Frequent Injuries in Baseball

Most Common Injuries in Baseball

For obvious reasons, baseball isn’t considered a high-risk sport like football or ice hockey – mostly because it isn’t a collision sport. Regardless, baseball brings its own risks. You are running, jumping, sliding (sometimes) and swinging a bat at a high velocity which puts you in danger of muscle strain, especially after long practice sessions. Consequently, baseball players frequently suffer from golf and tennis elbow – their ligaments are fatigued and deteriorating over time; and we haven’t even considered the risk of falling, collisions, and the danger associated with a hard ball flying at over 99m/h (albeit a generous estimate for most).

Types of Shoulder Pain

The most commonly overused muscle in baseball is the shoulder – usually during pitching. Shoulder tendonitis is common in young athletes who use overhead throws and the windmill pitch can cause a myriad of problems, especially when combined with poor form. Torn rotator cuffs can develop in the rotator cuff tendons and older players may begin experiencing Frozen Shoulder which reduces motion and causes pain in the shoulder joint. The shoulder can become unstable when combined with long periods of overhead throwing as the motion stretches the ligaments, leading to loose joints and sometimes dislocation. Finally, and possibly all pitchers’ worst nightmare is the Shoulder Separation – which is a traumatic injury that is a result of falling or colliding with a hard object with an outstretched hand.

Pain in the Elbow

Throughout the last couple of weeks, we outlined exactly what Tennis and Golfer’s Elbow was, and top ways of curing. We will go over it quickly now, but if you want a more in-depth guide, follow the links below.

Golfers Elbow and how to treat it – Click Here

Tennis Elbow and how to treat it – Click Here

PRICE Routine to help with minor sprains – Click Here

Tennis and Golfer’s Elbow are like two sides of the same coin. When the tendons in the arm are overloaded we often experience a dull pain on the outside of the forearm. Tennis Elbow denotes a pain felt due to overuse on the outside of the arm above the elbow whereas Golfer’s elbow is in a similar location but slightly under the elbow. Follow the links above to learn more.

Overloading the Spine

The human spine is a wonderous structure – we really couldn’t function without it. It transmits information from nerve endings all over the body through the central nervous system to the brain, and if that wasn’t enough, it is also the structure that keeps us standing up straight on two legs. It’s worth looking after your spine. Baseball poses a slight risk to the spine. Although admittedly it is a small risk – because the spine is so important – it is worth covering.

Catchers are prone to back injury during baseball due to the crouched position and overhead throwing. Some pitchers may also experience back damage especially when using the windmill pitch.

The most common damage sustained to the spine is muscle strains in the upper and lower back. This is usually dealt with rather simply by a physiotherapist or a sports massage (and rest). However, there is also a risk of a herniated disk which is when a disc in the spine ruptures and pinches surrounding nerves. This can be an agonizing experience. If you believe you have suffered from a herniated disc you should seek medical attention immediately. Even if it was only a small rupture, the damage could be exponentially augmenting each time you play – eventually leading to a severe hernia. As always, prevention is the best form of treatment.

If you have suffered from anything mentioned above and believe you could benefit from a rehab plan or require medical attention, please contact us at Mount Sinai Department of Rehabilitative Medicine for a bespoke rehab plan. We’ll get you back on the field ASAP. Contact our switchboard at (212) 241-6321

How to Deal With Sciatica, The Do’s and Don’ts

How to deal with sciatica, the do’s and don’ts

This week, we are going to look at ways of managing sciatica. In our previous blog we looked at what sciatica is, and suggested some causes of the problem. To quickly recap, sciatica is the compression of the sciatic nerve – which in turn causes pain down the lower back, through the hamstring all the way to the foot. What is most important to remember when dealing with sciatica, is that is a symptom, and not the underlying problem itself.

The first step when dealing with sciatica is diagnosing the underlying issue. The root of the problem can be anything from a slipped disc in the spine, to a spinal stenosis, or in more serious cases, a tumor. It could even come from a small fracture in the hip. Although we can treat sciatica without dealing with the genesis of the problem, you are more likely to experience a reoccurrence of sciatic pain if we do not.

