Baseball Injury Prevention

From AAOS (American Academy of Orthopaedic Surgery)

The U.S. Consumer Products Safety Commission reports that each year more than 627,000 baseball-related injuries are treated in hospitals, doctors' offices, clinics, ambulatory surgery centers, and hospital emergency rooms.
Although baseball is a non-contact sport, most serious injuries are due to contact — either with a ball, bat, or another player.
The most common baseball injuries include mild soft tissue injuries, such as muscle pulls (strains), ligament injuries (sprains), cuts and bruises, lacerations, and contusions. The repetitive nature of these sports can also cause overuse injuries to the shoulder and elbow.

 

Proper Preparation

• Physical exam. A pre-season physical exam is important for both younger and older players. The goal is to prevent injuries and illnesses by identifying any potential medical problems. These may include asthma, allergies, heart, or orthopaedic conditions.
• Warm up and stretch. Always take time to warm up and stretch.
• Warm up with some easy calisthenics, such as jumping jacks. Continue with walking or light running, such as running the bases.
• Gentle stretching, in particular your back, hamstrings, and shoulders, can be helpful. Your team coach or athletic trainer may provide a stretching program.
• First aid. Familiarity with first aid, including recognizing and treating the most common injuries, is especially important for coaches. Be able to administer basic first aid for minor injuries, such as facial cuts, bruises, strains, sprains, and tendonitis.
• Field knowledge. Be familiar with your baseball field, including its telephone and cardiac defibrillator.
• Emergency situations. Be prepared for emergencies. Have a plan to reach medical personnel for help with more significant injuries like concussions, breathing problems like wheezing, heat illness, and orthopaedic emergencies, such as fractures and dislocations.
• Follow the rules. Know the rules and encourage safe and appropriate play.

Ensure Appropriate Equipment and Its Use

• Equipment should fit properly and be worn correctly.

• Wear a batting helmet at the plate, in the "on deck" circle waiting your turn at bat, and during base running.
• Protective face shields attached to batting helmets can reduce the risk of facial injury if hit by a ball.

• Position-specific equipment should be used.
• Catchers should always use a catcher's mitt, helmet, face mask, throat guard, long-model chest protector, protective supporter, and shin guards.
• Batters should consider wearing protective jackets to avoid injury from being hit by ball.
• Wear molded baseball shoes that fit properly and have appropriate cleats.
• Gender-specific equipment may be of value, including athletic supports for boys/men and padded bras for girls/women.
• In youth leagues, softer baseballs decrease the risk of injury from being hit by a pitched ball.
• Players should be instructed in how to avoid getting hit by a ball.

Ensure a Safe Environment

• Inspect the playing field for uneven terrain (holes, divots), glass, and other debris.
• Use a field with breakaway bases. Many injuries occur while sliding into bases. The traditional stationary base is a rigid obstacle for an athlete to encounter while sliding. In contrast, a breakaway base is snapped onto grommets attached to an anchored rubber mat, which holds it in place during normal play. Although a sliding runner can dislodge it, the breakaway base is stable and will not detach during normal base running. Installing breakaway bases on all playing fields could significantly decrease sliding injuries.
• Assess weather conditions and be prepared to delay/cancel the game, especially in cases of particularly hot weather or thunderstorms with lightning.

Focus on Technique

Base Running

The American Academy of Orthopaedic Surgeons recommends the following tips for those individuals sliding into, as well as protecting, the bases while playing baseball and softball:

• Players under age 10 should not be taught to slide.
• Proper instruction in sliding technique must be taught and practiced before using any bag, including the breakaway bases. Practice should first be with a sliding bag.
• The "obstruction" rule must be taught and observed. Getting in the way of the runner or blocking the base without possession of the ball is dangerous to both the runner and fielder.
• When coming into home plate, it is important that
the runner attempt to slide to avoid a collision.
• To prevent ankle and foot injuries between the runner and fielder at first base, a "double bag" — a separate bag for both the runner and first baseman — should be used.

Pitching and Throwing

Follow established guidelines for youth baseball, which include limiting the number of pitches thrown and type of pitches thrown, according to age. The following guidelines are recommended by the USA Baseball Medical & Safety Advisory Committee.

