Tuesday, April 9, 2013

Sports Physicals

Don't wait to get your youth athletic physicals. Teams who are interested in reserving a block time, please call and schedule a date. Special pricing is available.

High School physicals are set for June 1st at Royal High School (8:30am)

Thursday, April 4, 2013

Overuse injuries of the youth baseball pitcher

Typical injuries that are seen at the youth level usually affect the growth plates which are the weakest link in the chain. Rather than soft tissue ‘s like ligaments and tendons which are usually seen in older – more mature athletes, growth plate injuries usually heal without a problem as long as they are recognized early and are given time to heal.

The parents and coaches are usually the ones pushing the athlete to play without recognizing the child’s perception of pain. Prevention of these types of injury is to realize that there shouldn’t be any pain when throwing. Simply thinking that the problem is tendonitis and taking over the counter medication isn’t the proper approach to arm pain. Having a formal examination and arriving at a proper diagnosis is important. If the parent, child or coach have any aspiration of playing at higher levels then its very important to recognize an injury and be ready to sit out as long as it takes. They need to be mentally ready to sit out, even if the most important game is on the line.

 Secondly, we do see many soft tissue injuries of the shoulder and elbow. We can point to either overuse being the cause or improper throwing mechanics. Counting pitches has become very popular and can be helpful in avoiding injuries. However, I have heard numerous stories where a child pitches one day and practices the next. I would suggest that following a game, that the arm has several days without any activity to ensure the arm has had an adequate amount of time to recover.

Proper Throwing Mechanics:
1. Start with hips leading toward home plate and generating strength from the legs
2. When the hands start to come apart, we want the hand to be on top of the ball. Gripping ball with the palm facing down. This helps with positioning of the arm and shoulder throughout the pitch.
3. Get arm quickly up into the throwing position before the lead leg comes down
4. Lead leg needs to be pointing toward home plate
 This helps the shoulder stay in the closed position where the arm isn’t “flown” behind them (which puts a lot of stress on the arm).  

Stretching: With shoulder injuries, I have found that the posterior (back) shoulder muscles become tight. Which can reach all the way to the upper spine. So learning posterior shoulder stretches is helpful. Oppositely, the front of the shoulder tends to become overly stretched. So, we would like to avoid any activities that will stretch the front.

Outside of the actual mechanics of throwing, the most important thing to recognize is the need to strengthen the legs, core muscles and improve balance. When talking to any higher level pitcher, you will discover that their leg and core development is the most important. At the professional level, pitchers are usually the ones who work on their leg strength more than any other position player.

 The pitcher’s mound should be used more for pushing off than to just stand on. Having a strong core and leg strength will enable an athlete to propel forward toward the plate which transfers to a higher velocity. Using the legs to create speed, rather than the arm is the way youth athlete should be taught.  

Balance: I encourage balance protocols in youth pitcher development. Youth athletes tend to have inadequate balancing ability. When a pitcher is in the middle of their motion, they may have a balance issue which will most likely require the arm to make up for it and will increase the stress on the joints. There are many easy ways to improve balance and should be a part of any program.  

Pitching coaches: There are a wide variety of coaches any many of they may not be exposed to proper techniques that will decrease arm stress. Some coaches may not recognize the cause of arm pain so I would suggest that the parents encourage their coaches to tape the throwing motion and lok for the mechanics that I have outlined. The child can also see what you are talking about which makes them take part in their improvements.  

Down time: Baseball has evolved to a year round sport which is a large reason why I see so many elbow and shoulder injuries in my clinic. When speaking to a prominent shoulder surgeon, he remarked that kids should have several months off between seasons to allow the arm to rest and grow. It’s important to remember that when a child is throwing on a daily/weekly/monthly basis, that the arm is still growing. The arm will in turn grow in response to the stresses that are placed on it. This can lead to an early onset of scar tissue from injuries which will lead to abnormal joint and muscle function. Some athletes participate in multiple sports. I would highly suggest if your child is a pitcher that they don’t participate in another “overhand” sport. An example would be a pitcher who is also a quarterback of their football team. I recently had a case like this in my clinic where a young man played year-round baseball as a pitcher who excelled at the national level and he was also a quarterback. He would also go to a quarterback coach in the weekends. While getting ready for his ninth grade baseball season, we found a tear in his ulnar collateral ligament which required surgery. He missed this season and could miss the next football season as well. This was an unfortunate situation for this young man who has a promising career as a college athlete. The problem is that this scenario is become more common. I would encourage anyone who has a child that has developed an injury to their arm, to have it properly evaluated and treated. I would also stress that to become a better pitcher, you need to concentrate on becoming a better athlete by improving your core, balance and leg strength.

