Q & A
Subject: Partially torn ankle ligament
Date: April 4, 2013
Q: Apparently I have a partial tear on one of my deltoid ligaments, its been hurting for Almost 7 months and I've only went to physio last month, there is pain when i run and fatigue when walking. Am I going to be alright?
A: Ankle injuries can often be more complicated and take longer to heal than people give them credit for. One reason for this is that as a weight bearing joint it is difficult to rest the ankle. The architecture of the ankle joint can also make it more difficult to heal than other types of joints.
One thing I would suggest if you aren't already using it is a brace. An ankle brace can help support the ankle and give it time to heal. If you have been wearing a brace the entire 7 months, perhaps you need to increase the support and try an air cast.
Another suggestion I have is to continue with physiotherapy. Some of the techniques used can help to improve healing and decrease pain.
Finally, I was wondering what kinds of diagnostic tests have been done. It is possible that the torn Deltoid ligament is not the only issue as the same mechanism of injury can cause more than one injury. A talar dome fracture or a high ankle sprain are two other diagnoses that I would attempt to rule out.
I hope this information is helpful!
Rebecca Chambers BScPT, MSc, CMT
Subject: Partially torn rotator cuff
Date: March 28, 2013
Q: Partially torn rotator cuff for 1.5 years. Did Physio for a while. Now getting really back neck pain, other shoulder hurting and getting numbness and tingling in the arm with the injury. I am desperate for relief? Any suggestions ?
A: Thank you for your question. The injuries you are describing may or may not be related. Shoulder issues are often related to neck pain in that the same postural or positional issues can cause both. For example if you spend a lot of time in front of a computer you will be prone to both issues. Likewise if you do any kind of overhead work you will be prone to both. The numbness is most likely caused by the neck rather than the shoulder.
My advice is to correct any ergonomic or postural problems as well as you can. Limit the amount of continuous time you spend driving, looking up or at a computer. Make sure you are looking straight ahead, not to the side or holding a phone with your shoulder. When working out work on back strengthening instead of chest.
If you need more guidance, my advice is to see a physiotherapist or trainer for specific exercises and treatment.
Rebecca Chambers BScPT, MSc, CMT
Subject: Biceps pain
Date: February 25, 2013
Q: I just started baseball season, inner bicep hurts after practice.
A: Thank you for your enquiry. What you are describing could be a number of things. What part of baseball aggravates your arm? Is it throwing or hitting? If it is throwing it could be the biceps as you described. It is possible to be other structures such as the medial collateral ligament of the elbow or the medial epicondyle as well. If it is hitting, the most likely structure is the medial epicondyle (think golfer's elbow).
One thing you can do regardless of the structure involved is ice after activity as well as reduce the amount of the activity that bothers it. As well, I would suggest seeing a professional to get the injury assessed and give you some guidance for specific exercises depending on which structure(s) is injured.
I hope this information is helpful.
Rebecca Chambers BScPT, MSc, CMT
Subject: Strained rotator cuff - lingering
Date: December 31, 2012
Q: About 7 years ago I severley strained my shoulder/rotator cuff playing baseball and got limited treatment for it, after treatment it partially subsided but I noticed my ability to throw was severly diminished.
In July of this year I re-injured this by putting all my upper body weight on it when I was sleeping. My shoulder has been bothering me every day since then. I have been to various walk in clinics this year that have dismissed it as a strain.... if it has lasted this long and my shoulder hurts/clicks when I throw with it are they right that I shouldn't worry? because it sure feels like they are wrong. I also notice working out and doing heavy lifting with my work that I can only lift about 25% of what I used to in the past, before the pain starts to come into factor. I'd like to get this problem completely solved (even if surgery is required) so that I am not dealing with it constantly i.e. i want to take perventative measures to fix it now.
Thanks for any information or insight you can provide.
A: What you are describing could be several things - too many possibilities to zero in on in an email unfortunately. It does sound like it's worth investigating. My suggestion is to find a Sports Medicine Physician in your area. They may send you for a diagnostic ultrasound or even an MRI to find out exactly what is wrong, and then suggest a course of action from there.
I hope this information is helpful.
Rebecca Chambers BScPT, MSc, CMT
Subject: Hip pain
Date: November 21, 2012
Q: Have been putting up with pain in my left hip. Hurts to bend it to put on shoes. Hurts to straighten leg in bed. Hurts to lay on it for period of time Sometimes get spasms of some sort when going from standing position to walking enough to make me collapse on the left side. I work and stand all day at my job as s far at bank. Only work 3.--4. Days a week. Any suggestion for pain relief. Thanks for any info.
