3 Reasons Why Young Baseball Pitchers Are Having Tommy John Surgery

The ulnar collateral ligament (UCL) is the primary stabilizer of your elbow during throwing.  When a baseball pitcher tears their UCL it is surgically reconstructed.  This is commonly known as ‘Tommy John Surgery”.  The rates of these surgeries are on the rise. Most strikingly, the incidence of Tommy John surgery in the 15 to 19-year-old age group is increasing at an average rate of 9.12% per year.  This article reveals 3 of the biggest reasons why.

#1 Pitchers are Competing with Arm Fatigue

Pitching with arm fatigue is the biggest predictor of having an arm injury.  A 2020 study proved that youth pitchers who compete with arm fatigue are 13.32 times more likely to suffer a shoulder or elbow injury.

Pitch counts and innings limits have been established to help minimize the negative impacts of pitching with a tired arm.  However, arm fatigue is a more complex factor than simply counting pitches or innings.

Pitchers today are practicing and competing more throughout the year.  There is no true off-season for some.  This means more high effort or maximum throws to stress the arm.  Other factors that contribute to arm fatigue include playing both pitcher and catcher and playing on multiple teams.

#2 Pitchers are Throwing at High Velocities

Higher fastball velocity is one of the biggest predictors of arm injury in baseball pitchers.  This is especially true as pitchers get older, bigger, and stronger.  A 2016 study from The American Journal of Sports Medicine proved higher fastball velocity was the biggest predictor of Tommy John surgery in MLB pitchers.

Peak pitch velocity was significantly higher among injured pitchers compared to uninjured pitchers (93.3 mph vs 92.1 mph).  Also, average pitch velocity was higher in injured MLB pitchers (87.8 mph vs 86.9 mph.

Many high school pitchers are now throwing in the upper 80’a and low 90s.  It is no coincidence that we are seeing injury rates rise along with these higher velocities.

#3 Pitchers are Specializing in Baseball 

Early sports specialization involves intense, year-round training in a single sport at the exclusion of other sports.  Some coaches, parents, and players believe specialization is necessary to develop the skills to compete at the highest level.  However, there is no strong evidence that early sports specialization is a requirement to achieve elite status in baseball.

A 2020 study out of San Diego State University looked at the effects of early specialization in over 500 high school baseball players. Highly specialized players were 3.7 times more likely to report an arm overuse injury compared to those who did not specialize.  Also, those who played baseball for more than 8 months per year were 2.03 times more likely to report an arm overuse injury.

Early sports specialization baseball
Early sports specialization is a contributor to elbow injuries in young pitchers

Some medical professionals and coaches recommend athletes should not specialize until around age 15.  Ideally, athletes should delay specialization as long as possible.  This is especially true for baseball pitchers who place unique demands on their throwing arm.  Becoming a well-rounded athlete, by playing multiple sports, is protective against arm injuries.

Steps to Reduce Your Risk for Tommy John Surgery

Avoiding pitching with arm fatigue and playing multiple sports are easily modifiable factors that will minimize your risk for injury.  Of course, maximizing your throwing velocity is not something you want to modify or avoid.  However, how you go about obtaining high velocity is important for your overall arm health.

Arm care programs are now a part of the game and most pitcher’s lifestyle.  It is best that your arm care program is specifically tailored to your body and physical abilities.  Seeing a physical therapist for an evaluation will help you target your exercises to get the best results.

BSR Physical Therapy
Schedule a free screen with your physical therapist

It is also imperative that you engage in a year-round lower body and core strength and conditioning program.  More and more research is showing a strong link between your lower half and arm injuries.  Start at a young so age so you develop good habits in the gym.

Another factor that can help condition your arm is a solid well-rounded long toss program.  These programs build arm strength, endurance, resilience, and mobility.  And when performed properly, long toss programs will improve your mechanics and velocity.

Final Thoughts on Tommy John Surgery

Undergoing Tommy John surgery is in no way a good thing. It does not guarantee higher velocities or better performance.  At best, 8 out of every 10 will make it back to the same level of play.  Even those that do return to pitching usually do so with poorer results.

Do what you can now to avoid overstressing your elbow.  Trust me, rehabbing for a year or two is no fun.  Taking the steps necessary to improve your arm’s health is going to make you a better athlete and better pitcher.  Take care of your arm, get yourself into the gym, and play multiple sports.

ACL Rehab: The Final 3 Keys to Returning to Your Sport

This year 250,000 ACL injuries are estimated to occur in the U.S. Unfortunately, only 63% of athletes ever return to their sport after ACL surgery. Also, in the first 2 years after surgery, 30% who return to high level sports sustain a second injury.  These high level sports are those that require jumping, pivoting and hard cutting.  A few examples are basketball, football, and soccer.

