Baseball Injury Prevention

The most common baseball injuries include mild soft tissue injuries, such as muscle pulls (strains), ligament injuries (sprains), cuts, and contusions (bruises).

Although baseball is a non-contact sport, most serious injuries are due to contact — either with a ball, bat, or another player.

The repetitive nature of the sport can also cause overuse injuries such as damage to the rotator cuff in the shoulder, or ulnar collateral ligament tears in the elbow.

Proper Preparation for Play

For Coaches

  • First aid. Familiarity with first aid, including recognizing and treating the most common injuries, is especially important for coaches. Be able to administer basic first aid for minor injuries, such as facial cuts, bruises, strains, sprains, and tendonitis.
  • Field knowledge. Be familiar with your baseball field, including its telephone and cardiac defibrillator.
  • Emergency situations. Be prepared for emergencies. Have a plan to reach medical personnel for help with more significant injuries like concussions, breathing problems like wheezing, heat illness, and orthopaedic emergencies, such as fractures and dislocations.
  • Follow the rules. Know the rules and encourage safe and appropriate play.

For Players

  • Physical exam. A pre-season physical exam is important for both younger and older players. The goal is to prevent injuries and illnesses by identifying any potential medical problems. These may include asthma, allergies, heart, or orthopaedic conditions.
  • Warm up. Always take time to warm up. Warm up with some easy calisthenics, such as jumping jacks. Continue with walking or light running, such as running the bases. Many warm-ups also include position-specific stretches. Gentle stretching, in particular your back, hamstrings, and shoulders, can be helpful. Your team coach or athletic trainer may provide a stretching program.
  • Cool down and stretch. Stretching at the end of practice is too often neglected because of busy schedules. Stretching can help reduce muscle soreness and keep muscles long and flexible. Slowly and gently stretch after activity, holding each stretch for 30 seconds.
  • Hydrate. Even mild levels of dehydration can hurt athletic performance. If you have not had enough fluids, your body will not be able to effectively cool itself through sweat and evaporation. A general recommendation is to drink 24 ounces of non-caffeinated fluid 2 hours before exercise. Drinking an additional 8 ounces of water or sports drink right before exercise is also helpful. While you are exercising, break for an 8 oz. cup of water every 20 minutes.

Ensure Appropriate Equipment and Its Use

  • Equipment should fit properly and be worn correctly.
  • Wear a batting helmet at the plate, in the “on deck” circle waiting your turn at bat, and during base running.
  • Protective face shields attached to batting helmets can reduce the risk of facial injury if hit by a ball.
  • Position-specific equipment should be used.
    • Catchers should always use a catcher’s mitt, helmet, face mask, throat guard, long-model chest protector, protective supporter, and shin guards.
    • Batters should consider wearing protective jackets to avoid injury from being hit by ball.
  • Players should always wear shoes with a snug heel, roomy toe box, good traction, flexibility in the sole, and plenty of ankle support and coverage. Shoes also should breather so as not to encourage bacteria or fungus growth.
  • Always break in a new pair of cleats before wearing them during a game, and check shoes periodically for signs of wear and tear. Children often outgrow their shoes before they wear them out.
  • Gender-specific equipment may be of value, including athletic supports for boys/men and padded bras for girls/women.
  • In youth leagues, softer baseballs decrease the risk of injury from being hit by a pitched ball.
  • Players should be instructed in how to avoid getting hit by a ball.

protective baseball equipment

Examples of appropriate safety equipment include a batting helmet with face shield and catcher’s protective gear.

Ensure a Safe Environment

  • Inspect the playing field for uneven terrain (holes, divots), glass, and other debris.
  • Use a field with breakaway bases. Many injuries occur while sliding into bases. The traditional stationary base is a rigid obstacle for an athlete to encounter while sliding. In contrast, a breakaway base is snapped onto grommets attached to an anchored rubber mat, which holds it in place during normal play. Although a sliding runner can dislodge it, the breakaway base is stable and will not detach during normal base running. Installing breakaway bases on all playing fields could significantly decrease sliding injuries.
  • Assess weather conditions and be prepared to delay/cancel the game, especially in cases of particularly hot weather or thunderstorms with lightning.