 Best of Luck

David Sommer, DC
Sommer Sports Chiropractic
Sports Concussion Clinic

I would like to acknowledge the work performed by Karen Mohr PT, Research Director at Kerlan-Jobe Foundation and Orr Limpisvasti MD, Kerlan-Jobe

Sunday, January 23, 2011

Always Learning

I just spent the weekend at a great seminar. After 15 years of practice, I finally made it to a Cox Decompression Seminar and I was not surprised about the amount of information that I learned. Dr. James Cox is without a doubt the biggest reason for the advancement of my profession in these last 3 decades. If you have been in my practice and treated by me then you most likely received a treatment that was founded by Dr. Cox.

His drive to advance the knowledge of our profession is un-paralleled and I appreciate it more everyday. I would also like to give Dr. Cox credit for these past blogs since it is his material. Life is about learning from others and spreading the word.

I hope that in the next few years, I can repay him with some case studies that will further help prove his efforts. I feel that I am at a time in my practice that I can start to explore in education of my colleagues.

If you would like to see more about Dr. James Cox, please follow this link. He has an enormous amount of material on his website.


Thursday, January 20, 2011

Part 4

There are many definitions of what a subluxation is but I will try and make it as simple as possible to understand. A subluxation refers to a joint that has moved from its normal position to a point that it’s stuck and is now affecting normal motion of itself and the joints adjoining it. When a joint becomes subluxated, pain receptors will “excite” and fire impulses which are recognized by the brain. The brain will then go into a protective mode which may cause many reactions like muscle spasms or inflammation. Joints are not meant to rub up against each other (in the case of a subluxation) but rather to glide by each other. Joints contain fluid to assist in movement and reducing friction but when a joint subluxates, the fluid can act as an adherent and keep the joint from moving back to its normal position. As a chiropractor, it’s my goal to locate a subluxated joint and move it back to its normal position. During this process (or what I call an “adjustment”) a “popping” sound may occur. The popping sound is created by separating the joint surfaces during the adjustment. Let me explain further; when two surfaces are pushed up against each other and they have a viscous material (joint fluid) between them, the fluid acts as an adherent. When you pull those surfaces apart it, a vacuum phenomenon is created. Once the vacuum phenomenon is released, a “popping” sound will be heard. I use the example of two wet pieces of glass against each other. If you tried to pull the wet glass apart it would be difficult, but once you broke the suction a popping noise would be heard. Maybe I went a little too far with my description, but many people ask about the popping sound. Some people envision the joint surfaces grinding over each other when it’s completely the opposite.

When a joint is subluxated many other things can be affected. Located around a vertebra are nerves that can become pinched which will often radiate pain to the surrounding areas of the back, the leg or arms (depending on which area of the spine we are talking about). Also, small muscles and tendons can be stretched which are also have pain sensitive nerves. The discs between the vertebrae can also become irritated by a subluxation. The main point is that having one joint subluxated can affect many surrounding areas and can create a great amount of discomfort. It must be pointed out that the longer a subluxation is left in place, the more possible the surrounding structures can be pre-maturely degenerated. So, if you suspect that something may have shifted in your spine, it’s important to get it checked as soon as possible. It’s not worth the possible headache!

