Off-Season Baseball Strength and Conditioning: Lessons from the Yankees

The winter months are quickly approaching here in the Northeast. For youth baseball players the cold winter is the ideal time to focus on developing muscular strength and explosive power. These physical attributes transfer to the baseball field as quickness, running speed, bat speed, throwing velocity, ball exit velocity, and overall resiliency needed to survive the grind of a full season. Under most circumstances, youth athletes should always be encouraged to participate in multiple sports throughout the year up until about the age of about 15 or 16. Continuing efforts to improve baseball skills, such as hitting, is important for the mature specialized youth athlete. However, baseball performance will never be optimized without a well structured and supervised off-season strength and conditioning program.

Steinbrenner Field, Tampa

Last week I had the unique opportunity to visit the New York Yankees spring training complex in Tampa, Florida. It was a special weekend for a lifelong Yankees fan and strength and conditioning nerd like myself. The Yankees strength and conditioning and sports science staff hosted a group of growth-minded coaches from the National Strength & Conditioning Association. The entire day was tremendous and a humbling learning experience.  Topics included leadership, hill running for baseball players, and programming for off-season strength training. The Yankees staff stressed the importance of a well-structured year-round strength and conditioning program for all players from the rookie leagues up through the majors. The Yankees organization fully expects to win many more World Series trophies and developing their athletes is a big part of their winning plan.

What Makes a Great Baseball Player?

Hitting a baseball is a sequence of coordinated muscle activity involving the hips, torso, and arms. Bat speed is an important factor affecting how hard the ball is hit and how far the ball travels. Training baseball players targets the lower body and explosive torso rotational exercises. Exercises which develop upper body power, lower body power, and torso rotational power, all transfer on the field to improved bat speed. Research also indicates lean body mass, lower body power, sprint speed, and grip strength are closely correlated with baseball-specific performance measures such as total bases, slugging percentage, home runs, and stolen bases. The off-season is the ideal time to train these attributes in baseball players because this is typically the period when the least amount of baseball-specific batting or pitching practice is taking place.

In 2010, researchers from Louisiana Tech University investigated the relationship between player variables and bat speed in 2 groups of high-school baseball players before and after completing a 12-week resistance training program. Both groups completed the same upper and lower body resistance training program and took 100 bat swings 3 days per week. However, one group also performed additional full-body rotational medicine ball exercises. Several body composition and physiological variables, along with bat speed, were assessed before and after the training program.

Researchers found bat speed was associated with greater lean body mass and height. This sounds like Aaron Judge to me. Torso rotational strength was even more closely associated with bat speed in these high school athletes. Lower body power, measured by vertical jump, was also closely associated with bat speed. Finally, lower body strength (measured with 3-repetition maximum squat) and upper body strength (measured with 3-repetition  maximum bench press) were also associated with bat speed. From this research, in order to improve bat speed in baseball players, off-season strength and conditioning programs should target improving lean body mass, rotational power, lower body power, lower body strength, and upper body strength.

The Off-Season Baseball Strength & Conditioning Program

Off-season baseball strength and conditioning focuses on improving total body strength, rotational power, and lower body power. Pitchers also focus some of their efforts on arm care programs in order to prepare for the volume of throwing which places unique stresses on the shoulder and elbow. Pitchers must possess adequate strength in order to develop power and throwing velocity. Programs typically last 10 to 12 weeks with training occurring 3 days per week. Volume and intensity of these programs are progressed and tapered down as the athlete gets closer to pre-season when baseball-specific skill training becomes increasingly important. Resistance training with free weights or cables, plyometric training, and medicine ball training are the cornerstones of the off-season program.

Resistance training has been shown to improve both bat speed and throwing velocity in youth baseball players.  These exercises seek to build foundational strength through movement patterns such as the squat, hinge, and press. However, as previously mentioned, baseball involves a great deal of rotational and diagonal movement which should be heavily incorporated into training. The cable push-pull exercise is great for improving torso rotational strength in the position player or pitcher. Baseball players often exhibit muscle imbalances where the front of the body (anterior chain) is stronger than the back (posterior chain). Therefore, it is common for programs to include a 2 to 1 ratio of pull to push exercises. Training volume with movements such as rows and lifts targeting the posterior chain should be stressed over movements such as presses.

Baseball is also an asymmetrical one-side dominant sport which involves throwing with one arm or batting from the same side of the plate. Barbell training for the squat, deadlift, and sometimes the bench press can be included in a periodized program to improve bilateral strength. However, it is very important for the baseball player to be training unilaterally with dumbbells or kettlebells. Single arm rows, split-stance squats or lunges, and single-arm kettlebell swings are great examples of unilateral exercises.

Power is the product of strength and speed. Power is expressed when throwing, swinging or jumping during the game of baseball. Strength is trained with resistance exercise using heavy loads at slower speeds. Plyometric training involves drills designed using maximal force as quickly as possible. These exercises are important for training the speed component of power. Research from Arizona State University showed complex training utilizing both heavy resistance training and plyometric jump training improved power in baseball players to a greater degree than either resistance or plyometric training alone. Lower body plyometric drills to improve explosive power for the baseball player include box jumps, lateral jumps, and split squat jumps.

