Baseball

When should a pitcher learn how to throw a curve?

How many pitches can a pitcher throw a week?

Why does my arm always hurt?

Let’s start with one statement: overhand throwing a baseball or softball is not the most natural action for the human. Underhanded softball pitching is slightly more forgiving on the shoulder, but can place unique stresses on the elbow or lower back.

A parent cannot let ego or immediate gratification get in the way of an immature arm- too much throwing at too young of an age may create significant damage.

Sure, making all-stars at age 11 with a wicked curve is a great feeling, but not being able to throw at age 16 due to permanent elbow damage is a real bummer.

Remember, elbow or shoulder injuries are a common career obstacle as many pro scouts or college coaches may shy away from the athlete with a history of arm problems.

While pitchers get the most attention, let/s not forget other high-volume throwing positions such as catcher and shortstop.

If I have a personal crusade, it is to save the arms of all the catchers.

There are not too many willing and talented catchers, so when one shows up, he/she gets a lot of playing time.

When there is a pitching change, that catcher is still out there.

From warming up pitchers in the pen to gunning out runners at second base, I have seen many a young catcher develop arm troubles.

Little League baseball has recognized the importance of protecting catchers by mandating that any player who throws more than 41 pitches in a game cannot move to catcher in the same game.

Now, some further tips on arm hygiene

• Signs of fatigue and poor technique include:
  • dropping the elbow (should be always at/above shoulder-level)
  • opening up too soon (chest facing the plate before the elbow is ready to deliver the baseball) and
  • getting pitches up in the strike zone or poor command/velocity.
•  Alternate high and low demand throwing positions- pitchers and catchers should move to less demanding positions on a regular basis to rest the arm.
•  Proper warm-up: short toss first (10-20 yards, 10-20 easy throws), progress to long-toss (35-40 yards, 10-15 easy throws) then finally to mound work
• Per USA Baseball, no off-speed baseball pitches (curve, sliders, and breaking balls) until the arm is fully mature (age 13-14 in girls, 14-15 in boys)
• Observe age-appropriate competitive pitch counts- pitch counts are a more appropriate arm-stress measure than innings pitched. Realize that these pitch counts are per week- not per team.

• Utilize rest days between pitching performances- Little League Baseball has produced recommended minimum rest periods between pitching performances.

• A player needs to train to be a pitcher- a recent study indicated that 8-12 year-old pitchers who throw between 300-600 pitches in a season have the lowest relative risk of elbow injuries. This suggests that a certain amount of throwing leads to arm conditioning and proper muscle use that actually can reduce injury, while too much throwing might lead to fatigue and overuse of these muscles.  On the other hand, not throwing for at least 2 months during the year can give an appropriate rest period to reduce the risk of arm or shoulder overuse injuries.

Do not hesitate to recognize the symptoms of arm trouble and then get professional advice- many throwers are accustomed to certain soreness after games. If this soreness intensifies into actual pain or lasts longer than usual- call and schedule an evaluation. Any joint stiffness or swelling maybe OK in adults, but is unacceptable in young throwers. Poor results- loss of velocity or command can be other signs of evolving arm troubles.

What other safety recommendations do you have for baseball?

• Have younger children use breakaway bases- greatly reduce sliding injuries,
• No on-deck circle for younger children,
• All batters, runners, and even younger base coaches must wear a helmet
• Only one child swing a bat at a time with close adult supervision
• Catchers must wear full protective equipment- even in warm-ups
• Use reduced impact baseballs for younger players

Cheerleading

Are cheerleaders athletes?

Better believe it!

Bases, flyers, backspots and tumblers need agility, strength, and frequent practice to fine-tune routines and prevent injury.

Unfortunately, the frequency of cheerleading injuries is rising with the increasing complexity of stunts.

How can cheerleaders, advisors, parents and coaches reduce these risks?

• Practice should take place in proper environments: use mats to practice landings and dismounts, and have high ceilings for jumping and throwing routines.
• Experienced and knowledgeable instructors should be consulted to teach the basics of cheerleading.
• A base must know how to support a flyer without hurting him/herself, while the flyer must know how to land safely.
• Teach flyers rolling and landing techniques over and over again.
• Bases need to work on proper lifting and holding techniques to reduce cumulative trauma to shoulders and the back.
• Tumblers should develop appropriate shoulder and hip strength to take pressure off elbows, wrists, and knees.
• Pre-season conditioning is essential with focus on shoulder and back strengthening exercises.
  • An athletic trainer, physical therapist, or sports medicine physician can demonstrate and recommend appropriate conditioning programs.
• Avoid multi-level pyramids or throwing of cheerleaders unless all participants are comfortable and well-trained in these skills.
  • One weak link can ruin the routine for all others.
• If an athlete has pain or discomfort with any portion of a routine, do not compromise personal safety or the safety of teammates.
  • Work with a coach or obtain medical evaluation before returning to practice or competition.