A: I will make the assumption that the pain is located on the outside of your hip and with that assumption, what you are describing sounds like it could be ITB (Iliotibial Band) friction syndrome or bursitis. These two conditions are caused by the same biomechanical factors and are treated the same way.
The first thing I would suggest doing is to sleep on the opposite side to the pain, and place a pillow between your knees. The second thing I would suggest is to look up ITB stretches (or "ITB roller" is even better) on the internet and start doing them. These may increase your pain a bit in the short term, but are the secret to reducing the friction that causes the pain in the long run. Manual releases of the ITB by a registered massage therapist will also help speed up your recovery. Some glute strengthening will also help alleviate some of the pain-causing friction. This can be looked up as well, or given by a trainer at the gym. (If you are in the GTA area I would suggest any of the SST Canada locations.)
In the meantime I would also suggest reducing friction-causing activities such as walking or jogging and then slowly return to these activities when the pain decreases.
If your pain is located in the groin or back of the hip, the diagnosis is a bit trickier, and I would suggest seeing a sports medicine doctor or registered physiotherapist.
I hope this information is helpful,
Rebecca Chambers BScPT, MSc, CMT
Subject: Strained back
Date: September 21, 2012
Q: I strained my back lifting boxes off shelves, off the floor and overhead. I am usually a sedentary office worker who is not used to lifting much of anything. The pain improves during the day if I take breaks from sitting to walk around however the pain is excruciating at night and keeps me up even when taking muscle relaxers and anti inlfammatories. I wake up in pain and very stiff. I use a knee pillow while on my side and I have tried pillows under my low back and knees while on my back but it does not help. Our mattress is very firm and is only a few months old. Do you have any suggestions for another pillow placement or some kind of support I can try? Thank you for your help.
A: Without doing an assessment, it is difficult to know for sure exactly what you should and shouldn't do, since different pathologies will respond to different changes in behaviour. However here are a few rules that you should follow for every back injury:
1. always lift with your knees. When you are carrying something heavy, always turn with your feet; do not twist with your back.
2. do not sit for prolonged periods (getting up every hour is what I recommend to many patients). When you are sitting try to have some lumbar support to maintain the natural slight arch in your lower back. But remember, we are just not meant to sit for long periods regardless of how "ergonomic" your work station is.
3. sleeping on your side with a pillow between your knees is the best position for any back injury.
I hope these tips are helpful. If you continue to have issues, I would suggest making an appointment with a medical professional.
Rebecca Chambers BScPT, MSc, CMT
Subject: Groin injury
Date: September 21, 2012
Q: I have a grade 3 adductor groin tear. The Injury occurred on 23 Aug, 2012. What is your advise for rehab?
A: A grade 3 tear indicates a fairly significant injury with major macroscopic tearing, if not complete rupture. What this means is that if you peeled the skin away you would be able to see the deficiency (hole or break) in the muscle easily with the naked eye. Adductor strains have the potential to become chronic even when minor, so this means that you will need supervised and controlled rehab, and lots of it, and it will probably take at least 8 weeks to heal.
As the tissue is healing, it will need some input to tell it which way the scar needs to form, so light activity (stretch, slight resistance) will be indicated to start. However, you don't want to put too much strain through the tissue or you will re-tear all the tissue that your body has worked so hard to form. Before you return to sport, you will want to progress the amount of strain the muscle can handle until the muscle is stronger than it was before you injured it. So you can see that this process is one that would be most beneficial if it was supervised by a professional. Some massage and modalities such as ultrasound or acupuncture may also help speed up the process. All of this can be done by a qualified physical or athletic therapist. Check any insurance plans you have to see what your package will cover.
I hope this information is helpful, and good luck with your rehab.
Rebecca Chambers BScPT, MSc, CMT
Subject: Elbow pain
Date: August 14, 2012
Q: I've been playing softball for 5 years now, and every game I have had to wear an arm brace and the muscle above my elbow on the inner side hurts after every game. Do you have any exercises I can do to minimize the pain?
A: What you are describing could be one of several things. If the pain is localized on the bone on the inside of the elbow what you are describing could be golfer's elbow. If this is the case, I would suggest a stretch with arm straight, palm up and using the opposite hand pull your fingers down toward the ground. You could also strengthen the forearm doing forearm curls.
If the pain is higher up, you could be describing a triceps or biceps strain. A good tricep stretch is reaching behind your neck and then down your back. You can add to the stretch by using the other hand to push it even further. It is difficult to stretch the biceps, but you can try by sitting, putting your hands behind you, arms straight, palms down with fingers away from you. To add to the stretch slide your bottom away from your hands.
If none of these help, I would suggest seeing a sports medicine physician or a physiotherapist. I hope this is helpful.
