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Athletes Beware -- Aches, Pains and Strains; How Did That Happen?

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No matter what position you play injuries can occur while playing; in your shoulder, legs, ankles and feet. The questions are: How did it happen and when can I play?

How did it happen?

Injuries can be classified into two general categories, acute and accumulation or overuse. They can occur at any point, warming up prior to a game or practice as well as during the game. Muscles often can be tight especially on cold days and it is very important to stretch and run prior to a game or practice.

Acute types of injuries are ones that occur with rapid onset; rupturing an Achilles tendon like Ryan Howard of the Philadelphia Phillies did during his last at bat while playing in the NLCS against the Cardinals. As a player they can also occur while running down to first base trying to beat out an infield hit, spraining your ankle rounding a base, fouling off a pitch hitting the instep of your foot or shin or hearing something pop in your shoulder or elbow after throwing a pitch. Bone bruises, bone fractures, muscle strains, tendon ruptures and ankle sprains can happen as a result of an acute injury. The injured areas immediately become inflamed causing pain, redness and swelling.

Accumulation or overuse injuries are due to continual repetitive activity of movements over a prolonged period of time that eventually will wear down or break down soft tissue structures in the body, starting as early as little league. Initially there is pain and mild swelling in the affected area and starts without warning, so it is difficult to figure out what happened. Many times a player will wake up with the problem and figure it will just go away on its own. It is not until the problem begins to limit the player's activity or the coach notices a change in the players effort will an overuse injury become a medical issue.

Factors contributing to these types of injuries are poor body biomechanics which can create muscle imbalances from the ground up. Pitchers who do not have proper pitching mechanics can develop long term arm and shoulder problems the longer they pitch. The reason is that continually repeating poor mechanics will cause stress and weakness. If it is not fixed early; little league, high school or college chronic injuries begin to surface. Players with abnormal foot biomechanics are vulnerable to foot, lower leg muscle imbalances and knee problems. That is why it is vitally important to be balanced starting with your feet. Landing improperly, not getting your feet set and not being able to transfer weight evenly over a prolonged period of time are key factors that can eventually translate into muscle brake down. A strong foundation is the building blocks to success; a balanced lower half will improve a player's ability to become a better hitter, position player or pitcher.

Strains and Sprains

A strain indicates a tear in the muscle and a pulled muscle is the result of a traumatic event to the tendon portion of the muscle as it attaches to the bone. This type of problem is commonly seen in the hamstring muscle group in the back of the upper leg. Quick bursts of speed from a stationary position such as coming out of the batter's box when your muscles are not properly warmed up could cause this type of leg problem.

Sprains, refers to a tear in a ligament and can range from tearing a few fibers, a slight tear, to a complete tear of all of the ligament fibers. Ligaments are non elastic tissues which connect bones to bones and stabilize joints. The ankle is the most commonly sprained joint in the foot. This can occur when hitting a base funny making your turn, pivoting to make a play or sliding incorrectly into a base.

When can I play?

It depends on the type and severity of the injury. Injuries can take as little as a few days or weeks to heal depending on how sever they are. If the injury is soft tissue in nature such as an ankle sprain, tendinitis or a strained muscle treat them aggressively and do not wish or wait for them to get better on their own. Always consult with your sports medicine physician if the problem does not resolve in a few days or continues to get worse over time. If the injury is in the lower extremity, a rule of thumb is: play when you can bare normal weight and there is no pain associated with movement.

In my practice I prefer using physical therapy modalities; electrical stimulation, supportive taping techniques using a special tape called Kinesio Tape, hot and cold therapy or injection therapy. Be careful about getting cortisone injections because they can also cause tissue breakdown if abused. A general consensus is 3-4 injections per year spread out over 12 months. Alternatively using topical or oral homeopathic remedies containing Arnica will help soft tissue injuries heal more quickly. I routinely recommend Traumeel to my patients for those types of injuries. Broken bones take much longer to heal, at the earliest it will take about 6 - 8 weeks depending on the type of fracture.

Balancing the foot will create lower half stability. Custom made orthotics made by sports medicine medical professionals or sports specific over the counter arch supports are the best way to perform that task. Custom made orthotics will provide the most support but can be expensive. Custom orthotics are usually made by taking a neutral position cast of one's foot and then shipping them to a laboratory that specializes in making orthotics. Over the counter arch supports such as my own Instant Arches Baseball and other prefabricated products are available on line or at local sports and shoe stores.

Staying in balance and understanding how injuries occur will prevent long term chronic problems. If you do not see improvement in a few days, wishing or hoping for an injury to get better is not the treatment of choice!

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