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August 3, 2017

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August 3, 2017

BASEBALL INJURIES

TYPES/MECHANISMS:

-overuse injuries of the shoulder and elbow due to the repetitive motion of throwing and pitching

oshoulder specific injuries:

§rotator cuff injuries: tears to muscle or tendon in acute or gradual incident, usually to supraspinatus or infraspinatus tendons

§impingement syndrome: friction btwn rotator cuff tendons and acromion process of shoulder blade

§shoulder instability: caused by prev injury or ligament and capsule laxity; can lead to subluxations

oelbow injuries:

§medial epicondylitis/little leaguer's elbow/golfer's elbow: caused by repetitive wrist flexion that stresses the muscle of forearm (attached to medial epicondylitis)

§lateral epicondylitis/tennis elbow: caused by repetitive wrist extension

§radial nerve entrapment: similar symptoms to tennis elbow

§medial ligament sprain: inflamed with overuse because of poor technique/tear with sudden force

§risk increases as # pitches increases

§risk factors: age, height, pitcher, days of training, grip strength, range of motion of external rotation of the shoulder, and muscle strength of the shoulder

§decrease of ROM of external rotation of the shoulder and increase of MS of external and internal rotation of the shoulder predispose injuries

oknee injuries:

§ACL: injuries occur when running base to base, esp. when changing direction

§Medial collateral ligament injuries: damage when force applied to outside of knee, or if foot fixed & body moves in oppo direction

§Meniscus injury: injured when foot fixed and body twists

-acute traumatic injuries: often due to collisions, falls and impacts, and often to the knee

-most injuries due to collisions with player, ball, bat, even though non-contact sport

-most common injuries:

omild soft tissue injuries, such as muscle pulls (strains), ligament injuries (sprains), cuts and bruises, lacerations, and contusions

INCIDENCE:

-U.S. Consumer Products Safety Commission reports each year more than 627,000 baseball-related injuries

-injury 2005-2006 and 2006-2007 school year of 100 US high schools

o131555 high school baseball-related injuries

oinjury rate of 1.26 injuries per 1000 athletic exposures

omost common:

§injury site: shoulder (17.6%), ankle (13.6%), head/face (12.3%), hand/finger (8.5%), and thigh/upper leg (8.2%)

§injury diagnosis: ligament sprains (incomplete tears) (21.0%), muscle strains (incomplete tears) (20.1%), contusions (16.1%), and fractures (14.2%)

§majority injuries = time loss of <7 days,  9.7% = medical disqualification for season, and 9.4% = surgery

§431 reported baseball injuries

·50 (11.6%) were attributed to being hit by a batted ball

·hit by batted ball to the head/face (48.0%) and mouth/teeth (16.0%)

·injuries not due to hit by batted ball (8.2% and 1.3%)

·injuries hit by a batted ball requiring surgery (18.0%), compared other baseball-related injuries (6.8%)

-National Collegiate Athletic Association Injury Surveillance System, 1988-1989-2003-2004 (16 yrs)

olow rate of injury compared with other NCAA sports

o25% of injuries are severe and result in 10+ days of time loss from participation

orate of injury= 3X higher game vs practice (5.78 versus 1.85 injuries per 1000 athlete-exposures AE)

oPractice injury rates 2x high in preseason vs regular season (2.97 versus 1.58 per 1000 AE)

o10% all game injuries =impact with batted ball, injury rate 0.56 injuries per 1000 game A-Es.

oSliding = 13% game injuries

TREATMENT:

-Treat overuse elbow and shoulder injury:

oRest

oIce to reduce soreness and inflammation

oIbuprofen for pain

oWorse pain see doctor

PREVENTION:

  • pre-season physical exam

    • prevent injuries and illnesses by identifying any potential medical problems

  • Warm up and stretch. 

    • Warm up

      •  with some easy calisthenics, such as jumping jacks. Continue with walking or light running, such as running the bases

      • 5 min cardo

    • Gentle dynamic stretching, in particular your back, hamstrings, and shoulders

      • drills such as running with high knees, heels to bum and cariocas

      • 5 min minimum-max 20 min

  • Prevent Overuse injuries by

    • Rest

    • Limiting pitch counts

  • Proper Nutrition & Diet

    • Bad diet = more prone to injury

    • Carbs to refuel muscles

    • Protein to rebuild muscles

    • Stay hydrated

  • First aid familiarity

  • Field knowledge familiar with your baseball field, including its telephone and cardiac defibrillator.