• Pitch Count Limits:

Age	Max. Pitches/Game	Max. Pitches/Week
8 - 10	50	75
11 - 12	75	100
13 - 14	75	125
15 - 16	90	2 games / week
17 - 18	105	2 games / week

• Ages for learning types of pitches:

Fastball	8
Change-up	10
Curveball	14
Knuckleball	15
Slider	16
Forkball	16
Splitter	16
Screwball	17

Good Communication

Good communication between doctors, players, parents, and coaches is key to diagnosing and treating more significant baseball injuries.
Young players may not be able to recall exactly how an injury happened or describe their symptoms in detail. They may even hide injuries because of concern about being removed from play.
Coaches and parents must pay close attention to changes in a player's participation or performance. Should there be an injury, doctors may need their help to provide accurate details and a medical history.

Safe Return to Play

An injured player's symptoms must be completely gone before returning to play. For example:

• In case of a joint problem, the player must have no pain, no swelling, full range of motion, and normal strength.
• In case of concussion, the player must have no symptoms at rest or with exercise, and should be cleared by the appropriate medical provider.
• In case of a shoulder or elbow overuse injury, the player should gradually return to a throwing program, increasing the number of throws depending on the length of time away from play, and their specific team position.

Patient, Heal Thyself- After Shorter Hospital Stays, Doctors Raise Demands and Time for Recovery

by Laura Landro
From the Wall Street Journal, October 26, 2010

For Michael Noonan, knee surgery in April was practically a breeze—an outpatient procedure that had the 41-year-old investment banker hobbling home on crutches in a matter of hours after surgeon David Altchek replaced his anterior cruciate ligament using small incisions.


But recovery was another matter. He needed the crutches for three weeks, had 12 weeks of physical therapy three times a week, then six weeks of exercises at home. He rented a strap-on ice compression device to reduce swelling, and wore a brace for about five weeks. Though fully healed now, being responsible for so much of his own rehabilitation, he says, "was like taking a new baby home for the first time—you don't really feel like you're licensed to do it."

Surgery is easier and faster than ever before: Nearly 65% of all surgeries don't require an overnight hospital stay, compared to 16% in 1980. Hospitals that once kept patients for three weeks after some major operations now discharge them within a matter of days. But the body still heals at its own pace, and reduced time in hospital care means patients are assuming more responsibility for their own recovery—and more risks. Patients not only have to perform rehabilitation regimens at home, but they are more often caring for their own incision wounds and dressings and having to watch for signs of infections and blood clots. They also may be managing drains, implanted IV ports and pumps, all of which can be difficult and stressful.

The move to speedier surgeries is largely the result of new minimally invasive techniques, improvements in anesthesia and cost-cutting by insurance companies and hospitals. Surgical procedures now often use smaller incisions, cut less muscle, and result in less blood loss. Newer anesthetics allow patients to regain consciousness quickly or not go to sleep at all. Pain medications are more effective.

At the same time, concern about rising health care costs has led to changes in Medicare and insurance plans that have encouraged the development of outpatient surgical centers and created financial incentives for hospitals to shift less complex surgery to their own outpatient facilities. So, many types of surgeries previously performed in hospitals with overnight stays are now being done on an outpatient basis: The number of freestanding surgery centers grew from about 240 in 1983 to more than 5,000 now.

The mean charge for outpatient surgery was $6,100 versus $39,000 for inpatient surgery in 2007, according to the most recent report on surgical costs from the federal government. Insurance companies are also less likely to pay for stays at rehabilitation centers, places where surgical patients were often sent after hospital discharge to recuperate.

With patients going home so quickly, more are having to grapple with complications on their own. Of all the complications that occur in the 30 days after surgery, such as infection and blood clots, almost half will surface after a patient leaves the hospital, according to data from one million patients in a surgical quality improvement program sponsored by the American College of Surgeons.

"The onus is really on patients to recognize if something is a problem," says Clifford Ko, a colorectal surgeon at the University of California, Los Angeles, and director of research and optimal patient care for the American College of Surgeons. "The recovery period is often as important as the procedure itself, and patients who don't follow their discharge instructions could have longer recovery times, greater risk of a complication, and potentially more pain."

