Fall Break? Why Playing Less May Mean Playing More

PMoSWVA

Opening October 1, 2013
Dr. Bolin
1215 Corporate Circle SW, Suite 201
Roanoke, Va 24018
(540)772-1890

Delmas Bolin, MD, PhD, FACSM

Director, Performance Medicine of Southwestern Virginia
Head Team Physician, Radford University
Associate Professor, Via College of Osteopathic Medicine

Have you ever come out of a practice and your throwing shoulder just aches?  Patients often ask me about these types of shoulder pain and what it means.   Am I doing damage?  Should I stop and go see a doctor, or just push through it and maybe take a couple of ibuprofen?  Here is a guide to common shoulder problems and warning signs to let you know when “pushing through” may not be the right thing to do.

To understand how problems can arise, one needs to understand a little about the mechanics of throwing.  Everyone “knows” how to throw a ball overhand.  Did you know that the legs and trunk muscles are critical to achieving maximum accuracy and velocity?  Image yourself throwing a ball; now imagine doing that with your feet frozen to the ground.  You can still throw, but it isn’t pretty is it?

Athletes that don’t properly use their legs and “core” trunk muscles when throwing use their shoulder muscles to make up for the loss of speed.   They overuse the shoulder rotator cuff muscles and, over time, the shoulder muscles develop too much stress and can develop several problems including tears of the “rotator cuff” muscles or cartilage tears that lead to instability of the shoulder.

The rotator cuff muscles are protected from rubbing against the collar bone above them by a small sack called a bursa.  When you throw too much and get tired, the bursa can get pinched and cause that deep, hard to place ache in the shoulder and on its side.  This pain typically gets better with ice, rest, ibuprofen, and importantly, not sleeping with that arm above your head.  Bursa pain will often wake people when they roll over on the shoulder. Overhead positions put the bursa in a place where it can get pinched – you’ll wake up sore and stiff.

Rotator cuff damage is worse.  If you have torn the rotator cuff muscles, they are no longer strong enough to hold the ball of your shoulder joint in the socket.  When you go to sleep, the strong deltoid muscle gradually pulls the shoulder’s ball up and out of the joint where it causes pain that wakes a patient from sleep.  Pain that wakes you from sleep consistently should prompt you to stop throwing and seek further medical evaluation.

Sometimes the shoulder pops when moving it.  Pops that simply make noise and cause no pain are not cause for concern.  Painful pops, particularly when pitching, should be investigated.  They can be one sign of a tear of the cartilage “gasket” that goes around the shoulder socket – that “gasket” is called a labrum.  Labral tears make the shoulder not quite as stable as it should be – like a wheel that has it’s axel not placed in the center; it will wobble.  A wobbling shoulder means that you will notice less control of your pitches, less accuracy, and less speed.  If you notice you are losing speed, it’s probably time to get this further evaluated.

Finally, younger pitchers (those under 15) should pay particular attention to night pain.  Pain in the shoulder at night while trying to sleep that persists night after night can be associated with stress injuries and fractures through the growth plates.  Although softball is generally gentler on shoulders than other throwing sports, parents and coaches should keep an eye out for growth plate injuries in their players who are throwing a lot and start having pain and decreased performance.

Prevention means concentrating on your throwing form.  Take time for a good warm-up; don’t throw too hard too quickly.  Spend time strengthening your core and lower body as these large muscles allow you to “drive” the ball toward the plate.   Training the shoulder muscles will help control the fine-tuning of the pitch (along with the arm and hand).  Train both sides of the body to remain “balanced” and  to develop good stamina for the trunk and leg muscles.  When you play 4-6 games in a weekend, tired core and leg muscles translate into overworked shoulder muscles.

Most shoulder pains are the result of overuse and  may last a day or too but should quickly resolve.  Signs that might suggest you should see your doctor include pain that lasts more than a week, night pain, or loss of speed and accuracy.  Luckily, most problems are readily addressed and prevented by developing good form and good training habits.   Building strong leg and core muscles will keep you “driving” the ball toward the plate, and keep you from driving to the doctor.