So, what can you do to increase your likelihood of returning to your sport?  Also, what can you do to reduce your risk of re-injury when you do return?  In previous articles we mentioned several big factors like committing to prehab before surgery, aggressive early post-op rehab, heavy strength training, and doing a lot of single leg exercises.  This article highlights the last 3 keys you have to understand in order to return to playing.

#1 You Must Confidently Hop and Land on 1-Leg

Multiple studies suggest your ability to hop on 1 leg predicts your ability to get back to your sport.  A 2020 study of 64 athletes who underwent ACL reconstruction surgery investigated a battery of tests to identify those who safely return to their sport. Athletes who returned to their sport within 2 years of surgery performed better on 3 separate single leg hop tests.  These are the single leg hop test for distance, the side hop test, and the triple hop test.

How well you do on the triple hop test is also associated with suffering a re-injury after returning to your sport.  A 2017 study out of the Cincinnati Children’s Hospital found performance on the triple hop for distance test is the most important of the various single leg hop tests.  Both distance hopped and your performance on your injured compared to your uninjured leg helps identify if you are at a high risk for a second ACL injury.

Plyometric exercises are started when you have adequate strength and confidence on your injured leg.   Plyometrics start with landing on 2 legs and progress to jumping and landing on 1 leg.  It will take several months of plyometric training for you to develop the necessary strength, stability, power, and confidence to return to some type of sport practice.

#2 Wait 9 Months or Longer to Return to Your Sport

In the first 2 years after ACL reconstruction, 3 out of every 10 athletes who return to their sport will sustain a 2nd ACL injury.  This should get your attention!  But there is hope.  A 2016 study published in the British Journal of Sports Medicine shows delaying your return more than 9 months since surgery reduces your risk.

ACL injury
Waiting at Least 9 Months Reduces Your Risk of Re-Injury

Specifically, for every month that you delay returning, until 9 months after ACL reconstruction, your rate of re-injury by goes down by 51%.  Some experts even recommend athletes who are 18 or younger should wait 2 years until returning to high level sports.

We have found most young athletes who pass return to sport testing get back to playing within 1 year after surgery.  However, not all athletes are able to pass their testing within this time period.  Inadequate quadriceps strength, poor performance on single leg hop tests, and a lack of confidence are what holds most athletes back.

#3 Your Mindset is the Most Important Factor of All

ACL rehabilitation
ACL rehab will challenge you mentally and emotionally

You probably have high expectations for a smooth recovery after your ACL surgery.  The majority of athletes expect good knee function and a return to the pre-injury level after surgery. However, these high expectations are not always fulfilled.  Many athletes do not return to their pre-injury level of sports.  The biggest reason why is the grueling mental and emotional rollercoaster you will ride while trying to get back.

The biggest key is to remain motivated throughout your rehab.  It will not be smooth.  And it will not be without mental and emotional challenges.  A 2017 study of 65 athletes who underwent ACL surgery found those who returned to their sport at 1 year were more motivated during rehab.  They were also more satisfied with their activity level and knee function.  In other words, they had more confidence in their ability to perform at a high level.

It is no easy task to stay motivated during a year or more of rehab.  Your physical therapist will help you set realistic goals and expectations.  It is going to take a team approach.  You cannot do it alone.

Prepare Yourself for the Marathon of ACL Rehab

We have had some tough love conversations with athletes who expect to return to playing 6 months after their surgery.  Yes, professional athletes can sometimes return to their sport earlier than 9 months after surgery.  This is no way suggests you should rush yourself if you are not ready.

The truth is you are ready to go back to your sport when you prove it to your physical therapist and surgeon.  You have to check all the boxes.  This includes being physically, mentally, and emotionally ready.  Let our physical therapists take you through the return to sport testing process.  Give us a call when you think you are ready.

The Key to Returning to Sports after ACL Surgery: Get Strong on 1 Leg

Persistent quadriceps and hamstring weakness after ACL surgery delays an athlete’s return to sport.  Weakness of your injured leg will also predispose you to future injury.  To combat these problems you need to get strong on one leg.  This means your left and right legs are equally strong.  Also, to be at your best and reduce your risk for future injury, your quads and hamstring will have to be trained to work together.  The exercises in this article will get you strong and ready to return to your sport.

Quadriceps and Hamstring Weakness is a Big Problem 

A 2021 study out of New Zealand looked at athletes 2 to 10 years after ACL surgery. Compared to athletes without an ACL injury, the post-surgical athletes had lower activity levels, quality of life, and greater fear of re-injury.  Side-to-side thigh muscle (quads and hamstrings) differences were found in the post-surgical athletes.  Their quads were 11.9% weaker on the injured compared to their uninjured side.  Their hamstrings were 7.9% weaker on the injured compared to uninjured side.

