As baseball tournament season arrives, it's crucial to address one of the common injuries seen in clinics: Little Leaguer's elbow. This overuse injury primarily affects the medial side of the elbow, posing greater concerns for skeletally immature athletes due to the presence of growth plates. Disruption of these growth plates can lead to long-term effects, potentially requiring extended recovery periods or even surgery.
Contrary to anecdotal beliefs, research indicates that different pitch types do not significantly impact the risk of Little Leaguer's elbow. Rather, the primary contributing factors are the pitch count, number of pitches thrown in a single outing, time between outings, and pitching mechanics. The quantity of pitches thrown is more influential than the specific types of pitches used.
Effective load management strategies are vital in preventing this injury. Pitch counts play a crucial role, with studies showing that exceeding 600 pitches in a season more than doubles the injury rate. Most recommended pitch counts fall within the range of 500-600 pitches per season. Additional load management techniques include avoiding participation in multiple teams, having dedicated off-season periods without throwing, and assuming non-throwing-intensive positions on days when not pitching (e.g., playing catcher or first base).
Addressing body mechanics is another essential aspect of prevention. While upper extremity mechanics are commonly assessed in throwing athletes, lower extremity mechanics are often overlooked. Evaluating how the lower extremities contribute to upper extremity function is crucial. When athletes seek clinical assessment, a comprehensive evaluation is performed, encompassing the ankle, up to the shoulder complex, and even neck range of motion. Distinguishing between proper body mechanics and athletic mechanics is essential, as they can significantly differ.
By understanding the causes and preventive measures for Little Leaguer's elbow, athletes, coaches, and parents can take proactive steps to minimize the risk of this overuse injury, allowing young baseball players to enjoy the game safely and sustainably.
Marathon season is in full swing, which means the aches and pains may be adding up for you! One of the most common injuries we see in runners of all distances is “shin splints” or medial tibial stress syndrome. Shin splints affect the muscles and tissues on the front of the leg, and is believed to result from repetitive contraction of those muscles during running, jumping, or other high impact activities. These repetitive contractions on the leg can result in myofascial strain, inflammation, and bony stress reaction which lead to pain. In this month’s blog, we are going to cover ways you can help prevent shin splints at home as well as what to do if you are dealing with them now!
When dealing with shin splints, one place we like to start is with some foam rolling. Foam rolling your leg can help to reduce pain and the feeling of “tightness” that can come with lots of running. When dealing with shin splints, rolling both your calves and your shins themselves is most beneficial! To roll your calves, begin in a long-sitting position on the floor with a foam roller under your affected calf. Use your arms to elevate your upper body while applying pressure to your calf on the foam roller. Slowly rock forward and backward over tender spots with varying degrees of inward and outward position of your foot to work all areas. If you find a tender spot, maintain steady pressure on that area while you slowly flex and extend your ankle several times. This same process can be repeated for the shin, but using your arms to hold yourself over the foam roller and placing your shin on the roller. Repeat for both legs.
After foam rolling the leg, we like to move on to some stretches. There are a variety of ways to stretch the calf muscles, but stretching the shin muscles can be a little trickier! To start, sit in a chair and place the top of your involved foot on the floor. Roll your foot so that more of your great toe side is touching the ground. Slowly move forward in your chair pushing down on your foot until a stretch is felt. Repeat for both legs.
Now that you have foam rolled and stretched your leg, we want to take some time to strengthen the leg. To address the shin splints themselves we want to focus on the shin muscles themselves. One way to do this is by sitting with your involved leg crossed over your uninvolved leg. Loop a piece of resistance tubing over your forefoot and secure it beneath your foot on the floor, then stabilize your lower leg with one hand. Against the resistance of the elastic, roll your involved foot upward, as though you are attempting to look at the bottom of your foot. Repeat for both legs.
If this at home care program does not fix your symptoms, then we recommend getting on our schedule! A thorough evaluation could provide more information about your situation. We have multiple forms of treatment that can be used to address shin splints, including instrument assisted soft tissue mobilization, dry needling, and NormaTec compression boots. If our treatments in office do not provide relief, it is possible that the bony stress reaction has developed into a stress fracture. In situations where stress fractures are suspected, x-ray imaging is ordered to confirm, and our care plan is catered to promote proper healing.