  • Emergency situations

    • plan to reach medical personnel: concussions, breathing problems like wheezing, heat illness, and orthopaedic emergencies, such as fractures and dislocations.

  • Follow rules

  • Appropriate Equipment, fit & use:             

    • Batting helmet with face shield

      • wear at the plate, "on deck" circle waiting your turn at bat, and during base running

      • face shields attached to batting helmets reduce the risk of facial injury if hit by ball

    • Catchers need:

      • catcher's mitt, helmet with face guard/mask, throat guard, long-model chest protector, protective supporter, and shin guards

    • batters need:

      • protective jackets to avoid injury from being hit by ball

      • padded shorts

      • cup

    • baseball shoes that fit properly and have appropriate cleats

    • use wood bat

  • Gender-specific equipment may be of value, including athletic supports for boys/men and padded bras for girls/women.

  • Instruct players how to avoid getting hit by ball

  • Youth leagues: softer baseballs decrease risk of hit by pitched ball

Ensure a Safe Environment

  • Inspect playing field for uneven terrain (holes, divots), glass, and other debris.

  • Breakaway bases:

    • Use a field with breakaway bases

      • Many injuries occur while sliding into bases

      • traditional stationary base = rigid obstacle

      • breakaway base is snapped onto grommets attached to an anchored rubber mat, which holds  place during normal play

      • sliding runner can dislodge it, BUT breakaway base is stable and will not detach during normal base running.

Focus on Technique

Base Running

The American Academy of Orthopaedic Surgeons recommends:

  • Players under age 10 not be taught to slide

  • Proper instruction in sliding technique taught and practiced before using bag, including the breakaway bases. Practice first with a sliding bag.

  • Teach and use: "obstruction" rule - not Get in way of runner/block base without possession of ball

Pitching and Throwing
  • established guidelines for youth baseball, recommended by the USA Baseball Medical & Safety Advisory Committee.

  • Pitch Count Limits:

 

Age

Max.
Pitches/Game

Max.
Pitches/Week

8 - 10

50

75

11 - 12

75

100

13 - 14

75

125

15 - 16

90

2 games / week

17 - 18

105

2 games / week

  • Ages for learning types of pitches:

 

Fastball

8

Change-up

10

Curveball

14

Knuckleball

15

Slider

16

Forkball

16

Splitter

16

Screwball

17

 

Safe Return to Play

  • injured player's symptoms = completely gone before returning to play.

    • For example:

      • joint problem, player must have no pain, no swelling, full range of motion, normal strength

      • concussion, player must have no symptoms at rest/with exercise, and be cleared by appropriate medical provider

      • shoulder or elbow overuse injury, player gradually return to throwing program, increasing # throws depending on length of time away from play& specific team position

Sources:

 

1. Curr Sports Med Rep. 2009 Sep-Oct;8(5):250-4.

Prevention of elbow injuries in youth baseball pitchers.

Fleisig GS, Weber A, Hassell N, Andrews JR.

2. Pediatrics. 2010 Mar;125(3):497-501. Epub 2010 Feb 8.

Shoulder injuries in US high school baseball and softball athletes, 2005-2008.

Krajnik S, Fogarty KJ, Yard EE, Comstock RD.

3. J Shoulder Elbow Surg. 2010 Jun;19(4):502-7. Epub 2010 Mar 1.

Risk factors for elbow injuries among young baseball players.

Harada M, Takahara M, Mura N, Sasaki J, Ito T, Ogino T.

4. Curr Sports Med Rep. 2010 Sep-Oct;9(5):294-8.

Youth baseball injuries: recognition, treatment, and prevention.

Ray TR.

5ץ Pediatrics. 2008 Jun;121(6):1181-7.

Epidemiological features of high school baseball injuries in the United States, 2005-2007.

Collins CL, Comstock RD.

6. J Athl Train. 2007 Apr-Jun;42(2):183-93.

Descriptive epidemiology of collegiate men's baseball injuries: National Collegiate Athletic Association Injury Surveillance System, 1988-1989 through 2003-2004.