Medicine ball training is a form of explosive exercise using rapid force development and transfer from the lower body and torso through the arms. Medicine ball throws are ideal for developing rotational power which is crucial for any baseball player. Twelve weeks of resistance training plus medicine ball training resulted in greater improvements in rotational strength compared to resistance training without medicine ball drills. In another study, 6 weeks of supervised medicine ball training in high school baseball pitchers was shown to result in a 2% increase in throwing velocity. It is very important that athletes are instructed in proper technique during these drills. Performing explosive medicine ball training with improper technique can result in decreased throwing performance or injury. Common medicine ball drills used with baseball players include the squat and throw, perpendicular throw, and hitter’s throw.

Conclusion

The baseball player’s off-season strength and conditioning program should coincide with specialized sports skill practice. However, the off-season is not the time where pitchers should be throwing at high volumes. Youth pitchers should rest from throwing for a minimum of 2 to 4 months per year. The off-season throwing program must be individualized to meet the needs of the athlete. Regardless of the structure of skill practice, the off-season is the ideal time to divert efforts towards improving strength, power, speed, and resiliency. As the off-season progresses and the athlete approaches the pre-season, the focus on strength and conditioning should decrease. At the same time, sport skill training (pitching, hitting, and fielding) increases.

Off-season strength and conditioning for baseball players improves performance through the development of strength, speed, and explosive power. These qualities are the foundation of a long and successful baseball career. Youth athletes should be instructed, supervised, and progressed by trained professionals who have experience with baseball players. The research is clear about how baseball players are built. The New York Yankees have taken notice and put these concepts into practice. Youth baseball players are not miniature professional athletes and should not be trained as such. However, the basic principles used by the Yankees can be applied to youth athletes by trained professionals who understand the science.

References

  1. Dodd, D. J., & Alvar, B. A. (2007). Analysis of acute explosive training modalities to improve lower-body power in baseball players. Journal of Strength & Conditioning Research, 21(4), 1177–1182.
  2. Escamilla, R. F., Ionno, M., DeMahy, S., Fleisig, G. S., Wilk, K. E., Yamashiro, K., … Andrews, J. R. (2012). Comparison of three baseball-specific 6-week training programs on throwing velocity in high school baseball players. Journal of Strength & Conditioning Research, 26(7), 1767–1781.
  3. Hoffman, J., Vazquez, J., Pichardo, N., & Tenenbaum, G. (2009). Anthropometric and performance comparisons in professional baseball players. Journal of Strength & Conditioning Research, 23(8), 2173–2178.
  4. Szymanski, D., Szymanski, J. M., Bradford, J., Schade, R. L., & Pascoe, D. (2007). Effect of twelve weeks of medicine ball training on high school baseball players. Journal of Strength & Conditioning Research, 21(3), 894–901. https://doi.org/10.1519/R-18415.1
  5. Szymanski, D., Szymanski, J., Schade, R., Bradford, T., McIntyre, J., DeRenne, C., & Madsen, N. (2010). The relation between anthropometric and physiological variables and bat velocity of high school baseball players before and after 12 weeks of training. Journal of Strength & Conditioning Research, 24(11), 2933–2943.

Does Stretching Reduce Injury Risk in Athletes?

Static stretching exercises are commonly performed as a method to improve muscle flexibility and overall mobility. Typically, stretches are sustained for 15 to 30 seconds and performed multiple times during an exercise session. Many athletes and fitness enthusiasts perform stretching in preparation for a training session or competition. Others believe regular performance of static stretching can reduce their risk of sustaining an injury. Stretching routines often consume an enormous amount of time for some athletes.  Does the current body of research suggest this time is well spent? Or can athletes better spend their time and energy on other types of training in order to reduce injury risk?

Stretching & Injury Risk

A review of the research published in the British Journal of Sports Medicine looked at the role of several forms of exercise in reducing the risk for sports injuries.  Twenty-five original studies including over 25,000 athletes looked at the preventative effects of stretching, strength training, and proprioceptive training. Stretching, before or after exercise, was determined to have no preventative effects against acute or chronic sports injuries. The most significant finding from this review was strength training reduced all sports injuries to less than 1/3 and overuse injuries were cut in half.

Other systematic reviews have also concluded no preventative effects for static stretching. One study even suggested that stretching may increase the risk of patellar tendon injuries or “jumper’s knee”. My experience with static stretching leads me to believe there is a neutral effect. In other words, there is no direct preventative or harmful effects to static stretching. Static stretching should be an extremely small part of any training program. In most cases, stretching is not necessary to reduce injury risk or improve performance.

The Acute Effects of Stretching

Static stretching induces range of motion improvements, but these effects are short-term typically lasting less than 30 minutes. Many myths exist with regards to what is actually happening at a physiological level.  Changes in mobility may result from acute reductions in muscle and tendon stiffness or from nervous system adaptations causing an improved stretch tolerance. Stretch tolerance refers to an athlete’s ability to tolerate the discomfort of the stretch. Athletes with a greater range of motion tend to demonstrate a greater level of stretch tolerance. Thus they are able to tolerate a greater stretch load. Improving stretch tolerance can be achieved through different training methods one of which is static stretching. However, if athletes are looking to reduce their risk of injury, or simply better prepare themselves for training, time can be better spent using more beneficial techniques.

Stretching or Strength Training?