Dance

What tips do you have for starting my child in dance?

When I ask many younger dancers about what types of dance they do, I often get something like the following answer “hip-hop/jazz/ballet/tap/lyrical/modern”.

There are many challenging types of dance, and at a young age, it is good for a child to learn the different skills needed to enjoy each type of dance.

The variety makes things interesting for a young dancer, and reduces the risk of overuse injury or burnout.

Also, this broad exposure allows the dancer to better choose favorites down the road.

For the very young dancer (under age 6 or 7) each class should cover a variety of dance disciplines with 1-2 classes a week a good starting point.

Emphasizing one type of dance per class is recommended more for school-age dancers who have learned the basic skill sets and can better focus on one discipline for at least an hour.

How can we best prevent dance injuries?

• Make sure that each child learns the foundation or basic steps of each type of dance before progressing to more advanced routines.
• Recommend that instructors use mirrors and the barre to help young dancers pay meticulous attention to technique. A proper turnout starting at the hips can greatly reduce the risk of knee and foot injuries as a dancer matures.
• Trying to cheat by rolling out with the feet to get extra turnout, for example, may produce significant problems in the future.
• As dancers pair up, try to combine dancers of the same height, talent level, and strength to reduce the risk of falls, drops, or overload injuries.
• Attention to the feet and footwear is also important. When able to be worn, slippers and shoes should be in good condition and fit well especially on the feet of rapidly growing dancers.
• An especially firm dance floor can increase the risk of stress injuries, and excessive sweat or moisture on the floor sets up the risk for slips or falls.
• I have also been impressed with the number of shoulder injuries seen in young dancers. Special strengthening and stretching exercises are highly recommended just as we prescribe for overhead throwing athletes.
• Another area of relative weakness is in the lower back and pelvis region as the artistic demands of dance often place unique challenges and without proper coordination of the lower back and pelvis muscles, chronic pain can be a common problem.
• As many dancers do practice multiple disciplines, it is important that parents must be the foremost advocate for their children, often only the family of a dancer can truly appreciate all the time and physical demands.
• Do not hesitate to foster communication between instructors and set necessary limits to reduce physical and emotional overload.

Any tips for summer camps or intensives?

Summertime, and the living may not be easy for a young dancer attending an intensive camp or class unless there is proper preparation.

To get the most out of these wonderful opportunities for learning and advancement, discuss the need for proper nutrition and rest beforehand.

May be important to take a week or so off before the intensive to ensure the dancer is appropriately rested for the experience, and not to immediately schedule any demanding work right afterward.

What nutritional concerns do you often see in dancers?

• Rehearsals can last for several consecutive hours and burn thousands of calories.
  • To keep up appropriate energy, recommend multiple small meals a day, include high-value energy sources before, during, and after a dance session.
  • Fruits and vegetables make for quick, healthy snacks while long-acting carbohydrates such as bagels and pasta are also a good choice.
• Dancers are often deficient in calcium and vitamin D (most studios are inside and away from regular sun exposure) which can increase the risk of bone stress injury.
  • Increasing dairy intake including chocolate milk is an strong choice for a recovery, is vital.
• Low red blood cell counts (anemia) due to low iron intake can reduce endurance and academic performance.
  • 3 good sources of iron intake per day (red meat, dark poultry, red fish, beans, eggs, peanut butter and spinach) can counter these issues.

How old should my daughter be when she goes en pointe in ballet?

• Going en pointe (dancing on the toes down position) is a significant milestone for ballet dancers as only serious and talented dancers reach this level, and it must be mastered for further development at higher levels of ballet.
• There is no set age at which a young woman is ready to dance en pointe, though most begin this position anywhere from age 11-13, often with 4 or more past years of dance training.
• Most sports medicine and dance physicians recommend looking at the overall development of the dancer rather than the age.
• The dancer should master all the basic dance positions and feel comfortable with all aspects of dance using these steps.
• If a dancer cannot do any other moves while en pointe, then she is clearly too young or inexperienced to be in that position.
• A young dancer contemplating the en pointe position should be free of any current leg, foot, or ankle injuries, and should also utilize conditioning exercises to strengthen the lower leg and ankle. Hypermobility of the ankle needs to be corrected before starting en pointe work.
• Finally, a dancer going en pointe must be dedicated to practicing ballet at least two times a week to learn this very demanding skill.