Dick R, Sauers EL, Agel J, Keuter G, Marshall SW, McCarty K, McFarland E.

7. Med Sport Sci. 2005;49:9-30.

Baseball injuries.

Lyman S, Fleisig GS.

8. Am J Sports Med. 2004 Jul-Aug;32(5):1189-96. Epub 2004 May 18.

Catastrophic injuries in high school and college baseball players.

Boden BP, Tacchetti R, Mueller FO.

9. Clin Pediatr (Phila). 2001 Apr;40(4):197-203.

Injury reduction and bounce characteristics of safety baseballs and acceptability by youth leagues.

Yamamoto LG, Inaba AS, Okamura DM, Yamamoto JA, Yamamoto JB.

10. Pediatr Emerg Care. 2000 Jun;16(3):215-20.

Sports-specific concerns in the young athlete: baseball.

Yen KL, Metzl JD.

11. Pediatrics. 2000 Mar;105(3):E32.

Sports injuries: An important cause of morbidity in urban youth. District of Columbia Child/Adolescent Injury Research Network.

Cheng TL, Fields CB, Brenner RA, Wright JL, Lomax T, Scheidt PC.

12. Clin J Sport Med. 1998 Jan;8(1):10-3.

Epidemiology of collegiate baseball injuries.

McFarland EG, Wasik M.

13. Pediatr Emerg Care. 1997 Apr;13(2):107-10.

Ventricular fibrillation following blunt chest trauma from a baseball.

van Amerongen R, Rosen M, Winnik G, Horwitz J.

14. Pediatrics. 1996 Sep;98(3 Pt 1):445-8.

Baseball injuries: a Little League survey.

Pasternack JS, Veenema KR, Callahan CM.

15. Ann Emerg Med. 1981 Jun;10(6):302-6.

Baseball injuries to the hand.

Dawson WJ, Pullos N.

16. Pediatrics. 2008 Dec;122(6):1418.

High school baseball injuries.

Coen RW.

17. http://www.sportsinjuryclinic.net/sports/baseball.php

18. http://orthoinfo.aaos.org/topic.cfm?topic=A00185

 

BASEBALL INJURIES

TYPES/MECHANISMS:

-overuse injuries of the shoulder and elbow due to the repetitive motion of throwing and pitching

oshoulder specific injuries:

§rotator cuff injuries: tears to muscle or tendon in acute or gradual incident, usually to supraspinatus or infraspinatus tendons

§impingement syndrome: friction btwn rotator cuff tendons and acromion process of shoulder blade

§shoulder instability: caused by prev injury or ligament and capsule laxity; can lead to subluxations

oelbow injuries:

§medial epicondylitis/little leaguer's elbow/golfer's elbow: caused by repetitive wrist flexion that stresses the muscle of forearm (attached to medial epicondylitis)

§lateral epicondylitis/tennis elbow: caused by repetitive wrist extension

§radial nerve entrapment: similar symptoms to tennis elbow

§medial ligament sprain: inflamed with overuse because of poor technique/tear with sudden force

§risk increases as # pitches increases

§risk factors: age, height, pitcher, days of training, grip strength, range of motion of external rotation of the shoulder, and muscle strength of the shoulder

§decrease of ROM of external rotation of the shoulder and increase of MS of external and internal rotation of the shoulder predispose injuries

oknee injuries:

§ACL: injuries occur when running base to base, esp. when changing direction

§Medial collateral ligament injuries: damage when force applied to outside of knee, or if foot fixed & body moves in oppo direction

§Meniscus injury: injured when foot fixed and body twists

-acute traumatic injuries: often due to collisions, falls and impacts, and often to the knee

-most injuries due to collisions with player, ball, bat, even though non-contact sport

-most common injuries:

omild soft tissue injuries, such as muscle pulls (strains), ligament injuries (sprains), cuts and bruises, lacerations, and contusions

INCIDENCE:

-U.S. Consumer Products Safety Commission reports each year more than 627,000 baseball-related injuries

-injury 2005-2006 and 2006-2007 school year of 100 US high schools

o131555 high school baseball-related injuries

oinjury rate of 1.26 injuries per 1000 athletic exposures

omost common:

§injury site: shoulder (17.6%), ankle (13.6%), head/face (12.3%), hand/finger (8.5%), and thigh/upper leg (8.2%)

§injury diagnosis: ligament sprains (incomplete tears) (21.0%), muscle strains (incomplete tears) (20.1%), contusions (16.1%), and fractures (14.2%)

§majority injuries = time loss of <7 days,  9.7% = medical disqualification for season, and 9.4% = surgery

§431 reported baseball injuries

·50 (11.6%) were attributed to being hit by a batted ball

·hit by batted ball to the head/face (48.0%) and mouth/teeth (16.0%)

·injuries not due to hit by batted ball (8.2% and 1.3%)

·injuries hit by a batted ball requiring surgery (18.0%), compared other baseball-related injuries (6.8%)

-National Collegiate Athletic Association Injury Surveillance System, 1988-1989-2003-2004 (16 yrs)

olow rate of injury compared with other NCAA sports

o25% of injuries are severe and result in 10+ days of time loss from participation

orate of injury= 3X higher game vs practice (5.78 versus 1.85 injuries per 1000 athlete-exposures AE)

oPractice injury rates 2x high in preseason vs regular season (2.97 versus 1.58 per 1000 AE)

o10% all game injuries =impact with batted ball, injury rate 0.56 injuries per 1000 game A-Es.

oSliding = 13% game injuries

TREATMENT:

-Treat overuse elbow and shoulder injury:

oRest

oIce to reduce soreness and inflammation

oIbuprofen for pain

oWorse pain see doctor

PREVENTION:

  • pre-season physical exam

    • prevent injuries and illnesses by identifying any potential medical problems

  • Warm up and stretch. 

    • Warm up

      •  with some easy calisthenics, such as jumping jacks. Continue with walking or light running, such as running the bases

      • 5 min cardo

    • Gentle dynamic stretching, in particular your back, hamstrings, and shoulders

      • drills such as running with high knees, heels to bum and cariocas

      • 5 min minimum-max 20 min

  • Prevent Overuse injuries by

    • Rest

    • Limiting pitch counts

  • Proper Nutrition & Diet

    • Bad diet = more prone to injury

    • Carbs to refuel muscles

    • Protein to rebuild muscles

    • Stay hydrated

  • First aid familiarity

  • Field knowledge familiar with your baseball field, including its telephone and cardiac defibrillator.

  • Emergency situations

    • plan to reach medical personnel: concussions, breathing problems like wheezing, heat illness, and orthopaedic emergencies, such as fractures and dislocations.

  • Follow rules

  • Appropriate Equipment, fit & use:             

    • Batting helmet with face shield

      • wear at the plate, "on deck" circle waiting your turn at bat, and during base running

      • face shields attached to batting helmets reduce the risk of facial injury if hit by ball

    • Catchers need:

      • catcher's mitt, helmet with face guard/mask, throat guard, long-model chest protector, protective supporter, and shin guards

    • batters need:

      • protective jackets to avoid injury from being hit by ball

      • padded shorts

      • cup

    • baseball shoes that fit properly and have appropriate cleats

    • use wood bat

  • Gender-specific equipment may be of value, including athletic supports for boys/men and padded bras for girls/women.

  • Instruct players how to avoid getting hit by ball

  • Youth leagues: softer baseballs decrease risk of hit by pitched ball

Ensure a Safe Environment

  • Inspect playing field for uneven terrain (holes, divots), glass, and other debris.

  • Breakaway bases:

    • Use a field with breakaway bases

      • Many injuries occur while sliding into bases

      • traditional stationary base = rigid obstacle

      • breakaway base is snapped onto grommets attached to an anchored rubber mat, which holds  place during normal play

      • sliding runner can dislodge it, BUT breakaway base is stable and will not detach during normal base running.

Focus on Technique

Base Running

The American Academy of Orthopaedic Surgeons recommends:

  • Players under age 10 not be taught to slide

  • Proper instruction in sliding technique taught and practiced before using bag, including the breakaway bases. Practice first with a sliding bag.

  • Teach and use: "obstruction" rule - not Get in way of runner/block base without possession of ball

Pitching and Throwing
  • established guidelines for youth baseball, recommended by the USA Baseball Medical & Safety Advisory Committee.