Rebecca Chambers BScPT, MSc, CMT
Subject: Lower back pain
Date: July 18, 2012
Q: About 3 months ago, I started noticing pain on my left side around the hip and lower back. With it came a numbing in my left leg that was most predominant in the "tear drop" of the quadriceps. It has becoming increasingly more predominant since then. I've been doing a lot of stretching, back strengthening exercises and yoga to try to improve it, but it hasn't seemed to help much. In the mornings my back and hip are very stiff. And I find that sitting doesn't aggravate it but standing for periods of time and carrying heavy items will. When I saw a doctor he indicated that it could be acute lower back pain - facet syndrome. What can I do to help alleviate the pain and loosen up the muscles more so my movement is more fluid?
A: Low back pain is difficult to assess, even more so by email. What you are describing could be an irritated facet joint, but since you are also describing neural symptoms an alternate diagnosis could be a herniated disc. These two conditions require different styles of exercise programs. As such, I would suggest you see a physiotherapist to get a more in depth assessment followed by the appropriate exercise program.
I hope this information is helpful.
Rebecca Chambers BScPT, MSc, CMT
Subject: Hip tendonitis
Date: June 7, 2012
Q: My son has tendonitis in his hip. What should he do to get back in shape?
A: Most tendonitis in the hip is caused by muscle imbalances. Because of our lifestyle we tend to spend more of our day sitting than we are meant to (even as a high school student) which leads to tightness in the front and weak and lengthened muscles in the back. This is a generalization and without doing an in-depth assessment or even knowing which of the hip muscles is affected it is difficult to know for sure what is going on.
I would suggest seeing a physiotherapist or even a reputable trainer to get a hip assessment done so he can get started on a stretching and strengthening program to address any imbalances. One exercise that is almost always indicated is lunges.
I hope this is helpful.
Rebecca Chambers BScPT, MSc, CMT
Subject: Fracture rehab
Date: May 24, 2012
Q: My 12-year-old son fractured his 5th metacarpal and distal radius on his throwing arm. He is a baseball pitcher and we were wanting a rehab plan to allow him to start back playing as soon as possible. His cast is coming off this Friday.
A: I'm sorry but this is very difficult to do without doing an assessment. After immobilization every person will have different deficits and the extent of those deficits will vary as well. My advice is to see a sports physiotherapist or athletic therapist (if you don't have coverage an athletic therapist is often cheaper), even if it's for a few visits following the removal of your son's cast. They will be able to do an assessment and send you home with a rehab program followed by return to sport exercise program.
You should be able to get a referral for this on your visit on Friday.
I hope this is helpful and good luck!
Rebecca Chambers BScPT, MSc, CMT
Subject: Fracture rehab
Date: May 24, 2012
Q: My 10 yr old son has a salter 2 fx of LD1 that occurred 4 weeks ago. The Plastics MD states another 2 weeks in cast then physio. How long would be an appropriate rehab time frame after the cast comes off before starting to practice catching and hitting. What exercises should he do when the cast comes off.
A: The exercises that will be involved in your rehabilitation will be aimed at restoring losses resulting from the injury and immobilization. This will include range of motion, strength and eventually return to sport specific activities. Some hands on treatment may be necessary if there is significant range of motion loss, and modalities may be required if there is residual pain or inflammation. Return to sport should be determined by your physician, physiotherapist as well as your son's tolerance.
Rebecca Chambers BScPT, MSc, CMT
Subject: Wrist injury
Date: May 11, 2012
Q: My son fractured his metacarpal bone below the pinkie and fractured his distal radius bone in his wrist. He has been in the high performance program and I am interested in any information you can provide on what to do after the cast is removed. He is 12 years old and a pitcher.
A: I would highly recommend going for some physiotherapy once your cast is off even if your specialist assures you that you don't need it. They will ensure you regain full range of motion and set you up with a strengthening program to avoid other injuries in the future (even more so if it is your throwing arm).
Rebecca Chambers BScPT, MSc, CMT
Subject: Upper back pain
Date: May 3, 2012
Q: I have a 17 year old daughter who plays select softball as well as high school ball. She has recently started to experience some pain in her upper back between her right shoulder blade and spine. It is not a constant pain throughout the day, but hurts when she swings her bat or throws a ball. The funny thing is when she swings or twist her body from the left it does not hurt. She is in no pain in her day to day routine, but during practice or a game she is hurting. Any ideas?
A: This sounds like a more complicated condition which could be a variety of muscle or joint issues. My recommendation is that if this is still a bothersome issue to go see a sports medicine specialist of some sort.
Sorry I could not be more helpful in this situation!