If you or someone you know is experiencing shin splint-type symptoms, schedule a visit today!
Golfing through wrist pain is a huge mistake! Whenever we hear any golfer mention pain in their wrist, we start to worry. Wrist injuries have the potential to be career ending if not taken seriously and not treated properly. When it comes to wrist injuries, we have our usual suspects of the sprains and strain. These are usually caused by hitting a shot flat, tree root, or something along those lines. There are also some “unusual” suspects that we run into with golfers. The one we want to talk about today is triangular fibrocartilage complex (TFCC) tears.
The TFCC is a complex group of ligaments and cartilaginous structures which stabilize the distal radioulnar joint, particularly during pronation (palms to the ground) and supination (palms to the sky) of the forearm. The TFCC is triangular in shape, and the central portion acts like a meniscus much like the meniscus in the knee. Injuries occur from ulnar overload, and the mechanism of injury can be acute (hitting the ball fat) or repetitive (improper swing mechanics). In our experience, the TFCC is a very common injury and can require surgical repair.
Since this injury tends to lead to surgery – our goal is to prevent or correct the issue quickly. Poor use of the lower body is the primary swing mechanic that leads to this injury. This is more of a general statement, than a swing characteristic. Most players believe their wrist or hand pain is due to an upper body problem, but in our experience, it can usually be traced back to a lower body dysfunction. Anytime a player is not using their lower body effectively to initiate the downswing, the upper body is forced to overcompensate and becomes more active. This only puts more stress and strain on the structures of the upper extremities.
This first step in diagnosing a wrist or hand problem is to evaluate how effectively the player uses their lower body. Here is a quick list of the most common examples of poor use of the lower body:
Hanging Back - the first thing to look for is a normal initiation of the downswing with a shifting of weight from the trail side to the lead side. If this does not happen, most players are forced to throw the club excessively from the upper body instead.
The second step is to diagnose why we have a poor use of the lower body. We determine this by performing different movement screens designed to look at how the body moves. We typically find three areas that do not function properly.
1. Internal rotation of the lead hip is paramount for allowing the lower body to fully rotate without forward thrust toward the golf ball. If the pelvis is unable to rotate around the lead hip due to joint or muscular restrictions, then forward and lateral movements will dominate the pattern.
2. The ability to separate the upper body from the lower body allows the golfer to maintain stable posture and proper sequence of motion during the swing. Limited thorax-to-pelvis separation is usually caused by reduced spinal mobility and shortened lat flexibility.
3. Finally, the ability to stabilize your lower body is directly proportional to gluteal and abdominal strength. A stable neutral pelvic posture helps prevent the lower body from thrusting toward the golf ball during the swing.
The third step is proper treatment. If you are having wrist pain and we find that there is nothing torn, the first thing we want to talk about is sleep. If you irritate your wrist for 8 hours a night, it does not matter what activities or treatments you are doing during the day - your wrist will not be able to fully heal. At night, it's best to look for if you sleep with your hands up by your head, or sleep with them in a flex or an extended position. These positions can lead to extra stress on the wrist. A good rule of thumb is to try to sleep with your arms down by your side or folded over your stomach.
If you are having wrist pain - do not play through the pain. Let’s get you in and assess your movement patterns. At KC Chiro, we work closely with golf teaching professionals to ensure that you can continue to play golf injury and pain free.
Racquet sports have been increasing in popularity in recent years! They demand a high level of motor control through high volumes of complex shoulder mechanics. This often leads to players presenting to the clinic with shoulder pain, frequently on the outside of their shoulder. Patients often complain of being unable to put on a coat or reach for their seat belt. These two movements mimic an orthopedic test we use in the clinic called Apley’s Scratch Test. Being able to connect a patient’s experiences with our clinical findings gives us confidence in our diagnosis.
When dealing with shoulder pain, we like to start with some soft tissue work on the scapular stabilizers and rotator cuff muscles. Stand with your back near a wall, and place a tennis ball or other soft rubber ball in the area between your shoulder blades. Lean toward the wall to trap the ball against your back, just to the side of your spine. Roll the ball up and down each side of your spine by bending your knees to lower and raise your torso with a gentle pressure.
