Overuse Injuries in Baseball

December 28, 2016

By Perry Nickelston, DC, NKT, SFMA

Athletes get hurt - it goes with playing hard and putting everything they have into the sport they love. The best training in the world can't prevent real world chaos from happening on the field. Slips, falls, hits, defective equipment, etc. are all fair game when an athlete steps onto the field.

However, you can have some control over overuse injury prevention and recovery by focusing on specific factors of movement control. Rotation is the linchpin to most overuse injuries.  The ability to control transverse plane (rotation) is essential to protecting against overuse injury. Since power lives in the transverse plane, torque and spiraling are the powerhouse of strength production. Control of rotation is crucial because it affects efficiency in movement. If efficiency in movement rotational patterning is lost, more effort is required to produce results, which often leads to overuse, compensation and ultimately injury. Durability and endurance also take a massive hit because more muscular effort is needed to accomplish a given task.

Every sport has its common compensation and injury patterns. In the sport of baseball, the top 3 overuse injuries are: medial elbow tendinitis, rotator cuff pain, and hip impingement.

Ida Rolf said, “Where you think it is it ain't.” To that point, the site of pain is rarely the ultimate cause of pain. Pain only tells you there is a problem, it does not tell you what the problem is. You are typically going to do some therapy and correctives to the painful region, but you should also address specific movement patterns that control force production. Stability always precedes force production.

The linchpin to stability and all of the above mentioned overuse injuries is the posterior oblique subsystem (POS) of movement. The POS is comprised of the latissimus dorsi, thoracolumbar fascia (TLF), and the opposite gluteus maximus. Its essential task is eccentric control of forward flexion, otherwise known as deceleration. Most athletes get hurt in the deceleration (slowing down) phase of movement. If there is weakness in the posterior sling, more force will be released through the joints and tendons. The posterior oblique subsystem is a primary stabilization system of the torso. When it's dysfunctional, the arm internally rotates and whips more, the rotator cuff muscles act as mobilizers instead of stabilizers and the stance-leg hip internally rotates too fast.

Deceleration is the key to preventing medial elbow pain, so you are really only as fast as you can slow down. Most of the force generation from a throw should come from the inside out - an explosion pattern of force production with rotation. If you can't explode, you implode. Implosion means using more of your arms and legs to generate power. Your arms and legs are designed to amplify force, not generate it. When they have to do both you get hurt.  The posterior oblique subsystem of the body is critical in deceleration of a throw.

Here are some steps you can take to help correct movement and prevent overuse injuries:

1. Apply deep tissue laser therapy to the damaged tissue.

Laser therapy helps to reduce pain and inflammation while accelerating tissue regeneration and increasing blood flow. The most elusive cause of elbow pain is weakness in the posterior oblique sling, so ensure you laser the TLF as well as the elbow and painful body regions. Start by applying 4,000 joules of laser energy over the TLF with a laser massage ball – this is the catalyst for increasing optimal fascial gliding. Then move diagonally into the affected hip, shoulder and elbow.


2. Soft tissue release of the TLF

Depending on your scope of practice and ability to touch clients, you can use a foam roller, instrument assisted soft tissue manipulation (IASTM), or your hands. The TLF is richly innervated and stimulating this region has high feedback to the brain and nervous system.

Here is the optimal reset pattern: start on the TLF, then to move to one side glute max, then to opposite side latissimus dorsi and repeat on the other side. Do both sides regardless of which side hurts.


3. The Iron Man

You know how Iron Man flies? If not watch the movie. That's exactly what you are going to do, but without the really cool suit. Lie face down on the ground with arms by your side and legs straight. Start by slowly squeezing your glutes. Pull back your shoulders. Lift your head then your feet. You should feel slight arching in your back. Do not keep excess tension in your hands or your feet. Hold for four seconds, then slowly relax for four seconds. Repeat 10 times. Do not hold your breath. This will engage the posterior oblique subsystem. If this is too difficult to do, perform the exercise with one arm and opposite side leg at a time. Then alternate. Slowly work up to both arms and legs together. Keep your head in neutral, not extending too much.

It's important to remember that what screams the loudest is not always the most important; the site of pain is just part of the larger puzzle. When diagnosing an overuse injury, you need to think bigger and broader. So get to it, have fun and get twisted.

Dr. Perry Nickelston, DC, NKT, SFMA is an instructor for LightForce Therapy Lasers (www.LightForceLasers.com). For more information on Dr. Nickelston, visit his web site: www.stopchasingpain.com

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