Rebecca Chambers BScPT, MSc, CMT
Subject: Biceps Discomfort
Date: March 26, 2012
Q: I have a problem with my left Bicep, when i flex it I can put my hand on the top of it and it makes this squishy feeling. I can keep flexing and relaxing and it always does it. It only does it when I workout. I can sit around at my house and do it and nothing happens. Thanks for the help!!!
A: Thank you for your question. What you are describing sounds like tenosynovitis. There is a sheath around the biceps tendon, which is filled with something called synovial fluid. When this sheath gets inflamed there is extra fluid produced and it gets trapped within the sheath. Other symptoms and causes are similar to tendonitis. Although it is difficult to be sure without doing a physical exam, this is sounds very much like what you are describing. If it is not symptomatic (no pain), I would still be cautious about your weight training routine. Take two weeks off any heavy overhead lifting (if it is the upper tendon of the biceps) or biceps strengthening (if it is the lower tendon of the biceps near the elbow) and concentrate on legs, back and throw some rotator cuff strengthening into your routine (specifically if it is the upper portion of the biceps tendon). If it is symptomatic, it may be time for some professional help, so I would recommend seeing a sports medicine specialist of some sort.
I hope this is helpful. If you have any other questions, do not hesitate to ask.
Good luck, Rebecca Chambers BScPT, MSc, CMT
Subject: Shoulder injury
Date: March 25, 2012
Q: I suffered a shoulder injury years ago, had surgery but have never had a good feeling in my shoulder. I was never a hard thrower, but have not come close to what I used to. My shoulder and arm often get sore, and feel very fatigued. Even when not playing I experience this. Any ideas how this can be resolved?
A: Thank you for your question. My first question to you is whether you did any rehabilitation post-op on that shoulder. It takes a lot of very specific rehabilitation to get your strength back after shoulder surgery, and depending on how much rehab you did, you may just need to do more. Returning to sport or weight training without guidance will not be sufficient as you will strengthen the big muscles without strengthening the rotator cuff. The rotator cuff is very important for providing stability to the shoulder which is a key element to both strength and dynamic activities such as throwing.
If you did an extensive amount of rehab on it (more than 6 months) and still feel that there is significant weakness, you may want to return to see your surgeon or a sports medicine doctor as there may be something else going on.
I hope that this helps, and if you have any other questions, please don't hesitate to ask.
Rebecca Chambers BScPT, MSc, CMT
Subject: First aid
Date: January 27, 2012
Q: Do you have a basic baseball trainer program providing basic knowledge as it relates to conditionning, prevention (especially pitchers) and first intervention when an injury occurs at practice or a game? I am a assistant baseball coach in the GTA and I will be responsible for players' conditioning and also their health. I'd like to have basic training to establish an action plan if a player gets hurt and also the players re-introduction into the team following an injury. Let me know if you're aware of such training. There are such programs in amateur hockey for all levels.
A: I am not aware of any program that is geared toward baseball specifically. There are several Athletic Therapy programs at both Colleges and Universities around the GTA (Sheridan and York University come to mind). You may want to see if they have single courses on sports injuries, but there won't be one geared specifically to baseball.
I would highly recommend basic first aid. Most acute injuries are treated in the same manner on the field, no matter the sport. Follow your basic RICE (rest/ice/compression/elevation) principles and you will be safe.
I would also highly recommend visiting the American Association of Orthopedic Surgeons website http://orthoinfo.aaos.org/topic.cfm?topic=A00185. They have an excellent basic review on treating and preventing baseball injuries. From that page you can also search throwing injuries and little leaguers elbow should pop up. This will give you some basic information on what this injury entails and how serious it can be.
Rebecca Chambers BScPT, MSc, CMT
Subject: Elbow injury
Date: November 22, 2011
Q: I am 19 years old and for a few years I have had pain in my elbow when I throw. I was playing first base and changed to third. At one point this season I couldn't even throw 5 feet. I went to the doctor and was told I had medial epicondyle inflammation and needed to rest it. What can I do to get my rotator cuff stronger and my scapula muscles stronger?
A: This is an interesting question, since most exercises for your rotator cuff and scapular muscles require a gripping motion which will in turn place stress on your elbow. I would suggest using a theraband that is tied into a loop at the end. You can then place that loop around your elbow for rotator cuff exercises. This may still place stress on your elbow, in which case you will have to rest from that specific motion. For scapular strengthening you can place the loop above the elbow which will take all the strain off your elbow. You could also use cable or ankle weights in the same manner.
I would highly recommend the training staff at SST Mississauga, as they follow excellent training protocols for rotator cuff and scapular strengthening.
I hope this information is helpful, and good luck with your elbow injury.