Extreme Sports

Skateboarding, BMX biking, snowboarding, skiing, scooter riding, and mountain biking are all sports practiced by dedicated athletes who put time and attention into bettering their tricks, handling, and overall skill.

These athletes deserve credit for their abilities- and also should follow some basic recommendations to prevent injury and spending unwanted time away from the skate park or trails.

Do helmets actually prevent injury? How can I tell that a helmet is properly fitted?

Personal experience backed by multiple studies proves that helmets do prevent injury. For example, helmeted cyclists are 88% less likely to suffer a brain injury during a crash.

Every time some one gets on a vehicle with wheels (skateboard, scooter, rollerblades, and bicycle) or a snowboard, there should be a helmet on the head.

A helmet handing off the handlebars or kept in the garage does no good. Helmets may not look cool, but a shaved head and scars from an accident look less cool.

PROPER HELMET FITTING TIPS

• The helmet should sit level, covering the forehead in front with the strap adjusters fitting right under the ears and straps lying flat against the head; not hanging loose, curling out, or being twisted.
• Test for proper tightness by being able to put only one finger between the straps and chin and if helmet can be rocked from side to side, tighten straps.
• The helmet should rock slightly forward and backward, but tighten straps if it can be moved up off the forehead or down near the eyebrows.
• Add-on stickers and paint can personalize the helmet, but often void helmet warranties. Buy only helmets with CPSC, ASTM, or Snell stickers certifying safety standards.
• Multi-sport helmets should carry stickers certifying each sport- look for this sticker on the helmet, do not trust sales information or pictures on the box.

What is the scoop on wrist guards, elbow pads, knee pads and other protective pads and guards?

Many younger athletes do not like to wear pads, “they get in the way, get too hot, and they are not very attractive.”

They do work, and work quite well in preventing broken bones, sprains, and road rash from falls or missed stunts.

Experience has shown that wrist guards can greatly reduce the risk of forearm fractures due to falls from skateboards or snowboards.

Most children would prefer wearing protective pads and guards to wearing a plaster cast for 4-8 weeks.

Know the course (or half-pipe) and your limits

• A common recipe for disaster is to barrel down an unknown trail unaware of obstacles or drop-offs that lie ahead. Taking the time to preview the course or to ride the pipe a few times at slow speed before trying tricks at full throttle can increase confidence and lower the risk of an unanticipated fall.
• Be aware of obstacles (rocks, trees, stairs, cars, and people) who might get in your away- always look forward 20-30 yards to anticipate any potential danger and to give time to make adjustments before an accidental impact.
• Be aware of your own skills- your strengths and weaknesses- and take into account your limits before deciding to do a particular course or maneuver. Do not be pressured by friends or your ego, if you do not feel comfortable riding the black diamond snowboarding run, do not do it. Have fun and build your skills at a run better suited for your abilities.
• Fatigue is also a major factor in injuries- many people decide to go out for one more run at the end of a long day, and that run ends up truly becoming the last one. Most authorities recommend stopping at the first signs of fatigue before judgment, endurance, and muscle strength become too low to prevent falls and serious injuries.

Football

How can I reduce the risk of my child getting hurt in football?

• Do not tackle with the head. Look straight at the opponent when making a tackle and do not lead with the head or bend the neck at the point of contact. Banning spearing and teaching proper head position when tackling have reduced serious neck injuries and paralysis.
• Learn proper technique- younger athletes should focus on the basics- throwing, blocking, tackling, and most importantly- learning how to absorb a tackle. Make sure coaches are well trained in safe techniques and these skills are reviewed in every practice or game.
• Wear well-fitting, appropriate safety equipment in good repair. Do not even think of taking the field without a full set of equipment and make sure it fits the athlete well especially the largest and smallest members of a team.
• Check equipment (especially the helmet air bladders) once a week, and make immediate repairs when needed.
• Do not forget the importance of eye protection and mouth guards- no quicker way to destroy several thousand dollars of orthodontic work with one blow to the mouth.
• Create teams with appropriate weight and age divisions- 2-3 year age differences or 30-40 pound weight discrepancies have great potential for injury in youth football.
• Be real careful about making weight or weight loss techniques as cutting weight or rapid weight gains can create health issues for young children. Do not force any child to rapidly gain weight or lose any weight without consulting a pediatrician or sports medicine physician.

Is there a particular helmet or mouth guard than can better prevent my child from getting a concussion?

There is no helmet than can provide 100% protection against concussion, and studies have failed to find certain types or brands of helmets or mouth guards that are superior in ability to prevent concussions. Helmets can protect against direct trauma to the face and scalp, but cannot be endorsed to fully prevent rotational forces that can create concussions.