First and foremost, athletes and fitness enthusiasts should build their training routines on a solid foundation of strength training. A comprehensive and proper strength training program may increase flexibility through enhanced stretch tolerance. Strength training also assists in the development of force capacity through the newly gained range of motion. In order to maximize the effect, athletes should perform strength training movements in a controlled fashion through the full available range of motion.

Strength training promotes a sense of resiliency, reduces injury risk, and improves overall performance in many aspects of life. I have written about the benefits of youth strength training for reducing injury risk and performance. Static stretching has no effects on injury reduction or performance, and does not promote resiliency within athletes. Sure, holding hamstring stretches for sustained periods of time feels nice and promotes a sense of relaxation. This may have a time and place but do not confuse the calming effects or short-term increases in mobility gained through static stretching as beneficial for injury risk reduction.

Stretch if You Must

Athletes who insist on performing static stretching should probably do so at the end of their training session or after competition. Prior to training or competition, perform dynamic activities as part of a preparatory warm-up. Performing the warm-up actively in weight bearing positions is the best approach. Also performing the warm-up with multiple joint movements will better prepare the athlete for the complex movements of sport or training. Dynamic stretching, sometimes referred to as mobility drills, places an emphasis on the movement requirements of the sport or activity rather than on individual muscles. An example would be performing body-weight lunge walking prior to a squat training session. There are endless possibilities for one to dynamically prepare the hips prior to squatting.

For athletes looking to improve their mobility and overall performance in the gym, static stretching should play a minimal, if any, role. Instead, try performing dynamic activity-specific preparatory movements with progressive loading. Performing ten minutes of piriformis and calf muscle stretching will do little to improve performance during a squat session. Instead, include some loaded goblet squats or split squats prior to warming up with the barbell. Increase the load progressively until you reach your working set intensity. With this approach, the dynamic warm-up and start of the training session are continuous and optimal for preparing the body for performance. After putting in the work at the end of the training session, feel free to lie down on the floor and stretch those “tight hamstrings”.

Conclusion

Contrary to popular belief, stretching has no beneficial effects on reducing injury risk and its role in performance enhancement is questionable at best. Athletes should use static stretching sparingly and focus their time and efforts towards more effective injury reduction strategies such as a well-supervised and progressive strength training program. Lying on the floor to stretch certainly feels good but in order to achieve lasting benefits, nothing can replace hard work and sweat in the gym.

References

  1. Behm, D. G., Blazevich, A. J., Kay, A. D., & McHugh, M. (2016). Acute effects of muscle stretching on physical performance, range of motion, and injury incidence in healthy active individuals: A systematic review. Applied Physiology, Nutrition, and Metabolism, 41, 1–11.
  2. Haff, G.G., Triplett, N.T. (2016). Essentials of strength training and conditioning (4th Ed). Champaign, Ill: Human Kinetics.
  3. Lauersen, J. B., Bertelsen, D. M., & Andersen, L. B. (2014). The effectiveness of exercise interventions to prevent sports injuries: A systematic review and meta-analysis of randomised controlled trials. British Journal of Sports Medicine, 48, 871–877. https://doi.org/10.1136/bjsports-2013-092538
  4. Peters, J. A., Zwerver, J., Diercks, R. L., Elferink-Gemser, M. T., & Akker-scheek, I. Van Den. (2016). Preventive interventions for tendinopathy: A systematic review. Journal of Science and Medicine in Sport, 19, 205–211.

Youth Strength Training and Performance

Previously, the safety of strength training and its role in reducing youth athletic injuries was discussed. We now turn our attention to the role of resistance training to optimize performance in young athletes. High levels of muscular strength and power are essential for maximizing sport performance in any young athlete. Muscular strength is defined as the maximum force which can be exerted during a given movement. Power is the product of force and velocity and relates more to the speed at which strength can be expressed. Strength and power can be significantly improved through properly designed, supervised, and progressed resistance training programs for athletes of any age.

When to Start Youth Resistance Training

Children as young as 10 years-old can achieve substantial performance improvements through properly supervised and progressed resistance training programs. A 2014 study1 in the Journal of Strength & Conditioning Research showed young children engaged in resistance training with free weights, Olympic weight lifting with barbells, or plyometrics significantly improved vertical jump, long jump, balance, speed, agility, strength, and power. Resistance training combined with plyometrics results in superior performance gains compared to resistance training alone3. Correct performance of each exercise with proper movement patterns is always emphasized and little importance is given to the amount of weight lifted. Pre-adolescent athletes can show substantial improvements in strength and power due to neurological adaptations. Large changes in muscle mass or body composition do not occur until puberty.

Priming the Athlete to Flourish in Adolescence

Peak height velocity, or a child’s “growth spurt”, marks the point in maturation where hormones (i.e., testosterone in boys) rise exponentially and many physiological changes occur. In boys, this is the point where muscle mass spikes and young athletes begin to show large improvements in muscular strength and power. A 2016 systematic review5 in the Journal of Sports Sciences, showed boys adaptations to resistance training are greatest during and following their peak height velocity. Ideally, these athletes should have already developed the foundational movement pattern competencies during childhood. During peak height velocity, increasing the training volume and intensity often results in profound improvements in strength, power, and performance. Athletes without prior resistance training experience, or those who have not mastered fundamental movement patterns, will be at a disadvantage compared to athletes who began training earlier in childhood.

