Back Clinic Sports Injuries Chiropractic and Physical Therapy Team. Athletes from all sports can benefit from chiropractic treatment. Adjustments can help treat injuries from high-impact sports i.e. wrestling, football, and hockey. Athletes that get routine adjustments may notice improved athletic performance, improved range of motion along with flexibility, and increased blood flow. Because spinal adjustments will reduce the irritation of the nerve roots between the vertebrae, the healing time from minor injuries can be shortened, which improves performance. Both high-impact and low-impact athletes can benefit from routine spinal adjustments.
For high-impact athletes, it increases performance and flexibility and lowers the risk for injury for low-impact athletes i.e. tennis players, bowlers, and golfers. Chiropractic is a natural way to treat and prevent different injuries and conditions that impact athletes. According to Dr. Jimenez, excessive training or improper gear, among other factors, are common causes of injury. Dr. Jimenez summarizes the various causes and effects of sports injuries on the athlete as well as explaining the types of treatments and rehabilitation methods that can help improve an athlete’s condition. For more information, please feel free to contact us at (915) 850-0900 or text to call Dr. Jimenez personally at (915) 540-8444.
Plantar fasciitis is a common affliction affecting many athletes, in particular runners. Adam Smith has written a great piece in the September issue of Sports Injury Bulletin outlining the relevant anatomy, how the injury occurs, how to differentiate from other similar pathologies, such as neural irritation in the tarsal tunnel, and finally how to manage it.
Speaking from experience as a former sufferer of plantar fasciitis, it can be a frustratingly recalcitrant condition and I have heard of some extreme measures to manage it. Read on for a story on the drastic measures an AFL player took to overcome the problem, and to understand more about the condition.
Many years ago an elite level AFL player had suffered a 2 year history of plantar fasciitis with no relief from any form of treatment. In the end the sports doctor at the club involved injected the plantar fascia origin with a corticosteroid injection the day before a game.
The hope was that as the plantar fascia weakened due to the steroid injection, the player would rupture it, go through the standard week rehab protocol, and then be pain free for ever more.
And yes, the player did rupture the plantar fascia during during the game and was consequently placed in a boot for about 10 days. He soon was walking, then running, and was playing again within four weeks with no more problems. The podiatrist made an orthotic to control the dropped arch and all the problems went away.
What has happened to that player now is anyone’s guess. He may now suffer from long term issues due to a poorly controlled arch that have caused other issues such as achilles tendon, knee pain and/or hip pain.
So do we really need the plantar fascia and why is it such a problem when it is injured?
Being bipedal (walking on two leg) animals, the plantar fascia gives the natural plantar arch support in weight bearing positions. It is a passive structure that acts like a high tension wire to keep the arch bones supinated as we push off.
Without a plantar fascia in place, we would need a better active system to create the arch support, such as the intrinsic plantar arch muscles, and also the extrinsic long arch support muscles such as the tibialis posterior, flexor hallucis longus (FHL) and the flexor digitorum longus (FDL). These muscles would need extra work to improve their arch control abilities. Alternatively, we could use a passive support mechanism in the form of an orthotic to control the arch position.
The majority of plantar fascia problems stem from a build up of tensile and compressive forces that degenerate the plantar fascia origin against the heel bone. The combination of tensile (stretch) force due to overpronation and the added compressive force as the plantar fascia is pushed against the heel bone leads to a pathological state whereby the plantar fascia degenerates and creates dysfunction and pain.
Therefore like other degenerative tendon issues (such as Achilles tendons) once the patient starts to feel pain often the injury has been building for months to years. Which explains why it then becomes so problematic to deal with.
Proper management takes time to not only correct the muscle imbalances that cause it � such as tight calves, poor hip control, poor pronation control � but due to its degenerative nature it requires a huge amount of time to even slightly change the existing pathology.
For more information, please feel free to ask Dr. Jimenez or contact us at 915-850-0900 .
Additional Topics: What is Chiropractic?
Chiropractic care is an well-known, alternative treatment option utilized to prevent, diagnose and treat a variety of injuries and conditions associated with the spine, primarily subluxations or spinal misalignments. Chiropractic focuses on restoring and maintaining the overall health and wellness of the musculoskeletal and nervous systems. Through the use of spinal adjustments and manual manipulations, a chiropractor, or doctor of chiropractic, can carefully re-align the spine, improving a patient�s strength, mobility and flexibility.
Historically athletes were barefoot in the sporting arena and it is only a relatively recent phenomenon for shoes to be worn in competition. In Roman times wrestlers competed barefoot, whilst runners wore little more than thin leather sandals to compete over long distances.
More recently several athletes have achieved significant success competing barefoot: Abebe Bikila from Ethiopia won the Rome Olympic marathon in 1960, and Zola Budd became the world record holder over 5000 meters. Since the 1970�s athletic shoe manufacture has boomed and with it so too has the incidence of running-related lower limb injuries. This prompted the question of whether these new designs were to blame for the injuries or simply reflected the growing interest in distance running as a sport. That notwithstanding, the interest around barefoot running to reduce such injuries has grown exponentially. This account aims to appraise some of the literature on this contentious subject.