Rebecca Chambers BScPT, MSc, CMT
Subject: Elbow cracking sound
Date: November 22, 2011
Q: I started playing baseball 2 years ago when I was 15. I never had anyone show me the proper techniques for nearly anything, I just learned through the internet, books & Youtube. I would occasionally learn things at tryouts and in house league. Now, I used to have a sidearm throw (which put WAY too much torque on my elbow) and i would wind up with tendonitis. My Elbow would hurt for a few days and then i could get back to throwing. I've fixed my throwing arm slot & re-adjusted it so I throw more 'over the shoulder' (I.e. my arm is slightly above my shoulder when I throw, the correct way to throw as I've found). My problem is with my elbow. After I play catch, I can flex my arm (so that my bicep & forearm are very close to each other) and I can make my elbow make a squishy crack noise. What is this? It happens every time i flex my arm now, and now my elbow starts cracking like when I crack my knuckles. Is this bad for me? Is there any way to make this stop?
A: Some joint cracking is called "cavitation." This means a nitrogen bubble is being released due to pressure changes. There is no evidence that repetitive cracking can cause long term damage. The important thing to note is if there is pain with the cracking it may indicate that there is something more serious going on, and you should see a health care professional.
I hope this information is helpful.
Rebecca Chambers BScPT, MSc, CMT
Subject: Rehab program for shoulder
Date: October 25, 2011
Q: I am 18 years old and I have a torn inferior glenoid labrum tear from the 5 to 8 o'clock position. I will have surgery on november 10th and wanted to know what i should do to rehab it after and if there is a porgram at the baseball zone for this.
A: Your rehab will depend on your surgeon's post-op protocol. Unfortunately sometimes you don't get this until after you have had the surgery and if you don't get it ASK!! (Or get one of your parents to ask nurses/surgeon for it since you may not remember).
Usually your arm will be immobilized for 6 weeks. During this time the surgeon should give you a list of things you can do (grip strength, icing etc). Once immobilization is over you will want to work with a physiotherapist who has sports experience for the initial rehab (or an athletic therapist if you do not have coverage). After the initial stages of physiotherapy you should ask what you can do on your own for your shoulder as well as your general fitness at which point you may be able to do some things at The Baseball Zone or Sports Specific Training (SST) instead of therapy. In the end stages is when you will be able to take greater advantage of The Baseball Zone and SST Mississauga to do more advanced workouts.
How long this will all take depends on the extent of the surgery, your healing ability and your diligence. Shoulder rehab from a surgery of this extent can take up to 6 months in total.
I wish you the best of luck in this journey and remember the harder you work, the more worthwhile the whole experience will be.
Rebecca Chambers BScPT, MSc, CMT
Subject: Baseball (shoulder pain)
Date: August 14, 2011
Q: I am 15 years old. I'm not normally a pitcher but I have been doing a lot of throwing. Lately I've been noticing pain in my throwing shoulder when I throw a ball. It seems to be coming from the sides and the inside. I'm not sure what the problem is. What should I do?
A: Although it is difficult to assess your shoulder without seeing you, usually shoulder throwing issues are a result of rotator cuff irritation. The rotator cuff is a group of muscles that control and stabilize the shoulder, and it could be any one of these that is the culprit.
My advice is to return to your previous (lower) throwing level for two weeks and begin some rotator cuff strengthening. Once the pain has subsided, slowly increase your throwing volume and progress your rotator cuff strengthening. Someone at the Baseball Zone or SST Mississauga should be able to help you with a rotator cuff program.
In the meantime, I would also recommend seeing a sports medicine physician, which is covered by OHIP for a thorough assessment.
I hope this is helpful.
Rebecca Chambers BScPT, MSc, CMT
Subject: Baseball (stress fracture)
Date: August 14, 2011
Q: My son is 12 years old. He started with pain in his elbow back in September of last year, then when practicing hard for baseball again in January, it got even worse. After an MRI, it was determined that he had a stress fracture from playing too much, he's a catcher and was suggested rest. That was January. This is August. He still suffers the same pain with any sport, even though he hasn't played baseball for a whole season. Is this normal? His doctor said, it could take a while, but I just can't imagine that it's taking more than eight months for a stress fracture. He had another MRI in June showing slight edema but improving. His doctor recommends no sport until next spring. Is this logical? Over a year for a stress fracture to heal? Just very frustrated with the fact that he can't play his favorite sport.
A: I am sorry to hear about your son's injury. Unfortunately this time line is not totally unreasonable. The problem with stress fractures is that there is no one incident of trauma. It is the trauma that stimulates the healing process, so without that, stress fractures take an inordinate amount of time to heal.