How Much Youth Strength Training is Enough

Research shows a dose-response relationship of strength training on performance in young athletes4. In order to maximize power and strength development, high school athletes should train at relatively high intensities, 2 to 4 times per week, with multiple sets per exercise, 6 to 8 repetitions per set, and with long rest periods between sets (3 to 4 minutes). High school athletes should incorporate Olympic lifts (clean, snatch) in order to maximize power development. A 2008 study2 in the Journal of Strength & Conditioning Research showed Olympic lifts resulted in superior improvements in vertical jump compared to training with traditional power lifts (squat, dead lift, and bench press).

Conclusion

The underlying key to success with any youth strength and conditioning program is related to supervision and progression by a qualified professional. Safety and performance outcomes can only be achieved when young athletes are coached appropriately. When implemented correctly, strength training can positively alter the trajectory of any young athlete’s athletic career or life.

References

  1. Chaouachi A, Hammami R, Kaabi S, Chamari K, Drinkwater E, Behm D. Olympic weightlifting and plyometric training with children provides similar or greater performance improvements than traditional resistance training. J Strength Cond Res. 2014;28(6):1483-1496.
  2. Channell B, Barfield J. Effect of Olympic and traditional resistance training on vertical jump improvement in high school boys. J Strength Cond Res. 2008;22(5):1522-1527. doi:10.1519/JSC.0b013e318181a3d0.
  3. Faigenbaum AD, Mcfarland JE, Keiper FB, et al. Effects of a short-term plyometric and resistance training program on fitness performance in boys age 12 to 15 years. J Sport Sci Med. 2007;6:519-525.
  4. Lesinski M, Prieske O, Granacher U. Effects and dose – response relationships of resistance training on physical performance in youth athletes: A systematic review and meta-analysis. Br J Sports Med. 2016;50:781-795. doi:10.1136/bjsports-2015-095497.
  5. Moran J, Sandercock GR, Ramírez-Campillo R, Meylan C, Collison J, Parry DA. A meta-analysis of maturation-related variation in adolescent boy athletes’ adaptations to short-term resistance training. J Sport Sci. 2016;414:1-12. doi:10.1080/02640414.2016.1209306.

Strength Training: Reducing Injury in Children

In our last article, we discussed the safety of youth resistance training. In addition to being safe for youth athletes, resistance training can also reduce injury and improve athletic performance. Resistance training has been shown to reduce injuries in adolescents who participate in football, soccer, basketball, and various other sports1-2. Adolescent females are especially vulnerable to knee injuries. Preseason conditioning programs that include plyometric training, resistance training, and jump training significantly reduce knee injuries in female athletes. Also, youth athletes who engage in regular resistance training recover quicker from injuries when they do occur.

When to Incorporate Resistance Training for Children

Youth athletes can benefit from developing fundamental movement skills (e.g., jumping, landing, and throwing) through appropriate fitness conditioning at early ages (6-10 years old). Once fundamental movement skills are mastered, appropriately supervised strength training programs can be initiated to reduce the likelihood of overuse injuries occurring during sport. Resistance training addressing specific risk factors associated with youth-sport injuries (e.g., low fitness, muscle imbalances, and training errors) reduce overuse injuries by as much as 50%1, 3. With early exposure to resistance training, young athletes may be able to prevent the development of deficits which predispose them to injury later in life.

Resistance Training for Youth Non-Athletes

Free-time physical activity among children and adolescents is on the decline. Strength training is beneficial for athletes and children who are not engaged in competitive sports. Physical inactivity is a risk factor for activity-related injuries in children. Youth who participate regularly in age-appropriate fitness programs, which include resistance training, may be less likely to suffer an injury.

Conclusion

Although the total elimination of injuries is unrealistic, appropriately designed conditioning programs that include strength training can help reduce the likelihood of sports- related injuries.  Clearly, incorporating resistance training supervised by qualified professionals is in the best interest of any young athlete looking to minimize risk for injury and improve performance. Our next article will discuss the role of resistance training for improving athletic performance.

References

  1. Faigenbaum, A., Kraemer, W., Blimkie, C., Jeffreys, I., Micheli, L., Nitka, M., & Rowland, T. (2009). Youth resistance training: Updated position statement paper from the National Strength and Conditioning Association. Journal of Strength and Conditioning Research, 23(5), S60–S79.
  2. Faigenbaum, A. D., & Myer, G. D. (2010). Resistance training among young athletes: safety, efficacy and injury prevention effects. British Journal of Sports Medicine, 44, 56–63. https://doi.org/10.1136/bjsm.2009.068098
  3. Lloyd, R. S., Faigenbaum, A. D., Stone, M. H., Oliver, J. L., Jeffreys, I., Moody, J. A., … Myer, G. D. (2014). Position statement on youth resistance training: The 2014 international consensus. British Journal of Sports Medicine, 48, 498–505. https://doi.org/10.1136/bjsports-2013-092952

Is it Safe for Children to Do Strength Training?

There is substantial interest and lingering concern from parents, coaches, and the medical community about the safety and appropriateness of strength training for children.   Are these concerns based on solid research or are they misconceptions which need to be put to rest?

What is Resistance Training?