This study shows a potential link between persistent thigh muscle weakness and quality of life up to 10 years after ACL surgery.  It is important to restore your quadriceps and hamstring strength within the first 9 to 12 months after your surgery.  The right ACL rehab program will get you strong enough to return to your sport and keep you healthy for years to come.

5 of the Best Single Leg Exercises after ACL Surgery

An estimated 70-90% of ACL injuries occur during rapid change of direction, landing, or decelerating on one leg. Decreased strength of your quadriceps and hamstring muscles increases your risk of sustaining these types of injuries.  Also, delayed hamstring activation during rapid change of direction contributes to this increase risk.  Therefore, exercises that activate and strengthen your quads and hamstrings together are ideal to protect your healing ACL graft after surgery.

Single leg exercises promote co-activation of your quads and hamstrings.  The 1-leg Romanian deadlift, band crossovers, and the single-leg squat all fit the bill. Perform these exercises with slow and controlled movements.  Maintaining a stationary trunk and avoiding knee collapse is important.  Do 3 to 4 sets of 8 to 12 reps.  Over time, increase the load and decrease the number of reps you do each set in order to maximize strength on one leg.

Sports are played in multiple planes.  This means you will be moving forward, backward, side to side, and in diagonal patterns. This requires reactive strength and stability on one leg. This is challenging to replicate during rehab.  Performing multi-plane lunges and hops are implemented before progressing to more challenging plyometrics.

Take the Next Step to Getting Strong After ACL Surgery

We have witnessed several athletes try to return to their sport before restoring all their strength.  Against our recommendations these athletes returned to their sport with poor results.  One young girl re-tore her ACL.  Another gentleman winded up tearing his other ACL.  Unfortunately this happens all too often.

You must commit yourself to getting strong.  This takes time.  Don’t rush back.  Some athletes don’t build up enough strength until well after 1 year from surgery.  Prehab, starting post-surgical rehab early, and taking your strength training seriously will set you up for success.  That is, an early and safe return to playing.  Call our office to schedule an appointment with your physical therapist and get started on your road to recovery.

ACL Rehabilitation: 3 Reasons Why You Need to be Doing Heavy Strength Training

There is no guarantee you will ever return to your sport after your ACL reconstruction.  In fact, only 1/3 of athletes never return to their prior level of sport.  Pre- and post-operative ACL rehabilitation can be the biggest difference maker in getting you back to playing.  And heavy strength training is the backbone of a successful rehab program.

Here are 3 reasons why you should be doing a progressive heavy strength training program for the bulk of your ACL rehabilitation.

#1: Greater Quadriceps and Hamstring Strength is Associated with Athlete Function 6 Months after Surgery

Restoring the strength of your thigh muscles within 6 months after your surgery is a critical component of rehabilitation.  Researchers from Ohio State University investigated thigh muscle strength and perceived function in 30 athletes 3 and 6 months after their ACL surgery.  Athletes with smaller side-to-side differences in quad and hamstring strength were functioning at a higher level.

Your strength training program begins once your pain, swelling, range of motion, and walking are back to normal.  For many athletes this is around 6 weeks after surgery.  Delaying the start of strength training will only prolong your rehab and decrease your chances of ever getting back to playing.  It is important to follow the advice of your therapist before surgery (ACL prehab) and immediately after your surgery (early ACL rehab).  This way you can start your strength training on time.

#2 Greater Quadriceps Strength is Associated with Passing Return to Sport Tests

In order to be cleared back to your sport, you will have to pass a battery of tests.  Testing includes a series of surveys, hop tests, and strength tests.  Specifically, the strength of your quadriceps muscle must be at least 90% of the strength on your uninjured side.

Being stronger is going to make you feel more confident about your ability to return to playing.  Greater quadriceps strength is also going to boost your running, jumping, and cutting during your sport.   A 2012 study of 50 athletes showed those with stronger quads scored higher on return to sport testing.  Specifically, these athletes did better hopping and landing on their injured legs.

If you want to pass return to sport testing and get back to playing, you have to take your strength training very seriously from day 1.

#3 Quadriceps Strength Predicts Function 10 Years after Surgery

If you want to continue to play for years after your ACL injury, your quad strength has to be restored.  Researchers from the University of Kentucky investigated a series of performance tests in a group of athletes who underwent ACL surgery 5 to 20 years earlier (average of 10 years ago).  They found quadriceps strength to be the single best predictor of function in these athletes.

These research studies suggest restoring your thigh muscle strength early after surgery helps speed up your rehab, gets you back to playing, and keeps you healthy for years to come.