One treatment that I have seen some moderate increase in the healing speed of stress fractures is shock wave therapy. The way that it works is that it induces a controlled amount of trauma, thus stimulating healing. Unfortunately it does not have a 100% success rate and is expensive, but it still might be worth investigating.
I hope this information is helpful and puts your mind at ease with respect to the healing timeline.
Rebecca Chambers BScPT, MSc, CMT
Subject: Baseball (elbow pain)
Date: June 21, 2011
Q: I am 15 years old and am a pitcher. Last September I had pain on the inside of my throwing elbow whenever I threw a ball or picked something up. I went through about 2 months of physio and the pain started to go away. Now this season has started again and I'm feeling more pain than before on the same spot of my elbow when I pitch. When I throw, the pain shoots down usually from my elbow down to my forearm. My previous physiotherapist suggested that it was because of overuse when I was younger, around 11 or 12. What do you suggest I do?
A: This is a difficult question for me to answer without doing an in-depth assessment. There are many structures that could be at fault including tendons, ligaments, bones and nerves. I am not sure what your physiotherapist was referring to when mentioning a childhood injury, my only guess is that they think you may have had "little leaguer's elbow." This is an overuse condition caused by the repetitive stress of throwing. Why it manifests differently in children is because of the stress is placed on the growth plate while the child is still growing. This can cause pain in the bone, change the speed of growth of the bone (ulna), and even cause a small piece of the bone to break off. Because of your age, you may still be growing and little leaguers elbow could still be a possibility. My advice is to see a sports medicine doctor (or go back to the one you saw previously) to get a full assessment and an x-ray if necessary.
I hope this is helpful.
Rebecca Chambers BScPT, MSc, CMT
Subject: Baseball (shoulder pain)
Date: June 14, 2011
Q: I am 16 years old and am a 2nd baseman. I have had shoulder pain in my right shoulder for about a year following a fall during a baseball game. I have had an MRI done, and they found no significant tears or damage. I did one round of basic physio, at which time it was my off season and therefore seemed to have worked. I started playing again this year and the pain has returned. The pain radiates from my shoulder down my arm, sometimes into my pec muscles when I make a hard throw. I went to a massage therapist, her assessment was this: "adhesions present in teres major and infraspinatus rt shoulder. Tightness through rhomboid, subscap and upper trap rt shoulder". What do you suggest I do for this injury. It is really affecting my game.
A: Unfortunately this is a very difficult issue for me to help you with in an email. The shoulder is a very complicated joint complex since it is made for mobility rather than stability. This means that it has very little joint stability and relies on the muscles surrounding it to provide stability (mostly your rotator cuff). Without doing an in depth assessment it is impossible for me to determine which structures are at fault, but I can guess that one of three general scenarios is probably happening:
1) You may have irritated a tendon when you fell, which is continuing to be irritated at present (tendonitis); or
2) You may have stretched one of the stabilizing muscles of the shoulder, allowing impingement to occur (pinching of a structure between the bones); or
3) One other slightly more serious issue that is a possibility is a labral tear. This issue sometimes does not show up on a regular MRI, and requires a more invasive test called an MR arthrogram.
My advice is to return to your sports medicine physician, and explain that you have done physio (hopefully this included LOTS of shoulder strengthening!) and your shoulder is still sore. He/she can go over the mechanism of injury and do special tests in the office and decide what the best route would be from here.
Sorry I don't have a more specific answer for you, but hopefully this is still helpful.
Rebecca Chambers BScPT, MSc, CMT
Subject: Baseball (rotator cuff injury)
Date: May 31, 2011
Q: I have a 5mm tear of my right supraspinatus (rotator cuff) from a throwing injury in rec baseball. I got xrays/ultrasounds and its extremely official. I'm new to injuries and went to get physio at a random place and I really felt they didn't know what to do and they were very "generic" about everything. I need this fixed and it hurts just throwing a tennis ball with my dog at the park. Can you recommend me a specific physio who specializes in ball throwing injuries. My tear ONLY affects my shoulder when throwing an object... it doesnt hurt when doing a throwing motion with nothing in my hand.
A: I first want to warn you that rotator cuff tears are extremely slow to recover. The rotator cuff tendons do not have a very good blood supply. This is one of the reasons that they are susceptible to injury. It also means that they are very slow to heal.
Also, you are not likely to find a physiotherapist who focuses solely on throwing injuries, but I will give you the name of an excellent sports physiotherapist that I used to work with and who I know does have experience with throwers. His name is Carlo DiNardo and the clinic he works at is called Kick Physiotherapy.