Before discussing the evidence, clear definitions of the terms children and resistance (or strength) training are helpful. Resistance training is a specialized form of conditioning whereby an individual is working against a wide range of resistive loads to enhance health, fitness, and performance. Forms of resistance training include the use of body weight, weight machines, free weights (barbells and dumbbells), elastic bands and medicine balls. Resistance training should be distinguished from terms such as weightlifting and bodybuilding. The term children refers to girls and boys (generally up to the age of 11 and 13 years, respectively) prior to puberty and have not developed secondary sex characteristics.

Injury Rates in Children

With qualified supervision, the risk of injury from resistance training for children is very low. Faigenbaum and Myer (2010) summarized over 30 studies conducted on youth resistance training and found reports of only three injuries when properly supervised. The three injuries reported were short-term non-serious injuries such as muscle strains and low back pain. In fact, the estimated risk for injury from youth resistance training has been estimated to be 0.05 to 0.17 for every 100 hours of training. These injuries rates are far lower than those for children engaging in sports such as soccer, football, baseball, gymnastics, lacrosse, and running. Youth injury rates from resistance training are also believed to be no different than those of adults.

Growth Plate Injuries


The most often cited concern associated with youth resistance training is the potential for injury to the growth plate and “stunted growth”. There have been a few retrospective case reports describing injuries to the growth plates in children.  However, most of these injuries were caused by improper lifting technique, poorly chosen loads, or a lack of qualified adult supervision. For example, in one case report a 13-year-old boy sustained elbow growth plate fractures when he lost control of a 65-pound barbell he attempted to press overhead exercising alone at home.

Injury to growth plates has not been reported in any prospective youth resistance training study that provided professional supervision and instruction. There is also no evidence that resistance training can negatively impact growth in height during childhood. The risk of growth plate injury is likely greater when children perform jumping and landing activities during competitive sports or even free play.

Conclusion

Many of the forces that youth are exposed to in sports and recreation (e.g., soccer, basketball, football, and running) are greater both in duration and magnitude than properly performed resistance training. However, problems can, and often do arise, when children are introduced to resistance training with inappropriate instruction or supervision. With the increasing volume and intensity of youth sports, it is more important than ever that children are properly instructed, supervised, and progressed by qualified personnel. Therefore, parents and coaches should seek out qualified professionals who are knowledgeable and up to date with the most current evidence about youth resistance training. When appropriately performed, youth resistance training is safe and extremely beneficial for improving health, fitness, and performance.

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References

  1. Faigenbaum, A., Kraemer, W., Blimkie, C., Jeffreys, I., Micheli, L., Nitka, M., & Rowland, T. (2009). Youth resistance training: Updated position statement paper from the National Strength and Conditioning Association. Journal of Strength and Conditioning Research, 23(5), S60–S79.
  2. Faigenbaum, A. D., & Myer, G. D. (2010). Resistance training among young athletes: safety, efficacy and injury prevention effects. British Journal of Sports Medicine, 44, 56–63. https://doi.org/10.1136/bjsm.2009.068098
  3. Lloyd, R. S., Faigenbaum, A. D., Stone, M. H., Oliver, J. L., Jeffreys, I., Moody, J. A., … Myer, G. D. (2014). Position statement on youth resistance training: The 2014 international consensus. British Journal of Sports Medicine, 48, 498–505. https://doi.org/10.1136/bjsports-2013-092952

Heat Illness: Dangers of Athletic Practices in the Summer

Pre-season sports practices will be kicking off over the next few weeks. With the excitement of another season comes the dangers of playing in hot and humid conditions. There are 3 forms of exertional heat illness that players, parents, and coaches should be familiar with. These are heat cramps, heat exhaustion, and heatstroke.

3 Forms of Exertional Heat Illness

1. Heat Cramps

Heat cramps are the least serious.  They involve painful cramping of large muscles.  The most are the calf muscles. Sodium loss and dehydration from high rates of sweating lead to heat cramps.

Treatment of heat cramps involves moving the athlete to a cooler environment.  It is also important to administer fluids like sodium-containing sports drinks. The best prevention is remaining hydrated before and during practices.  Liberal use of sodium-containing foods or beverages can also help.

2. Heat Exhaustion

Heat exhaustion is a more serious disorder.  Signs of heat exhaustion are fatigue, dizziness, nausea, vomiting, fainting, and a weak rapid pulse. In these cases, the athlete’s cardiovascular system is unable to meet the needs of the body as it becomes dehydrated.

Dehydration caused by fluid loss from sweating leads to heat exhaustion. Athletes who are unfit or not acclimated to the heat are more susceptible. Treatment involves resting in a cool environment with the feet elevated to facilitate blood return to the heart.  It is also important for the athlete to drink fluids.  Cold water or a sodium-containing beverage is best.

3. Heat Stroke

Youth sports

Heatstroke is a life-threatening disorder requiring immediate medical attention. An inability to control core body temperature becomes a medical emergency. A core body temperature exceeding 104 degrees, confusion, disorientation, and unconsciousness are hallmark signs.

If left untreated, body temperature will continue to rise progressing to coma and even death. Rapid cooling of the body in an ice bath is the best form of treatment. If cold-water immersion is unavailable the athlete should be wrapped in cold wet sheets while others fan the body.