Gait Cycle & Running Biomechanics
The normal gait cycle consists of both stance and swing phases. The stance phase occupies 60% and swing 40% of the time taken to complete one cycle of consecutive heel striking by the same foot. The stance phase itself is divided into contact, midstance and propulsive phases. It begins and ends with both feet in contact with the ground known as the �double support phase�. The swing phase is divided into follow-through, forward swing and foot descent phases. The phases of running are very similar except for the fact that there is a flight phase when neither foot is in contact with the ground between stance phases. Evidently, with slower jogging the stance phase is longer than the flight phase, however, during sprinting this relationship reverses and the stance phase becomes the shorter of the two phases.
There are several key biomechanical considerations that must be borne in mind before a comparison can be made between barefoot and shod running. During running there is an increase in rotation at the pelvis, hip, and knee which must be absorbed by increasing the muscle forces acting over these joints. Moreover, as running speed increases the point of foot impact changes from predominantly heelstriking to that of forefoot weight-bearing when sprinting. The normal angle of gait is approximately 100 abducted from the line of progression. As speed increases this angle decreases approaching zero as the foot strike nears the line of progression. Runners who have developed stride patterns that incorporate low levels of impact force and rapid pronation are at a reduced risk for over-use running injuries such as stress fractures, plantar fasciitis, and ligamentous sprains. It is important to note that many shod runners never develop injuries, however, the available data indicates that 19-79% will develop an injury over their years spent running.
Biomechanical Abnormalities and Injury
Excessive Pronation � Pronation of the foot occurs at the sub-talar joint and when it occurs in excess is associated with many running-related injuries. Examples include, first metatarsophalangeal joint abnormalities, medial arch and plantar fascia strain, Achilles and tibialisposterior tendinopathy, patellofemoral joint dysfunction, and stress fractures. One study illustrated that shod running decreased torsion and increased pronation significantly, the paper concluded that the reduction in torsion produced by stiff soled shoes may well be a factor in running injuries caused by excessive pronation.
Excessive Supination
This movement also occurs at the subtalar joint and may compensate for a weakness of the antagonist pronating musculature (e.g. peroneal) or as a result of spasm or tightness of the supinating musculature (e.g. tibialis posterior, and the gastrocnemius- soleus complex). The supinated foot is less mobile and provides inferior shock-absorption which may well predispose to the development of stress fractures of the tibia, fibula, calcaneus and metatarsals. Lateral instability of the foot and ankle may be associated with excessive supination resulting in an increase incidence of ligamentous sprains of the foot and ankle. Such a lateral stress on the lower limb could result in tightening of the ileo-tibial band with associated bursitis of the femoral epicondyle.
Abnormal Pelvic Mechanics
During normal running the pelvis assumes a rotated position with anterior-posterior and lateral tilt. Weakness in the muscles needed for stabilisation of this position will result in excessive movement in any one of the three planes. A less efficient transfer of force will subsequently occur. The most common pelvic abnormalities are excessive anterior tilt, excessive lateral tilt and asymetrical pelvic movement. The complex inter-play of musculature to compensate for each of these abnormalities may well result in muscle tightness, strains and tendinopathy. Adaptation and biomechanics of running barefoot A leading study on the subject of barefoot running was conducted by Lieberman et al. who compared foot striking patterns and collision forces in habitually barefoot with shod runners. They found that habitually barefoot endurance runners often land on the fore-foot (fore-foot strike) before bringing down the heel. Less frequently they may also land with a flat foot (mid-foot strike), or even less often, on the heel (rear-foot strike). In contrast, shod runners mostly rear-foot strike which is facilitated by the elevated and cushioned heel of the modern running shoe.
The same study conducted kinematic and kinetic analyses on the two populations and discovered that even on hard surfaces, barefoot runners who fore-foot strike generate smaller collision forces than shod rear-foot strikers. This is brought about by the manner in which the barefoot runner�s foot is more plantarflexed at landing with a greater degree of ankle compliance at impact. These features combine to decrease the effective mass of the body that collides with the ground and so potentially reducing injury through repeated heavy loading. In addition, the stride length of barefoot runners is shorter and the strides have a greater vertical leg compliance which acts to lower the body�s centre of mass relative to the force of impact. Again, these features work to reduce jarring and result in a smoother running motion experienced by the individual.
Footwear and Injury
It has been surmised that modern footwear produces a lower level of perceived foot impact than that actually experienced and thus increases injury risk. There is good evidence to show that the more cushioning runners believe to be under the foot, the harder they strike. Furthermore, modern shoe designs are far more forgiving on poor running technique and since the athlete suffers less pain bad habits become re-inforced. In contrast, barefoot runners have been found to have a reduction in impact peak with reduced mechanical stress and enhanced ankle extensor function. In one particular study peak load in the hip and knee joints of participants with osteoarthritis was decreased significantly in barefoot walkers. These findings appear to point to the supposition that shoes may increase loads in poor physiological patterns and thus perpetuate injury.
