as stress fractures (spondylolysis), are also common in young athletes. Persistent back pain from overuse injuries needs to be evaluated by a medical professional. The equipment and high-speed movements in lacrosse increase the risk of a rare injury from a direct blow to the chest from the ball, a stick or player collisions. The condition, called commotio cordis, can be life-threatening. Chest protectors may reduce the impact and risk of this injury.

ARM INJURIES
The design of lacrosse protective gear allows the arm to move freely but leaves the shoulder open to injury. Clavicle (collar bone) fractures and ligament injuries, or “separated shoulders,” may occur. A change in the appearance of the shoulder, pain, swelling or limited motion after a collision or fall should be evaluated.
Body checks, stick checks and slashing may cause hand and wrist injuries. Soft tissue injuries such as ligament sprains may heal with rest and ice. Others may need a brace or other treatment.

Download the PDF.

In Strong Hands: Meet the Strength and Conditioning Coaches at Scottish Rite for Children

In Strong Hands: Meet the Strength and Conditioning Coaches at Scottish Rite for Children

by | Mar 4, 2022 | Sports Medicine

Meet the coaches of our Bridge Program. This program is designed to improve movement quality, strength, speed, and other measures in young athletes to simultaneously boost performance while reducing the risk of injury.

Certified Strength and Conditioning Specialists® (CSCS®) are professionals with special training and expertise. Standards set by the National Strength and Conditioning Association (NSCA®) are designed to ensure that these coaches have the proper training and skills to promote safe participation in these activities.

As the Bridge Program coordinator, Matt Schiotz, M.S., CSCS, brings experience as an elite-level sports performance coach with more than 20 years of experience coaching diverse groups of athletes. Schiotz’s coaching journey began with the Kansas City Chiefs before moving to the head strength and conditioning coach role at the University of Southern California. He then returned to the NFL as a strength and conditioning coach for more than a decade.

Schiotz’s most recent coaching role was at Baylor Scott and White Sports Performance Center at The Star in Frisco, where he was also the Director of Performance. He has also worked as a performance coach, providing virtual training sessions using app-based programming and data analysis. Schiotz received his Master of Science in Exercise Physiology from the University of Kansas.

“I am very excited to join the team at Scottish Rite,” Schiotz says. “I believe the continuum from physical therapy to performance training is a model balancing safety and maximum outcomes. Though I have worked with athletes of all ages, my true passion is working with young athletes to help them achieve their sport and performance goals. Seeing them return to a sport or activity they love is my reward, especially as a parent myself. Combined with an athlete’s hard work, I am confident that lessons learned in this program will help each participant optimally develop and be set up for a future of athletic success.”

Justin Haser, M.S., CSCS, is an elite-level sports performance coach with experience working with athletes across all sports. Haser began his coaching career at Ohio University before moving on to the University of Pittsburgh, where he worked with the football team.

Before joining the team at Scottish Rite, he was a sports performance coach at Baylor Scott and White Sports Performance Center at The Star in Frisco. He has coached athletes of all backgrounds, from 8-year-olds to professionals in the NFL and NBA. He led the Return to Play Program, designed to serve athletes as they transitioned out of therapy and back to a full return to their sport.

“I am excited to keep things rolling here at Scottish Rite,” Haser says. “I believe the transition period between finishing physical therapy and returning full time to sport can often be overlooked. Having gone through this process twice myself, I know firsthand the challenges an athlete will face. I played Division I football for Ohio University. During my career, I had a shoulder injury that required two surgeries, the second of which ultimately ended my athletic career. After my career ended, I spoke with my strength coach at the time and explained the situation. He invited me to assist in the weight room for my final year and a half prior to my graduation. Ultimately, this experience showed me what I wanted to do professionally and launched my coaching career. I am looking forward to helping these young athletes by providing guidance and support on their journey back to their field of play!”

Scottish Rite for Children in Frisco is offering training classes for young athletes. Sessions begin the first week of each month. Contact our Therapy Services team at 469-515-7150 or bridgeprogram@tsrh.org to learn more.

What is a Bridge Program?

What is a Bridge Program?

by | Dec 22, 2021 | Sports Medicine

Getting back to sports after an injury or surgery can be a long road. From the beginning of rehabilitation, the team is actively considering the best path for the athlete to get back to play safely with the lowest risk of re-injury. Depending on the condition and treatment, the natural course of recovery may take as long as 12 months. Formal physical therapy may last three to six months, but when that is over, what’s next? There are several options to “bridge” the gap between discharge from therapy and safe return to sports. The idea is to continue training in an environment where the instructor is familiar with young athletes and aware of the challenges associated to returning to sports after an injury. For some, a high school athletic trainer may be well-suited to collaborate with the athletic program’s strength and conditioning coach. The best option is to stay with a program that understands your child’s history and goals. One that is led by a qualified professional familiar with post-injury and post-surgical recovery timeframes. We are pleased to introduce this option to our current and former patients. Keep reading to learn more about this program at Scottish Rite for Children Orthopedic and  Center.

Sports Medicine 

Top Things to Know About the Bridge Program 

What is it?    The Bridge Program is specially designed for the young athlete who has completed their physical therapy sessions but is still needing focused training to help them return safely to their sport. Why was the program created?  When therapy ends, patients are often not ready to return to sport, but do not know where to turn. The purpose of the program is to offer additional resources to the patient who completes therapy and is in search of continued training with returning to sports as their main goal. Our team is well-equipped to direct the program development and care in this stage of recovery. What is the difference between physical therapy and performance training?  In therapy, physical and occupational therapists are movement experts who optimize quality of life through prescribed exercise, hands-on care and patient education. Once the patient is pain free and exhibits quality movement, performance training is the natural next stage.  Performance training can be offered in a small class setting under the direction of a certified strength and conditioning specialist (CSCS). It is not covered by insurance, but some guarantors have HSA/FSA funds that may qualify for this program. Learn more about this kind of coach in an earlier blog [here]. Who can participate in the Bridge Program?  This program is open to athletes that do not have an injury or have been cleared from all restrictions except the final clearance by their physical therapist or doctor to return to sport and to be considered for this program. How will the program help an athlete in their sport?  With an overall focus on where your child is in his growth pattern, our coaches can address each athlete individually and customize programs that work on weaknesses which may protect him from injuries in the future. We look to provide a starting baseline, progress and discharge summary for the athlete and family to view results throughout our eight-week programs. How do you sign-up?   Call 469-515-7150 or email BridgeProgram@tsrh.org to request more information. Classes are offered with rolling admission.