Knee surgery patients, for example, are counseled to maintain their weight after surgery. But a recent study shows that most patients gain weight, which can jeopardize the health of the other knee. Depression, another common after-surgery occurrence, also can inhibit healing, if patients don't seek treatment.

Efforts are underway to improve follow-up for patients, particularly those who have surgery in doctor's offices, which don't have the same regulation as outpatient surgery centers. The Institute for Safety in Office-Based Surgery has developed a checklist that includes assuring that discharge instructions are provided and a plan for follow-up care is clear. "Patients need to be asked things like if there is redness at the incision site, do you know what to do?" says Fred Shapiro, a Harvard anesthesiologist and president of the group. (Redness at an incision site can be a sign of infection.)

Infections that can occur after any surgery can lead to a severe bloodstream infection that can be fatal. A study published in July in the Journal of Hospital Infection of 84,000 patients who developed a surgical site infection found that more than half occurred after discharge, increasing the risks of an emergency room visit, readmission to the hospital, and another surgery.

For months after a procedure, surgical patients are also at high risk of developing blood clots which can travel to the lung and cause death from a pulmonary embolism. After joint replacement, for example, though the risk is greatest within two to five days, a second peak development period occurs about 10 days after surgery when most patients have been discharged from the hospital. In knee surgery patients, a clot can form in the calf if the patient fails to elevate the leg and perform specific movement exercises. Blood clots and subsequent pulmonary embolisms remain the most common cause for emergency readmission and death following joint replacement, according to the American Academy of Orthopaedic Surgeons.

The American Academy of Orthopaedic Surgeons sponsors workshops to teach its members better communications skills to help patients understand procedures and to stress the importance of follow-up care, such as providing clear written instructions and monitoring patients after surgery. "We can have a perfect total knee replacement but then have a poor outcome if we don't convince surgeons that explaining the post-operative care is in everyone's best interest," says John Tongue, a Portland, Ore.-area orthopedic surgeon and clinical associate professor at Oregon Health & Science University who teaches the workshops.

Insurers have become stricter about paying for inpatient rehabilitation programs where surgical patients were once transferred to recover. The move has been spurred partly by studies that show that cheaper at-home visits from therapists are effective.

But Nina Reznick, a 63-year old patient who had both hips replaced last July, says the home therapist her insurance paid for did not have the equipment or time to really help, so she did extra exercises on her own. She believes that effort enabled her to walk a week after surgery. "You are really on your own, and you have to be very motivated," she says.

Some doctors say that the changing demographics of their patients also can contribute to bumpy recoveries. Dr. Altchek, who performs knee and rotator cuff surgery at the Hospital for Special Surgery in New York, says that more younger patients are opting to replace troublesome knees and hips so they can resume athletic activities such as tennis and skiing; close to 42% of all knee replacements in 2008 were for patients aged 45 to 65, compared to less than 35% in 2002, and studies show that waiting too long once a joint starts to deteriorate before having surgery can make recovery more difficult.

But younger patients may also be impatient and assume they are healed, and then quit rehabilitation too early, Dr. Altchek says.

Andrew Minko, a 41-year-old patient of Dr. Altchek's who plays tennis and surfs, has had two surgeries to repair joints on his left shoulder and now needs surgery on his right shoulder. Though he healed well, he admits he was somewhat lax about doing his exercises at home and may have rushed into some activities too quickly after the previous procedures. For the upcoming surgery, he says, "I will be more diligent about the recovery."

Arizona Fall League 2010

If your not already aware, the 2010 season of the Arizona Fall League is in progress. This is my 16th year serving as the Medical Director of the AZ Fall league. The fall league games are a great way to enjoy the cooler weather and check out new talent in baseball.
Below is a article about Bryce Harper, the No. 1 overall pick in the 2010 First-Year Draft and Washington Nationals player. Bryce will be playing in the Arizona Fall League as a member of the Scottsdale Scorpions. Definitely a player to watch now and in the future of baseball.



Nats' Harper to play in Arizona Fall League


By Bill Ladson / MLB.com

The Nationals have decided that outfielder Bryce Harper, the No. 1 overall pick in the 2010 First-Year Draft, will play for the Scottsdale Scorpions of the Arizona Fall League. He will report on Tuesday.