Bipedalism has been around for millions of years and it is only relatively very recently that humans have been shod. The running technique of early distance running bipeds almost certainly differed enormously from the style that is seen today with modern foot-wear. The pre-historic �hunter-gatherer� would be more likely to have had a fore-foot or mid-foot-strike gait which studies have shown to be protective from many of the running injuries seen today.
Modern running shoes allow a greater degree of �laziness� in running style and in so doing ingrain bad habits which ultimately predispose to injury. Information on how barefoot running can be integrated into one�s training and how to overcome the obvious hazards of penetrating and friction injuries are growing at a great rate through internet forums and sites. There are already products available such as the Vibram FiveFingers� which are gaining in
popularity as the option of running barefoot or �nearly barefoot� grows. Furthermore, interest in the subject has been helped enormously by popular literature such as the bestselling book �Born to Run� by Christopher McDougall which follows the Tarahumara Indians of Northern Mexico who run ultra-marathons in simple leather strapped sandals.
In short, the evidence indicates two clear points. Firstly, from observations of populations who run barefoot or are habitually barefoot there appears to be lower injury rates versus the shod population. Secondly, the wearing of modern running shoes promotes a heavy impacting heelstrike gait which predisposes to injury. For the subject to gain wide-spread acceptance there will need to be an increase in the number of well designed prospective and randomised controlled trials on the subject.
References:
1. Clinical Sports Medicine by Peter Brukner and Karim Khan. Third Edition, Chapter 3; pp.45-55
2. Hreljac A. Impact and overuse injuries in runners.
Med Sci Sports Exerc 2004; 36:845-9 3. van Gent RN, Siem D, van Middelkoop M, van Os AG, Bierma-Zeinstra SM, Koes BW. Incidence and
determinants of lower extremity running injuries in long distance runners: a systematic review. Br J Sports Med 2007; 41(8):469-80
4. Buschbacher R, Prahlow N, Dave SJ (eds). Sports Medicine and Rehabilitation: A Sports Specific
Approac, 2nd ed. Baltimore (MD): Lippincott Williams and Wilkins; 2008, p. 200-1
5. Stacoff A, Kaelin X, Stuessi, Segesser B. The torsion of the foot in running. Int J Biomech 1989; 5:375-89
6. Lieberman DE, Venkadesan M, Werbel WA, Daoud AI, D-Andrea S, Davis IS, Mang-Eni RO, Pitsiladis Y. Foot strike patterns and collision forces in the
habitually barefoot versus shod runners. Nature 2010; 463:531-535 7. Jungers WL. Barefoot running strikes back. Nature
2010; 463:433-434 8. Robbins S, Waked E. Hazard of deceptive advertising of athletic footwear. Br J Sports Med
1997; 31(4):299-303. 9. Divert C, Mornieux G, BaurH, et al. Mechanical comparison of barefoot and shod running. Int J
Sports Med 2005; 26:593-8 10. Shakoor N, Block JA. Walking barefoot decreases loading on the lower extremity joints in knee
osteoarthritis. Arthritis Rheum 2006; 54:2923-7 11. Christopher McDougall. Born to run: the hidden
tribe, the ultra-runners and the greatest race the world has never seen. Profile books, published 2009.
12. Robbins SE, Hanna AM. Running-related injury prevention through barefoot adaptations. Med Sci Sports Exerc 1987.;19:148-56
For more information, please feel free to ask Dr. Jimenez or contact us at 915-850-0900 .
Additional Topics: What is Chiropractic?
Chiropractic care is an well-known, alternative treatment option utilized to prevent, diagnose and treat a variety of injuries and conditions associated with the spine, primarily subluxations or spinal misalignments. Chiropractic focuses on restoring and maintaining the overall health and wellness of the musculoskeletal and nervous systems. Through the use of spinal adjustments and manual manipulations, a chiropractor, or doctor of chiropractic, can carefully re-align the spine, improving a patient�s strength, mobility and flexibility.
The talk in soccer circles this week is the imminent return to action of Theo Walcott, the Arsenal and England star who damaged his knee back at the start of 2014. After 286 days of rehab, Walcott made a return to Arsenal’s Under 21 team last week. This has left journalists salivating at finding out when he will be returning to the main team.
For a young professional sports person, nine months is a long time out of the game. For Walcott, missing out on this Summer’s soccer World Cup in Brazil was perhaps more than just rubbing salt into the wound.
In issue 139 of Sports Injury Bulletin, I present a case study of a similar problem in a rugby player of identical age. This big lump of a kid ruptured his lateral meniscus in the knee — a bit different to Walcott’s ACL injury. However, this player also missed a big chunk of the season (17 weeks) and I had to live with his personal frustrations, and the yo-yo of daily emotions.
The piece shows the knee anatomy, details the types, clinical features and management of meniscus tears, and the required post-surgical rehabilitation.
On a recent Rehab Trainer course, one of the participants asked me what she should do about the small lateral meniscal tear in her knee. This is a bit like answering “how long is a piece of string?”, as it depends on so many things.
But to wrap it up in a nutshell, the surgeon will use a set of criteria to determine if a meniscal tear needs repairing, removing, or to be left well alone.
Criteria for Surgery
1. Age
The younger the patient, the more comfortable surgeons are about operating. Often the small degeneration tears in older patients are just a precursor to a knee that is about to become arthritic. With older patients, many surgeons will try for rehab first.
