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Glabrum - Picture of Shoulder

Labral tears of the shoulder: surgery or not?

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At the recent American Orthopaedic Society for Sports Medicine, a comparison of non-surgical treatment and surgical treatment for SLAP labral tears of the shoulder in baseball players was presented. The labrum is a cartilage structure that makes the Glabrum - Labral Shoulder Tearsocket of the shoulder deeper and helps hold the upper arm. SLAP tears are a specific type of labral injury that is mainly caused by repetitive throwing.   Although surgical repair of SLAP tears is common, little is known about the effectiveness of nonsurgical pain relief and the effects of surgery on performance.

Return to play

Return to same level of play

Surgery

48%

7%

Non-Surgery

40%

22%

 

 

 

The return to play rate in SLAP injuries is low, typically reported at less than 50%. In this study the return to play rate for those that underwent surgery was 48% while those that underwent rehabilitation was only slightly lower at 40%. The most interesting finding in this study however was that the group that had surgery rarely, only 7% of the time, returned to the level of play that they had previously attained. The non-surgery group in comparison returned to the same level of play 22% of the time.

John E. Kuhn, MD, associate professor of orthopedic surgery and rehabilitation and chief of shoulder surgery at Vanderbilt University Medical Center in Nashville, Tennessee described the findings as “very significant” and summed up the findings:

“A lot of these throwing athletes can be treated non-operatively,” Dr. Kuhn said. “They had very good success with rehabilitation.  That suggests that patients can throw with SLAP tears, and that not every SLAP tear needs to be repaired,” he said. “Many can be rehabilitated; the sources of pain or disability may not even be the SLAP lesion itself,” he added. The research suggests that surgery in this patient population really should be a career-salvaging option, he explained. “It really shouldn’t be something you throw at somebody quickly or early. Rehab them, do everything you can to prevent surgery,” he concluded.

Another take home message from these findings that should be discussed further is the importance of avoiding shoulder injuries from throwing.  As stated the percentage of those injured with SLAP tears that return to play is less than 50%.  The best advice then logically is to avoid getting a SLAP tear altogether.  Unfortunately, there is no sure fire way to avoid getting a tear if you are a pitcher. However what can be done is limiting the risk factors for injury.  Risk factors for throwing injuries include a decrease in shoulder internal rotation, poor scapular control, and high pitching load.  These risk factors should be screened for and proper preventative exercises should be built into any strength and conditioning program for baseball players, especially pitchers. Non surgical treatment in these cases included rehabilitation that focused on stretching the posterior capsule of the shoulder to increase internal rotation and training the scapular muscles to hold the scapula in a stable position during the wind-up and cocking phase of the throwing motion. These exercises should also be at the core of any preventative arm care program for baseball players. Manual therapy, including myofascial release and Graston treatment can also be beneficial to aid in increasing range of motion.  These preventative strategies should be overseen by a healthcare provider knowledgeable in baseball injuries.

If you would like more information about how to recover from or prevent shoulder injuries contact our office today.

Another article outlining preventative exercises is coming soon…

-Dr. Kevin Rose, DC

 

 References

Yin, S.”SLAP Tears Often Treated Successfully without Surgery”. Medscape Medical News, July 7 2012.

Wilk et al. Passive range of motion characteristics in the overhead baseball pitcher and their implications for rehabilitation.  Clin Orthop Relat Res. 2012 Jun;470(6):1586-94.

Wilk et al. Shoulder injuries in te overhead athlete.  J Orthop Sports Phys Ther. 2009 Feb;39(2):38-54.

 

 

 

Ankle Kinesio Tape

Kinesiology Tape for Dancers

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Many dance medicine specialists and dancers have begun to use Kinesiotape as a staple to manage their injuries.  Developed Ankle Kinesio Tapemore than 25 years ago in Japan by chiropractor Dr. Kenzo Kase, the Kinesiotape method drew worldwide interest when the U.S. Olympic volleyball player Kerri Walsh wore the tape to support her shoulder during the 2008 Games in Beijing. Now many elite athletes, including dancers use Kinesiotape.  Unlike traditional athletic tape, the latex-free Kinesio stretches easily, and permits greater range of motion, making it popular with dancers. It allows the dancer to perform while still protecting them from further injury. “The old way of taping was stiff and tried to support ligaments, but we have learned it gave less support than we suspected,” says Dr. Rebecca Clearman, M.D, “Kinesiotape, on the other hand, helps dancers self-correct. (For instance) if a dancer is hyper-extending, it can serve as a reminder at the end of the range to not go as far.”

