Avoiding Shoulder Injury during Baseball Spring Training

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The shoulder is the most flexible joint in the body with a range of nearly 1,000 different positions. Because of that flexibility, it is the area most prone to injury whether you pitch or play the field. Throwing a baseball sends a tremendous amount of twisting force, called torque, into the rotator cuff. Leading Sports Medicine Doctor Kevin Plancher on preseason tips for staying injury free.

Former Dodgers catcher Roy Campanella says, "You gotta be a man to play baseball for a living, but you gotta have a lot of little boy in you." When spring training starts, it's tempting to hit the field with a little boy's energy. But according to Kevin D. Plancher, M.D., a leading orthopaedic surgeon and sports medicine expert, pre-season conditioning is crucial to preventing a shoulder injury that could mean game over.

The shoulder is the most flexible joint in the body with a range of nearly 1,000 different positions. "Because of that flexibility, it is the area most prone to injury whether you pitch or play the field," says Dr. Plancher.Throwing a baseball sends a tremendous amount of twisting force, called torque, into the rotator cuff (a series of four small muscles that holds the shoulder in place and decelerates the arm). Nearly 60 percent of pitchers suffer some form of shoulder injury during a season. After signing a three-year, $47 million deal with the Los Angeles Dodgers prior to the 2007 season, pitcher Jason Schmidt started a few games before a debilitating rotator cuff injury took him off the field. Two surgeries later, he was relegated to the minors.

It's not just pros who need to go slow: weekend warriors and youths should also take precautions before it's time to play ball. Shoulder-related injuries and surgeries have increased three-fold in the last decade for youths who play baseball. Although it's not a contact sport, hundreds of kids are seriously injured each year playing baseball.

Dr. Plancher outlines his recommendations for pre-season conditioning and best practices once it's time to play ball:

Weight training Exercises should focus on strengthening the rotator cuff and the muscles that stabilize the shoulder. Each repetition should be performed with relatively light weight since the rotator cuff muscles can be injured by too much weight; the goal is not to lift increased amounts but to strengthen the underused muscles that hold the shoulder together. "Players should do simple exercises such as the forward dumbbell raise or the lateral fly and substitute an incline press for a military press to avoid injury," notes Dr. Plancher. Professional baseball players often lift weights three or four times a week with one day off between sessions to allow the body to rebuild.

Easy does it "Because the rotator cuff muscles are smaller, weaker muscles, they tend to fatigue at a faster rate when engaged in strenuous activity," says Dr. Plancher. The goal of these drills is to improve efficiency of movement, not conditioning; once the muscles become fatigued, joint function is compromised and the risk of injury increases.

Cardio counts A cardiovascular fitness routine is the foundation for resilient muscles; aim for 20 to 30 minutes a day.

Don't start the engine cold Before hitting the field, Dr. Plancher recommends that players warm up with aerobic activity to get the blood flowing to muscles and joints. This should include 10 to 15 minutes of pre and post-game stretching to keep stressed areas flexible and strong. A strong shoulder involves greater dynamic range of motion but should not create hyper-flexibility through improper static stretching techniques. Proper warm up techniques include forward/backward arm circles, external/internal rotations, and arm pumps.

Avoid moonlighting Dr. Plancher cautions against pitching in multiple leagues simultaneously because the body needs a break from the constant wear and tear of throwing. To reduce overuse injuries, Little League Baseball officially advises that pitching be limited to a maximum of six innings per week and include mandatory rest periods between starts (the ideal is four days off).

Be a team player Parental involvement in a child's league is critical. Parents may be the first to notice early signs of injury in their child and they are the best defense when a coach pushes too hard.

Perfect your technique Hitting, throwing or pitching a ball incorrectly can further stress the shoulder.

Know when to quit Avoid the temptation to play through pain; most joint injuries only worsen with continued stress. "Players need to recognize the difference between an overuse injury, which tends to be less severe and responsive to self-treatment, and a traumatic injury, which should be evaluated by an orthopaedist immediately," says Dr. Plancher. In general, athletes should call a doctor if a significant affliction fails to improve within 24 hours; if they hear a popping or cracking sound with the injury; if they experience muscle weakness; if they have significant pain, swelling or fever.

Rest Most rotator cuff injuries will resolve themselves within 3-4 weeks if they receive the RICE treatment - Rest, Ice, Compression, and Elevation. "Resting the joint immediately and coaxing it back into service with gentle stretches and strengthening exercises as it heals is far better than rushing the rehabilitation," Dr. Plancher notes. "An incompletely healed joint is more likely to be reinjured."

No pain, all gain Massage prevents scar tissue from building up and promotes connective tissue repair as well as joint fluid production. Athletes who need an excuse to schedule one can rationalize that massage may be just what the Doctor ordered.

About Dr. Plancher: Kevin D. Plancher, M.D., M.S., F.A.C.S., F.A.A.O.S., is one of the nation's leading orthopaedic surgeons and sports medicine experts, specializing in the treatment of knee, shoulder, elbow and hand injuries. He is Associate Clinical Professor in Orthopaedics at Albert Einstein College of Medicine in New York City, an official surgeon of the U.S. Ski and Snowboard Teams. the Head Team physician for the professional lacrosse team, the Long Island Lizards and Team Physician for the United Football League, a an Independent professional American Football league that began play in October 2009. Dr. Plancher is on the editorial review board of the Journal of the American Academy of Orthopaedic Surgeons. In 2007, 2008 and 2009, Castle Connolly Medical Ltd., a New York City research company, named Dr. Plancher America's Top Doctor in Sports Medicine. Every year from 2001 to 2009 he has been included in Castle Connolly's list of Top Doctors in the New York Metro area, as published in New York Magazine's yearly "Best Doctors" issue.

Dr. Plancher received his M.D. degree (cum laude) and an M.S. degree in physiology from Georgetown University in Washington, DC. He completed his residency at Harvard University's orthopaedic program and a fellowship at the Steadman-Hawkins Clinic in Vail, Colo., where he studied shoulder and knee reconstruction and served as consultant to the clinic for six years. He has been team physician for more than 15 high school, college and national championship teams.

An attending physician at Beth Israel Hospital in New York City and Stamford Hospital in Stamford, CT, he maintains offices in Manhattan and Greenwich, CT. http://www.plancherortho.com Dr. Plancher lectures extensively in the U.S. and abroad on issues related to orthopaedic procedures and injury management. He also has been named to the sports medicine arthroscopy program subcommittee for the American Academy of Orthopaedic Surgeons. Dr. Plancher has been awarded the Order of Merit (magna cum laude) for distinguished philanthropy in the advancement of orthopaedic surgery by the Orthopaedic Research and Education Foundation. In 2001, he founded The Orthopaedic Foundation for Active Lifestyles, a not-for-profit foundation focused on maintaining and enhancing the physical well-being of active individuals through the development and promotion of research and supporting technologies. http://www.ofals.org

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MELISSA CHEFEC
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