Wednesday, April 23, 2014
Inquirer Daily News

Arm, Shoulder Injuries

POSTED: Wednesday, April 23, 2014, 5:30 AM

Did you know that up to 91 percent of competitive swimmers have reported experiencing shoulder pain? Unfortunately most young swimmers will develop such pain—it’s just part of the sport.The same used to be true of youth pitchers in baseball.

For years, there was growing evidence that youth baseball pitchers were experiencing a high number of shoulder and elbow injuries. These injuries appeared related to excessive exposure to throwing the baseball. It was an epidemic, a talented 13-year old kid’s future ended due to shoulder and/or elbow ligamentous injuries. It got to a point where these kids and their parents were coming to orthopaedic surgeons for the elbow-saving Tommy John surgical procedure. Enough was enough.

In the beginning of 2007, Little League baseball became the first organization to implement a pitch count rule to protect young pitching arms. This is an age-based system in which a pitcher who throws a certain number of pitches must wait several days before competitively throwing again. Even Major League Baseball managers follow pitch counts to protect multi-million dollar shoulders from injury.

POSTED: Wednesday, April 9, 2014, 5:30 AM

I wanted to open a discussion regarding association of wrist pain and exercise that requires increased weight bearing on upper extremities. In my practice, I see patients from mixed demographics with complaints of wrist pain. In fact, wrist pain happens to be one of the most searchable conditions on the Internet.

A large number of patients associate wrist pain with increase or change in exercise activity—sometimes, a newly developed love for yoga or Pilates.

With multiple benefits comes the unfortunate side effect: pain in the least expected locations such as wrist, elbow and shoulder joints. While this phenomenon is more common in women, we are beginning to see an increasing occurrence in men. How can physical activity that has been praised for thousands of years for bringing emotional and physical well being cause its followers pain and injury?

POSTED: Monday, March 10, 2014, 5:30 AM

For statistics on common baseball injuries, click here.

It’s that time of year. Spring sports are in the air, even if the spring weather isn’t. Let’s head to the ballpark and start with baseball.

Upper Extremity

POSTED: Wednesday, January 29, 2014, 12:41 PM

This Saturday, the Phillies and Rothman Institute will host the 6th annual Sports Medicine Symposium at Citizens Bank Park.

The event, which begins with registration and continental breakfast at 6:30 a.m., is targeted for sports medicine physicians, physical therapists, certified athletic trainers and other professionals. Sports Doc panelist Dr. Michael Ciccotti, Director of the Sports Medicine team at Rothman Institute and head team physician for the Phillies, will present along with fellow Rothman Institute sports physicians and Phillies Certified Athletic Trainers and strength/conditioning coaches.

“We’ll be looking at common sports injuries—specifically, those in the overhead and the throwing athlete,” says Dr. Ciccotti.

POSTED: Monday, January 27, 2014, 9:40 AM

My last blog was about basketball injuries. Now, let’s dive into the pool and talk about common swimming injuries.

Swimming Mechanics

Poor swimming mechanics may be a contributing factor in many swimming injuries. But assessing these mechanics is beyond the expertise of most sports medicine. Your swimming stroke should be assessed by your coach, taking into account your specific injury, in order to eliminate an underlying biomechanical cause. A team approach should be taken with swimming injuries incorporating these stroke changes along with a specific rehabilitation program from your athletic trainer or sports medicine provider.

POSTED: Wednesday, January 8, 2014, 5:30 AM
Team West pitcher Jazmine Ayala in action Wednesday. Team Southeast from McLean, Virginia was defeated 9-0 by Team West from Tucson, Ariz., in the 2013 Little League World Series Championship game Wednesday night Aug. 14, 2013 in Portland. (AP Photo/The Oregonian, Ross William Hamilton)

Throwing a baseball or softball is one of the most difficult activities in sports and requires extreme accuracy and skill. It is also one of the most unnatural motions in sports and leads to many injuries, especially among baseball pitchers.

The speed of the pitching shoulder in baseball has been shown to reach 6900 degrees per second in youth pitchers (and higher speeds in adult pitchers). That is equivalent to spinning your arm in a circle approximately 19 times in 1 second (or about half the time it took to read this last sentence). With speeds that fast, it is no surprise that shoulder and elbow injuries are common. One way to decrease injury risk is to perform an off-season throwing program that gradually builds arm strength and prepares a thrower or pitcher for their season.