Wednesday, January 12, 2011

Part 3

Pain in the low back and leg (fig. 12 a,b,c) Is the most common symptom with pain during movement. The inability to bend and twist the low back is very evident. The amount of pain depends upon the severity of the disc protrusion. The pain in the low back and leg may be sharp stabbing pain, extending with seeing agony from the low back to the foot, or it may be of less severity representing a dull ache. The pain may be felt in the back or any area of the lower extremity supplied by the sciatic nerve. Usually, the pain is in one leg. The pain may be described as any of these sensations: burning, numb, pins and needles, worms crawling in the skin, tingling, or a feeling that someone has your leg in a vise and squeezing it. In severe cases, inability to move the leg may be evident.

Thursday, January 6, 2011

Part 2

DISC INJURIES (Slipped Disc)
Figure 9 shows a normal disc and figure 10 shows a protruding “slipped” disc. The disc is a spongy pad which holds the vertebrae apart. The disc consists of outer rings of fibers which surround and contain a mass of gel-like fluid called the nucleus pulposus. The vertebrae above balances over the mass of fluid and depends upon it to allow the spine to be moveable. Loss of this disc material makes the spine move abnormally and any tearing or ripping of this disc may result in the substance of this nucleus shifting backward and gradually putting pressure against the sciatic nerve roots which results in back pain and, possibly pain down the leg as seen in figure 11.

The pain of a disc may stay in the low back or may radiate down the leg, usually in the back or side of the thigh and calf or front of the leg. Sometimes, one or more of the toes may become numb or tingle. Pain may be noted on the top or bottom of the foot or along the side of it. You will notice marked spasm in the low back. In many cases the patient will lean to either the right or left and find it painful to stand erect. Coughing, sneezing or straining may aggravate the pain.

There is a tear in the rubber band-like disc allowing the inner gel-like material to slip backward to pinch the nerve root.

Depending on the severity of the disc bulge, the pain (sciatica) will travel down the leg.

Happy New Year!

In my first blog report of the 2011 year I would like to begin a series of posts that will help educate my readers. It is often that I have patients come to my clinic after they have failed to get relief from other facilities and it’s my belief that this is usually due to a lack of a proper diagnosis. Since the lower back is the most common problem I will focus on the symptoms and diagnosis of the lumbar spine. Hopefully this information will help you understand all the possible scenarios of the lumbar spine. With this information you will have plenty of material that will help you ask the proper questions to your doctor. The topics that I will cover in the next few weeks will include the following:

1. Normal Anatomy & Disc Degeneration
2. Disc Injuries (Slipped Disc)
3. Sciatica (Leg Pain)
4. Vertebrae & Sacroiliac Subluxation
5. Facet Syndrome
6. Short Leg Syndrome
7. Spondylolithesis
8. Scoliosis
9. Transitional Vertebrae

If you have lower back pain, you are not alone. Lower back pain with or without leg pain, afflicts 1 out of every 3 Americans. The pain in the leg is called sciatica and may occur in the buttock, thigh, leg, ankle or foot and represents irritation of the longest nerve in the body – the sciatic nerve. This nerve starts in the lower back where it is formed from the union of five nerve roots that come from the spinal cord. Most authorities state two basic sources of lower back pain – the intervertebral disc and the facet joints. There are many reasons why these structures create pain and will be covered in this series.

Part 1
Figure 1 shows what a normal spine looks like. (A) Notice what a normal disc looks like. (B) Shows the normal facet articulations and (C) shows the opening where the nerve exits the spine.

Figure 2 shows what degeneration looks like. (A) Points to a degenerated disc which reduces the size of the hole where the nerve exits the spine (B)

The nerve that comes from the spine must pass through the narrowed opening then travels down the leg. Therefore, narrowing of the disc with misalignment of the joints causes pressure of the nerves by narrowing this opening. The loss of the disc height is called disc degeneration while misalignment of the joint is called a subluxation. Treatment of the back must be directed toward relieving the disc narrowing and the subluxation. Disc degeneration is sometimes referred to as Arthritis but this is a poor choice of term. Arthritis is not always the cause of pain but can be reaction from the body when disc height is lost and subluxation of the joint is present.
That’s why treatment with pain killers or anti-inflammatories doesn’t get rid of the problem. Your doctor needs to concentrate on reducing the pressure on the nerve.