-Diane

By GRETCHEN REYNOLDS

Sometimes physicians will notice a medical trend well before science confirms its existence. That has been the case with injuries to the anterior cruciate ligament, the main ligament that stabilizes the knee joint, in young athletes. “Doctors who treat kids have all been saying over and over that the numbers of A.C.L. tears are going up dramatically,” says Dr. J. Todd Lawrence, an orthopedic surgeon and pediatric sports medicine specialist at the Children’s Hospital of Philadelphia. But surprisingly little firm data has confirmed that hunch.

So, for a study presented this month at the annual conference of the American Academy of Pediatrics in Boston, Dr. Lawrence and his colleagues parsed emergency room records of pre-adolescent youngsters treated at Children’s Hospital, looking for A.C.L. tears, as well as tears of the meniscus, the small pillows of cartilage that help to cushion the knee bones.

They also checked for fractures of the tibial spine, a fingerling spit of bone that extends from the tibia, or shinbone, to which the A.C.L. attaches. In prepubescent children whose skeletons are still growing, the slender tibial spine can be weaker than the tissues of the A.C.L. and break under the pressures of hard twisting or planting of the knee, even as the A.C.L. remains intact. “There was a time when the tibial spine fracture was the knee injury of childhood,” Dr. Lawrence says. “Twenty years ago, medical textbooks usually included a statement saying that kids did not tear their A.C.L., that they fractured the tibial spine instead.”

But when the researchers examined the pediatric hospital records, from 1999 through early this year, they found only 155 tibial spine fractures, while there were 914 confirmed A.C.L. tears and 996 meniscus tears. More important, while the incidence of tibial spine fractures increased at a rate of about 1 percent per year during that period, the incidence of A.C.L. tears increased by more than 11 percent per year. The difference almost certainly was not a result of better equipment leading to better diagnoses of A.C.L. tears, Dr. Lawrence says. “Even in 1999, M.R.I. technology was quite good,” so it was possible for physicians to differentiate between the injuries.

Which means that increasingly large numbers of young athletes, both boys and girls, are now suffering an injury to which doctors once thought they were almost immune.

Why? Scientists still aren’t sure, and that question was outside the scope of the current analysis. But Dr. Lawrence, a pediatric orthopedic surgeon who treats many of the afflicted young athletes, is willing to speculate. “I think it’s primarily because kids are out there trying to emulate professional athletes,” he says. “You see these very young athletes playing sports at an extremely intense, competitive level. Kids didn’t play at that level 20 years ago. They didn’t play one sport year-round.” As a consequence, their knees never had to withstand the kinds of repeated twists, sprints, loads and hard hits that young players now regularly absorb, he says.

Most of the A.C.L. tears that were treated at Children’s Hospital and picked up by this study, Dr. Lawrence points out, also involved a simultaneous meniscus tear, an indication of just how much wrenching and grinding the knee had undergone. Injury patterns have changed, he continues, because childhood sports have changed. “There’s a developmental soccer team here” in Philadelphia, he says, “for U-6 players,” meaning a competitive, select team for 4- and 5-year-olds. “When I heard that, I said, are you kidding me?”

The long-term effects of sports-related A.C.L. and meniscus tears in youngsters remain largely unknown, in part because such injuries were so rare decades ago. But there are indications that the consequences could be calamitous.

Recent studies of adult Swedish soccer players who tore an A.C.L. found that, within 12 to 14 years after the injury, 51 percent of the female players and 41 percent of the men had developed severe arthritis in the injured knee. The same time frame could have an injured 10-year-old dealing with a severely arthritic knee before he or she is 25. Meanwhile, many athletes who return to sports after an A.C.L. tear report that they don’t play as well, according to a new study of 500 Australian athletes, and a third of the athletes in that study did not return to any activity afterward.

“It’s definitely not a minor injury,” Dr. Lawrence says, “and it’s not something you want to see in a child.”

Whether anything can be done to lessen the toll on young knees, though, is uncertain, he and other researchers say. Knee injury prevention programs, including those that teach balance and proper landing techniques, have shown some utility in reducing the incidence of A.C.L. tears, especially in girls. But the programs are relatively new and have not been universally successful, in part, perhaps, because they can make some young athletes overly self-conscious, as an interesting review article published earlier this year suggests. In teaching children to think overtly about how to plant a leg or bend a knee while maintaining balance, some youngsters may become less fluid in their movement, more ungainly — and potentially ripe for injury, the review’s authors speculate.

A better solution would probably be to stop assuming that children can train like miniature Ronaldos or Kobe Bryants. “A lot of what we see in our injury data is almost certainly due to a statistical measure called exposure hours,” Dr. Lawrence says. “The more you do a risky activity at a high level, the more likely you are to get hurt.” His advice? “Encourage kids to play multiple sports and not to do any one sport year-round, and especially not when they’re 5 or 6, or even 9 or 10. They’re kids. Let them play and have fun, like kids.”