Two common mistakes among baseball and softball players are:

POSTED: Friday, October 18, 2013, 6:00 AM

For those of us that follow baseball, it seems like every time we turn around another pitcher is going down with a major injury. The most recent notable name is Matt Harvey from the New York Mets.  Like many before him, he started having pain with pitching while experiencing decreased velocity and poor control of his pitches.

After visiting with several doctors, he was eventually diagnosed with an Ulnar Collateral Ligament (UCL) tear of his elbow. After seeking advice from several other pitchers with a similar injury, including the Phillies’ Roy Halladay, he eventually decided to undergo “Tommy John Surgery” or UCL reconstruction. Rather than try non-operative treatment, he elected to undergo surgery to maximize his chances at returning to the mound and be as competitive and dominant as he once was.

These clinical scenarios are not only common, but they can get a lot of media attention depending on the caliber of the pitcher involved. With increased attention, increased misconceptions are developed as well usually because a lot of the medical information is interpreted out of proper context. Lately, in my office, I’ve been seeing a lot young pitchers with minimal elbow pain and discomfort terrified that they may need Tommy John Surgery and miss a year of pitching. I’ve had other pitchers, and even parents and coaches, ask if they should have Tommy John Surgery in the absence of an injury, in efforts to try to increase velocity and control.

POSTED: Thursday, September 5, 2013, 5:30 AM

“What should I do? Heat or ice?” 

The amount of times I have been asked this could qualify for the Guinness Book of World Records. The most confusing part for people is that if you ask 20 different health care professionals, you will get 20 different answers because the literature varies on this—as do most people’s experiences and preferences on what to tell their patients. 

There are a few general rules that I tell my patients to follow as guidelines for when to use heat or ice.  The first—and this most, if not all healthcare practitioners will agree upon—is that 24-48 hours after sustaining an injury, ice should be applied.  This is where RICE (Rest, Ice, Compression and Elevation comes into play. After the 48 hours, we enter that gray area.

About this blog

Whether you are a weekend warrior, an aging baby boomer, a student athlete or just someone who wants to stay active, this blog is for you. Read about our growing list of expert contributors here.

Robert Senior Sports Doc blog Editor
Alfred Atanda, Jr., M.D. Nemours/Alfred I. duPont Hospital for Children.
Robert Cabry, M.D. Drexel Sports Medicine, Team physician - U.S. Figure Skating, Assoc. Team Physician - Drexel
Brian Cammarota, MEd, ATC, CSCS, CES Symetrix Sports Performance, athletic trainer at OAA Orthopaedics
Desirea D. Caucci, PT, DPT, OCS Co-owner of Conshohocken Physical Therapy, Board Certified Orthopedic Clinical Specialist
Michael G. Ciccotti, M.D. Rothman Institute, Head Team Physician for the Phillies & St. Joe's
Julie Coté, PT, MPT, OCS, COMT Magee Rehabilitation Hospital
Peter F. DeLuca, M.D. Rothman Institute, Head Team Physician - Eagles, Head Orthopedic Surgeon - Flyers
Joel H. Fish, Ph.D. Director - The Center For Sport Psychology, Sports Psychology Consultant - 76ers & Flyers
R. Robert Franks, D.O. Rothman Institute, Team Physician - USA Wrestling, Consultant - Philadelphia Phillies
Ashley B. Greenblatt, ACE-CPT Certified Personal Trainer at The Sporting Club at The Bellevue
Cassie Haynes, JD, MPH Co-Founder, Trap Door Athletics, CrossFit LI Certified
Eugene Hong, MD, CAQSM, FAAFP Team Physician - Drexel, Philadelphia University, Saint Joe’s, & U.S. National Women’s Lacrosse
Jim McCrossin, ATC Flyers and Phantoms
Kevin Miller Fitness Coach, Philadelphia Union
Heather Moore, PT, DPT, CKTP Owner of Total Performance Physical Therapy, North Wales, Pa.
David Rubenstein, M.D. Main Line Health Lankenau Medical Center, Team Orthopedist - Philadelphia 76ers
Justin Shaginaw, MPT, ATC Aria 3B Orthopaedic Institute, Athletic Trainer - US Soccer Federation
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