2. Function
This depends on what the knee has to do. If the patient does nothing but collect stamps all day and the knee does not bother them, then clearly the surgeon will want to leave it alone. But if the patient is an athlete with a repetitive catching and locking knee due to a meniscal tear, they will be more comfortable about operating.
3. Type of tear
Issue 139 of Sports Injury Bulletin details the types of tears we see in meniscus. In short, tears such as bucket handle tears do not do well without surgery, while small longitudinal tears can do well without surgery.
4. Location of tear
The outer portion of the meniscus has a nice, rich blood supply (hence, called the “red-red zone”). These areas can do well if left alone. Inner third zone tears (the “white zone”) with no blood supply don’t heal, so they need repairing or removing.
So, if the patient is lucky and fits the criteria for conservative management, or let’s say they simply don’t want surgery, then what options do we have to prevent the injury from getting worse?
Suggestions to Avoid Further Meniscus Injuries
Avoid positions that catch the meniscus. For example, full squatting may catch the posterior horn of the meniscus and flare it up, so the patient has to learn to avoid these positions if possible.
Keep the quadriceps working. If the quads remain strong and active then the shearing effect of the tibia moving across the femur is reduced. This will limit the stress to the meniscus.
Watch for swelling. Regular assessments for a knee effusion (called a “fluctuation test”) may need to be done a few times a week to make sure the knee stays dry. The knee’s biggest enemy is an effusion as it shuts off the quads straight away.
Intervene if the knee has an effusion. Donut felt compression, regular icing, NSAIDS if indicated, needle aspiration if indicated. Avoiding an effusion at all costs is pretty important for any knee injury.
For more information, please feel free to ask Dr. Jimenez or contact us at 915-850-0900 .
Preventing Sports Injuries
Many athletes largely depend on chiropractic care to enhance their physical performance. New research studies have determined that aside from maintaining overall health and wellness, chiropractic can also help prevent sports injuries. Chiropractic is an alternative treatment option utilized by athletes to improve their strength, mobility and flexibility. Spinal adjustments and manual manipulations performed by a chiropractor can also help correct spinal issues, speeding up an athlete’s recovery process to help them return-to-play as soon as possible.
A common soccer move — bouncing the ball off of the head — may not be as harmless to the brain as has been thought, new research suggests.
A study of more than 200 adult amateur soccer players of both genders found that regularly “heading” the ball, as well as suffering accidental hits to the head, significantly boosted a player’s risk of concussion.”The prevailing wisdom is that routine heading in soccer is innocuous and we need only worry about players when they have unintentional head collisions,” study leader Dr. Michael Lipton, of the Albert Einstein College of Medicine in New York City, said in a college news release.”But our study suggests that you don’t need an overt collision to warrant this type of concern,” said Lipton. He is professor of radiology, psychiatry and behavioral sciences at Einstein.Another concussion expert who reviewed the findings agreed.Soccer Athletes at Risk
The study “seems to provide additional evidence that such practices within the game of soccer can put athletes at risk for traumatic brain injury,” said Dr. Jamie Ullman. She directs neurotrauma at North Shore University Hospital in Manhasset, N.Y.Much of the research into sports-related concussions has concentrated on high-impact sports, such as football or hockey. But head trauma experts have long known that other sports — including soccer and rugby — might carry risks, too.In prior studies, Lipton said his team found that “30 percent of soccer players who’d had more than 1,000 headings per year had a higher risk of microstructural changes in the brain’s white matter, typical of traumatic brain injury, and worse cognitive performance.”Exploring the issue further, the new study focused on online questionnaires answered by 222 adult amateur soccer club players in the New York City area, both male and female. All had played soccer at least six months during the prior year.Men averaged 44 headers in two weeks, the survey found, while women averaged 27. One or more accidental head impacts, such as a ball hitting the back of the head or a head colliding with another player’s knee, were reported by 43 percent of women and 37 percent of men.Players who regularly headed the ball were three times more likely to have concussion symptoms than those who didn’t head the ball often, Lipton’s team reported.Players who suffered accidental head impacts two or more times within a two-week span were six times more likely to have concussion symptoms than those without accidental head impacts, the findings showed.Of those who headed the ball or reported accidental head impacts, 20 percent had moderate to severe concussion symptoms, according to the report.Of the seven players with very severe symptoms, six had two or more unintentional head impacts over two weeks, four were among those who headed the ball the most, and three were in the group that headed the ball second-most.Lipton stressed that the findings cannot be generalized to child, teen or professional soccer players.Still, “our findings certainly indicate that heading is more than just a ‘sub-concussive’ impact, and that heading-related concussions are common,” Lipton said. “We need to give people who have these injuries proper care and make efforts to prevent multiple head impacts, which are particularly dangerous.”That means watching out for symptoms, he added.”Many players who head the ball frequently are experiencing classic concussion symptoms — such as headache, confusion and dizziness — during games and practice, even though they are not actually diagnosed with concussion,” Lipton explained.”Concussion sufferers should avoid additional collisions or head impacts during the following days or weeks, when their risk of incurring a second concussion is extremely high,” he said. “Because these injuries go unrecognized and unmanaged, there may be important clinical consequences for the short and long term.”Dr. Salman Azhar is a neurologist and director of stroke services at Lenox Hill Hospital in New York City. He said the new findings are in accordance with prior studies, and the odds for concussion appeared to rise along with the frequency of head impacts.”The chance of having moderate-to-severe symptoms increased when the unintentional heading went from just one per two-week period to two per two-week period,” Azhar noted.The study was initially published online Feb. 1 in the journal Neurology.