The Basic Components of Your ACL Strength Training Program

Your physical therapist will determine when you are ready to start your strength training program.  Improving hip, hamstring, and quadriceps strength is a big emphasis here.  The bulk of exercises are done standing with dumbbells, kettle bells, and barbells.

Proper exercise technique is mandatory.  This restores balance between both legs. Single leg exercises improve your strength, balance, and coordination.  Exercises done with 2 legs are loaded with more weight for maximum strength.  However, it is important that you don’t compensate by overusing your uninjured leg.  Your therapist will watch for this very closely.

Your hamstrings and glutes are strengthened with exercises like leg curls, deadlifts, and hip thrusts.  Your quads and glutes are trained with different squat and lunge variations.  Start with 3 sets of 8 to 12 reps 3 days per week.  As your program progresses, you will increase the load and number of sets but reduce the number of reps each set.

ACL Rehabilitation: Don’t Put Go Light with Your Strength Training

Getting strong after ACL surgery is not an easy.  But neither is excelling at any sport.  There will be some speed bumps and setbacks along the way. Your physical therapist will help you overcome these.

Your road back to playing will be a long one but hang in there.  Stay focused on your end goal.  But also learn about yourself throughout the process (your rehab).  Call our office to schedule an appointment when you are ready to started on your road back to playing.

ACL Rehab: 4 Steps to Early Success

ACL rehab is a grind after surgery.  Your recovery will be slow and full of ups and downs.  Only 63% of athletes will ever return to their previous level of sport.  However, you can be better. This article tells you what to do during your first few weeks after surgery to help get you back playing quickly.

Early Accelerated ACL Rehab is a Proven Approach

Most athletes have their injured ACL reconstructed with a graft from their patellar tendon. The patellar tendon graft heals quickly to your bone.  This allows accelerated rehabilitation soon after your surgery.  Early accelerated rehab results in quicker return of your full range of motion and strength.

A 2015 study published in the British Journal of Sports Medicine compared an accelerated progressive rehab program to a standard slower rehab.  Progression through this accelerated program is based on athlete’s ability to pass several different functional tests.  Two years after surgery, these athletes reported superior knee function, sport abilities, and quality of life.

To get off to a good start it is important to concentrate on 4 important aspects of your early rehab.  They are:

1.       Control and reduce your swelling

2.       Get your knee straight

3.       “Turn on” your quadriceps muscle

4.       Lose your limp

Step 1: Get Your Swelling Down

Immediately after surgery it is normal for your knee to be swollen, stiff, and painful.  It is important manage the swelling in your knee.  A light compression wrap is helpful for the first 7-10 days.  We recommend icing your knee several times per day for 10-20 minutes until the swelling is down.

Gentle range of motion exercises will help move the swelling out of your knee.  But you do not want to be overly aggressive with stretching your knee, especially with bending it.  Gentle stationary cycling is performed daily.  Also heel slide and wall slide exercises are done 3 time per day until you have full range of motion.

Step 2: Get Your Knee Straight

Properly managing your knee swelling will assist with straightening out your knee.  However, you will also have to work at restoring the last few degrees.  It is important to be able to fully straighten your knee to the same degree as your uninjured knee.

If you do not get your knee straight it will be nearly impossible to get all your strength back.  Also, you will walk with a limp and develop problems that affect your hip and back.  Be diligent with performing these knee straightening exercises at least 3 times per day.

Step 3: “Turn On” Your Quadriceps

Persistent quadriceps weakness plagues many athletes for years after ACL surgery.  It is important to get this muscle firing early after your surgery.  Controlling your swelling and getting your knee straight must occur in order for you to get your quad going.  Your quadriceps muscle strength will be one of the keys for you getting back to sports.

Straight leg raises and knee extension exercises are performed early after surgery without any risk to your healing ACL graft.  Your physical therapist will also supplement these exercises with neuromuscular electrical stimulation.  This gives your quads a little boost until they are firing on all cylinders.  Weight bearing exercises like partial squats and step ups are gradually introduced provided your swelling is under control.

Step 4: Lose Your Limp

If your swelling is down, your knee is straight, and your quad is firing then you are ready to walk without crutches.  You will not be cleared to walk without crutches until you can do so without any limp.  It is important that you are walking normally without any compensation.

Losing your limp will require some assistance from your physical therapist.  Several hands-on exercises are used to retrain your walking pattern.  Also, cone and hurdle drills assist with bending your knee and promoting stability on your injured leg.  Expect to be walking unassisted without a limp within 2 to 3 weeks of your surgery.

Your Physical Therapist Will Help Keep You Motivated and On-Track During Your ACL Rehab

ACL rehab is time-consuming as well as mentally and emotionally demanding.  It starts before your surgery and can last for up to a year.  Follow the 4 steps outlined in this article and you will set yourself up for success.