After doing some gentle soft tissue work, we like to move on to our stretches. Start by putting one hand on the small of your back. Then begin tilting your head to the opposite side of the arm behind your back, and use the same side’s arm to grab behind your ear and pull your head towards your shoulder. You should feel a firm put tolerable stretch that you hold for 10-15 seconds. Then slowly move your chin towards your chest while maintaining your tilted head position. Hold for another 10-15 seconds.
Now that your shoulders and upper back are thoroughly warmed up, we want to move onto an exercise that challenges those muscles. An easy shoulder exercise you can do anywhere is a palm press. Place your palms together in front of you with your fingers aligned. Firmly press your palms together, putting pressure through all of your palm and fingers. You should feel a strong contraction in your shoulder muscles. Try moving your hand to point your fingers back towards your body, then again away from your body. Try starting with 10 second presses and increasing as your shoulders can tolerate.
If your shoulder pain persists after trying our at-home recommendations, we have a variety of treatments we can use to help. Chiropractic adjustments and myofascial release techniques both can be helpful with shoulder pain. One of the techniques we have the most success with in shoulder pain cases is dry needling. Dry Needling that involves inserting very thin monofilament needles directly into sore/tender areas in order to help relieve pain and improve range of motion. If patients are failing to progress through our treatment protocol, a common next step we utilize in office is imaging. While x-rays can be useful, MRIs are often the better option when assessing the shoulder and the type of imaging we prefer to order in these scenarios.
Hopefully these tips help you navigate your shoulder pain!
As chiropractors, one of the most common conditions we see in office is low back pain. There are a lot of causes of low back pain, one of the more severe conditions being a lumbar disc injury. A few things that patients notice while experiencing a lumbar disc injury is back and/or leg pain associated with coughing, sneezing, or going to the bathroom. This actually mimics one of the orthopedic tests we use in office called the Valsalva maneuver. In this scenario, a patient’s history matches our clinical findings, helping us to confirm a diagnosis.
When we are confident in our lumbar disc diagnosis, one of our initial exercises we prescribe to patients is a nerve glide. The type of nerve glide given to the patient depends on where they are experiencing symptoms and what position is most comfortable. Typically we find that a seated sciatic nerve glide. To perform a seated sciatic nerve glide, begin seated in a firm chair with your hips and knees at 90 degrees and your head looking down at both feet on the floor. Next, fully straighten your affected leg at the knee until you feel a stretch in the back of your thigh. Do not move into a position that reproduces sharp or radiating pain. At the same time that you are moving your leg forward and up, extend your head to look at the ceiling as to nod “yes.” Then return to the start position.
Another exercise we prescribe initially with lumbar disc patients is a directional preference exercise. To find a directional preference, we will first test have the patient perform repeated end range movements in either extension (bending backwards), flexion (bending forwards), and/or lateral bending (bending side to side), while monitoring symptoms. The direction that improves symptoms will be prescribed as part of the home exercise program!
As patients progress and symptoms allow, we will begin adding in strength based exercises. One of our favorites for lumbar disc patients is the dead bug exercise! To perform a dead bug, lie flat on your back with your hips and knees bent to 90 degrees and your straightened arms reaching toward the ceiling, palms facing each other. “Tuck your tail” to flatten your lower back into the floor. Then, simultaneously slowly lower one arm and the opposite leg back down toward the floor. Return to the start position and repeat with your opposite limbs. Avoid arching your back, and keep your core braced throughout this movement!
When dealing with a lumbar disc injury, it is important to stay aware of your symptoms. If you begin feeling any leg weakness, numbness in your hips/pelvis, or the inability to control your bowel/bladder you need to seek emergency help. These symptoms are what are considered “red flags'' and need to be evaluated by a healthcare professional. If you feel an increase in your pain frequency or intensity, or if you feel your symptoms begin going down/further down your leg, let your healthcare provider know. These are symptoms that need to be monitored to be sure your disc injury is not getting worse. When treating a disc injury in-clinic, one of our first lines of treatment is our spinal decompression table. The spinal decompression table provides a gentle stretch to the lumbar spine, improving range of motion and reducing radiating symptoms. As you progress and as your symptoms allow, we begin adding in more traditional techniques including chiropractic adjustments if indicated and tolerated.