For more information, ask Dr. Jimenez or contact us at 915-850-0900
Presented By:
Dr. Alex Jimenez D.C.,C.C.S.T
Spinal Trauma Specialist
Concussions, or head injuries, are considered to be some of the most common sports injuries. Athletes can experience head trauma due to a variety of injuries and accidents related to their specific sport. While there are various symptoms which can characterize the presence of a concussion, recent research studies have found that certain markers in the blood can predict an athlete’s recovery from a head injury.
Researchers at the National Institutes of Health found that the blood protein tau could be an important new clinical biomarker to better identify athletes who need more recovery time before safely returning to play after a sports-related concussion. The research study, supported by the National Institute of Nursing Research or NINR, with additional funding from the Eunice Kennedy Shriver National Institute of Child Health and Human Development, or NICHD, published online in the Jan. 6, 2017 issue of Neurology, the medical journal of the American Academy of Neurology.
How Blood Markers Can Help Athletes with Concussions
Despite the millions of sports-related concussions that occur annually in the United States, there is no reliable blood-based test to predict recovery and an athlete’s readiness to return to play. The new study shows that measuring tau levels could potentially be an unbiased tool to help prevent athletes from returning to action too soon and risking further neurological injury.
“Keeping athletes safer from long-term consequences of concussions is important to players, coaches, parents and fans. In the future, this research may help to develop a reliable and fast clinical lab test that can identify athletes at higher risk for chronic post-concussion symptoms,” said NINR Director Patricia A. Grady Ph.D., R.N.�
Athletes who return to play before full recovery are at high risk for long-term symptoms like headaches, dizziness, and cognitive deficits with subsequent concussions. About half of college athletes see their post-concussive symptoms resolve within 10 days, but in others, the symptoms become chronic.
Tau is also connected to development of Alzheimer’s and Parkinson’s diseases, and is a marker of neuronal injury following severe traumatic brain injuries.
In the study, led by Dr. Jessica Gill, NIH Lasker Clinical Research Scholar and chief of the NINR Division of Intramural Research’s Brain Injury Unit, researchers evaluated changes in tau following a sports-related concussion in male and female collegiate athletes to determine if higher levels of tau relate to longer recovery durations.
“Incorporating objective biomarkers like tau into return-to-play decisions could ultimately reduce the neurological risks related to multiple concussions in athletes,” said Gill.
To measure tau levels, a group of 632 soccer, football, basketball, hockey, and lacrosse athletes from the University of Rochester first underwent pre-season blood plasma sampling and cognitive testing to establish a baseline. They were then followed during the season for any diagnosis of a concussion, with 43 of them developing concussions during the study. For comparison, a control group of 37 teammate athletes without concussions was also included in the study, as well as a group of 21 healthy non-athletes.
Following a sports-related concussion, blood was sampled from both the concussed and control athletes at six hours, 24 hours, 72 hours, and seven days post-concussion.
Concussed athletes who needed a longer amount of recovery time before returning to play, (more than 10 days post-concussion) had higher tau concentrations overall at six, 24, and 72-hours post-concussion compared to athletes who were able to return to play in 10 days or less. These observed changes in tau levels occurred in both male and female athletes, as well as across the various sports studied.
Together, these findings indicate that changes in tau measured in as short a time as within six hours of a sports-related concussion may provide objective clinical information to better inform athletes, trainers, and team physicians’ decision-making about predicted recovery times and safe return to play.
Further research will test additional protein biomarkers and examine other post-concussion outcomes.
Preventing Sports Injuries with Chiropractic
Chiropractic care is frequently utilized by athletes to treat common sports injuries. Aside from treating the side effects associated with concussions, chiropractic can help relieve neck pain and back pain caused by an injury or accident. Chiropractic care can also help prevent sports injuries from occurring as the spinal adjustments and manual manipulations can help improve the strength, flexibility and mobility of the structures surrounding the spine, particularly improving the health and wellness of the neck and head.
Organization Information
About the National Institute of Nursing Research (NINR): NINR supports basic and clinical research that develops the knowledge to build the scientific foundation for clinical practice, prevent disease and disability, manage and eliminate symptoms caused by illness, and enhance end-of-life and palliative care. For more information about NINR, visit the website at www.ninr.nih.gov.
About the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD): NICHD conducts and supports research in the United States and throughout the world on fetal, infant and child development; maternal, child and family health; reproductive biology and population issues; and medical rehabilitation. For more information, visit NICHD’s website.