We recommend that if you suffer from sciatica, get a diagnosis on what caused it. That way we can deal with the pain alongside remedying the original problem, and reduces the chances of it reoccurring.

For now, let’s look at some of Mount Sinai’s recommendations for dealing with sciatica at home.

Conservative (non-surgical) treatment is best in most cases. When you are suffering from sciatica, or begin suffering due to some other cause, apply heat or ice to the painful area. Try the ice first (48-72hrs); then use heat on the pain. Over the counter pain relievers such as ibuprofen or acetaminophen can also help with inflammation and general pain relief.

Surprisingly to a lot of patients, bed rest is not recommended. Although short term bed rest may be needed for patients in extreme pain, staying inactive and reclined for long periods of time weakens the body and extend the life of agonizing symptoms.

Upon first suffering the symptoms of sciatica, it is recommended to tone down your physical activity for the first few days, and gradually work your way back to your daily routine.

You should reduce your activity in the first couple of days – and gradually adjust your body to your usual activities. This will ensure you do not overstress any of the damaged components, and give your body time to adapt.

Patients are recommended to start exercising again after around 2-3 weeks. You should include exercises to strengthen your abdominal muscles and improve flexibility in your spine.

If weightlifting or contact (collision) sports such as American Football are part of your usual exercise routine, you should not return to your sport/hobby for at least 6 weeks since the pain began. Do not lift heavy objects or twist your back. Your physician can help identify good exercises to remedy sciatica.

More serious complications depend on the causes of sciatica, such as slipped discs or spinal stenosis. Call a provider immediately if you have:

·        Unexplained fever with back pain

·        Back pain after a severe blow or fall

·        Redness or swelling on the back or spine

·        Pain traveling down your legs below the knee

·        Weakness or numbness in your buttocks, thigh, leg, or pelvis

·        Burning with urination or blood in your urine

·        Pain that is worse when you lie down, or awakens you at night

·        Severe pain and you cannot get comfortable

·        Loss of control of urine or stool (incontinence)

Also call if:

·        You have been losing weight unintentionally (not on purpose)

·        You use steroids or intravenous drugs

·        You have had back pain before, but this episode is different and feels worse

·        This episode of back pain has lasted longer than 4 weeks

Sciatica usually goes away on its own if you follow our guidelines. However, if you need a consultation, or are suffering from any of the symptoms outlined at the end of the article, please contact us on (212) 241-6321 to book an appointment.

Age-Related Musculoskeletal Changes

As we get older our bodies become more fragile, as bone and muscle densities reduce, increasing the likelihood of broken bones and body instability. Movement may become slower, and walking gait may become shorter, more unsteady, and with less swinging of the arms. Older individuals may become tired more easily and perform tasks less energetically, but what are the internal processes that drive these changes in musculoskeletal function?

From around the age of thirty bone mass begins to decrease in both men and women, increasing in rate in women after the onset of menopause. As a result, the risk of bone fractures increases. One common feature of ageing is a gradual shrinking in size. This is due to fluid loss in the spinal disks. Between the vertebral bones in the back are the gel-like cushions which serve to absorb shocks between the vertebrae. With age these discs begin to lose fluid, meaning the spinal bones grow closer together and the spine shrinks. Furthermore, the actual bones begin to lose mineral content, becoming thinner. Being less rigid the spinal column becomes curved, adding to the appearance of height loss.

As with the spinal disks, lubricating fluid between joints may also be lost during the ageing process, reducing protection against cartilage rubbing together and wearing away. As a result, the joints may become stiffer and less flexible, increasing the risk of developing arthritis. As bone wears away the minerals may be deposited around joints and calcify, causing extra joint stiffness.

In tandem with skeletal wear, the muscular system is also affected by age. As bone density decreases around one's 30s so does muscle mass. The result of this muscle loss, known as sarcopenia, is that the muscles are less able to support the bones, and stress on certain joints, such as the knees or back, increases. Deterioration is not universal throughout all types of muscle, and the muscle fibres that contract faster are more susceptible to damage than the slower contracting fibres. This translates into overall slower contraction of the muscles in old age and affects physical mobility, muscular strength, and grip. Around 7% of people over 70 are affected by functional sarcopenia - age-related muscle loss – and this figure increases to around 20% of the elderly over 80. As muscles lose function people become less able to move autonomously and this may translate into the development of muscle contractures, where the muscles shorten and harden.