You are going to need some support and guidance.  Your physical therapist is your guide and will help you through the rough patches. Give us a call to get started with your rehab.  The doctors of physical therapy at BSR have been helping injured athletes get back to their sport since 2007.

ACL Prehab: Increase the Chances of Returning to Your Sport

An estimated 250,000 anterior cruciate ligament (ACL) reconstruction surgeries are done each year.  Unfortunately, surgery does not guarantee a return to playing sports. Rehabilitation after surgery is a grind.  And only 63% of athletes return to their pre-injury level of sport.  Thankfully, pre-surgery rehab or “prehabilitation” will accelerate your recovery after surgery.  Read on to learn how ACL prehab will help get you back to playing your sport.

Get Back to Playing with ACL Prehab

A 2016 study lead by researchers at the University of Delaware compared return to sport rates in athletes who underwent extended prehab to those who did not.  All athletes completed the same post-surgical rehab program. After surgery, athletes were tracked for 2 years. A significantly higher % of athletes returning to their pre-injury sport completed extended prehab (72%) compared to those who did not complete the extended prehab (63%).

What is ACL Prehab?

Extended prehab focuses on decreasing knee swelling, restoring range of motion, normalizing your walking pattern, and returning at least 70% of your strength.  The progressive prehab program also includes retraining your balance.  You are advanced only after meeting specific criteria.  You are finally cleared for surgery once all these criteria are met.

The exercises that follow are a few that we prescribe at BSR.  Perform your exercises daily for the best results.  Remember, everyone progresses at a different pace.  Some athletes meet all milestones in just a few weeks.  Others take a few months.  Your physical therapist will help you determine the best way to progress your program so you can get back to playing.

Range of Motion ACL Prehab Exercises 

You don’t want to develop knee stiffness after your ACL surgery.   This leads to a slow and frustrating recovery.  By restoring full knee range of motion before surgery, you will significantly reduce your chances of running into this problem.

Fully straightening your knee is crucial for your recovery.  Be diligent with these exercises.  Perform range of motion exercises at least 3 times per day until your mobility is equal to your other knee.

Strengthening Prehab Exercises

The strength of your quadriceps muscle is one of the biggest keys to you getting back to playing sports after your surgery.  It is common for quadriceps weakness to persist for 1, 2, or even 10 years after ACL surgery.  Start exercising this muscle early!  Straight leg raises and partial squats are not the most glamorous exercises, but they are a first step in the right direction.

Neuromuscular Training Exercises

You should be able to easily stand and balance on your injured leg without difficulty. Before advancing to high-level sporting activities, you will need single leg balance and stability.  Get good on 1 leg before you go in for your surgery.

Begin neuromuscular training after you have full range of motion, no limp, and good strength.  Start by practicing single leg balance for 30 consecutive seconds.  Then your physical therapist will advance you to more challenging exercises like band kicks or drills on a wobble board.

Start Your ACL Prehab Today

Don’t put off your rehab until after your surgery.  Your rehab starts before your surgery!  We have watched too many good athletes neglect this phase of their rehab and never return to their sport.  Get a head start with the ACL prehab exercises in this article as soon as possible after your injury.  ACL injury recovery is a marathon full of ups and downs.  Be proactive from the start.

For help getting started, call our office to schedule an appointment with one of our doctors of physical therapy.  We have been helping injured athletes of Southern Ocean County get back to their sport since 2007.

Sports Hernia Exercises to Get You Back Playing

Are you an athlete experiencing deep pain in your lower abdomen or groin when you exert yourself?  A sports hernia is common in athletes who do repetitive kicking, twisting, or turning at high speeds. This includes athletes who play soccer, football, basketball, baseball, tennis, and hockey.  Many athletes miss significant playing time due to ongoing pain.  This article describes what a sports hernia is.  We then highlight 6 exercises to help you get back to playing after a sports hernia.

What is a Sports Hernia?

sports hernia treatment

The injury is called a “hernia”.  However, hernia means a body part or tissue squeezes through a weak area of muscle or fascia.  With the common inguinal hernia, part of the intestine pushes through the injured lower abdominal wall.  With a sports hernia, this rarely occurs.  There is no injury or tearing of the inguinal wall.  The injury is to the fascia, muscles, or tendons of the abdomen and pelvis.

With a sports hernia, no organ pushes through the injured tissue.  This is why the preferred term is now “athletic pubalgia”.

Proven Treatments for Sports Hernia

Once diagnosed, rehab is recommended for at least 3 to 6 months.  If you do not improve with rehab you are a surgical candidate.  A 2014 study looked at 100 cases of sports hernia treated with rehab or surgery.  In people undergoing surgery, 94% successfully returned to their pre-injury sport or work.  In the rehab group, 93% returned to their pre-injury levels.  Therefore, both rehab exercises and surgery are effective treatments for sports hernia.