If you or someone you know needs help navigating a lumbar disc injury, we’re happy to help!
The holiday season is drawing to a close, and as the dust settles, you may realize you have developed some back pain! Between travel, sleeping in different beds, cooking/cleaning more than usual, and everything else that comes with the holidays, this is common. Thankfully, a lot of these aches and pains can be dealt with through basic movements and getting back into your normal routine. In this month’s blog, we are going to cover some of those basic movements!
One of the more popular gift ideas around the holidays in recent years have been massage guns! Which in turn has led to one of the most common questions we get after the holidays being “how should I use my new massage gun”. Massage guns are fine to be used over any sore and stiff joints/muscles, and really shine when used as part of a warm up (although you can use them any time is convenient). It is important to be mindful of whether the massage gun is aggravating your stiffness/soreness, which may mean you need to reduce the time you are using the gun, the frequency you are using the gun, or need to set up an appointment with us for an evaluation.
Once you have worked on your sore muscles with the massage gun, it’s time to add in some movement. Since we are covering general soreness in today’s blog, we are going to cover some general movements! One of our go-to’s is the Mad Cat/Old Horse (or Cat/Cow). To perform the Mad Cat/Old Horse exercise, begin on all 4’s with your hands under your shoulders and your knees under your hips. Extend your back upward into a “mad cat” position. Next, flex your back downward to sag into an “old horse” position. Slowly transition back and forth between these two positions. Another of our favorite movements is a thoracic rotation on all 4’s, done immediately following the Mad Cat/Old Horse. Place one hand behind your neck with your elbow pointing downward. Rotate your trunk to move your elbow towards your opposite knee. Rotate back, raising your elbow toward the ceiling. Neither of these movements should cause an increase in stiffness or soreness, so feeling worse immediately after doing them is a sign to set up an appointment to see what is going on.
By this point in our routine, you should be feeling loosened up and moving a bit easier! This is where we pull out our number 1 back-pain relieving exercise: walking! Going for a walk has repeatedly been shown to be at or near the top of exercises for back pain. As a bonus, it takes no special equipment and can assist in burning off some of the extra holiday calories. If you already walk regularly, we recommend completing the first part of the routine beforehand to see if it helps! With Kansas and Missouri weather the way it is, we recommend keeping an eye on the forecast and only walking when it is safe to do so. The benefits of walking can be quickly eliminated with a hard fall on ice!
The holidays can be stressful enough without having to deal with pain during or after them. This quick and easy routine can help your body make it through in good shape! If any of the activities increase your pain, stiffness, or soreness, give us a call, shoot us a text, or schedule an appointment online so we can get you feeling better as quickly as possible.
Summertime is golfing time for many of our patients! As the rounds start adding up, aches and pains can begin creeping in. One of the keys to staying healthy and maximizing performance in golf is maintaining your ability to rotate through multiple joints simultaneously. It may sound simple enough, but without consistent practice, maintaining the ability to rotate can be difficult! In this month’s blog, we are going to cover exactly how to do that quickly and efficiently.
At Inside Sports Clinic, we prefer to start our sessions with some self-administered soft tissue work. In the case of rotation for golf, using a foam roller and targeting the lat muscles can provide a nice stimulus to the muscle and help you to create more rotation with the upcoming exercises! Spending 30 seconds to 1 minute on each side is plenty of time to create the desired effect, being sure to spend more time on any particularly tender areas.
Once we have foam rolled the lats, it is time to begin moving through the complete range of motion. Thankfully, all you need is a golf club and a little space to get that accomplished! Grabbing the club as wide as you comfortably can, reach your arm out to one side, using the opposite arm to help push through the complete range of motion. After a few reps to each side, try reaching back by turning your shoulders, while still keeping your hips square. After a few reps of reaching back on each side, we can begin turning the hips with the shoulders. At this point, you should be rotating your whole body, reaching with one arm and using the opposite arm to help push you back further. Ideally, this should feel like a firm stretch from your shoulder, down through your torso, into your hips, knees, and ankles.