While it is a natural process of ageing to lose both muscular and skeletal mass, the process can be slowed and prevented to a certain degree by maintaining a healthy lifestyle, with regular exercise to promote strength, balance, and flexibility. Keeping fit can also help the bones to stay strong, to reduce the risk of shrinking or breaking. To further support the maintenance of sturdy bones diet control is crucial, being well-balanced and high in calcium. Particularly women need to be aware of getting enough calcium and vitamin D in their diet as they age to lessen the risk of developing arthritis or osteoporosis. 

Living With Osteoarthritis – Managing the Symptoms

 As we get older the cartilage covering our joints become worn, resulting osteoarthritis. This condition manifests itself in the form of joint pain and stiffness and, while there is no cure for this chronic disease, there are treatments and measures that can be taken to reduce suffering.

It may seem counter-intuitive to reduce joint pain by increasing your movement, however, exercise is proven to be incredibly beneficial in reducing osteoarthritis symptoms. Rather than wearing down the cartilage further, strengthening exercises will alleviate pain, through building up the surrounding muscles, reducing strain put on the joints. Exercises that focus on range of motion are also excellent for improving the condition, as they encourage flexibility of the joints and reduce stiffness. Choose exercises that work the joints but that aren't too strenuous. Taking a brisk walk, or joining a relaxing class such as yoga or tai chi, that gently uses your muscles, will keep your body working to support your bones and joints. For less impact while working out, swimming or water aerobics both engage muscles while avoiding putting force on the joints.

Linked to exercise, maintaining a healthy weight is integral to relieving osteoarthritic symptoms. Excess weight can add additional pressure to weight-bearing joints such as the hips, knees, feet and back bone. Losing this extra weight, and then maintaining a healthy one, will reduce pain and restrict further damage to cartilage. Combined with living an active and healthy lifestyle, medications are available that can reduce symptoms, such as pain and inflammation around the joints, making it more manageable.

Physical, or occupational, therapists can teach osteoarthritis patients the best ways to use, and move, joints to prevent further wear and tear of the cartilage. As well as introducing range of motion and flexibility exercises, thermotherapy treatments may be suggested to mediate symptoms. Cold treatments are effective at numbing pain, decreasing swelling, and blocking nerve impulses to the joints while heat therapy will improve blood circulation and relax muscles, removing tension. Often a combination of the two techniques are used, applying heat in the morning to loosen up joints, followed by cold treatment later in the day to reducing any swelling that builds up.

Although steps can be taken to reduce osteoarthritic suffering, assistive devices may become necessary. These can range from walking aids, such as walking sticks or specially modified shoes, to devices that help in carrying out everyday activities. Kneelers for gardening, extenders for door knobs and taps, and clothing that is easier to fasten are all available so that patients can keep their everyday lives as normal as possible.  

World-Class Care – Introducing Dr. Donald Kastenbaum

This week we introduce one of our senior faculty members in orthopaedic surgery, Physician-In-Chief Dr. Donald Kastenbaum. Having performed over 5,000 primary and revision total hip and total knee replacements Dr. Kastenbaum has certainly earned the position of authority he holds in the field of orthopaedics. An expert in hip and knee surgeries, he has helped to develop several prosthetics for hips and knees that are being used worldwide in replacement surgeries.

Dr. Kastenbaum's journey to his current position of prestige began with studying for a medical degree at the University of Health Sciences – the Chicago Medical School. On completion of this he began an internship in general surgery at the Lenox Hill Hospital, followed by a residency in orthopaedic surgery at the Hospital for Joint Diseases Orthopaedic Institute. His specialisation into the field of hip and knee surgeries was further honed with a fellowship in Sports Medicine at New York University Hospital Medical Center before crossing the pond to complete another in Total Hip and Knee Replacement Surgery/ Arthritis at the London Hospital Medical Center.

