Posts tagged elbow pain
The Importance Of An Offseason In Adolescent Baseball Players
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Early sport specialization where our youth athletes focus on a single sport year round has become more popular over the last decade. The 10,000 hours reference (original study in violinists not athletes) reinforced this concept despite the adverse events of early sports specialization include burnout, depression/anxiety, lower athletic performance, and sports injuries. Research into high level professional athletes indicates the vast majority of these athletes did not specialize in an individual sport until their late teens (post high school). Playing a variety of sports or playing sports on a seasonal vs. year round allows for recovery and correction of repetitive sport specific movements like throwing. A recent study highlights the importance of the offseason in youth baseball athletes.

Otoshi and colleagues in the Journal of Shoulder and Elbow Surgery enrolled close to 700 elementary school baseball players who underwent a medical history, physical examination, and ultrasound investigation of their elbow joint (2019). Authors reported an inverse relationship between elbow pathology found on ultrasound and the duration of the athletes’ off season. Athletes who played either a longer season or multiple seasons per year were found to have the greatest prevalence of elbow pathology. Conversely, an athlete’s risk of pain and pathology on ultrasound was significantly lower if their off season last longer than 1-2 months. As expected, authors found off season recovery was significantly associated with the presence of elbow pathology.

Manual Therapy Improves Outcomes In Patients With Tennis Elbow
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Manual therapy, including joint mobilization and manipulation, is a Physical Therapy intervention designed to reduce pain and improve mobility.  These interventions have been shown to accelerate a patient's recovery compared to usual care or exercise alone.  Although mechanisms behind its' effectiveness are still being researched, manual therapy unique ability to reduce pain allows an individual to exercise at a higher intensity.  Greater loading of the injured tendon accelerates a patient's recovery and return to work and sport.  A recent review of the literature highlights the benefits of manual therapy for patients with lateral elbow pain.

Lucado and colleagues reviewed 20 studies on the effectiveness of manual therapy applied either locally to the elbow or globally to the upper quarter in patients with lateral elbow pain (J Hand Ther. 2018).  These techniques included mobilizations, mobilizations with movement, and manipulation.  The authors found local elbow manual therapy treatments reduced pain and improved pain free grip strength in the short term.  Regional manual therapy techniques applied to the upper quarter improved pain, grip strength, and function.  The authors concluded there is compelling evidence for the utilization of manual therapy by Physical Therapists at all time points in a patient's recovery from lateral elbow tendinopathies.

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Shoulder Stabilization Improves Pain and Function in Patients with Elbow Pain
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Lateral elbow pain, tennis elbow, is a limiting condition causing pain with repetitive movements including gripping.  This condition was previously though to occur secondary to inflammation within the wrist and fingers tendons insertion into the arm, but current researchers have not found inflammatory cells in patients with this condition.  Instead, cells of the injured tendons display degeneration and disorganization consistent with the healing process.  Gradual loading of these injured tendons with exercise has been shown to accelerate the recovery process and tendon remodeling.

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Loading of the injured tendon through exercise is critical to its' healing.  Both over loading and under loading are equally detrimental to the recovery of the tendon.  New research demonstrates utilizing shoulder strengthening reduces pain and improves arm function in patients with lateral elbow pain.  Lee and colleagues randomized patients to either elbow or shoulder strengthening groups (J PT Sci. 2018).  Authors reported both groups improved grip strength, pain, and tenderness after the completion of the strengthening program.  No differences were noted between groups indicating loading of the injured tendons can be done specifically at the elbow or globally through the shoulder.  The key is loading based on the tissue tolerance of the injured tendon.  

To learn more on how to successfully manage your tendon pain contact the experts at MEND

No Difference Between Surgery and Placebo Surgery For Tennis Elbow
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Tennis elbow or lateral epicondylalgia is a painful condition affecting the wrist and finger extensor tendons as they attach into the arm.  Breakdown of the tendon at its' insertion and weakness in the forearm muscles lead to pain and reduced tolerance for gripping and hand movements.  Physical Therapy treatments including manual therapy to the spine and extremity joints has been shown to accelerate recovery and lead to reduced healthcare utilization over the long term.  Importantly, manual therapy improves a patient's tolerance for strength training exercises which allow for long term relief.  Patient's who do not improve with conservative treatments may opt for surgical debridement of the injured tendon and muscle.  

A recent double blinded, randomized controlled trial compared the effectiveness of surgery to a sham or placebo surgery in patients with chronic tennis elbow pain (Krosiak et al. Am J Sports Med. 2018).  Patients were randomized to either a sham/placebo group (skin excision and exposure of the tendon) or a surgical debridement and excision of the affected tissue.  Interestingly, both groups improved pain and function at 6 month follow up but there were no significant differences between groups.  Authors stopped the study early due to the lack of differences between the surgical and placebo groups.  The authors reported no additional benefit of surgery over placebo for patients with chronic elbow pain.

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Imaging's Role in Youth Baseball

In our previous blog posts we have written on the limitations of MRI for many injuries and conditions.  In general, these expensive tests have high rates of false positives where patients without pain often have positive results including ligament/labrum tears or tendon changes.  The incidence of false of positives increases in athletes with the majority of major league baseball players, regardless of symptoms, demonstrating rotator cuff tears or labrum injury.   It appears these changes are no different in our little leaguers.  

An article in the Journal of Bone and Joint Surgery examined 10-13 year old little league baseball players.  Each player underwent an MRI on both elbows at the start of the season.   The authors found many of the players with or without pain had imaging findings in their elbow.  Adding to our existing data that many athletes have positive MRI findings without pain or injury.  Two factors were associated with a positive MRI and elbow pain including year round baseball play and working with a private pitching coach.  

Athletes are encouraged to work with a local Physical Therapist to treat their elbow pain and reduce their risk of throwing injuries. 

Shoulder Range of Motion and Risk of Injury in Professional Baseball Players

Shoulder and elbow injuries are on the rise among youth and professional baseball players.  Our previous post on baseball injuries detailed the risk of future injury if an athlete has lost range of motion in his shoulder prior to the season.  In particular, emphasis has been placed on the amount of internal rotation (hand behind lower back) in an athlete's throwing shoulder.  A common adaptation in a thrower's shoulder is to develop additional external rotation (cocking phase of throwing) and lose internal rotation (Figure A).  An important point is the athlete should maintain the same total range of motion from side to side given this adaptation (Figure B).  An at risk shoulder would have an total range of motion less than the uninvolved side.  

A recent prospective study in the American Journal of Sports Medicine examined the impact of a Professional thrower's range of motion on their injury incidence during the season.  Wilk et al. examined 296 professional pitchers for range of motion and followed these players through the upcoming season.  As expected, the authors noted significant side to side differences in their shoulder range of motion.  51 pitchers reported 75 shoulder injuries for a total of 5570 days on the disabled list and 20 surgeries were performed.  The authors found <5 degrees greater external range of motion in the throwing shoulder of pitchers made them 2 and 4 times as likely to become placed on the disabled list or undergo surgery during the season.  

A thrower requires a greater degree of shoulder external rotation than another athlete, if this adaptation is not present it may be a sign of further problems.  In particular, the total range of motion should be measured and be equal between the throwing and non throwing shoulders.  For more injury prevention information or to address risk factors for your sport contact the experts and Mend Physical Therapy.