About the National Institutes of Health (NIH): NIH, the nation’s medical research agency, includes 27 Institutes and Centers and is a component of the U.S. Department of Health and Human Services. NIH is the primary federal agency conducting and supporting basic, clinical, and translational medical research, and is investigating the causes, treatments, and cures for both common and rare diseases. For more information about NIH and its programs, visit www.nih.gov.
For more information, ask Dr. Jimenez or contact us at 915-850-0900�. �
By Dr. Alex Jimenez D.C.,C.C.S.T
Spinal Trauma Specialist
Additional Topics: Neck Pain and Auto Injury
Neck pain is characterized as the most prevalent symptom after being involved in an automobile accident. During an auto collision, the body is exposed to a sheer amount of force due to the high speed impact, causing the head and neck to jolt abruptly back-and-forth as the rest of the body remains in place. This often results in the damage or injury of the cervical spine and its surrounding tissues, leading to neck pain and other common symptoms associated with whiplash-related disorders.
As a team physician for the St Louis Cardinals during their 2011 World Series Championship season, I learned a lot about the importance of players taking care of themselves firsthand. I would see players preparing themselves both mentally and physically for the game ahead. Kids look up to these players and emulate them. Major League Baseball (MLB) recognizes this and wants their youth players to be healthy and play as safely as possible. This is why MLB took time, energy, and resources, to determine what would be best for today�s young pitchers. Below is a snapshot of what the MLB and the American Sports Medicine Institute (ASMI) found as risk factors for the young pitcher. It�s recommended that these guidelines be followed by coaches, parents, and players.
The MLB Pitch Smart guidelines provide practical, age-appropriate parameters to help parents, players, and coaches avoid overuse injuries and encourage longevity in the careers of young pitchers.
It was found that specific risk factors were seen as creating a higher incidence of injuries. According to the ASMI, youth pitchers that had elbow or shoulder surgery were 36 times more likely to regularly have pitched with arm fatigue. Coaches and parents are encouraged to watch for signs of pitching while fatigued during their game, in the overall season, and during the course of the entire year.
The ASMI also found that players that pitched more than 100 innings over the course of a year were 3.5 times more likely to be injured than those who did not exceed the 100 innings pitched mark. It�s important to note that every inning counts. Games and showcase events should count toward that total number of 100.
Rest is key. Overuse on a daily, weekly, and annual basis is the greatest risk to a young pitcher�s health. Numerous studies have shown that pitchers that throw a greater number of pitches per game, as well as those who don�t get enough rest between outings, are at a greater risk of injury. In fact, in little league baseball, pitch count programs have shown a reduction in shoulder injuries by as much as 50% (Little League, 2011). Setting limits for pitchers throughout the season is vitally important to their health and longevity in the game.
Pitching with injuries to other areas of the body will also affect a player�s biomechanics and change the way he delivers his pitch. An ankle, knee, hip, or spinal injury can cause changes in the biomechanics of how a player throws and will put more stress on his arm. Be cautious with these injuries, because at times the changes in the mechanics of the player can be very subtle; however, they can cause a significant amount of strain on a player�s pitching arm.
For best results for your youth baseball player�s longevity in the sport and keeping a healthy arm for seasons to come follow the MLB�s pitch count and required rest guide.
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3 Common Shoulder Sports Injuries
The shoulder is the most mobile joint in the body, which also makes it prone to injury. If you�re an athlete, taxing your shoulder over time with repetitive, overhead movements or participating in contact sports may put your shoulder at risk for injury.
There are several nonsurgical and surgical options available to treat labrum tears in the shoulder.
These are three common shoulder injuries caused by sports participation:
1. SLAP Tear
This is a tear to the ring of cartilage (labrum) that surrounds your shoulder’s socket. A SLAP tear tends to develop over time from repetitive, overhead motions, such as throwing a baseball, playing tennis or volleyball, or swimming.
Athletic performance decreases. You have less power in your shoulder, and your shoulder feels like it could �pop out.�
Certain movements cause pain. You notice that pain occurs with certain movements, like throwing a baseball or lifting an object overhead.
Range of motion decreases. You may not throw or lift an object overhead like you used to, as your range of motion decreases. You may also find reaching movements difficult.
Shoulder pain you can�t pinpoint. You have deep, achy pain in your shoulder, but you can’t pinpoint the exact location.
It�s common to experience shoulder instability if you�re an athlete. This injury can occur if you�re participating in contact sports, including football or hockey, or ones that require repetitive movements, like baseball.
Shoulder instability happens when your ligaments, muscles, and tendons no longer secure your shoulder joint. As a result, the round, top part of your upper arm bone (humeral head) dislocates (the bone pops out of the shoulder socket completely), or subluxates (the bone partially comes out of the socket).
Dislocation is characterized by severe, sudden onset of pain; subluxation (partial dislocation) may be accompanied by short bursts of pain. Other symptoms include arm weakness and lack of movement. Swelling and bruising on your arm are visible changes you may also notice.
This is another injury commonly seen in athletes participating in repetitive, overhead sports, including swimming and tennis. Rotator cuff injuries are typically characterized by weakness in the shoulder, reduced range of motion, and stiffness.