Phase 1: Starting Exercise 

Early rehab exercises focus on flexibility, core stability, and hip strength.  You should be able to perform these exercises with minimal or no pain.  Most exercises involve isometric contractions (static holds) of your lower abdominal and pelvic muscles.  Emphasize a neutral spine and slow controlled movements.  To start, perform dead bugs, bridging, and plank variations.  Also consider other abdominal and hip strengthening exercises.  Within a few weeks, you will be feeling better and stronger.

Perform the initial exercises with special attention to proper technique and building endurance. These exercises lay the foundation for more advanced exercises to come.  We recommend 2 to 3 sets of 12 to 20 repetitions for each exercise.  Perform them daily.

Phase 2: Exercise Progressions

After you have adequate core stability and hip strength, you are ready to progress.  The next phase of rehab involves rotational movements.  This is because sports hernia injuries often result from pivoting or twisting.  Examples are kicking a soccer ball or swinging a baseball bat.  Single-leg exercises are also very important during this phase.  Lunges, split squats, single-leg dead lifts, and single-leg squats help prepare you for return to your sport.

Balance, control, and endurance are important aspects of these exercises.  Perform 2 to 3 sets of 10 to 12 repetitions.  Perform them 3 to 4 days per week.  You can continue performing any stretching and phase 1 exercises on alternate days.  Also, prior to returning to sport your physical therapist will put you through agility and plyometric training.

Final Thoughts on Exercises for Sports Hernia

Core and hip strengthening exercises are proven treatments to get you back playing after a sports hernia.  The 6 sports hernia exercises in this article are a sample of many effective options.  You will also benefit from receiving manual therapy performed by your physical therapist.

As always, your symptoms and goals dictate the approach that is best for you.  So commit to these exercises for at least 6 weeks. If you would like help getting started, call our office to schedule an initial evaluation with your physical therapist.

Shoulder Labrum Tears: 5 Exercises Before Jumping into Surgery

Pain with or without clicking deep in your shoulder may indicate an injury to your labrum. The glenoid labrum is a layer of cartilage within the socket of your shoulder joint.  It plays an important role in stabilizing your shoulder during pushing movements, overhead reaching and sports that involve throwing.  Repetitive overhead throwing in baseball players often leads to breakdown of the labrum.  Repetitive pressing or pushing movements in the gym can also irritate your labrum.  Trauma such as falling on an outstretched arm or bracing yourself during a motor vehicle accident can injure your labrum.

Surgery is often recommended to repair a torn labrum.  However, exercise can also be a very effective treatment option.  Non-operative management includes non-steroidal anti-inflammatory drugs and steroid injections to decrease pain and inflammation.  Physical therapy and exercise also plays an important role in recovering full function of your shoulder. This article outlines a game plan for rehabilitating your injured shoulder after a labrum injury.

Glenoid labrum tear

Surgery or No Surgery for Glenoid Labrum Tears?

Both surgery and a non-surgical approach can lead to satisfactory results in 66% to 85% of people with labrum tears.  A small study published in The American Journal of Sports Medicine suggests nearly half of those with labrum tears do well with surgery.  The same may be true for those who pursue non-surgical treatment.  Regardless of treatment, it appears that 80 to 85% report satisfactory results 2 to 3 years later.  However, the level of satisfaction and return to sport in overhead athletes is closer to 66%.  This is understandable given the demands baseball pitchers and tennis players place on their shoulders.

Patients with labrum injuries should undergo 3 to 6 months of non-surgical treatment before considering surgery.  If this approach fails your doctor may recommend surgery.  Rehabilitation focuses on improving shoulder range of motion and strengthening the rotator cuff and shoulder blade muscles.  Below are videos of 2 important stretches and 3 commonly prescribed strengthening exercises you can perform in your home.

Cross Body Stretch

This stretch addresses tightness in the back of your shoulder which is often stiff in overhead athletes.  The infraspinatus, teres major, and teres minor muscles can become shortened from repetitive throwing or weight training.  This stretch is performed lying on your side with your hips and knees bent.  Your involved shoulder and elbow are positioned in 90 degrees of flexion.  Your hand of the uninvolved arm grasps your elbow and gently pulls it across the body.  You want to feel a mild stretch on the outside or back of your shoulder.  Hold this position for 30 seconds.  Perform this stretch 2 to 3 times each session.

Sleeper Stretch

The cross-body stretch is superior to the sleeper stretch for improving shoulder range of motion in young baseball players.  However, the sleeper stretch is the more popular of the two stretches.  Start in the same position as the cross-body stretch.  However, with the sleeper stretch, your wrist and forearm are gently moved down towards the table.  You want to feel a mild stretch on the outside or back of your shoulder.  Hold this position for 30 seconds.  Perform 2 to 3 stretches each session.   For most people, both the sleeper and cross-body stretch do not need to be performed.  My personal experience, and the best available evidence, suggests the cross-body stretch is the most beneficial for improving range of motion.  Choose which one works best for you.