Softball Pitching and Injury Rates Study Results
By: Cindy Bristow (former Womens Fastptich USA Olympic Coach)

Softball Pitching is a natural motion; it won’t hurt a pitchers arm. Ever heard or said that before? If so then read on to find out the real story.

My whole life I’ve heard people say that softball pitching is a natural motion and won’t hurt your arm. These same people aren’t doctors, or even pitchers, which is why I always found this hilarious. I’m not a doctor either but I am a pitcher and having had a pitching arm so painful that I couldn’t raise my hand to drink a cup of water during a game I was pitching, I’ve found these comments absurd. Now learn the actual truth behind this long-held myth.

Think about it for a minute. You’re standing there, at a dead stop, holding an object in your hand (any object that has some amount of weight to it) and in one quick motion you’re going to try to propel this object through the air as hard and as fast as you possibly can. Doing so would require a tremendous amount of power, strength, speed and force – all things that require lots of muscles doing lots of things. Now, imagine that you’re going to repeat this same process over and over and over hundreds of times a day, thousands of times a week, hundreds of thousands of times a year and millions of times over your lifetime. And now tell me – with a straight face – that it won’t hurt me, and in fact, it’s actually “natural”. Come on…I think this whole idea of “natural” has been fostered to promote a psychotic notion of over practice on the part of the pitcher.

I’ve often said that there’s nothing “natural” about throwing something forward as hard as you can as often as possible over years of your life. While allowing your arm to drop down (as in the underhand pitching motion) might be a more natural place for your arm to be since our arms were designed to hang down when at rest, there is nothing “natural” about using our body to throw something forward to the millionth degree. I think this whole concept of “natural” evolved from the fact that in the overhand throwing motion the arm is raised above the head being supported only by very small muscles around the shoulder joint, and our bodies aren’t built with the intention of our arms being raised over our heads in a forceful manner for long periods of time.

Well now there is finally some evidence to show that softball pitching is not as “natural” as everyone has wanted to believe. In a recent study done by Dr. Nikhil Verma at Rush University Medical Center in Chicago 7 female windmill pitchers were studied using motion analysis and other scientific evaluations of their biceps muscles while they were pitching underhand and throwing overhand. Keep in mind these studies were conducted with pitchers throwing underhand and overhand at 53 mph.

What they found:

• During the underhand pitching motion the biceps brachii works much harder than when throwing overhand.
• The biceps are most active (or the most stress placed on it) when the pitcher is in the 9-o’clock and follow-through phases of the pitch. The 9 o’clock position is when the pitcher’s hand is behind her on its way down to the release point. This makes sense as this is also the point when the arm is stretched the most.

Their conclusions:

Repetitive eccentric biceps contractions may help explain the high incidence of anterior shoulder pain clinically observed in elite windmill pitchers. The English version – pitching too much (which is repetitive contractions of the biceps) can explain why there are so many elite softball pitchers with pain in the front (anterior) of their shoulder (as a result of so many years of over throwing in practice and games).

What we can learn:

That we should quit saying that softball pitching is a natural motion as this promotes the concept that it isn’t potentially harmful – which it is.
That one, two or even 100 underhand pitches won’t wreck your arm. It’s the constant overuse that leads to exaggerated stress on the pitcher’s biceps.

Be reasonable with your pitchers in regards to:

• Practice – both in the number of pitches they throw each day and the number of days they pitch each week.
• Games – Let your pitchers rest whenever they can. Don’t be greedy and expect another coach to rest your pitcher whenever she gets to their team.
• Fatigue – Pitcher’s get REALLY tired during the season, just ask them (or better yet, just watch them). Let them rest when they’re tired. They won’t forget how to pitch by taking a few days off.
• Rest – REST is VERY important to pitchers as it is to all athletes. Tired pitchers become sloppy and make mistakes and get injured. If your pitchers feel like they must throw everyday from a mental point of view then mix in some ½ and ¾ days where the pitchers only throw ½ speed at ½ distance followed by ¾ speed at ¾ distance and that’s it! Practice over.
• Use your head and don’t overdo it!

For more information on this study check it out for yourself in the March Issue of The American Journal of Sports Medicine.

http://www.softballexcellence.com/

We are pleased to announce that Lori Field, M.S. LAc, OTR, of Abundant Life Acupuncture, and originally from Australia, will be working in our office on Tuesdays and Fridays from 9 am – 7pm.

You can learn more at her web site:

www.abundantlifeacupuncture.com

Or contact her directly at (425) 443-0831