Warming up to Performing in the Cold

PMoSWVA

New Office! Now Open!
Dr. Bolin
1215 Corporate Circle SW, Suite 201
Roanoke, Va 24018
(540) 772-1890

Delmas Bolin, MD, PhD, FACSM

Director, Performance Medicine of Southwestern Virginia
Head Team Physician, Radford University
Medical Director, Roanoke College Athletic Training Program
Associate Professor, Via College of Osteopathic Medicine

One of the issues that comes up every year about this time is from parents – “shouldn’t my child wear a coat when it’s cold?”  I see a lot of teens and young adults every morning at the bus stop wearing short sleeves or even shorts when it is cold outside.  When it comes to playing in the cold – what’s the best strategy?

When it comes to cold weather, grandma was probably right – being cold seems to be associated with catching cold.  After all, that is why it is called “a cold”.  But, it isn’t very practical to wear a coat while trying to play ball outside in the cold.  The problem is that coats – and long “underwear” are bulky and limit your ability to move, so you’d prefer not to have them on.  While it is noble to sacrifice your comfort for mobility, there are probably a few things to consider about keeping warm.

Warm muscles perform better.  Warmth, besides just being about temperature, is also about blood flow.  When you are cold, your body shifts your blood flow to you inner organs and your brain, shunting it away from your arm and leg muscles.   You will notice this when you are warm but you notice your hands are cold – blood is being moved away from exposed areas with high surface area such as fingers and toes into your core.   When your core temperature gets to low, you start to shiver – your body’s random firing of muscles to generate heat rather than motion.  You can probably guess; if your body is more concerned with using your muscles to generate heat, it won’t be as concerned with using them to perform coordinated movements.  Muscle control and coordination is what makes pitchers pitch well and batters react well; lose some of it and…you may just lose.

A second issue to consider is that muscle coordination is actually important in preventing injury.  The order in which your brain tells your muscles to move in split-second time is important for moving your body in the correct way.  ACL tears, rolled ankles, and other injuries can result from muscles that don’t quite work in the correct order.  Keeping the muscles warm not only keeps them performing well but may also help you avoid injury.

So how can you keep warm in the cold? The key is insulation. Your body generates heat and sweat when you exercise.  This is part of why we “warm up” and “get our blood moving”.  When you first get to practice, start out with multiple layers.  Sweats or fleece is a good outer layer for warm up.  There are now all manner of spandex type under layers from t-shirts to long sleeve mock turtlenecks and matching long pants.  The spandex is form fitting and moves well with you.  It can be expensive, but it usually will fit under practice clothes.  There are multiple thicknesses to layers that you can buy and use according to the conditions.  If you can’t find them at the sporting goods store or online, look in stores that stock hiking gear.  Keep your layers on during warm up, and as your temperature goes up, you can quickly get rid of layers as you need to.

Multiple layers are a good idea.  Keep the tightest, form-fitting layers that wick sweat close to the body and cover your uniform with layers that you can shed as you get “warm.” Batting and fielding gloves are good protection.  Those disposable glove warmers are good to keep around on cold days to warm your hands when you are in the dugout or standing around.  Pitchers should mimic the pros and put a coat on, especially on the pitching arm if not the whole body, to keep it warm between innings.

What about hats?  If it isn’t sunny and you don’t need a brimmed hat, consider wearing a toboggan or “stocking” type cap.  We lose incredible amounts of heat through our scalps, where there is a very high blood flow.  This is why you see professional athlete’s heads steaming sometimes when they are on the sidelines.  Caps can limit that heat loss.

Finally, don’t neglect hydration during the cold.  When you are cold, you don’t think about drinking as much as you do during the summer; but, you are still sweating.  Replace fluids, but be creative.  Cold beverages cool down your core.  Warm beverages warm you up.  You’ve probably never thought of drinking warm Gatorade®, but it is a strategy to keep some in a thermos bottle to drink on cold days.  Remember that by the time you know you are thirsty, your body is already about 2% dehydrated and your performance has already started to deteriorate.

Performing well in the cold is not difficult, but it will take a little discipline to think and plan ahead.  It is our job as parents to coach you about wearing your coats and hats.  As athletes who want to perform at high levels, however, it’s up to you to take the active role in finding out about what conditions you will be playing or practicing in, having the right gear (and having it clean and ready to use) and having the right fluids to help you play at your best.  It is, after all, your game.

 

What’s Driving All These Shoulder Injuries?

