A few weeks back, I had the incredible opportunity to meet and sit with Bert Reid of Pappas/OPT Physical Therapy in his office in Wakefield. During that visit, Bert and I discussed a number of topics related to baseball and sport injuries and treating athletes of all ages. He gave me a tour of his Wakefield facility which includes a full compliment of rehabilitation and fitness equipment, and as well as photos and sports memorabilia and local team shout-outs to Bert and his amazing staff at OPT, which recently merged with Pappas Physical Therapy. At the end of our meeting, Bert shared a number of articles and research documents on a very hot topic leading up to Opening Day for youth baseball – what is the most common injury for the youth baseball player. Bert and I agreed to converse over email regarding this topic and I am so thrilled to share our conversation with you. Bert is an expert in the physical therapy and sports rehabilitation profession and his decades of knowledge are so important to share with youth baseball parents, players, and coaches. Please follow along as Bert and I discuss a number of topics related to this very important discussion about the youth baseball player’s health and wellness.
RIBBE: Bert, first off thank you for taking the time to answer these important questions. So, what is the most common injury, based on your experience, that a youth baseball family should be concerned with.
Bert: The most common injury of Little League and/or a young person playing baseball would be the diagnosis of Little League shoulder and Little League elbow. What exactly does that mean, how does it occur, and what is the best approach to make sure it doesn’t turn a small problem into a very big problem.
RIBBE: Bert, if a youth baseball player tells his/her coach that they are experiencing pain while throwing the baseball, what are the first steps that should be taken? By the player? By the coach? By the parent?
Bert: The first thing, the most accepted strategy, and this is from Dr. James Andrews, is if the player says they have ” shoulder pain”, the recommendation is immediately 3 weeks of no throwing. He/she would be allowed to hit, play in the field and stretch out but not allowed to throw for 3 weeks. If the pitcher says he/she has elbow pain, the immediate recommendation is 3 weeks of no activity. The difference is zero activity for elbow trouble, with the shoulder they allow the player to hit and play the field. They would try to minimize the amount of throws so playing catcher or centerfield is dicey. Realize a couple of things, that recommendation applies to the research of a thousand baseball players, and that represents the path towards an earliest return, a better outcome and the likelihood of not turning a small problem into a big one. A single player, like a pilot study if you will, may possibly be able to come back somewhat sooner. But generally, over the course of the studies, three weeks is the recommendation. Shut down time, and during that time they would be into rehabilitation. Physical therapy or with the athletic trainer, whomever has the expertise. The coach has to open the communication with the player and have the trust that the player will admit to having soreness in the shoulder or elbow. That is a matter of maturity on the player, and that the coach can trust that an injury will be reported. What the player (and parent for that matter) may want to hear most is that the coach understands the injury, and that both of their goals is to make sure a small problem does not become a big problem. Usually if you tell the player if we take care of this problem now you will be looking at three weeks, if you don’t tell me about it or you prolong taking care of it it could take you out for three months or more. If they don’t report the injury and a major injury is in fact suffered, the player could be out for at least 12 months, for things such as UCL (Ulnar Collateral Ligament Tear) or Rotator Cuff (Shoulder) repair. The actual return to play statistics from Dr. Steven Cohen at Al, of the Rothman Institute of Orthopedics, the Doctors for the Philadelphia Phillies, are: https://pubmed.ncbi.nlm.nih.gov/23015998/
RIBBE: At what point or what would be the criteria for a player to be seen by a medical professional, such as yourself?
Bert: The criteria for deciding when a player should be seen by the orthopedist, the sports medicine doctor, or the Doctor of physical therapy is similar in the sense to when a runner is injured. If you are compensating and changing the way you run because of the injury a good rule of thumb is you should not be out there running. It has been stated that if you are able to play with some symptoms but don’t have to change your technique, compensate or avoid the symptoms then you are likely safe. If you are trying to run, but limping and compensating in the gait technique, best advice would be to avoid the activity.
Bert: It brings up another interesting paradigm that the player will report that they have a symptom. It’s very important to understand that where the symptom is is very likely not where the problem is. From a kinetic chain biomechanics standpoint, the job of the physical therapist is to identify which joint or muscle group is limited in its motion, or which one has an element of weakness, and that limitation would cause a symptom such as tendinitis. The important understanding there is that symptoms will occur as a result of somewhere else in the kinetic chain where there is a lack of good range of motion for lacking the functional stability/strength to control the motion. An example of this would be for the runner having very tight hip internal rotation can change the way the limb hits the ground during shock absorption, and then during the propulsion phase also limited which would cause a torqueing at the knee. So the runner may feel the symptom at the knee or diffusely at the knee, but the problem exists because their hip mobility is poor and causes symptoms at the knee. In the baseball player a lack of good shoulder internal rotation is the number one cause for elbow sprain/strain and shoulder pain. For example, a group of pitchers with a lack of shoulder internal rotation are twice as likely to have elbow strain/sprain than a group of pitchers with normal range of motion of the shoulder.
RIBBE: In the dugouts, team managers have a first aid kit with ice bags. Is an ice bag still recommended for treating an upper body injury, such as a sore elbow or tight shoulder or is there another remedy you would suggest?