Focus on Technique

Base Running

The American Academy of Orthopaedic Surgeons recommends the following tips for those individuals sliding into, as well as protecting, the bases while playing baseball and softball:

  • Players under age 10 should not be taught to slide.
  • Proper instruction in sliding technique must be provided and players must practice sliding, beginning with a sliding bag, before being allowed to slide during a game.
  • The “obstruction” rule (the fielding player cannot obstruct the path of the runner) must be taught and observed. Getting in the way of the runner or blocking the base without possession of the ball is dangerous to both the runner and fielder.
  • To prevent foot and ankle injuries between the runner and fielder on first base, a “double bag” (a separate bag for each team — one white, one orange) should be used so both the runner and first baseman have their own base.

Pitching and Throwing

Follow established guidelines for youth baseball, which include limiting the number of pitches thrown and type of pitches thrown, according to age. The following guidelines are recommended by Pitch Smart, a Major League Baseball and USA Baseball initiative that provides guidelines to help parents, players, and coaches to avoid overuse.

Table of pitch count limits

Both coaches and parents should be responsive to young pitchers who complain of arm or shoulder pain. Be sure to seek out medical care for arm pain that does not go away or that comes back every time a child resumes pitching.

Prevent Overuse Injuries

Because many young athletes are focusing on just one sport and are training year-round, doctors are seeing an increase in overuse injuries. The American Academy of Orthopaedic Surgeons has partnered with STOP Sports Injuries to help educate parents, coaches, and athletes about how to prevent overuse injuries. Specific tips to prevent overuse injuries in baseball include:

  • Limit the number of teams in which your child is playing in one season. Kids who play on more than one team are especially at risk for overuse injuries.
  • Do not allow your child to play one sport year round — taking regular breaks and playing other sports is essential to skill development and injury prevention.
  • Do not allow your child to pitch on consecutive days and avoid pitching on multiple teams with overlapping seasons.

Injury Diagnosis

Good communication between doctors, players, parents, and coaches is key to diagnosing and treating more significant baseball injuries.

Young players may not be able to recall exactly how an injury happened or describe their symptoms in detail. They may even hide injuries because of concern about being removed from play.

Coaches and parents must pay close attention to changes in a player’s participation or performance. Should there be an injury, doctors may need their help to provide accurate details and a medical history.

Safe Return to Play

An injured player’s symptoms must be completely gone before returning to play. For example:

  • In case of a joint problem, the player must have no pain, no swelling, full range of motion, and normal strength.
  • In case of concussion, the player must have no symptoms at rest or with exercise, and should be cleared by the appropriate medical provider.
  • In case of a shoulder or elbow overuse injury, the player should gradually return to a throwing program, increasing the number of throws depending on the length of time away from play, and their specific team position

Arthritis of the Knee

Arthritis is inflammation of one or more of your joints. Pain, swelling, and stiffness are the primary symptoms of arthritis. Any joint in the body may be affected by the disease, but it is particularly common in the knee.

Knee arthritis can make it hard to do many everyday activities, such as walking or climbing stairs. It is a major cause of lost work time and a serious disability for many people.

The most common types of arthritis are osteoarthritis and rheumatoid arthritis, but there are more than 100 different forms. While arthritis is mainly an adult disease, some forms affect children.

Although there is no cure for arthritis, there are many treatment options available to help manage pain and keep people staying active.

Anatomy

The knee is the largest and strongest joint in your body. It is made up of the lower end of the femur (thighbone), the upper end of the tibia (shinbone), and the patella (kneecap). The ends of the three bones where they touch are covered with articular cartilage, a smooth, slippery substance that protects and cushions the bones as you bend and straighten your knee.

Two wedge-shaped pieces of cartilage called meniscus act as “shock absorbers” between your thighbone and shinbone. They are tough and rubbery to help cushion the joint and keep it stable.

