Stress Fracture in Figure Skaters

This figure skating season is nearing an end as only a few more international and national level competitions are left. Also, this is about time of the season when athletes get injured as an intensity of competitions increases. Those skaters who qualified for the nationals are probably training harder to do well in the competition. Some may be trying to secure a spot at the Worlds. Or some may already been training for the next season. Training hard is necessary to be successful. However, training too hard can be potentially damaging to the body. One of the common injuries suffered by figure skaters is stress fracture. The common injury sites are foot, lower leg, hip, and lower back. Stress fractures are categorized into 2 categories. One is a high risk fracture and the other is a low risk fracture, depending on where the fracture is located. High risk fractures are treated more aggressively because of their higher chance of non-union fracture. Many cases may require a surgical fixation of the fracture. Low risk fractures are usually treated with relative rest, partial or non weight bearing, activity modification, and rehabilitation. In case those do not work, then, it may be treated more aggressively. One of the reasons why it makes it challenging is that a lot of skaters will ignore a pain and keep training until it gets to the point that they cannot. By the time it becomes that painful, it may be too late. Once diagnosed with a stress fracture, a skater will be off the ice for a long time, probably around 6 weeks to a few months. Good news is that it is preventable. Causes of stress fractures include sudden increase in training intensity and time, a change of skates, nutritional factors, over training, not having proper mechanics, etc to list a few. Female skaters are more prone to stress fracture than male skaters. A study done at BYU showed that figure skaters sustain about 8 times of their body weight when they land on ice from a jump. That means that they have to be able to sustain that much force only using knee and hip muscles (and core muscles play an important role as well). When we jump and land on the ground, we can use ankles, knees, and hips and muscles around them to absorb the force. However, when skaters jump on ice, they are forced to use only knee and hip because of rigid type skates they wear. It becomes very important that they have enough muscle strength in their knees and hips to sustain that much force. By being evaluated for any risk factors they may have and by eliminating those factors when they are healthy, injuries such as stress fracture can be prevented.

Pitch Count in Professional Baseball Pitchers: USA vs Japan

There have been so many injuries in MLB about a half way through the season especially UCL tears, the most recently a NY Yankee pitcher, Tanaka. A lot of people in baseball world including coaches, media, and medical staff are discussing that pitchers in Japan pitch too much and they will get hurt. A pitch count is strongly reinforced in the US including little league baseball and professional baseball. However, it is not in Japan. Especially high school baseball in Japan is so popular and it is not rare that a single pitcher pitches a complete game in 6 straight games in a week long period tournament. However, if we look at how much Japanese professional pitchers pitch and compare it to American pitchers, it may be a bit surprising. In Japanese professional baseball league, they play 144 games with 6 men rotation. A typical healthy starting pitcher will be pitching in about 24 games a season. Let's say he pitches 125 pitches a game, he would be throwing 3000 pitches a season. In comparison, in MLB, 162 games are played a season with 5 men rotation. A pitcher will be pitching in 32 -33 games on average with average of about 100 pitches per outing. He would end up throwing 3200-3300 pitches a season. More games played, more pitches thrown, less time to recover... this may be something we should be looking at when it comes to Japanese pitchers getting hurt after coming to play in MLB. Ohh and these pitch count numbers do not include pitches thrown in each bullpen session and side session between starts. 

Knee Balance Exercise

We all know that balance is an important factor for athletic performance and injury prevention. Balance exercises are done usually on a foot on the ground or uneven surface to make it harder. Or you can add a ball toss to make it more challenging. Also, you can do a balance exercise on your knee instead of your foot. It is hard to put your knee down on a hard surface so try doing it on a balance pad or BOSU ball, etc. It challenges more of your hip muscles and postural stability than regular balance exercise on a foot. Pictures below show the knee balance exercise. This is another way to train your hip and core stability and proprioception. Again, balance is an important factor when it comes to performance enhancement and injury prevention!

Left knee balance with his left foot and right leg in the air.

Knee balance with ball toss.