Bert: Generally you can’t go wrong with the old axiom PRICE – Protect, Rest, Ice, Compression, Elevate. Ice after injury is very effective for the first one to three days. Not as effective after the first several days, but still recommended for symptom relief locally. Newer evidence suggests ice does less than what we thought it did years ago, but early on it does have an effect that saves time down the road regarding edema/inflammation.
RIBBE: If a player has an elbow sleeve, will that solve as a quick fix for a player’s elbow injury? What is the purpose (if any) of the elbow sleeve?
Bert: Elbow sleeves can help with compression, some people feel like it “feels good” to have that compression and tactile stimulation. It doesn’t do anything to prevent or to heal the injury. Generally if it feels good, it is okay to wear one, but it should not be looked at as any kind of a solution. It may help relieve some symptoms, but remember we don’t want to chase symptoms. As a physical therapist treating a youth baseball player, I want to find out where the mechanical flaw is in the kinetic chain.
RIBBE: If a player has an elbow injury and continues to “play through the pain”, can he/she cause damage to other parts of the upper body?
Bert: Playing through the pain is never recommended. In this example of the player that has an elbow injury, as stated in previous answers, the recommendation is three weeks of no activity before beginning a rehabilitation program. The payback is that you may be out three weeks plus rehab time, but if you damage the elbow and require surgery it would be more like 14 months to return to play on average.
RIBBE: Do catchers experience arm and shoulder injuries in the same frequency as pitchers? What about infielders and outfielders?
Bert: Catchers definitely have arm injuries as a result of continually tossing the ball back to the pitcher, but it is at such a lesser intensity. A pitcher throwing a fastball will be moving the arm through an arc of motion as much as 3000° per second. It is the fastest velocity that we can create, and the forces are maximum. Any degree of less velocity is less likely to injure the shoulder… so the many throws per game of the warm-up and then in game return the ball to the pitcher do add up, but do not constitute the same level of likely injurious velocity. They are more likely to get hurt when throwing out a base runner at second base trying to steal because of the high rate of arm speed.
RIBBE: In your experience, should youth sports athletes such as youth baseball players stretch their upper body muscles before games? What benefits (if any) do stretching the muscles of the upper body give the youth athlete?
Bert: Definitely a need to stretch and more importantly go through some functional baseball movements in warm-ups. This is a very important message for the warm-ups for all sports, running, tennis, and baseball as well. Every joint, every muscle, every fascia, every ligament, every tendon has these sensors called Proprioceptors. They respond to movement and guide us regarding the angle of movement, the speed of movement, what muscles to call in and when to call them in, among other beautiful and amazing graceful activations. The most important message here is that we have to warm-up the proprioceptors, we have to wake them up. And they will help us move better, more gracefully, more powerfully, and just as importantly they will prevent the injury. What this means for the baseball player is warming up in a functional baseball way. These are things that look like throwing, they activate the muscle groups which protect your shoulder, focusing also on the landing leg which is the “braking system” for the throwing shoulder to protect it from injury. We also do a core warm-up because the middle of the body is where the power is created in the shoulder is acting as an extension of the core. You do not want to create power with the shoulder or elbow or you will ruin it. You create power at the core and the shoulder becomes an extension of the core. So, we do warm-ups before baseball for a purpose to turn on, to rev up the proprioceptor’s. Unfortunately, most of what is handed down from generation of basic stretches are things that are not likely to hurt anybody but they rarely help because they are not baseball specific, and not based on the proprioceptive activity that matches baseball tasks and movements.
RIBBE: Referring to youth baseball players, are there strength and conditioning movements for the upper body areas – shoulder, forearm, elbow – that players should be doing under supervision? At what age would a player want to start this type of conditioning program?
Bert: Newer information shows that you can begin strength training at any time. It is progressive, precautionary, a great idea to build strength and endurance and now is done in what is called a “sport – specific” way. For example there are running exercises for runners, there are baseball exercises for baseball players, and there are football exercises that are specific to football. Again, they focus on the proprioceptors and the movements related to the sport. General fitness is wonderful, the weight room is a good idea if you want to become stronger in the weight room but that does not necessarily translate into becoming a better athlete. A good example of this would be you can become the bicep king of South County, and have beautiful biceps, and that does not make you a better tennis player or baseball player. Doing heavy squats in the weight room means you would likely get bigger legs and become better at squats but it does not mean you will become a better baseball player. You would still have to go through the process of developing baseball specific strength and power, as well as endurance which are all subsets of strength.
I am so excited to talk baseball and rehabilitation and more importantly, path to recovery with OPT’s Bert Reid. Bert is a fountain of knowledge when it comes to sharing important tips on injury diagnosis and the clear route back to the playing field. In the weeks and months to come, Bert and I will be chatting about a number of baseball related topics that he sees with patients from youth sports athletes to the amateur and professional athletes at his facilities. This article contains a lot of great information and if you need further clarification on any of the topics discussed, feel free to contact me at firstname.lastname@example.org. You also connect with Bert or a Pappas/OPT staff member by going to their website, www.pappaspt.com/opt-ri/, to learn more about their facilities, locations, and services.
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