Harper will be on the taxi squad, which means he will play twice per week. When he doesn't play, Harper will work on his swing and his skills in the outfield.

The news comes after Harper hit .319 with a .407 on-base percentage for the Nationals in the instructional league. He also led the team in several offensive categories, including hits, homers, RBIs and walks.

"He performed admirably in the instructional league," general manager Mike Rizzo said. "He got his feet on the ground and he was immersed in baseball, which he embraced greatly. He is what we call a baseball rat."

Rizzo said he thought about putting Harper in the AFL before the young slugger started playing in the instructional league, but he didn't make the decision until recently. Rizzo said Harper's performance on and off the field reinforced his decision.

"He's 17 years old and he doesn't even turn 18 until Saturday," Rizzo said. "He is very excited. What I had to decide on was: 'Is he going to be over his head in the AFL?' It's a very advanced league, but I think he is going to handle it. It's going to be very valuable to him."

The club did not want Harper to be idle for the next two months, so they believed it was better for him to continue playing baseball under Randy Knorr, who is managing the Scorpions. Knorr is considered one of the best teachers in the Nationals' organization.

Rizzo, Nationals manager Jim Riggleman, hitting coach Rick Eckstein and Phil Rizzo, a special advisor to the general manager, will also be in Arizona to help develop Harper.

"There is a high level of baseball going on," Mike Rizzo said. "Two months of this guy working out, practicing and playing will only benefit him. He is going to be fine in the [AFL]."

Harper is expected to begin the 2011 season at Class A.

"He is going to A-ball, make no mistake about it," Rizzo added. "He is not going to be a rushed guy. We are going to let his performance and development dictate where this guy goes."

Harper, after putting up monster numbers in high school, received a lot of publicity last year when Sports Illustrated referred to him as the "Chosen One," and baseball's version of LeBron James.

Shortly thereafter, he turned more heads when he received his high school equivalency in lieu of becoming a junior in high school, then headed to the College of Southern Nevada to join a junior-college program that plays in a wooden-bat conference.

Having been used primarily as a catcher in the past, Harper is currently playing right field. Rizzo believes that Harper will get to the big leagues faster if he plays somewhere other than behind the plate. He is considered an above-average outfielder with a great throwing arm and speed.

In addition to the physical tools, Harper had the stats to warrant being taken No. 1 overall. In 2008 as a freshman at Las Vegas High School, Harper had a .599 batting average with 11 home runs and 67 RBIs in 38 games. He followed that up with a .626 batting average, 14 home runs and 55 RBIs the next season.

Playing against a high level of competition and hitting with a wooden bat didn't present much of a challenge to Harper. The 17-year-old hit .442 with 29 home runs and 89 RBIs during the 2010 regular season.



Bill Ladson is a reporter for MLB.com and writes an MLBlog, All Nats All the time. He also can be reached on twitter -- @washingnats. This story was not subject to the approval of Major League Baseball or its clubs.

http://mlb.mlb.com/news/article.jsp?ymd=20101013&content_id=15613880&vkey=news_mlb&c_id=mlb&partnerId=ed-4229999-55422965&source=ed-4229999-55422965

Dr. Mattalino's travels with USA Baseball in Puerto Rico, October 2010- Entry 9

Team USA defeated Cuba (one of their toughest opponents), 4-1. This win earned USA a spot in the semifinals and the #1 ranking so far in the tournament. The first game of the Semifinals was held on Oct. 12th, with the USA playing the Dominican Republic.
Team USA undefeated record in this tournament earned them a spot in the 2011 Pan American Games in Guadalajara, Mexico, tentatively scheduled for next October. And a spot in the 2011 IBAF Baseball World Cup, date and location TBD.

*Highlights from the game are below

GOLDEN ARCHES: U.S. starter and Chicago Cubs 2010 Minor League Pitcher of the Year Chris Archer was dazzling Monday night, authoring six scoreless innings, allowing two hits, walking none and striking out 10. Archer kept the Cuban lineup off-balance all night, not allowing a runner past first base in his final four frames.


BARD HITTIN’: With an infield hit in the first inning, Brian Barden moved his hit streak to six games (8-22, .364). The veteran of the 2008 U.S. Olympic Baseball Team has played three positions for Team USA in the Pan American Qualifier, seeing time at left field, shortstop and second base.