How can my child best prepare for August early season practices?

• Football players should prepare for pre-season practices by asking coaches for training recommendations and doing some pre-conditioning in the weeks before the practices begin.
• Adequate hydration is absolutely essential: drink 2-3 large glasses of fluid throughout the day before practice, then drink regularly through practice.
• Get in the habit of weighing players before and after practice- for every pound lost, drink 2 large glasses of fluid (about 16 ounces) after practice. A properly re-hydrated athlete has regained all lost weight and has clear urine (looks like water).
• Wearing lighter clothing and removing unnecessary equipment during running or conditioning drills can also help with sweating and heat loss.

Running

Do you have any guidelines for the amount of distance running for children?

The risks of injury and illness in distance running may be related to the total mileage and number of hours training per week.

There is no agreement among sports medicine professionals about distance limitations for children.

Until further data are available concerning the relative risk of endurance running at different ages, the American Academy of Pediatrics recommends that if children enjoy the activity and are free of injury or ailments, there is no reason to keep them from training for and participating in such distance events including marathons and half-marathons.

Regardless of age, the 10 percent rule is an appropriate guide when designing a training program.

• The variables include weekly distance, intensity, and number of training days per week.
• Each week, one should only increase one of those three variables, and no more than 10 percent from the previous week.

Soccer

What about all this we are hearing about heading and brain injury?

The soccer and sports medicine community continues to evaluate the safety of heading, especially in younger players. Recent review of the scientific literature allow for the following observations and recommendations:

• There is emerging data highlighting possible connections between repeated heading and long-term neurologic changes.
• There is a significant risk of head injury in soccer due to contact with the ground, another player, or the goalpost. Since a history of previous head injury places a player at higher risk for further and more serious head injuries, I now am more careful in clearing athletes with a history of head injuries to play soccer.
• The scientific literature has not shown that helmets reduce the risk of head injury in soccer. Thus, many sports medicine physicians do not recommend helmets at this time.
• Proper heading technique- striking the ball with the forehead as the head, neck and torso are in a solid line without any twisting- can reduce forces on the head. Until children are developmentally ready to learn this skill,  I do not recommend teaching heading skills (ex: lining kids up to head the ball).
• It is also imperative that officials strongly enforce the 10-yard rule on restarts to reduce the risk of a ball striking a child directly in the head.
• Unsafe play is a common cause of soccer-related injuries. Officials should enforce rules and reduce dangerous play.

Does soccer have a high risk of knee injuries, especially in female athletes?

Yes, adolescent and young adult female players have a significantly higher risk of Anterior Cruciate Ligament (ACL) tears and anterior knee pain injuries than male players of similar ages. Please see the section on Knee Injury Prevention for more information on this important topic.

Swimming

How can a swimmer reduce shoulder problems?

• Maintain a sensible training schedule with sufficient rest between training sessions.
• Focus on meticulous stroke technique and vary strokes to reduce overload of one particular stroke on the shoulder joint.
• Factors that can contribute to shoulder injuries in swimmers:
  • Improper water entry (favor all fingers entering water first versus thumb-first entry)
  • Excessive body rotation with breathing
  • Breathing only on one side
  • Prolonged pull-through (arm should not pass beltline on pulling phase)
• Develop an individualized rotator cuff and scapula strengthening program. The four rotator cuff muscles keep the humerus (funny bone) in proper location within the shoulder joint- if they get tired, which often happens during repetitive overhead activity such as swimming, shoulder pain can result.
• The scapula is the wing bone on the upper back that provides the foundation for all shoulder motion. Realize that many coaches either do not understand the importance or do not want to take away important pool-time to teach the exercises. However, experience and study has shown that an appropriate strengthening program can supplement swim training and reduce shoulder pain and missed pool time.
• Schedule an appointment or contact a sports medicine professional to develop an appropriate program.

Is there a way to help prevent swimming-related ear infections?

Swimming-related ear infections are caused by fungal or bacterial infections of the external ear canal, and can cause discharge and extreme pain.

• Using a hairdryer to dry out the canals after swimming can help (do not put it too close to the ear for fear of sound or heat injury)
• Benefit from regular use of protective ear drops. These drops can be made at home (mixture of ½ rubbing alcohol and ½ vinegar) or purchased pre-made at a pharmacy; use 2-3 drops in each ear canal after swimming to help prevent this type of infection
• A true external ear infection requires an office visit and often prescription drops to help fight the infection. Occasionally, pain medication is also required, and the swimmer must stay out of water for 4-5 days until the infection begins to heal.

Volleyball

My daughter always seems to have a sore shoulder- what can I do about that?