The knee joint is surrounded by a thin lining called the synovial membrane. This membrane releases a fluid that lubricates the cartilage and reduces friction.

normal knee anatomy

Description

The major types of arthritis that affect the knee are osteoarthritis, rheumatoid arthritis, and posttraumatic arthritis.

Osteoarthritis

Osteoarthritis is the most common form of arthritis in the knee. It is a degenerative,”wear-and-tear” type of arthritis that occurs most often in people 50 years of age and older, but may occur in younger people, too.

In osteoarthritis, the cartilage in the knee joint gradually wears away. As the cartilage wears away, it becomes frayed and rough, and the protective space between the bones decreases. This can result in bone rubbing on bone, and produce painful bone spurs.

Osteoarthritis develops slowly and the pain it causes worsens over time

osteoarthritis and bone spurs

 

Rheumatoid Arthritis

Rheumatoid arthritis is a chronic disease that attacks multiple joints throughout the body, including the knee joint. It is symmetrical, meaning that it usually affects the same joint on both sides of the body.

In rheumatoid arthritis the synovial membrane that covers the knee joint begins to swell, This results in knee pain and stiffness.

Rheumatoid arthritis is an autoimmune disease. This means that the immune system attacks its own tissues. The immune system damages normal tissue (such as cartilage and ligaments) and softens the bone.

Posttraumatic Arthritis

Posttraumatic arthritis is form of arthritis that develops after an injury to the knee. For example, a broken bone may damage the joint surface and lead to arthritis years after the injury. Meniscal tears and ligament injuries can cause instability and additional wear on the knee joint, which over time can result in arthritis.

Symptoms

A knee joint affected by arthritis may be painful and inflamed. Generally, the pain develops gradually over time, although sudden onset is also possible. There are other symptoms, as well:

  • The joint may become stiff and swollen, making it difficult to bend and straighten the knee.
  • Pain and swelling may be worse in the morning, or after sitting or resting.
  • Vigorous activity may cause pain to flare up.
  • Loose fragments of cartilage and other tissue can interfere with the smooth motion of joints. The knee may “lock” or “stick” during movement. It may creak, click, snap or make a grinding noise (crepitus).
  • Pain may cause a feeling of weakness or buckling in the knee.
  • Many people with arthritis note increased joint pain with rainy weather.

Doctor Examination

During your appointment, your doctor will talk with you about your symptoms and medical history, conduct a physical examination, and possibly order diagnostic tests, such as x-rays or blood tests.

Physical Examination

During the physical examination, your doctor will look for:

  • Joint swelling, warmth, or redness
  • Tenderness about the knee
  • Range of passive (assisted) and active (self-directed) motion
  • Instability of the joint
  • Crepitus (a grating sensation inside the joint) with movement
  • Pain when weight is placed on the knee
  • Problems with your gait (the way you walk)
  • Any signs of injury to the muscles, tendons, and ligaments surrounding the knee
  • Involvement of other joints (an indication of rheumatoid arthritis)

Imaging Tests

  • X-rays. These imaging tests create detailed pictures of dense structures, like bone. They can help distinguish among various forms of arthritis. X-rays of an arthritic knee may show a narrowing of the joint space, changes in the bone and the formation of bone spurs (osteophytes).
  • Other tests. Occasionally, a magnetic resonance imaging (MRI) scan, a computed tomography (CT) scan, or a bone scan may be needed to determine the condition of the bone and soft tissues of your knee.

x-rays of normal knee and knee with osteoarthritis

Laboratory Tests

Your doctor may also recommend blood tests to determine which type of arthritis you have. With some types of arthritis, including rheumatoid arthritis, blood tests will help with a proper diagnosis.

Treatment

There is no cure for arthritis but there are a number of treatments that may help relieve the pain and disability it can cause.

Nonsurgical Treatment

As with other arthritic conditions, initial treatment of arthritis of the knee is nonsurgical. Your doctor may recommend a range of treatment options.

Lifestyle modifications. Some changes in your daily life can protect your knee joint and slow the progress of arthritis.