Here are the contact details:
10055 Keele Street, Unit 105
Maple, Ontario
(905)417-3800
www.kickphysio.ca
I hope this is helpful.
Rebecca Chambers BScPT, MSc, CMT
Subject: Baseball (Quadriceps strain)
Date: May 30, 2011
Q: My 15 year old son attended his team baseball practice outside (cold and wet) about one month ago. He was running the bases and appears to have pulled a muscle on the front of his left leg between his knee and his hip (quad maybe?). Since then, everytime he has to sprint, the leg starts to hurt again. I have made an appointment for a physiotherapist to have a look at him but I would appreciate any advice you may have.
A: You are correct, it sounds like a strained Quadriceps muscle. There are several levels of muscle strains. First degree strain only involves micro tears (if you opened up the tissue you could not see the tears with the naked eye). Second degree tear is more extensive and usually creates some damage to the blood vessels as well. Third degree tear is a complete tear of the muscle. The way you will know if you had a second degree strain or higher is if there was any bleeding (this may show up later, and anywhere from the point of pain down to the ankle). A third degree tear will create a palpable or visible defect in the muscle as well as significant weakness and dysfunction.
Your son's strain sounds like a first to second degree strain. These can take anywhere from 3-8 weeks to recover from depending on the extent of damage. Heat, light activity (low resistance cycling, gentle strengthening and stretching) with a gradual increase in intensity before returning to sprinting will optimize your recovery. Ultrasound, acupuncture and some sort of manual treatment are all treatments that your physiotherapist may also perform to help speed up your recovery.
Rebecca Chambers BScPT, MSc, CMT
Subject: Baseball (Elbow Injury)
Date: April 25, 2011
Q: My son has 3 pins in his catching elbow and periodically his muscles (from lower bicep to upper forearm) will seize up. He does stretch out his arm before use and remembers to stay well hydrated. Any ideas on why this might be happening?
A: Your question is a very interesting one, and one that I have encountered in the past, but am not totally sure of the answer. An in-depth assessment might lead to a better answer, but I will put forward a few hypotheses.
Often after an orthopaedic surgery of this magnitude, there are changes to the muscle and bone that may cause the muscle to function less optimally, leading to overwork and then cramping. The following are a few examples:
- I am not sure of the extent of rehab he had post-surgically, but if he is missing the last bit of his elbow or wrist range of motion this would definitely create this scenario.
- If the bone wasn't fixed at exactly the same angle, or if there was excessive healing of the bone this would also put the muscle at a mechanical disadvantage.
- Finally, if there was excessive scar tissue affecting the nerve or vascular flow to the muscle, this might also cause the muscle to spasm.
There are a few things that you can do which might reduce the frequency of these spasms. Continue to drink lots of water and stretch, these are your best two options. Some further strengthening of the forearm muscles may also help. This will help improve the blood flow to the existing muscles as well as create an environment where they would be working at a lower percentage of their maximum effort with the same activity. A few visits to a professional that does some manual therapy (a physiotherapist trained in manual therapy, sports massage therapist or ART practitioner) might also reduce any remaining scar tissue to enable muscles to work more optimally, and improve blood flow and nerve signals.
Rebecca Chambers BScPT, MSc, CMT
Subject: Baseball (Elbow Injury)
Date: February 18, 2011
Q: A few weeks ago my 14 year old son took a bit of an awkward swing at an inside pitch during batting practice and reported pain on the top of his left arm where the forearm and the biceps meet. He is right handed. There is no joint pain and he has not seen a doctor. The pain has recurred a couple of times in the same spot during subsequent batting practice sessions. He works out at SST 3 to 4 times a week and reports no discomfort. He has also grown about 6 inches in the last year. I would appreciate any insight you may have.
A: Although this could be a couple of injuries, the most obvious one that comes to my mind is lateral epicondylitis; commonly known as tennis elbow. Tennis elbow is usually a repetitive injury and can come from many types of activities (including something as simple as repetitive keyboarding). It is named tennis elbow since it comes from the impact of the tennis racket with the ball during a backhand stroke. If you think about this, it is very similar to the impact felt in the lead arm as the bat hits the ball. Hitting the ball in awkward position will mean that the muscles are at a disadvantage and therefore even more prone to injury. Another contributing factor could be muscle tightness due to your recent growth spurt as I commonly find that immediately following a growth spurt it takes a while for muscle length to catch up with bone growth.
A few things that you can try for this injury at home include:
- Take a break from batting practice and continue with other activities for at least one week.
- Stretch the forearm muscles: this is done in two positions; both with the arm straight in front of you. Position one is with the palm down, use the other hand to pull the hand down so the fingers point towards the floor. Position two is exactly the same, but with the palm facing up.