Several volleyball skills including serving, blocking, and hitting require an overhead motion that can stress both the dominant (hitting/serving) and non-dominant arm.

Excessive hitting repetitions or poor technique (limited follow through) are often the causes, so work with coaches to limit these issues.

Many volleyball players can benefit from scapula (wingbone in back of shoulder) and overall shoulder stretching and strengthening exercises.

Going even a step further, paying attention to lower back strength and flexibility along with proper jump timing and technique can also be of great benefit.

For a comprehensive evaluation of hitting, blocking, or serving technique, please feel free too contact the office.

Can we do something to prevent ankle injuries, especially when landing around the net?

Net play is a common cause of ankle injuries, especially when players cross under the net.

Landing lightly from a jump on both feet with hips, knees, and ankles all lined up and slightly bent can not only reduce the risk of ankle injuries, but also severe knee injuries.

Balance training can reduce the risk of ankle injuries as well.

Protective ankle braces have been shown to reduce first-time ankle sprains and also for those unfortunate to have sprained ankles in the past, protective ankle braces can reduce the risk of re-injury especially in the first six months after an ankle injury. Bracing does not reduce the need for a proper ankle rehabilitation program after an injury.

For more information on ankle braces in volleyball, click here.

Wrestling

How can I determine an appropriate wrestling weight for my child? Is it OK for my child to cut weight, and if so, how much is too much?

Often there are no easy answers or simple formulas to help determine an appropriate wrestling weight.

However, some standards can help the decision-making process.

• A physician can use a growth curve, which plots height and weight in comparison to age-matched individuals, and measures of body mass index, which measures weight in regards to height, to help determine an appropriate body weight.
  • This is something I do with pre-participation exams especially in athletes who participate in wrestling or other sports that are weight-class dependent.
• Another measure called body fat percentage can help determine an appropriate wrestling weight though it historically has been used more to assess if an individual has cut too much weight.
  • There are several methods for this measurement (calipers, bioelectric impedance, and water immersion) and a physician can help decide the most beneficial measurement, if needed, for a particular athlete.
  • The California Interscholastic Federation now requires bioelectric impedance monitoring to determine appropriate pre-season weight class selections for high school wrestlers.
• Once a wrestler is in season, authorities do not advocate more than a 2-3 pound drop in body weight when cutting weight for a match or meet.
  • Good evidence tells us that a reduction greater than 2-3 pounds brings about dehydration and depletion of body energy sources that place the individual at greater risk for fatigue and injury.
  • Many wrestlers know too well that after cutting a large amount of weight, they were not able to wrestle as effectively and many also report difficulties with concentration and schoolwork.
  • This is particularly important in younger athletes who are going through key phases in physical growth and development.
• When attempting to cut weight, use caution with any weight loss medication.
  • Serious health issues can develop due to the use of these items, especially in growing athletes. If in doubt, consult with a sports medicine physician.
• Frequent weight cycling (losing and gaining weight) can affect the immune system and make the athlete more at risk for respiratory illnesses and infections.
  • This can be a major problem at the end of the winter season when many major meets take place.

How can we reduce the risk of common wrestling skin infections?

Due to close contact with mats and other athletes, wrestlers frequently contract skin diseases such as ring worm (aka tinea gladitorum), herpes, impetigo, and other infections.

Not only are these a concern to the individual athlete, but they can easily spread to team members and opponents, thus officials routinely check the skin before large meets.

To help prevent the disappointment of disqualification due to dermatologic disease, the following recommendations may help:

• Wrestling mats should be cleansed with appropriate cleansing solution both before and after meets and practices.
• Wrestlers should shower after meets or competition and use a good anti-bacterial soap.
• Wrestlers should not share any personal care or grooming items (brushes, towels, razors, soaps, etc).
• In the ideal world, the athlete should shower before leaving the gym or school and have wrestling clothing cleansed on a daily basis.
• Coaches and parents should do frequent skin checks, and athletes should feel comfortable reporting any skin issues.
• Any athlete with skin concerns should be immediately removed from participation and evaluated by qualified medical personnel. This is particularly important early in the season to prevent spread to the entire team and a resultant season-long struggle with skin issues. Once appropriate treatment has begun, cover any areas of skin concern when returning to participation by using tape or a bandage which can do the trick in most cases.

What other wrestling tips do you have?

Good neck strengthening and stretching exercises can help prevent spine injuries, ask a sports medicine physician for good recommendations.

Shoulder strengthening is also important for many of the holds and techniques used on the mat.

Mouth guards are essential to reduce dental/mouth trauma so demand that wrestlers wear mouth protection for all practices and meets.