Shoulder Flexion in Side-lying

It is important to strengthen your shoulder muscles while limiting stress on your injured labrum.  The biceps tendon attaches to your labrum.  Strong contractions of your biceps muscle can pull on the upper part of your labrum.  Therefore it is best to perform strengthening exercises which minimize biceps activity.  Perform shoulder flexion raises in a side-lying position to minimize biceps activity and reduce strain on your labrum.  Start on your side holding a light dumbbell.  Your elbow remains straight as you raise your arm slightly overhead.  Your arm remains parallel to the floor as you perform the movement.  Perform 3 sets of 10 to 20 repetitions several times per week.

External Rotation Diagonal

Stand holding a resistance band in one hand.  Anchor the band at knee to waist level.  Start with your hand positioned in front of your opposite front hip pocket.  Your elbow remains bent at a right angle throughout the exercise.  Perform the movement by flexing and rotating your arm across your body.  You will end up in a position similar to the arm cocking part of throwing.  Hold this position 1 to 2 seconds.  Reverse the movement back to the starting position.  This is a great exercise for the rotator cuff and lower trapezius muscle.  Perform 3 sets of 12 to 20 repetitions several times per week.

Prone Row to External Rotation

Position yourself on your stomach with your arm hanging over the side of your bed or a treatment table (if available).  Hold a light weight.  Usually 1 or 2 pounds is enough to begin with.  Perform a high row with your elbow in line with your shoulder.  Pause 1 to 2 seconds then rotate your hand upwards towards the ceiling.  Hold this position 1 to 2 seconds.  Reverse the movement back to the starting position.  This is another great exercise for the rotator cuff and lower trapezius muscle.  Perform 3 sets of 8 to 12 repetitions several times per week.

Tips for Getting Started

Symptoms of a labrum injury can range from a minor annoyance to debilitating.  In many people it severely limits overhead activity and the ability to carry out routine daily activities.  The right exercises can help.  For the best results, exercise 3 to 5 times per week.  Infrequent or random exercise will do you little good.  Give these 5 exercises a shot for at least 3 months and see how things go for you.  If you want more help give us a call.  Our physical therapists can help you find additional exercises right for you and supplement these with manual therapy treatments.   You don’t have to keep suffering and you have options other than surgery.

Concussion in Sports 

Concussions are common in athletes.  They commonly occur in contact sports, such as football, and non-contact sports, such as soccer. BSR Physical Therapy and our doctors of physical therapy can help evaluate, manage and treat patients with concussion.  This article helps to answer some common questions you may have.

What is a Concussion?

“Sport-related concussion is a traumatic brain injury induced by biomechanical forces … This may be caused either by a direct blow to the head, face, neck or elsewhere on the body with an impulsive force transmitted to the head.”

Does it Show up in MRI, CT Scans or X-Rays?

Acute concussion injuries do not show up on imaging.  Emergency room departments will commonly perform CT scans for the brain and skull to ensure that there are no fractures, brain bleeds or serious injuries.  MRI will commonly not find any acute injuries as well, but new research has shown chronic changes in the brain long after the time of injury.

What are the signs and symptoms of a Concussion?

Some common symptoms include neck pain, dizziness, blurred vision, difficulty concentrating, sensitivity to light, sounds, and motion sickness.  Some people can also experience changes in mood or behavior.  It is common to have symptoms immediately but some can develop in hours or over the next couple of days.  In most cases, symptoms resolve on their own with relative rest, however, there are some cases that last a little longer than usual (more than a week or two).

When should I seek professional help?

High school athletes should have an athletic trainer as part of the sports medicine team to evaluate the athlete for a suspected concussion.  Athletic trainers are qualified healthcare professionals to manage suspected head injuries and refer out when appropriate. In cases where symptoms do not resolve with time and relative rest, appropriate referral to a healthcare professional is indicated.

How can physical therapists help?

Physical therapists may be asked to help manage and treat those who still have lingering symptoms from a concussion.  The physical therapist should take a good history of the injury and progression of the symptoms. A comprehensive physical examination should be performed to assess neck motions, balance, concentration and eye movements to see if there are impairments causing symptoms and limiting functional ability.  An individualized plan of care and treatment is then provided to decrease concussion symptoms and progressively return to activity.

When can I go back and play?