His medical work on an international scale continued after his British fellowship, and over the past decade he has both lectured and worked worldwide. Having trained over 30 Chinese orthopaedic fellows, Dr. Kastenbaum returns to China every quarter in order to carry out, and teach, advanced surgical techniques, including minimally invasive and revision hip and knee surgery. Closer to home, he created Mount Sinai's first Comprehensive Arthritis Center, a facility designed to provide complete orthopaedic and rheumatological care, and physical therapy services. Dr. Kastenbaum holds positions within this institution as both Co-Director and Surgeon-In-Chief.

That, however, does not complete his list of medical contributions. In 2002 he was invited to be a part of the Insall Scott Kelly Institute for Orthopaedic and Sports Medicine, and was given the position of Associate Chairman of the Department of Orthopaedic Surgery, before becoming the Vice President in 2005. To add to his already-full career Dr. Kastenbaum also holds the position of President of the Mount Sinai Beth Israel Medical Board and Chairman of the Surgical Chairs. He is renowned as an expert in Hospital Perioperative Management, Safety/ Efficiency/ Outcome Analysis and aids hospitals across the world in developing their models of “best practice”.

All of Dr. Kastenbaum's involvements in different institutions are predicated on his great knowledge and expertise in the field of orthopaedic surgery. For more information on the medical procedures this world-class doctor can provide call 212-241-6335 to book a consultation.

Our Tips for Healthy Bones and Reducing Joint Pain

 It is estimated that between one third and one half of the population of the United Stated aged 20 and over suffers from some form of joint pain. This can be caused by a variety of factors, from genetic predispositions to natural wear and tear of bones as we get older. While there may be no definite cure for chronic joint issues, there are ways that pain can be reduced so that it does not restrict everyday activities.

One tried-and-tested technique for reducing pain and inflammation around affected joints is to use temperature therapy. Cryotherapy, or ice therapy, is suggested as colder temperatures reduce the blood flow to the problem area and thus lessen swelling in the surrounding tissue. It is recommended that, on the first day pain is experienced, you should ice the area every hour for 15 minutes, reducing this to four or five times the next day, and each successive day that the pain remains. If the pain is caused by stiffness rather than inflammation, heat therapy can be used to relax the muscles and to warm up the joints so that they move more smoothly. Hydrotherapy with warm water will ease

pressure on the joints, and immersing the affected area while massaging it will stimulate blood flow to the area.

Often chronic joint pain is caused by the breakdown of protective cartilage over time. This can be counteracted to a certain extent by increasing intake of vitamin D, which is needed to help the body absorb calcium to strengthen bones. Increasing vitamin C levels can also be beneficial as it is a key component in making the cartilage that cushion the bones, and as such may reverse some of the damage. Diet plays a large role in join pain, and reducing sugar intake is an effective step to maintaining healthy joints as, if too much sugar is consumed it can begin to bond to proteins in a process known as glycation and can cause further weakening of the bones and joints.

Temporary relief from joint pain can be obtained with pain killers, however, there is also a whole range of more natural home remedies that have been suggested as having pain-alleviating properties. For reducing inflammation around the affected joints, turmeric and ginger tea may prove an effective solution. Turmeric contains an antioxidant called curcumin while ginger is high in compounds known as gingerols. Both of these active substances are known to be anti-inflammatory and as such can reduce painful joint swelling. For pain relief try taking a magnesium supplement or soaking the painful area in Epsom salts, which contain magnesium sulfate. These are effective natural pain relievers as magnesium relaxes muscles and nerve endings while also helping bones to mineralize, making them stronger.

To a certain extent bone deterioration and resulting joint pain is unavoidable, as natural processes weaken them with age. Nonetheless, there are steps that can be taken to keep bones as strong as possible, reducing joint pain to a minimum.  

Degenerative Spinal Conditions

As we get older there is an increased risk of spinal injuries occurring, resulting from natural wear and tear of the bones and joints over time. Sometimes this causes minor discomfort that disappears with time or over-the-counter medicines but occasionally the results can be more severe.