  • Pitch Count Limits:

 

Age

Max.
Pitches/Game

Max.
Pitches/Week

8 - 10

50

75

11 - 12

75

100

13 - 14

75

125

15 - 16

90

2 games / week

17 - 18

105

2 games / week

  • Ages for learning types of pitches:

 

Fastball

8

Change-up

10

Curveball

14

Knuckleball

15

Slider

16

Forkball

16

Splitter

16

Screwball

17

 

Safe Return to Play

  • injured player's symptoms = completely gone before returning to play.

    • For example:

      • joint problem, player must have no pain, no swelling, full range of motion, normal strength

      • concussion, player must have no symptoms at rest/with exercise, and be cleared by appropriate medical provider

      • shoulder or elbow overuse injury, player gradually return to throwing program, increasing # throws depending on length of time away from play& specific team position

Sources:

 

1. Curr Sports Med Rep. 2009 Sep-Oct;8(5):250-4.

Prevention of elbow injuries in youth baseball pitchers.

Fleisig GS, Weber A, Hassell N, Andrews JR.

2. Pediatrics. 2010 Mar;125(3):497-501. Epub 2010 Feb 8.

Shoulder injuries in US high school baseball and softball athletes, 2005-2008.

Krajnik S, Fogarty KJ, Yard EE, Comstock RD.

3. J Shoulder Elbow Surg. 2010 Jun;19(4):502-7. Epub 2010 Mar 1.

Risk factors for elbow injuries among young baseball players.

Harada M, Takahara M, Mura N, Sasaki J, Ito T, Ogino T.

4. Curr Sports Med Rep. 2010 Sep-Oct;9(5):294-8.

Youth baseball injuries: recognition, treatment, and prevention.

Ray TR.

5ץ Pediatrics. 2008 Jun;121(6):1181-7.

Epidemiological features of high school baseball injuries in the United States, 2005-2007.

Collins CL, Comstock RD.

6. J Athl Train. 2007 Apr-Jun;42(2):183-93.

Descriptive epidemiology of collegiate men's baseball injuries: National Collegiate Athletic Association Injury Surveillance System, 1988-1989 through 2003-2004.

Dick R, Sauers EL, Agel J, Keuter G, Marshall SW, McCarty K, McFarland E.

7. Med Sport Sci. 2005;49:9-30.

Baseball injuries.

Lyman S, Fleisig GS.

8. Am J Sports Med. 2004 Jul-Aug;32(5):1189-96. Epub 2004 May 18.

Catastrophic injuries in high school and college baseball players.

Boden BP, Tacchetti R, Mueller FO.

9. Clin Pediatr (Phila). 2001 Apr;40(4):197-203.

Injury reduction and bounce characteristics of safety baseballs and acceptability by youth leagues.

Yamamoto LG, Inaba AS, Okamura DM, Yamamoto JA, Yamamoto JB.

10. Pediatr Emerg Care. 2000 Jun;16(3):215-20.

Sports-specific concerns in the young athlete: baseball.

Yen KL, Metzl JD.

11. Pediatrics. 2000 Mar;105(3):E32.

Sports injuries: An important cause of morbidity in urban youth. District of Columbia Child/Adolescent Injury Research Network.

Cheng TL, Fields CB, Brenner RA, Wright JL, Lomax T, Scheidt PC.

12. Clin J Sport Med. 1998 Jan;8(1):10-3.

Epidemiology of collegiate baseball injuries.

McFarland EG, Wasik M.

13. Pediatr Emerg Care. 1997 Apr;13(2):107-10.

Ventricular fibrillation following blunt chest trauma from a baseball.

van Amerongen R, Rosen M, Winnik G, Horwitz J.

14. Pediatrics. 1996 Sep;98(3 Pt 1):445-8.

Baseball injuries: a Little League survey.

Pasternack JS, Veenema KR, Callahan CM.

15. Ann Emerg Med. 1981 Jun;10(6):302-6.

Baseball injuries to the hand.

Dawson WJ, Pullos N.

16. Pediatrics. 2008 Dec;122(6):1418.

High school baseball injuries.

Coen RW.

17. http://www.sportsinjuryclinic.net/sports/baseball.php

18. http://orthoinfo.aaos.org/topic.cfm?topic=A00185

 

 

 

 

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