PMoSWVA

Opening October 1, 2013
Dr. Bolin
1215 Corporate Circle SW, Suite 201
Roanoke, Va 24018
(540)772-1890

Delmas Bolin, MD, PhD, FACSM

Director, Performance Medicine of Southwestern Virginia
Head Team Physician, Radford University
Associate Professor, Via College of Osteopathic Medicine

I hear from many of you that you are so dedicated to softball that you play all year round.  There is summer ball travel league, then fall ball, then the spring season, then a couple of showcase tournaments and…  Some of you are playing on 2 teams at a time.  Does this story sound familiar?  It is all too common for young athletes to be put into “competitive overdrive.”  Younger athletes are pushed to play their sports year-round to be “good enough” for college.   Have you ever wondered why professional athletes don’t play year round?  Especially for our young developing athletes, there are some sound reasons why playing less and taking a break from playing may help you develop more.

Why do people play all year?  The reasons are numerous.  You have some talent, and a coach or two knows that you can help them win.  Several other girls are playing and if you don’t, someone else will get your spot.  You may never get it back.  Plus, this extra experience will be good for you and help you to develop over and above what you get with your local team, maybe even get you noticed by a college scout.   I know the arguments; long before I did sports medicine, I coached youth soccer and then collegiate soccer.  I used to think the same way;  now I know that there are risks to playing too much and these deserve recognition and discussion.

Overuse injuries are the first reason to consider taking a training break.  Before age 16, most girls have multiple growth plates that can be injured.  The growth plate is a spacer of cartilage that forms a scaffold in the middle of growing bones.  With repetitive motions, the growth plate can be injured and lead to stress fractures.   Your body is designed to respond to stress…to a point.  With weight lifting, your muscles get stronger and larger.  With impact sports, your body responds to the impacts by making the bones stronger.  The process doesn’t happen overnight, though.  The changes occur over weeks.  Pushing too hard, too fast, and too long leads to stress injuries.  Daily repetitive injury to the bone overwhelms the body’s repair mechanism and happens too quickly for the body to repair it as usual.  These injuries are more common in athletes who adopt a year-round playing.  The symptoms are usually a vague pain that develops at the area of injury during exercise but quickly gets better (at first) when the activity is stopped.  With increased damage, however, the symptoms persist, and can remain even after you’ve had a good night’s sleep.  X-rays are usually the first step, but are often negative.  Often, advanced studies such as a bone-scan or an MRI are needed to make the diagnosis.  Once the diagnosis is established, the treatment is…rest (and sometimes, a cast).  Most of these will make you miss 6-10 weeks (for treatment and then reconditioning and getting back to game speed).

Another reason for taking a break from training is one you may not think of…how your brain responds to training.  The concept of training is simple enough; “practice makes perfect” – some say “perfect practice makes perfect.”  What are you really trying to accomplish?  You are learning a new pitch, a new technique, or a better way of performing.  How does that happen?  In your brain,  you store a series of “neurologic patterns” – an “engram” – as you learn a new skill.  The “engram” is a program of how your brain tells your muscles to perform a task.  For example, most of you will put on a pair of pants the same way every time, or brush your teeth the same way – it is a learned behavior (an engram) and you can do it without consciously thinking about it.  So it is with learning a pitch.  You practice the new technique, it is awkward at first, and then it gets easier and more natural.  During breaks from activity, your brain stores and processes the information and streamlines it – you will often notice that you will perform a new technique a little better after a brief break in training.

In addition to facilitating healing and allowing for skill development, the best reason to consider taking a break is to avoid burnout.  I have seen a few college softball players leave the sport “because it just isn’t fun anymore.”  They have played the sport year round for several years are “done.”   Younger athletes are often shy about taking a break, fearing that another athlete will “get ahead” of them if they do something else over the summer.  That is rarely the case – ask your coaches.  Taking a break doesn’t mean doing nothing, however; cross training can help you develop improved speed and stamina while allowing your muscles to go through a completely different set of workouts. Often a skill learned in another activity can make you a better player.

No matter what your schedule, remember to keep having fun while you are working so hard to improve.  When you do take breaks, remember to stay active.  Take care of your body, allowing it adequate rest and time to recuperate.  When you come back to softball, see if you brain isn’t refreshed and a little better tuned for performance.  It’s one of the reasons the pros have an off-season.  Sometimes, less is more.