Acute Disc Herniation

Also known as a slipped disc, acute disc herniation (ADH) occurs when one of the intervertebral discs (pads of cartilage between each spinal vertebra which provide shock absorption and spinal mobility) moves out of place. ADH can occur anywhere along the spine but is usually in the lower back. It can cause severe pain in the back and legs if the disc slips so that it is pressing against the spinal column. It can also produce neural symptoms, including tingling, numbness, and weakness in the limbs.

ADH can often be treated with rest and anti-inflammatory medications. Physical therapy may be used to gently introduce movement and extension back into the spine, however, if symptoms don't improve then surgery may be necessary to fix the problem. A microdisectomy, where the herniated portion of the disc is removed, leaving the undamaged section intact, may be sufficient. However, in cases of repeat occurrences or very severe herniations it may be necessary to remove the whole disc and fuse together the vertebrae from above and below it.

Spinal Stenosis

Spinal problems can also arise as a result of an abnormal narrowing of the canal through which the spinal nerves run. Most often this condition develops with age and becomes significant in a person's 50s, though occasionally it can be congenital. As the canal begins to compress the spinal cord and nerves it will cause a radiating pain, numbness, and weakness. If the canal narrowing occurs in the lower back then it will cause sciatica-like symptoms in the legs and buttocks, while if it occurs nearer to the neck symptoms can be more severe, with a risk of paralysis. Spinal stenosis rarely occurs in the thorax as the middle back is the most stable and strong area, allowing for minimal movement.

In many cases the symptoms of spinal stenosis can be relieved with medications however, if symptoms persist to an extent where the patient can no longer perform everyday tasks decompression surgery may be considered. This involves removing a section of bone in order to relieve pressure on the spinal cord.

Our doctors treat both conditions, at all levels of severity. if you require help with spinal pain call 212-241-6335 to book a consultation.

The Best Exercises for Strong Bones

 With advancing age the risk of developing osteoporosis rises. This risk may be increased by having lower than normal peak bone mass, and subsequent greater than normal bone loss. The chances of this happening can be lessened by doing exercises that involve weight bearing. This is because when you do weight bearing exercises your bones adapt to the impact exerted by this extra weight and the pull of your muscles by building more cells, and thus become denser and stronger. The type of exercises that are most beneficial vary depending on age.

Children

For children, bone strengthening exercises can start before they can even walk. Crawling and active play begin the gaining of muscle mass. After they have learnt to walk unaided, activities such as climbing, walking and running, and jumping all contribute to the development of strong bones.

Teenagers and Young Adults

As children reach adolescence an active lifestyle is crucial to increasing bone mass. It is around this age that the most can be done to achieve a high peak bone mass in their early twenties. All sorts of competitive sports, from soccer to tennis to martial arts are beneficial, as are more individual exercises. Skipping, body weight exercises and high-energy activities such as aerobics and dance can strengthen muscles, while putting weight on the bones, encouraging them to increase cell production. In order to build up strong bones children should aim to undertake 60 minutes of exercise a day.

 

Adults

From your mid-thirties natural bone loss begins to occur. In order to reduce the rate of this, muscle-strengthening activities should be done at least twice a week. This can include doing some of the activities that young adults do, but also less exercise-focussed pursuits, such as brisk walking, stair climbing, carrying groceries, gardening and moderate-resistance weightlifting. These activities are less aimed at building bone mass as they are at maintaining muscle strength. Adults need less frequent exercise than children, but should aim to do at least 150 minutes of cardiovascular exercise a week, on top of muscle-focussed exercises.

Elderly

For elder individuals, or those at high risk of osteoporosis and fragile bones, it is advised to avoid particularly high impact exercises. However, maintaining a healthy, active lifestyle is beneficial. Going for a walk or doing necessary housework are both good ways of keeping active throughout the day. Swimming can improve stamina and joint flexibility in a low-weight environment, while tai chi is recommended as it is low impact but can improve balance and posture while strengthening muscles in the legs.

Until a bone is broken, there are no symptoms of osteoporosis. As the likelihood of developing it increases as you age the best preventative method is to build up strong bones at a young age and to sustain beneficial exercises throughout life.