  • Minimize activities that aggravate the condition, such as climbing stairs.
  • Switching from high impact activities (like jogging or tennis) to lower impact activities (like swimming or cycling) will put less stress on your knee.
  • Losing weight can reduce stress on the knee joint, resulting in less pain and increased function.

Physical therapy. Specific exercises can help increase range of motion and flexibility, as well as help strengthen the muscles in your leg. Your doctor or a physical therapist can help develop an individualized exercise program that meets your needs and lifestyle.

Assistive devices. Using devices such as a cane, wearing shock-absorbing shoes or inserts, or wearing a brace or knee sleeve can be helpful. A brace assists with stability and function, and may be especially helpful if the arthritis is centered on one side of the knee. There are two types of braces that are often used for knee arthritis: An “unloader” brace shifts weight away from the affected portion of the knee, while a “support” brace helps support the entire knee load.

Other remedies. Applying heat or ice, using pain-relieving ointments or creams, or wearing elastic bandages to provide support to the knee may provide some relief from pain.

Medications. Several types of drugs are useful in treating arthritis of the knee. Because people respond differently to medications, your doctor will work closely with you to determine the medications and dosages that are safe and effective for you.

  • Over-the-counter, non-narcotic pain relievers and anti-inflammatory medications are usually the first choice of therapy for arthritis of the knee. Acetaminophen is a simple, over-the-counter pain reliever that can be effective in reducing arthritis pain.

    Like all medications, over-the-counter pain relievers can cause side effects and interact with other medications you are taking. Be sure to discuss potential side effects with your doctor.

  • Another type of pain reliever is a nonsteroidal anti-inflammatory drug, or NSAID (pronounced “en-said”). NSAIDs, such as ibuprofen and naproxen, are available both over-the-counter and by prescription.
  • A COX-2 inhibitor is a special type of NSAID that may cause fewer gastrointestinal side effects. Common brand names of COX-2 inhibitors include Celebrex (celecoxib) and Mobic (meloxicam, which is a partial COX-2 inhibitor). A COX-2 inhibitor reduces pain and inflammation so that you can function better. If you are taking a COX-2 inhibitor, you should not use a traditional NSAID (prescription or over-the-counter). Be sure to tell your doctor if you have had a heart attack, stroke, angina, blood clot, hypertension, or if you are sensitive to aspirin, sulfa drugs or other NSAIDs.
  • Corticosteroids (also known as cortisone) are powerful anti-inflammatory agents that can be injected into the joint These injections provide pain relief and reduce inflammation; however, the effects do not last indefinitely. Your doctor may recommend limiting the number of injections to three or four per year, per joint, due to possible side effects.

    In some cases, pain and swelling may “flare” immediately after the injection, and the potential exists for long-term joint damage or infection. With frequent repeated injections, or injections over an extended period of time, joint damage can actually increase rather than decrease.

  • Disease-modifying anti-rheumatic drugs (DMARDs) are used to slow the progression of rheumatoid arthritis. Drugs like methotrexate, sulfasalazine, and hydroxychloroquine are commonly prescribed.

    In addition, biologic DMARDs like etanercept (Embril) and adalimumab (Humira) may reduce the body’s overactive immune response. Because there are many different drugs today for rheumatoid arthritis, a rheumatology specialist is often required to effectively manage medications.

  • Viscosupplementation involves injecting substances into the joint to improve the quality of the joint fluid.
  • Glucosamine and chondroitin sulfate, substances found naturally in joint cartilage, can be taken as dietary supplements. Although patient reports indicate that these supplements may relieve pain, there is no evidence to support the use of glucosamine and chondroitin sulfate to decrease or reverse the progression of arthritis.

    In addition, the U.S. Food and Drug Administration does not test dietary supplements before they are sold to consumers. These compounds may cause side effects, as well as negative interactions with other medications. Always consult your doctor before taking dietary supplements.

Alternative therapies. Many alternative forms of therapy are unproven, but may be helpful to try, provided you find a qualified practitioner and keep your doctor informed of your decision. Alternative therapies to treat pain include the use of acupuncture and magnetic pulse therapy.