- Strengthen the forearm daily with forearm curls, reverse curls and grip strengthening at a PAIN FREE weight/resistance and range of motion
- When the above is easy (give it at least a week), the curls should be done with emphasis on the "eccentric" phase; slowly lifting up with a quick drop and stop before you go all the way down. (Research has shown that this is the best way to promote tendon healing)
- Sometimes heat and a tennis elbow brace can also help recovery
Please note that if you let tennis elbow become chronic, it is very difficult to get rid of, so now is the time to take care of it. If you find that the above does not help at all within one to two weeks, you should seek medical attention to rule out more serious issues.
Rebecca Chambers BScPT, MSc, CMT
Subject: Baseball (Shoulder Pain)
Date: February 18, 2011
Q: I attend the Baseball Zone three times a week and in the last week or so, I seem to have a pain in between my shoulders. It bothers me more to swing a bat than throw a ball. What kind of exercises can I do to strengthen that?
A: Pain between the shoulder blades can be any number of issues. Because it is worse with swinging a bat than throwing, which requires a movement that is closer to a pure twisting motion, it makes me suspect that you have irritated either spinal joints, costovertebral (rib) joints or the spinal muscles, rather than shoulder blade musculature (rhomboids, trapezius muscles). I would recommend doing some slow, pain free, rotational strengthening in both directions, but if this is still an issue, I would suggest seeing a sports medicine specialist to get a more definite diagnosis.
Rebecca Chambers BScPT, MSc, CMT
Subject: Baseball (Rotator Cuff Tendonitis)
Date: February 18, 2011
Q: I have been diagnosed with rotator cuff tendonitis in my throwing shoulder. I was just wondering what i could do at home to treat it?
A: The rotator cuff is essential in the stability of the shoulder, and as such imbalances in the strength or tissue length of these muscles can wreak havoc on the shoulder.
The first question you need to look at is how much internal rotation you have. You can do this by lying on the sore shoulder side with your arm straight ahead of you and elbow bent to 90 degrees. See how much the wrist can move down toward your feet. If the arm stays straight up, I would work on this stretch using the other hand to pull the palm toward the floor (For a better idea please refer to this video - http://www.youtube.com/watch?v=1ld6j0vaCcM)
Also I would work on strengthening the rotator cuff. This can never hurt. Remember to work on both internal and external rotation. External rotation is just as important as it is used in slowing the arm down during follow through. Start by working both rotations with your elbow squeezed into your side. As that gets easy, move your elbow up to 45 degrees and then 90. You should be able to do the same amount of resistance for both directions.
Don't forget to strengthen your core: obliques and back muscles; if these are weak, your rotator cuff will be overused!
Rebecca Chambers BScPT, MSc, CMT
Subject: Baseball (Elbow Injury)
Date: January 20, 2011
Q: My son hyperextended his throwing arm about three weeks ago. He experiences some pain in the elbow when trying to throw, so he has not tried to throw for a week. The pain is still there so apparently the condition has not improved. He can do arm exercises that do not require a throwing motion. An ultrasound revealed a little more than normal amount of fluid in the elbow joint, and massaging the bicep just above the elbow and wearing a flex bandage helps just a little. What else should he do?
A: Ultrasound is a superficial diagnostic test which - in an orthopaedic situation - is used to assess soft tissue damage. Examples of injuries that would be assessed with ultrasound would be lateral or medial epicondylitis (tennis or golfers elbow) or a ligament sprain. The fact that the ultrasound showed that there was extra fluid within the joint suggests that some tissue was damaged, but it sounds as if it was not elucidated which structure was injured.
This injury could still be a range of issues. Without doing a thorough assessment, it is difficult to even guess; it could be anything from a simple first degree sprain which probably would not show up on an ultrasound, to something a bit more sinister such as damage to the cartilage or bone within the joint.
Sometimes it is difficult to read a child's discomfort level as they do not always communicate what they are feeling. However, if it is an activity he is dying to get back to, and pain is stopping him from participating, I would take his complaints seriously.
Finally, remember that even in a child, a week off is not a long time for tissue to heal. If he went back to throwing at full intensity (full distance/speed) right away, it may be a simple fact of returning to activity too quickly. Bracing and icing are positive things you are doing, but I would take at least another week off, perhaps with some gentle, pain free strengthening around the joint (a physiotherapist or athletic therapist would be able to provide these to you). At that point, I would recommend a slow return to activity: 50% intensity of throwing would be a good place to start for the first week back. If there is still no improvement I would return to your Sports Medicine Physician or Orthopaedic Surgeon for further investigations such as an x-ray or MRI.
Rebecca Chambers BScPT, MSc, CMT