Being aware of these injuries and knowing their symptoms may encourage you to seek medical treatment sooner; early treatment intervention could result in a better outcome and earlier return to sports.
There�s nothing more frustrating for an athlete than sitting injured on the sidelines watching others compete. Although there�s not one foolproof way to stop shoulder pain from occurring, there are several tips that may help prevent it from starting or getting worse.
If you notice shoulder pain during certain activities, say while throwing a baseball or swimming, stop that activity for a period of time and find an alternative exercise, such as riding a stationary bike. Doing so can give your shoulder some time to rest and heal, while maintaining your cardiovascular fitness.
At the same time, don�t eliminate all shoulder movement. This is because you don�t want to develop a stiff shoulder from infrequent use. Consider doing some mild stretches to keep your arm moving.
2. Change Your Sleeping Position
If you notice pain in your right shoulder, don�t sleep on your right side. Try sleeping on your left side or back instead. If sleeping on your back irritates your shoulder, try propping your arm up with a pillow.
3. Warm Up
Exercising cold muscles is never a good idea. Before practicing your volleyball serve or baseball pitch, warm up your body with mild exercise. For example, start walking for a few minutes and gradually build up to a jog. Doing so raises your heart rate and body temperature and activates the synovial fluid (lubricant) in your joints.1 In other words, a mild warm up gets your body ready for the intense workout that follows.
4. Build Up Your Endurance
It�s a good idea to increase your endurance over time. If it�s been a few weeks or months since you�ve hit the tennis court, consider playing for a short period of time�maybe just 20 minutes to start�and build up to a longer period of playing time. Don�t fall into the trap of doing too much too soon, especially when your body is not used to it.
Strengthening your shoulder muscles can help provide support and stabilization to your shoulder joint. This, in turn, may prevent painful injuries like a shoulder dislocation, which is when the ball of your shoulder comes out of its socket.
Speak to your doctor before starting a strengthening program. They can suggest exercises to perform or may recommend working with a physical therapist.
6. Cross-Train
Some sports are particularly taxing on the shoulder due to repetitive, overhead movements. So you may want think about cross-training. If you�re a swimmer, for example, alternate some of your swimming workouts with a running or biking workout to reduce the stress on your shoulder, while still staying physically fit.
Alternatively, if you�re a painter or construction worker�two occupations commonly associated with repetitive, overhead movements�talk to your boss and ask if there are other non-repetitive tasks you can take on.
Above all, listen to your body and be proactive. You may need to make some adjustments to workout or daily routine to help prevent further damage down the road. It may also be worth getting your doctor�s input, even if you think you�ve got a minor injury. Catching injuries or discomfort early may help keep you in the game and prevent painful injuries down the road.
Being aware of sports�injuries and knowing their symptoms may encourage you to seek medical treatment sooner as early treatment intervention could result in a better outcome and earlier return to sports.�For Answers to any questions you may have please call Dr. Jimenez at
Exercise is an important part of a healthy lifestyle, and sports are one approach many people choose to use to get their exercise.
For people with back pain, sports can still be a viable option if they pay attention to their back.
For others who participate in sports, knowing the type of strain various sports place on the back may help prevent a back injury.
This article gives specific information about sports injuries and back pain from bicycling, weight lifting, running, swimming, skiing, golf, and tennis.
Types of Sports-Related Back Injuries
In any sport, injuries to any part of the spine are possible, as well as injuries to the soft tissue and fascia that help comprise the makeup of the body. Up to 20% of all injuries that occur in sports involve an injury to the lower back or neck.
Lower Back Injury
The lower back is subject to a great deal of strain in many sports. Sports that use repetitive impact (e.g., running), a twisting motion (e.g. golf), or weight loading at the end of a range-of-motion (e.g., weightlifting) commonly cause damage to the lower back.
Neck Injury
The neck is most commonly injured in sports that involve contact (e.g., football), which place the cervical spine (neck) at risk of injury.
Upper Back Injury
The thoracic spine (mid portion of the spine at the level of the rib cage) is less likely to be injured because it is relatively immobile and has extra support. Injuries seen here can involve rib fracture and intercostal neuralgia as well as intercostal muscle strains in sports that involve rotation of the torso (e.g. weight training with rotation), swimming, golf, tennis, and even skiing.
Stretching and Warm-Up Prior to Exercise
While static stretching prior to any type of exercise used to be recommended, a number of studies in recent years have shown that stretching the muscles prior to exercise is not needed. A number of studies have shown that it does not help prevent injury, and likely does no harm either.1,2,3
For every sport, a thorough warm-up should be completed before starting to play. The warm-up will target the muscles used in that sport, but it should also prepare the back for the stresses to come.
The warm-up used should be specific to the sport to be played. A typical warm-up should include:
Increase circulation gradually by doing some easy movement (such as walking) to increase blood circulation to the muscles and ligaments of the back
Stretch the lower and upper back and related muscles, including hamstrings and quadriceps
Start slowly with the sport movements (e.g. swing the golf club, serve the ball)
Work with a Professional to Prevent or Manage Back Injury
There are professionals or instructors in almost every sport who are willing to share their expertise. Ideally, someone with this type of expertise can teach the correct form for a new sport or help develop and keep the proper technique for a current sport.