After foam rolling and stretching, it is time to work on strengthening the core musculature to improve your ability to control your rotation. For this situation, our go-to exercise is a plank series. Starting with the basic plank everyone is familiar with, being mindful of the position of your head, neck, and hips. We prefer 10 seconds of a high quality plank over 60 seconds of holding a plank just to hold a plank! If you feel comfortable, we can then progress to side planks, where you are on your side using one elbow to hold the plank position (hence the name side plank). If you feel comfortable with both the standard plank and the side plank individually, we can then begin rolling from the standard plank, into a side blank, back to the standard plank, and then to the other side plank. If you can perform a high quality rolling plank, your golf game will benefit!
Between foam rolling, our mobility drill, and our plank progression, you now have all the tools to develop and maintain rotation! Ensuring you can rotate means you can be confident in having the physical tools to have steady, consistent mechanics that allow for a more predictable swing from round to round while also reducing the likelihood of any overuse injuries that may arise from playing a lot of golf! If you or someone you know has pain with golf, schedule an appointment today.
High school baseball season has officially concluded, and the summer club season is underway! Younger and younger ages are playing longer and longer seasons, which leads to more and more strain on the athlete. Most associations have done a good job of implementing pitch counts and other protective measures, but the fact remains that baseball can be tough on the upper extremity. While we have covered it in the past, arm care is a complex topic that requires a complete and thorough strategy for management. In this blog, we are going to go over a simple way to begin your arm maintenance routine!
When beginning an arm maintenance routine, soft tissue work is a nice way to get moving and warm specific muscles up. Our preferred tool of choice is the foam roller, because of their ease of use and low cost. For the shoulder, begin rolling on the lats (short for latissimus dorsi) with big, slow rolls across the full length of the muscle, being sure to hit each side for approximately 60 seconds. After rolling the lats, you can move up into the triceps muscle, again being sure to roll each side for approximately 60 seconds.
Foam rolling is a great tool to create a temporary increase in a joint’s range of motion. After foam rolling, we want to push our joints through a full range of motion to maximize the effectiveness of both the foam rolling and our mobility drills! Baseball requires a ton of rotation through the torso and shoulder, and our favorite drill for upper body rotation is our quadruped thoracic rotation exercise. Getting on all fours, reach one of your arms across your body as far as you comfortably can, curling your wrist back towards yourself. Then pull your arm back through back across your body, and reach your hand towards the ceiling, trying to face your palm towards the ceiling. Perform this drill with each arm, with at least 10 repetitions per side!
After completing the foam rolling and mobility drill, it is time to challenge your upper extremity musculature with a resisted exercise. Bands are a great form of resistance due to how portable they are, you can take them anywhere! For our baseball players we really like what we call a D2 Extension pattern. It relatively mimics the reverse of a throwing motion, allowing us to directly strengthen the muscles that assist with decelerating the shoulder in a throwing motion. Grabbing the band in one hand, secure the opposite end of the band under the opposite foot. Reach your hand across your body as if you were trying to put that hand in the opposite pocket, with your thumb pointing behind you. Begin the movement by bringing your hand back across your body, up towards your shoulder, and turning your hand so your thumb is pointing up all at the same time. Repeat this exercise for 10 repetitions with each hand!
Like we said before, caring for the arm/upper extremity can be complicated. So while we have laid a foundation with this blog, it is important to have a thorough plan that addresses the other aspects of arm care. If the demands of the season do start to add up and begin affecting your arm, we have a variety of ways of helping get you back on track. Schedule an appointment with us to see if we can help!
It is May, which means high school track and field is reaching its peak! The diverse nature of track and field makes the warm-up crucial for success. Over the course of a meet, an athlete may need to warm up and cool down as many as 4 times! This can be complicated further if the athlete has events that are close together. While a comprehensive and thorough warm-up is preferred, doing something is definitely better than nothing. Today we are covering the bare bones minimum track and field warm-up that requires minimal time and energy for those unique situations that only track and field provides!