Core Stability and Respiration

Core stability is a crucial part of athletic performance and injury prevention during athletic activities. Importance of core muscles are well documented and known. However, less is known about how it may be affected by respiration. Abdominal muscles such as transverse abdominis and internal/external abdomini create the wall of the trunk, and the pelvic floor muscles create the bottom part of the core. The top part of it is the diaphragm. The diaphragm is also important in respiration. In fact, the abdominal muscles and diaphragm work in sync for respiration and core stability. In inhalation, the diaphragm contracts concentrically and the abdominal muscles contract eccentrically. In exhalation, they work in reverse. And the roles of these muscles get challenged with arm and leg movements and with respiration. It is known that a role of diaphragm in core stability decreases as it is challenged by increased demand for respiration. For example, during running, the diaphragm will work more for respiration and less for core stability than it does when at rest. What this may mean is that, during activities that increase respiration rate, the abdominal muscles may work non-optimally because they will have to help with respiration if the diaphragm cannot work optimally, leading to poor core stability. Performance of core muscles are also affected by other factors. Excessive lumbar extension will lengthen abdominal muscles putting them in non-optimal muscle length. Interestingly, the diaphragm also attaches to lumber spine from 1-3 level and excessive lumber spine extension may also affect performance of the diaphragm. Thus, it may be very important to take this into account when it comes to core stability.   

Pitch Velocity and Elbow Injury in Baseball

Shoulder and elbow injuries are very common in baseball players especially in pitchers. It is hard to watch baseball news on TV without hearing the word "Tommy John surgery" these days. Even before this Major League Baseball season starts, there are already quite a few pitchers that are going to miss this season from Tommy John surgery. Tommy John surgery is a reconstructive surgery for a torn ulnar collateral ligament in the elbow. We have discussed this and its rehabilitation in our previous posts. And it seems like a more popular topic in baseball news lately because of its frequency and names of the players involved in this. There is an interesting article published a few years ago done on high school baseball pitchers and it found out that there was a positive correlation between pitch velocity and stress placed on the elbow. The faster the pitch velocity was, the more stress placed on the medial side of the elbow where UCL is, according to this study. So does this mean that pitchers that throw faster pitches will be more prone to elbow injury such as UCL sprain?! We do not know. But this may be something that we cannot ignore....  

What is Meniscus Tear?!

Sports news world is busy with the news of the basketball player having a meniscus repair surgery. But what is meniscus?! Meniscus is a fibrocartilage that exists in the knee. Its roles are to absorb shocks and to make the knee joint more stable by deepening the concave part of the joint (tibia). There are 2 menisci in the knee; one located laterally and the other located medially. Medial meniscus is more commonly injured. Degenerative meniscus injury is common as people age. But it also happens in sports especially in sports that involve a lot of cutting, changing directions, and twisting such as soccer and basketball. It also happens with anterior cruciate ligament injury. Depending on where the injury is and how severe it is, it can be repaired. The center of meniscus does not have sufficient blood supply and does not heal well. The outside of it, on the other hand, is more vascularized and has more chance to heal. Meniscus repair seems to do better in younger athletes and in those who are having an ACL reconstructive surgery at the same time. Older knees have less chance of successful meniscus repair surgery. Athletes with meniscus tear may complain of dull aches and pain, sharp pain with motion, swelling, loss of motion, loss of function, joint line tenderness, etc. It may cause clicking sounds and it may feel like knee is locking up. The picture below is an arthroscopic view of torn meniscus. Whether a torn meniscus can be repaired depends on the location of the injury and the severity of it. Also, the age is a factor. If it is shaved off, it usually takes about 4 to 10 weeks to rehab. It is repaired it will take a lot longer. Rehabilitation of repaired meniscus usually involves non-weight bearing for 4-6 weeks and start partial weight-bearing and rehab may take as long as 4-6 months.

 



Lateral Posterior Hip Muscle Exercise for Baseball Pitchers

It is well known the importance of hip muscles, especially gluteal muscles and external rotators. They play an important role in not only stabilizing the hips but also the knees and lower legs. Every baseball pitcher has to be on one foot during stride phase of the pitching motion. If he is not able to maintain the stability of his lower leg, hip, and trunk, he will not be able to effectively transmit a ground reaction force through trunk, upper body, and to his arm and to the ball. Doing hip exercise on a table is a good way to start but he will need to train the muscles in standing as well. Here is one easy way to work on his hip muscle strength.

 

This is an isometric hip muscle (gluteal) strengthening exercise. He is pushing the physio ball into the wall with his left knee while trying to maintain his upright posture with his right leg. With this exercise, he should be able to maintain the upright posture without moving any part of the body. This works on his bilateral hip muscles, especially gluteus medius. If he brings his left knee up to the level of his hips, he now is working on his external rotators of his left hip as well as his right gluteus medius. Also he needs to use his core muscles to stabilize his pelvis.