Acupuncture uses fine needles to stimulate specific body areas to relieve pain or temporarily numb an area. Although it is used in many parts of the world and evidence suggests that it can help ease the pain of arthritis, there are few scientific studies of its effectiveness. Be sure your acupuncturist is certified, and do not hesitate to ask about his or her sterilization practices.

Magnetic pulse therapy is painless and works by applying a pulsed signal to the knee, which is placed in an electromagnetic field. Like many alternative therapies, magnetic pulse therapy has yet to be proven.

Surgical Treatment

Your doctor may recommend surgery if your pain from arthritis causes disability and is not relieved with nonsurgical treatment. As with all surgeries, there are some risks and possible complications with different knee procedures. Your doctor will discuss the possible complications with you before your operation.

Arthroscopy. During arthroscopy, doctors use small incisions and thin instruments to diagnose and treat joint problems.

Arthroscopic surgery is not often used to treat arthritis of the knee. In cases where osteoarthritis is accompanied by a degenerative meniscal tear, arthroscopic surgery may be recommended to treat the torn meniscus.

Cartilage grafting. Normal, healthy cartilage tissue may be taken from another part of the knee or from a tissue bank to fill a hole in the articular cartilage. This procedure is typically considered only for younger patients who have small areas of cartilage damage.

Synovectomy. The joint lining damaged by rheumatoid arthritis is removed to reduce pain and swelling.

Osteotomy. In a knee osteotomy, either the tibia (shinbone) or femur (thighbone) is cut and then reshaped to relieve pressure on the knee joint. Knee osteotomy is used when you have early-stage osteoarthritis that has damaged just one side of the knee joint. By shifting your weight off the damaged side of the joint, an osteotomy can relieve pain and significantly improve function in your arthritic knee.

Total or partial knee replacement (arthroplasty). Your doctor will remove the damaged cartilage and bone, and then position new metal or plastic joint surfaces to restore the function of your knee.

uni knee replacement implant and total knee replacement implant

(Left) A partial knee replacement is an option when damage is limited to just one part of the knee. (Right) A total knee replacement prosthesis.

Recovery

After any type of surgery for arthritis of the knee, there is a period of recovery. Recovery time and rehabilitation depends on the type of surgery performed.

Your doctor may recommend physical therapy to help you regain strength in your knee and to restore range of motion. Depending upon your procedure, you may need to wear a knee brace, or use crutches or a cane for a time.

In most cases, surgery relieves pain and makes it possible to perform daily activities more easily.

Source: Department of Research & Scientific Affairs, American Academy of Orthopaedic Surgeons. Rosemont, IL: AAOS; April 2014. Based on data from the National Health Interview Survey, 2012; U.S. Department of Health and Human Services; Centers for Disease Control and Prevention; National Center for Health Statistics.

Shoulder Pain and Common Shoulder Problems

What most people call the shoulder is really several joints that combine with tendons and muscles to allow a wide range of motion in the arm — from scratching your back to throwing the perfect pitch.

Mobility has its price, however. It may lead to increasing problems with instability or impingement of the soft tissue or bony structures in your shoulder, resulting in pain. You may feel pain only when you move your shoulder, or all of the time. The pain may be temporary or it may continue and require medical diagnosis and treatment.

This article explains some of the common causes of shoulder pain, as well as some general treatment options. Your doctor can give you more detailed information about your sho

Anatomy

Your shoulder is made up of three bones: your upper arm bone (humerus), your shoulder blade (scapula), and your collarbone (clavicle).

The head of your upper arm bone fits into a rounded socket in your shoulder blade. This socket is called the glenoid. A combination of muscles and tendons keeps your arm bone centered in your shoulder socket. These tissues are called the rotator cuff. They cover the head of your upper arm bone and attach it to your shoulder blade.

 

Cause

Most shoulder problems fall into four major categories:

  • Tendon inflammation (bursitis or tendinitis) or tendon tear
  • Instability
  • Arthritis
  • Fracture (broken bone)

Other much less common causes of shoulder pain are tumors, infection, and nerve-related problems.