If you have been following along with our previous posts, you will know that we are big fans of foam rollers. A time crunch is when foam rollers really start to shine! All track and field events could benefit from a quick (~60 second) foam rolling of the hips.
Once you have foam rolled your hips, we will take advantage of the foam rolling with a targeted mobility drill. A quick and easy mobility drill for the hips is the Hip 90/90 drill. This drill allows us to work the hips through internal and external rotation, as well as working on some flexion. By driving your knees into the ground at either end position, we can also work some hip extension!
Track and field events do not only challenge the hips, so it is important to add in a mobility drill that targets just the hips. A lunge with rotation is a great option for building on the hip work we have already done, while incorporating the rest of the body. Both forward and reverse lunges can work here, and a mixture of both allows you to get the benefits of both! The rotational component should be smooth and controlled with the intention of working into the end ranges of motion of the rotation.
Up to this point, our warm up has been slow and controlled. Now it is time to add in some speed to really prime your body for performance! One of our favorites is the squat jump, with a particular emphasis on achieving triple extension. Triple extension refers to extending the ankle joint, the knee joint, and the hip joint. Running, jumping, and throwing activities are rooted in triple extension at their core, making the squat jump a quick and easy way to generally replicate those movements anywhere, at any time.
We would like to emphasize that a complete and thorough warm up is preferable to what we have put together here. This warm up is meant to serve as a way to serve as a “better than nothing” alternative for those unique situations where the complete warm up may not be feasible. The length of this warm up also makes it easy to add in another exercise or two more specific to the athletes event.
If you or someone you know is dealing with a track and field injury, we can help! Call our office or schedule online today!
The weather is warming up, and while the cold has not stopped some of you die-hard runners out there, for many of you that means running outside again! With the increase in running frequency and intensity outside (let’s admit it, pushing yourself on the treadmill can be difficult), our clinic begins to see an increased rate of injury in our runners. Patellofemoral pain is defined as pain around the knee cap while performing an activity with a bent knee. Multiple studies cite patellofemoral pain as the top injury in runners, with an average estimate of 20% of recreational runners dealing with it at some point. Today we are going to cover our recommended strategy for reducing your risk of developing patellofemoral pain!
Soft tissue treatments are a great way to start any session, and if you are familiar with our blogs, you know that we are fans of foam rollers. Foam rolling your quads helps to relax the muscle and ensure that our tissues have the ability to hit full extension easily. You can replace a foam roller with any soft tissue tool you prefer such as a massage gun.
Now that we have our quads and knees prepped, we want to reinforce comfort in that fully extended position. Quad sets are a great starting point! Sit down with your legs straight in front of you. Squeeze your quads (the muscles on the front of your thigh) and gently push your knee cap towards the floor at no more than 70% of your maximal force. Hold this contraction for around 5 seconds, relax, and repeat. Placing a towel under your knee may make this exercise more comfortable. Be sure to perform this exercise on both knees!
Now that we have reinforced that fully extended position, we want to incorporate the knee into a more complex movement. A reverse lunge allows us to generally emulate a running position while allowing for greater balance because the working leg is staying in a fixed position. If the reverse lunge becomes too easy, consider progressing to a forward lunge!
This series of exercises is a solid starting point for reducing your risk of developing patellofemoral pain, but it needs to be combined with appropriate programming. Avoid increasing your weekly volume by more than 10% unless under guidance of a coach, and avoid increasing by 15% unless you are an experienced runner under guidance of a coach.
In our office, one of our primary goals while treating runners is to maintain some degree of training as much as reasonably possible. We also take the time to identify the mechanism of injury. The most common issues we see leading to patellofemoral pain are lower leg mechanical issues and programming acquired issues. For mechanical issues, we perform a foot and gait analysis, re-establish any lost range of motion, and go through a rehab protocol to strengthen and stabilize the lower leg. For programming acquired issues, we establish that the training program being followed is sound, confirm that appropriate recovery measures are being taken, and manage pain symptoms to minimize the amount of time lost from running.
If you are dealing with persistent knee pain or planning on getting back into running soon, we can help! Give our office a call or schedule online today!
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