Each case is unique in presentation, so no two concussions are alike no matter how “bad” they initially looked.  So the answer really is, it depends. The physical therapist will put you through a thorough return to activity protocol to simulate the demands of your sport to help gauge the readiness to return to sport.  In the end, in the State of New Jersey, a physician has the power to medically clear an athlete to return to sport, but a collaborative effort between the physical therapist, athletic trainer and physician should be made to ensure a safe return at a high level.

Conclusion

In summary, sports-related concussions are common in athletic endeavors in both contact and non-contact sports.  Symptoms from concussions usually resolve on their own with time and relative rest.  When symptoms linger for longer than usual, a qualified healthcare professional should be consulted.  Physical therapists are able to help assist in treating patients who have post-concussive symptoms and help return an athlete to play at a high level.   Give us a call if you would like some help getting back in the game after a concussion.

by Dr. Mark Daitol, PT, DPT, CSCS

Low Back Pain in Athletes

Low back pain in athletes occurs at an alarmingly high rate.  Various studies suggest one- to two-thirds of athletes will experience low back pain during a competitive season.  Athletes are required to perform high-speed movements often with excessive loads.  Sports such as golf, baseball, gymnastics, hockey, and tennis require repetitive rotational movements that stress the bones, joints, and discs of the spine.   Repetitive rotation and extension (arching backward) with high forces at fast speeds contributes to injuries of the spine discs and bony structures.  Injured athletes must learn to control and dissipate these forces.  Thankfully, rehabilitation exercises can help the injured athlete get safely back to their sport.

Low Back Stress Injuries in Athletes

Stress reactions and stress fractures of the spine are common in young athletes.  The spine of children and adolescents are susceptible because the bones are still developing.  Spondylolysis is a crack or stress fracture in one of the vertebrae of the low back.  Most commonly, the stress fracture occurs in the fifth vertebra of the lumbar spine (L5).  In some cases, the stress fracture weakens the bone and the vertebra starts to shift or slip forward out of place. This condition is called spondylolisthesis.

Spondylolysis

In children and adolescents, this slippage most often occurs during a growth spurt.  The severity of the slippage is graded from 1 to 4.  Most athletes with grades 1 and 2 respond very well to a period of rest and rehabilitation.  The injured bone heals with rest from any repetitive rotation and extension movements involved in their sport.  Rehabilitation targets strength of the trunk muscles to help relieve stress on the healing bone.  Some higher-grade injuries may require surgery to stabilize the spine.

Research Support for a Safe Return to Sport

Athletes with stress injuries of the spine require a minimum of 3 months rest from their sport.  The severity of the injury and the nature of the sport may require longer periods of rest.  One study found excellent return to sport rates after 4.6 months of rest and rehabilitation across a number of sports.  A recent study showed baseball (54%), soccer (48%), and hockey (44%) to have the highest prevalence of stress injuries in boys.  Gymnastics (34%), marching band (31%), and softball (30%) were found to have the highest injury rates in girls.  Athletes in these sports may benefit from longer rest and rehabilitation periods.

A 2017 study from the Children’s Hospital in Columbus, OH investigated the timing of referral to physical therapy in athletes with stress injuries of the spine.  Athletes who began physical therapy sooner were able to make a return to sport 25 days earlier than those who delayed treatment.  The early physical therapy group returned to sport at approximately 3 months.  The delayed physical therapy group returned after 4.5 months of rest and rehabilitation.   These studies suggest appropriate rest and early rehabilitation foster a safe and timely return to sport.

Common Rehabilitation Exercises for Athletes with Low Back Pain

Early rehabilitation for stress injuries of the spine begins with controlling pain and normalizing mobility.  Most athletes experience a significant reduction in pain once they are removed from sports activities.  Trunk and hip strengthening exercises begin in non-weight bearing positions such as on the back, side, or all-fours position.  Athletes are instructed on how to maintain a neutral spine position to minimize stress to the healing bone.  The curl-up and heel hover are two exercises that are initiated once the athlete can control this neutral spine position.

After the athlete can maintain a neutral spine in non-weight bearing positions exercises are progressed to kneeling and standing.  The athlete is taught to control rotation and extension of the spine through exercises such as the chop and Pallof press.

Anti-extension and anti-rotation exercises are emphasized during the later stages of rehabilitation.  The strength and endurance of the trunk muscles are progressively challenged with these exercises.  All exercises should be performed with a neutral spine and in a pain free manner.

Closing Thoughts on Low Back Pain in Athletes

Low back injuries can be frustrating for the young athlete.  Appropriate rest and rehabilitation can expedite a safe return to sport.  These 6 exercises are only a sample of the types of treatments that can help.  Meet with your physical therapist and get started on the road to recovery.  Your physical therapist will continually assess your injury and progress your exercise program based on your goals.  The objective is to get you back to your sport as quickly and safely as possible.  Contact us today if you have questions about which treatments are right for you.