Impact of Humidity

Heat illness

High humidity means the air contains many water molecules. In these instances, the air cannot accept much more water. During exercise in the heat, excessive body heat is lost through the evaporation of sweat at the surface of the skin. If humidity is high, sweating will be much less effective in releasing body heat because evaporation is inhibited.

Even though sweat secretion will continue during the activity, without evaporation the rate of core body temperature will continue to rise. Therefore, high humidity increases the likelihood of experiencing any of the 3 forms of exertional heat illness.

Steps to Prevent Heat Illness

Athletes can take preventative steps to minimize the effects of playing in hot environments. Strategies that promote heat adaptation assist with an athlete’s ability to tolerate and perform in hot and humid environments.

Adaptation requires a series of gradual progressively increasing temperatures in order to produce sufficient adaptations. Longer and more frequent heat exposures produce heat adaptation benefits resulting in the greatest capacity and performance benefits. Regimens lasting more than 14 days show the greatest benefits.

Coaches and parents should take preventative steps when threatening conditions are present. Practices in the early morning or evening can avoid the severe heat stress of midday.

Fluids should be available and athletes should be given drink breaks every 15 to 30 minutes. Weighing athletes before and after exercise can help estimate individual sweat rate and fluid needs. Fluids containing electrolytes and carbohydrates can provide benefits over water alone.

Light-colored, lightweight, loose-fitting clothing should be worn whenever possible. And finally, heavy use of equipment (i.e., football pads and helmets) should be minimized or avoided early in the practice season when athletes are not yet fit or acclimated to the heat.

Early Sports Specialization in Young Athletes

In the United States, it is estimated that 72% of school-aged youth (8 to 17 years old) participate in at least one organized sport. Sports participation has many benefits, including living a healthy lifestyle, having a positive self-image, and building social relationships. It is also estimated that nearly 30% of school-aged athletes specialize in a single sport year-round6.  Early sports specialization has been defined as intensive year-round training in a single sport at the exclusion of other sports4. This may include athletes who:

  1. Choose one main sport,
  2. Participate for greater than eight months per year in one main sport, and
  3. Quit all other sports to focus on one sport.

Young athletes who engage in year-round intense training programs in a single sport are prone to overuse injuries, burnout, and dropping out of sports. Sports believed to be most susceptible to these negative consequences are baseball (pitchers especially), cheerleading, gymnastics, soccer, swimming, tennis, and volleyball.

Injury, Burnout, and Dropping out of Sports

Evidence is emerging which shows specialized young athletes are at more risk for injury compared to those who engage in multiple sports. One study of 7 to 18 year old athletes, showed that those who specialized in a single sport were 2.25 more likely to sustain a serious overuse injury compared to unspecialized young athletes4. Another study of 546 high school athletes found a relationship between the development of knee injuries and single- sport training in those engaged in basketball, soccer, and volleyball3. It appears that female high school athletes who specialize in a single sport are particularly vulnerable to hip and knee overuse injuries1,3. A possible explanation for these injury trends is the lack of diversified activity which may not allow young athletes to develop the appropriate neuromuscular skills that are effective in injury prevention. Year-round training in a single sport also does not allow for the necessary rest from repetitive use of the same muscles and segments of the body. The positive transfer of skill with diversification of sport participation is important in the successful development of any young athlete2.

Young athletes are under a tremendous amount of pressure brought about by adult-driven specialized training programs, weekend tournaments, showcases, and competitions. The psychological risk of burnout, depression, and increased risk of injury is believed to result in withdrawal from sport. In the physical therapy clinic, we are faced with many young athletes who lose their desire to return to sport following injury. It is my belief that these young athletes view their injury as a means to escape from the increased pressures of youth sports.

Research has indicated that adolescents need to enjoy their sport, and that intrinsic motivators are keys to maintaining participation and goal achievement in sports. Unfortunately, this is often not the case as the temptation of collegiate scholarships and stardom causes thousands of adolescent athletes to specialize in single sports. While this may result in more highly skilled, sport-mature athletes at a younger age, it is isolating the child and has the potential to lead to increased stress and pressure. Consequently the child loses a sense of control or decision-making power over their lives. These consequences may be far-reaching with the adolescents overall maturation and development5.

Conclusion

Parents and coaches should be cautious with encouraging young athletes to engage in intense year-round training specialized in any single sport. Adults involved in instruction of youth sports should be on the alert for signs of burnout, and physical symptoms in highly specialized athletes and be prepared to take corrective action such as backing off training. A more proactive approach is the better option. Encouraging multiple sports participation has the benefits of reducing injury risk, decreasing the chance of burnout, and the promotion of basic motor skills which will enhance the young athletes overall development throughout their lifespan.