Bursitis

Bursae are small, fluid-filled sacs that are located in joints throughout the body, including the shoulder. They act as cushions between bones and the overlying soft tissues, and help reduce friction between the gliding muscles and the bone.

Sometimes, excessive use of the shoulder leads to inflammation and swelling of the bursa between the rotator cuff and part of the shoulder blade known as the acromion. The result is a condition known as subacromial bursitis.

Bursitis often occurs in association with rotator cuff tendinitis. The many tissues in the shoulder can become inflamed and painful. Many daily activities, such as combing your hair or getting dressed, may become difficult.

Tendinitis

A tendon is a cord that connects muscle to bone. Most tendinitis is a result of inflammation in the tendon.

Generally, tendinitis is one of two types:

  • Acute. Excessive ball throwing or other overhead activities during work or sport can lead to acute tendinitis.
  • Chronic. Degenerative diseases like arthritis or repetitive wear and tear due to age, can lead to chronic tendinitis.

The most commonly affected tendons in the shoulder are the four rotator cuff tendons and one of the biceps tendons. The rotator cuff is made up of four small muscles and their tendons that cover the head of your upper arm bone and keep it in the shoulder socket. Your rotator cuff helps provide shoulder motion and stability.

Learn more: Biceps TendinitisShoulder Impingement/Rotator Cuff Tendinitis

Tendon Tears

Splitting and tearing of tendons may result from acute injury or degenerative changes in the tendons due to advancing age, long-term overuse and wear and tear, or a sudden injury. These tears may be partial or may completely separate the tendon from its attachment to bone. In most cases of complete tears, the tendon is pulled away from its attachment to the bone. Rotator cuff and biceps tendon injuries are among the most common of these injuries.

Impingement

Shoulder impingement occurs when the top of the shoulder blade (acromion) puts pressure on the underlying soft tissues when the arm is lifted away from the body. As the arm is lifted, the acromion rubs, or “impinges” on, the rotator cuff tendons and bursa. This can lead to bursitis and tendinitis, causing pain and limiting movement.

Learn more: Shoulder Impingement/Rotator Cuff Tendinitis

Instability

Shoulder instability occurs when the head of the upper arm bone is forced out of the shoulder socket. This can happen as a result of a sudden injury or from overuse.

Shoulder dislocations can be partial, with the ball of the upper arm coming just partially out of the socket. This is called a subluxation. A complete dislocation means the ball comes all the way out of the socket.

Once the ligaments, tendons, and muscles around the shoulder become loose or torn, dislocations can occur repeatedly. Recurring dislocations, which may be partial or complete, cause pain and unsteadiness when you raise your arm or move it away from your body. Repeated episodes of subluxations or dislocations lead to an increased risk of developing arthritis in the joint.

Learn more: Chronic Shoulder Instability

Arthritis

Shoulder pain can also result from arthritis. There are many types of arthritis. The most common type of arthritis in the shoulder is osteoarthritis, also known as “wear and tear” arthritis. Symptoms such as swelling, pain, and stiffness, typically begin during middle age. Osteoarthritis develops slowly and the pain it causes worsens over time.

Osteoarthritis, may be related to sports or work injuries or chronic wear and tear. Other types of arthritis can be related to rotator cuff tears, infection, or an inflammation of the joint lining.

Often people will avoid shoulder movements in an attempt to lessen arthritis pain. This sometimes leads to a tightening or stiffening of the soft tissue parts of the joint, resulting in a painful restriction of motion.

Learn more: Arthritis of the Shoulder

Fracture

Fractures are broken bones. Shoulder fractures commonly involve the clavicle (collarbone), humerus (upper arm bone), and scapula (shoulder blade).

Shoulder fractures in older patients are often the result of a fall from standing height. In younger patients, shoulder fractures are often caused by a high energy injury, such as a motor vehicle accident or contact sports injury.

Fractures often cause severe pain, swelling, and bruising about the shoulder.

Learn more: Shoulder Trauma (Fractures and Dislocations)

Link to full article:

https://www.orthoinfo.org/en/diseases–conditions/shoulder-pain-and-common-shoulder-problems/