Kinesiotape can be used to stimulate or relax a muscle, depending on the direction of the recoil of the stretched tap. Whether relaxing or activating, the tape gets placed along the line of the muscle. For activating, the direction of the tape goes from muscle origin to insertion. The tape’s degree of stretch determines the strength of the recoil action, so each application can be tailored to a dancer’s needs.

It’s like a brace, but better, because of it allows greater range of motion and also provides proprioceptive input (joint balance). Kinesiotape comes in a variety of brands and can be purchased by the consumer, however initially the tape should be applied by a dance medicine professional with knowledge of dance mechanics.  After several sessions the injured dancer can learn to put the tape on properly by himself/herself.

Kinesiotape is not a magic bullet. Proper diagnosis of the injury by a qualified healthcare professional is always the first step and during recovery, proper rehabilitation and correction of biomechanical errors are keys.

-Dr. Rose is a San Diego Chiropractor and a Certified Chiropractic Sports Practitioner®.  He is a member of the International Association of Dance Medicine and Sciences and has experience with ballet dancers from youth to professional.

Preventing Throwing Injuries in Youth Baseball

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 More and more young baseball players, especially pitchers, are coming down with “Little League elbow,” or “Little League shoulder.” Don’t let the names fool you; these are real medical diagnoses with real consequences.  Among pitchers under 12-years-old, as many as 45 percent complain of chronic elbow pain, according to several published studies. At the high school level, nearly six in every 10 pitchers suffer chronic elbow pain.  Most will heal with a combination of rehabilitation and prolonged rest while some will require surgery.

How to prevent throwing injuries

Limit the number of pitches

A broad recommendation is that pitchers base their number of pitches each week by multiplying their age by 10, so an 8-year-old would limit his pitches to 80 per week. A 12-year-old would throw no more than 120.

The American Academy of Orthopaedic Surgeons (AAOS) recommends limiting the number of pitches per game to 60 to 100, with no more than 30 to 40 in a single practice session, adding that innings pitched should be limited to about four per week, with a minimum of three days rest between starts.

Warm Up

Research studies have shown that cold muscles are more prone to injury.  The AAOS suggests an active full body warm up followed by slow, gentle stretching, holding each stretch for 30 seconds.  A knowledgeable coach or trainer should be able to guide your athlete in this area.

Throw Correctly and Master the Basics

Poor throwing motions put undue stress on the elbow and shoulder.  It is especially important that between the ages of 8 and 14 players receive skilled instruction in proper throwing mechanics.  Pitching lessons should focus on gaining control, increasing velocity and developing a command of the strike zone.

Recognize the warning signs

One of the most important factors to preventing the development of serious injuries is early identification and treatment. Young players often ignore pain or are encouraged to play through it.  This way of thinking can be extremely harmful and lead to more serious complications that may not heal without aggressive treatment and possible surgery.  However, if caught early, most youth throwing injuries can be relieved with a combination of therapy, rest, and rehabilitative exercises.

Early signs of injury include decrease in ability to throw the ball as fast or as accurately, loss of enjoyment in playing baseball, elbow or shoulder pain with or after throwing.   If any of these signs are present, the player should be evaluated by a healthcare professional.  More significant signs include prolonged persistent pain after throwing, swelling at the elbow, and difficulty straightening the elbow.

Any persistent pain, loss of motion or joint should keep a player on the sidelines until the symptoms disappear or a doctor clears the players. Be sure to consult a health care professional familiar with the intricacies of baseball injuries if any of these signs are present.

-Dr. Kevin Rose, DC, CCSP®

 

Dr. Rose is a Certified Chiropractic Sports Practitioner® located in San Diego.  As a former professional baseball player, having played three seasons in the minor leagues, Dr. Rose understands the unique characteristics of baseball injuries first hand. 

 

Injury Prevention and Rehabilitation

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At Proform Sports Chiropractic, we help create lifelong musculoskeletal health, emphasizing physical activity and exercise throughout life. Our goal is to prevent injury and achieve optimal health, mobility, and quality of life throughout each person’s lifespan.

Our two primary areas of interest are musculoskeletal injury prevention and rehabilitation. Our offfice focuses on on injury prevention and on effective treatment and rehabilitation that are essential to putting the person back on the path to optimal health.