References

  1. Bell DR, Post EG, Trigsted SM, Hetzel S, Mcguine TA, Brooks MA. Prevalence of sport specialization in high school athletics: A 1-year observational study. Am J Sports Med. 2016;44(6):1469-1474. doi:10.1177/0363546516629943.
  2. Fransen J, Pion J, Vandendriessche J, et al. Differences in physical fitness and gross motor coordination in boys aged 6 – 12 years specializing in one versus sampling more than one sport. J Sports Sci. 2012;30(4):379-386.
  3. Hall R, Foss KB, Hewett TE, Myer GD. Sport specialization’s association with an increased risk of developing anterior knee pain in adolescent female athletes. J Sport Rehabil. 2015;24:31-35.
  4. Jayanthi NA, Labella CR, Fischer D, Pasulka J, Dugas LR. Sports-specialized intensive training and the risk of injury in young athletes: A clinical case-control study. Am J Sports Med. 2015;43(4):794-801. doi:10.1177/0363546514567298.
  5. Myer GD, Jayanthi N, Difiori J p, et al. Sport specialization, part I: Does early sports specialization increase negative outcomes and reduce the opportunity for success in young athletes? Sport Heal A Multidiscip Approach. 2015;7(5):437-442. doi:10.1177/1941738115598747.
  6. Myer GD, Jayanthi N, Difiori JP, et al. Sports specialization, part II: Alternative solutions to early sport specialization in youth athletes. Sport Heal A Multidiscip Approach. 2016;8(1):65-73. doi:10.1177/1941738115614811.
  7. Bell DR, Post EG, Trigsted SM, Hetzel S, Mcguine TA, Brooks MA. Prevalence of sport specialization in high school athletics: A 1-year observational study. Am J Sports Med. 2016;44(6):1469-1474. doi:10.1177/0363546516629943.

Direct Access Physical Therapy: Q & A

Many healthcare consumers are unaware of the fact that they are free to access the services of a physical therapist without a physician referral. Every state allows for evaluation and some form of treatment without a physician referral. This has been the case in the state of New Jersey for almost 15 years, yet most of the patients that we work with in our Barnegat and Manahawkin physical therapy clinics are unaware of this. Most continue to believe that they must first visit another health care provider before seeking the services of a physical therapist. When we educate people about direct access we are greeted with a bit of surprise and many questions. Below are a few of the common questions we receive about Direct Access.

Direct Access saves time, saves money, and improves outcomes.

What are some of the advantages of accessing the services of a physical therapist first?

Directly accessing the services of a physical therapist saves time and money. Consumers are able to avoid wait times to see physicians and avoid delays in treatment while further testing might be pursued. Often these tests are not necessary and can potentially slow or negatively impact recovery (MRI for Low Back Pain>). A 2014 systematic review concluded that direct access controls health care costs and promotes high quality healthcare1. Compared to accessing physical therapy through a physician referral, those who directly accessed services were more satisfied with care, were prescribed fewer medications, underwent fewer diagnostic tests, and achieved better overall outcomes in fewer physical therapy treatment sessions. We have observed similar findings at both our Barnegat and Manahawkin physical therapy clinics. Patients who access our care directly achieve better overall outcomes in 20% fewer treatment sessions.

Are physical therapists qualified to deliver direct access services independent of physician referral?

Yes. Physical therapists are licensed healthcare professional who hold doctoral degrees. Physical therapists undergo extensive training in differential diagnosis and medical screening. This entails distinguishing non-serious musculoskeletal problems (low back pain, rotator cuff problems, meniscus tears, arthritis, etc) from more sinister potentially life threatening conditions (cardiac disorders, cancer, etc). Physical therapists at BSR Physical Therapy have also undergone more extensive residency, fellowship, and board certification training which focus further on these diagnostic skills. Physical therapists are not trained to make or confirm serious diagnoses but we are able to recognize when patients do not belong in our clinics and need an appropriate medical referral. We routinely refer patients to other medical specialists based on our physical exam or when the patient is not progressing towards their goals. Physical therapist’s clinical examination skills are on par with or better than most other healthcare professionals (Evidence here). How many other healthcare providers are going to spend one full hour actively listening to their patients in order to elicit all their concerns and then perform a comprehensive physical examination?

Will insurance companies cover direct access physical therapy services provided without a physician referral?

More and more health insurance companies are now covering physical therapy services without a physician referral. This is because of emerging research evidence showing cost savings with this approach2. At our clinics our front office professionals verify all health insurance benefits before starting treatment. In the majority of instances (>75% of cases) we are finding that a physician referral is not necessary to access and cover physical therapy care.

Approximately 10% to 20% of our patients access physical therapy care directly and this number is on the rise. Healthcare consumers are saving time, money, and achieving superior outcomes with greater convenience when directly accessing physical therapy. Health insurance companies are now recognizing these advantages as well. As health care reform continues to evolve, the health care consumer is becoming a more active participant in their own care. Direct access to physical therapy is here to stay and growing.

References:

  1. Ojha H a, Snyder RS, Davenport TE. Direct access compared with referred physical therapy episodes of care: a systematic review. Phys Ther. 2014;94(1):14-30.
  2. Pendergast J, Kliethermes S a, Freburger JK, Duffy P a. A Comparison of Health Care Use for Physician-Referred and Self-Referred Episodes of Outpatient Physical Therapy. Health Serv Res. September 2011:1-22.

Neck Pain: Postural Correction Strategies

Retraining neutral sitting posture is an important factor in the recovery from of an episode of neck pain and also for preventing future episodes of neck pain. Sitting postural correction becomes especially important for those of us who spend a great deal of our time working at a computer or seated at a workstation of any kind. Most present day occupations and many leisure activities (involving the internet or a mobile device) place the neck and upper back in vulnerable positions stressing many anatomical structures of the cervical spine.

