Overuse or Undertrained?Overuse or Undertrained?Injuries in adolescences Injuries in adolescences

Chris Peterson DOChris Peterson DO

TheSportsMedicineClinic.comTheSportsMedicineClinic.com

Definition Definition

Repetition without RecoveryRepetition without Recovery Constant VibrationConstant Vibration Malpositioning of LimbsMalpositioning of Limbs PsychologicalPsychological Under-TrainedUnder-Trained

The Statistics on Adolescent The Statistics on Adolescent InjuriesInjuries

30 Million kids in sports30 Million kids in sports 1/3 of childhood injuries are d/t 1/3 of childhood injuries are d/t

sportssports Athletic injuries are the most Athletic injuries are the most

common reason for ER visits (4common reason for ER visits (4thth for for GP)GP)

Football has highest rate of injuryFootball has highest rate of injury

The Statistics on Adolescent The Statistics on Adolescent InjuriesInjuries

Soccer:Soccer:

5.6 injuries/1000 player hours5.6 injuries/1000 player hours

Risk of injury Increases with skill levelRisk of injury Increases with skill level

Elite youth has highestElite youth has highest

Exposure (2 vs. 1 match/week)Exposure (2 vs. 1 match/week)

Games>PracticeGames>Practice

Common Throwing InjuriesCommon Throwing Injuries

Youth Baseball: Injury RatesYouth Baseball: Injury Rates

Increase of overall injury rate by 5% Increase of overall injury rate by 5% per year. per year.

PopulationPopulation

Poor Trunk Proprioception and ReflexPoor Trunk Proprioception and Reflex Postural SwayPostural Sway Trunk Displacement following Trunk Displacement following

PerturbationPerturbation Weak HamstringsWeak Hamstrings Prior InjuryPrior Injury

Shoulder at RiskShoulder at Risk

Ill-defined symptoms-ignoredIll-defined symptoms-ignored Posterior tightness or stiffnessPosterior tightness or stiffness Inability to “get loose”Inability to “get loose” Tries to “play through”Tries to “play through” “ “I rushed my warm up”I rushed my warm up” Multiple teamsMultiple teams

Overuse or Under-trainedOveruse or Under-trained

Asymmetric pathology in the shoulder Asymmetric pathology in the shoulder and elbow is prevalent and, with and elbow is prevalent and, with overuse, can progress to disabling overuse, can progress to disabling injury.injury.

Joint injury occurs as a result of the Joint injury occurs as a result of the body’s inability to properly coordinate body’s inability to properly coordinate motion segments during the pitching motion segments during the pitching delivery, leading to further structural delivery, leading to further structural damage.damage.

Common Throwing InjuriesCommon Throwing Injuries

Traditional Thinking:Traditional Thinking: Increasing arm strength by Increasing arm strength by

increasing pitching (different from increasing pitching (different from throwing).throwing).

Comparing Injured vs Comparing Injured vs Healthy PitchersHealthy Pitchers

There is little evidence to support There is little evidence to support current safety recommendations for current safety recommendations for adolescent pitchers.adolescent pitchers.

Common Throwing InjuriesCommon Throwing Injuries

Where does the velocity come from?Where does the velocity come from?

Historically-50% Arm/50% BodyHistorically-50% Arm/50% Body

Current-20% Arm/80% TrunkCurrent-20% Arm/80% Trunk

““X-factor”X-factor” What does this mean to me?What does this mean to me?

Time to change my focus!!!Time to change my focus!!!

PosturePosture

Thoracic Kyphosis=Shoulder KillerThoracic Kyphosis=Shoulder Killer

Tight Hips-Contra lateral SideTight Hips-Contra lateral Side

What to expect when you are What to expect when you are expecting.expecting.

Shoulder Injuries:Shoulder Injuries: Growth Plate Changes (good and Growth Plate Changes (good and

bad)bad) Internal ImpingementInternal Impingement GIRD GIRD SICK ShoulderSICK Shoulder

Where’s the Data?Where’s the Data?

Role of BMI in overuse injuriesRole of BMI in overuse injuries ““Athletic BMI”Athletic BMI”

20-2520-25 Lower rate of injuriesLower rate of injuries

Overuse or Under-trainedOveruse or Under-trained

The athletic build population has a The athletic build population has a lower tendency to suffer overuse soft lower tendency to suffer overuse soft tissue injuries tissue injuries

Commencing physical activity at a Commencing physical activity at a younger age may have a positive younger age may have a positive effect in preventing overuse injurieseffect in preventing overuse injuries

Preventing Throwing InjuriesPreventing Throwing Injuries

Recommendation:Recommendation: Maintain throwing but limit Maintain throwing but limit

pitchingpitching Work on entire kinetic chainWork on entire kinetic chain 3 months of “active rest” per year3 months of “active rest” per year Throw the curveball after you Throw the curveball after you

shaveshave

Pitchers Report CardPitchers Report Card

MechanicsMechanics Functional StrengthFunctional Strength Pitch CountPitch Count

Preventing Throwing InjuriesPreventing Throwing Injuries

Do not throw to warm up……..Do not throw to warm up…….. Warm up to throw.Warm up to throw. CoreCore

Bottom LineBottom Line

Biomechanics (Orthotics)Biomechanics (Orthotics) Neuromuscular TrainingNeuromuscular Training Prevention Programs (PEP, F-MARC-Prevention Programs (PEP, F-MARC-

11+)11+) ComplianceCompliance

Unable to eliminate all RiskUnable to eliminate all Risk Need Full Rehab Prior to RTSNeed Full Rehab Prior to RTS

Overuse or Under-trainedOveruse or Under-trained

Who is right?Who is right? Darwin was right.Darwin was right.

Overuse or Under-trainedOveruse or Under-trained

Time to look away from the Time to look away from the pathology and work on players pathology and work on players anatomy.anatomy.

Prevention is now more important Prevention is now more important than ever.than ever.

Overuse or Under-trainedOveruse or Under-trained

““Athletes are dysfunctional”Athletes are dysfunctional”

Goal:Goal:

““Health Dysfunctional Athlete”Health Dysfunctional Athlete”