Before starting to work with any sports or exercise professional, it is advisable to inquire about his or her credentials. In general, if the individual is certified by the National Strength and Conditioning Association (NSCA), he or she should be up to date on the latest evidence related to stretching, exercise routines for specific sports, and additional information designed to benefit your personal routine.
Mets’ Infield, Chiropractor Is The Most Important Position
There are many ways to describe the Mets� projected starting infield of David Wright, Asdrubal Cabrera, Neil Walker and Lucas Duda. But two weeks ago, as Mets Manager Terry Collins discussed how he would handle their playing time, he provided a telling answer while rattling off the positions.
�We�ve got a bad back, bad back, bad knee and a bad back,� Collins said, referring to Wright, Walker, Cabrera and Duda.
The 2017 Mets, for all of their potential and talent, cannot ignore a significant question mark: health. Aside from the arm-related injuries of the pitching staff, the condition of the spines of three key infielders will hover over the team all season.
Wright, the long-tenured third baseman, has played only 75 games during the past two seasons; part of the reason was neck surgery in June, but mostly it is because of spinal stenosis, a chronic condition. Walker, the second baseman, had surgery to repair a herniated disk in his lower back in September. And Duda, the power-hitting first baseman, missed four months last season because of a stress fracture in his lower back.
All three reported to spring training relatively healthy; in Wright�s case, fusion surgery on a herniated disk in his neck had healed. But only two days into the exhibition schedule, the Mets have suffered a setback.
After experiencing what he said was a pain-free off-season, Duda reported feeling spasms in his back late last week. The pressure had an adverse effect on his hips, and he received a cortisone shot on each side Friday.
�So we�ll take a few days now instead of two weeks down the road,� Duda said. �Just being cautious.�
That should be the Mets� motto all year.
Although baseball players put repeated strain on their core when pitching or swinging, they do not suffer more back injuries than athletes in sports that entail more forceful impact, such as football or hockey, said Dr. Andrew C. Hecht, the chief of spine surgery for Mount Sinai Health System, who wrote a soon-to-be-released book on spine injuries in athletes.
�What happens when you have a few on one particular team is that it highlights it,� Hecht said.
Walker�s injury was the simplest. He first felt discomfort in his lower back and tingling in his leg late during the 2012 season, which he thought was caused by the sport�s day-to-day rigors. Some back pain recurred in the years that followed, but never to the degree that it did last season, when he said he also experienced numbness in his leg and foot.
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Hecht, who is not involved in the treatment of these Mets players, said lumbar disk herniation like Walker�s is �as common as common can be.� Surgery to repair the injury involves removing only the part of the herniated disk that is pinching the nerve and causing the pain, Hecht said.
Walker, 31, said he completed his physical therapy in less than three months and went through normal off-season workouts. Although he is healthy now, Walker said that he has a regimen of daily exercises and stretches to keep his back in good shape.
Despite the back ailment last season, Walker still hit .282, with 23 home runs and a career-high .823 on-base-plus-slugging percentage. The Mets felt confident enough in his recovery that they gave him a one-year, $17.2 million qualifying offer. Walker accepted, and the sides have talked about a contract extension.
Duda�s injury, a vertebral crack, is another common back ailment in athletes, Hecht said. The usual treatment is rest and rehabilitation.
Before his recent flare-up of back spasms, Duda, 31, said he, too, was regularly doing exercises to support his back. Until last week, there was reason to be optimistic about Duda�s outlook because, after missing 107 games last season, he returned in September to play eight games.
Still, as a precaution, right fielder Jay Bruce took ground balls at first base during workouts on Sunday. Jose Reyes and Wilmer Flores are options to back up Walker; Cabrera, the infielder with the balky knee last season; and Wright.
Wright�s stenosis, a narrowing of the canal in the spinal cord that can lead to chronic stiffness and pain, is the most complicated ailment. Hecht said the condition was rare among younger athletes, and while Wright is only 34, he is entering his 14th major league season.
Wright said doctors have told him his condition was the �perfect storm� of three factors. He was born with a narrow spinal canal, Wright said, explaining, �Ideally, you�d want a little more space so that those nerves don�t get pinched.� Wright also sustained a vertebral fracture years ago, which, along with the wear and tear of playing so much baseball, has contributed to his injury.
Wright had neck surgery in June, for an injury that he said was unrelated to his spinal stenosis, which was diagnosed in May 2015. After rest and rehabilitation, he returned to the field in August 2015, but he often required hours of stretching and preparation to play. That kind of maintenance is expected to continue for the rest of his career.
While expectations of how much Wright can play will be tempered again this season, he can try to limit the effects of spinal stenosis. Compared with last year, Wright said, he has a better idea of how to manage his back in spring training, even though he is still building up his arm strength after his neck surgery.
�I know the routine and the process,� he said. �I understand my body a little bit better.�
In any sport, injuries to any part of the spine are possible, as well as injuries to the soft tissue and fascia that help comprise the makeup of the body. Up to 20% of all injuries that occur in sports involve an injury to the lower back or neck.�For Answers to any questions you may have please call Dr. Jimenez at
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