Frequent correction of neutral sitting posture serves two primary functions. First, it allows for regular reduction of adverse loads placed on the joints of the spine due to poor neck and upper back posture. Second it provides a training effect to the deep cervical stabilizing muscles during their functional postural supporting role. The aim of postural correction strategies is to change postural habits, not to strengthen weak muscles. Ultimately this should result in a comfortable low effort strategy which is easily assumed and maintained during prolonged sitting activities. Rigid high-effort correction of sitting posture should always be discouraged as this often results in increased muscle activity and pain.

Key Aspects of the Seating Surface

  • The feet should be flat on the floor
  • The thighs should be slightly inclined downward from horizontal (hips slightly higher than knees)
  • The buttocks should be completely supported by the seating surface
  • Go here for more tips on computer ergonomics

Sequence of Correcting Sitting Posture

  1. Gently roll the pelvis back and forth until sitting on the bony prominences deep within the buttock (ischial tuberosity). This will restore the natural curve (lordosis) in the small of the low back. This first step is the most important.
  2. Without arching or extending the spine, slightly lift the breast bone (sternum). Minimal correction should be needed here.
  3. Finally, slightly lift the back of the head towards the ceiling in order to achieve a neutral position of the eyes relative to the horizon. If steps one and two are performed correctly, minimal to no correction will be needed at the head and neck.

The neutral position should be comfortably maintained for ten seconds and repeated every 10 to 20 minutes during sitting. A timer is recommended to ensure adherence to the schedule. In between repetitions of the postural correction exercise a relaxed non-rigid posture should be assumed. We should not attempt to maintain “the perfect posture” during prolonged sitting. This is not recommended or realistic. Over the course of several days or a few weeks of practice, the neutral sitting posture will be more easily attained without conscious thought. Through self-awareness the body will learn this new strategy just like any other practiced skill ultimately leading to a healthy postural habit requiring little effort or conscious thought.

Now go ahead and try it….then re-read this blog post for reinforcement.

References

  1. Falla, D., O’Leary, S., Fagan, A., & Jull, G. (2007). Recruitment of the deep cervical flexor muscles during a postural-correction exercise performed in sitting. Manual Therapy, 12(2), 139–43.
  2. Wegner, S., Jull, G., O’Leary, S., & Johnston, V. (2010). The effect of a scapular postural correction strategy on trapezius activity in patients with neck pain. Manual Therapy, 15(6), 562–6.

 

Low Back Pain: How Helpful is an MRI?

It’s not often that we are in agreement with insurance companies but they seem to be getting one thing right as of late. We have noticed an increase in patient’s referred to our clinics for low back pain that have not undergone MRI. It appears that large insurance companies are denying authorization for these MRI’s until you undergo a course of physical therapy (more on the topic).

It is no fun when insurance companies dictate your care.  This is understandable.  However, when it comes to back pain physical therapists are on board with these decisions.  So, should patients with an acute onset of low back pain undergo routine MRI?  Or are you better off undergoing a course of physical therapy first? Why not be safe and undergo the MRI first? How can a physical therapist offer treatment without knowing what the problem or diagnosis is?

We’ll answer these questions and more below.

Physical Therapy or MRI First?

A recent study published in the journal Health Services Research investigated this question. Researchers found people who are referred for an early MRI need more care in the long run. This occurs at increased costs compared to those receiving early physical therapy. The additional cost of receiving the MRI first is nearly $5000 more than receiving early physical therapy.

Earlier research studies show that consulting a physical therapist early results in decreased odds of undergoing diagnostic imaging (here) and decreased odds of undergoing future surgery for low back pain (here). Delaying physical therapy has also been associated with higher prescription opioid (narcotic pain medication) use and most of us are aware of how big of an epidemic this is becoming (more here).

Delaying physical therapy is linked to prescription pain medication use

Why Not Play it Safe and Undergo the MRI First?

A 2003 study in the Journal of the American Medical Association compared the use of early MRI vs. early x-ray for people with a new episode of low back pain. One year later, pain levels and disability were no better in those undergoing the MRI. But how about this! The group receiving the early MRI was much more likely to undergo back surgery. This is not surprising given the high likelihood of abnormal findings in people with no low back pain.

A 2015 systematic review reported the prevalence of disc degeneration in asymptomatic people ranged from 37% of 20-year olds to 96% of 80-year olds. Similar rates have been reported for asymptomatic disc problems. If so many people without low back pain have these findings on MRI we cannot confidently say that these findings are the true cause of your symptoms.

Making erroneous assumptions based on MRI findings often leads to over treatment. The more testing and treatment a patient undergoes the more likely factors such as fear and anxiety come into play. These are the factors that have been associated with persistent or chronic low back pain.

Physical Therapy Treatment without MRI

MRI or further medical work up is needed when serious pathology is suspected or when response to treatment is poor. However, low back pain caused by serious pathology occurs in less than 2 percent of cases. Doctor’s of physical therapy are trained to  identify these signs.  When there are any suspicions you will be quickly referred to your doctor.

These problems are usually ruled out after a detailed interview and medical history. Physical therapists then base their examination and treatment on your signs and symptoms; not based on your diagnosis or MRI. Physical therapists are concerned with how movement affects pain and how pain affects movement.

In most cases of low back pain delaying the MRI is the best approach.  If you would like your physical therapist to evaluate your movement and make recommendations, give us a call.