OLD AQUAINTANCES: Kansas City Royals prospect Mike Moustakas was no stranger to Cuban starter Vladimir Garcia, having faced the righty just over four years ago in the quarterfinals of the COPABE Junior (18U) Pan American Championships. Moustakas played left field and batted clean-up for the 18U National Team, and finished the day 3-for-4 with two runs scored. As for Garcia, he came on in relief in the seventh inning and failed to record an out, allowing two earned runs on two hits. Moustakas slapped a two-run double down the left field line to get the U.S. on the board first Monday night, giving his team a lead it would not relinquish.

QUALITY QUALIFYING: By finishing in the top seven of the Pan Am Qualifier, the United States has punched its ticket to the 2011 Pan American Games in Guadalajara, Mexico, tentatively scheduled for next October. Additionally, Team USA’s top-six finish guarantees it a spot in the 2011 IBAF Baseball World Cup, date and location TBD.

FAMILIAR FOES: Monday marked the ninth time a USA Baseball Professional Team and Cuba have met since 2000, including the Sydney 2000 Olympic Games. The U.S. moves to 6-3 in those games. Prior to Monday’s game, Team USA had most recently faced its intercontinental rival last September in Italy, as it took home gold from the 2009 IBAF Baseball World Cup.

SEMIFINAL BREAKDOWN: With the win, the U.S. is the No. 1 seed advancing from Round 2, while Cuba finishes the round as the No. 2. Earlier today, Venezuela defeated the Dominican Republic, 12-4, to finish third. Although both teams completed play with 4-3 records, Venezuela earned the tie-breaker with Monday’s win. Team USA will face the Dominican Republic in the 1 vs.4 game at 7:30 p.m. ET at Hiram Bithorn Stadium in San Juan on Tuesday night.



TODAY’S OTHER ACTION (Round 2 records):
2:00 p.m. ET (Ponce) – Panama 5 (3-4), Nicaragua 2 (0-7)
2:00 p.m. ET (San Juan) – Venezuela 12 (4-3)*, Dominican Republic 4 (4-3)**
7:30 p.m. ET (San Juan) – Canada (2-4), Puerto Rico (2-4) (Late)

Dr. Mattalino's travels with USA Baseball in Puerto Rico, October 2010- Entry 8

Team USA defeated Canada, 4-0, to Stay an Undefeated 8-0 in Pan Am Qualifying on October 10, 2010. The game was held at Hiram Bithorn Stadium in San Juan, Puerto Rico.

*Highlights from the game are below.

K MACHINE: With his two strikeouts in the fifth, starter Mike Montgomery finished with eight for the game, pushing his tournament total to a team-leading 14. The lefty overtook fellow Kansas City Royals prospect Everett Teaford (13).


HIT PARADE: By going 1-for-3 Sunday, Brian Barden has logged at least one base hit in each game he has played in the tournament (7-for-19 in five games). His .368 average is good for second on the team (Brett Jackson, .667). Barden is a two-time USA Baseball alum, having previously donned the red, white and blue for the bronze medal-winning 2008 U.S. Olympic Baseball Team.

MOOSE BREAKS LOOSE: Mike Moustakas, who entered Sunday’s tilt with a .200 average, despite being tied for the team lead with six RBIs, found his stride at the plate, going 3-for-4 with a double and a run scored to raise his average 50 points.

QUITE THE OPENING ACT: For the second day in a row, Los Angeles Angels of Anaheim prospect led off the game with a home run. Sunday’s shot to left was the 19-year-old’s team-leading third of the tournament and came on an 0-1 count.

FAMILIAR FOES: Sunday marked the 14th time since 2008 that a USA Baseball Professional Team has faced Canada in international competition, including exhibitions. Team USA is 12-1-1 in those games.

UPCOMING OPPONENT PREVIEW: The U.S. will face intercontinental rival Cuba on Monday at 7:30 p.m. ET in Ponce’s Paquito Montaner Stadium to conclude Round 2 play. Cuba is 6-1, 4-1 heading into Sunday’s game against Puerto Rico, its lone loss coming Saturday night against the Dominican Republic, 9-6. Cuba and the U.S. have a long history of competition, with USA Baseball’s Professional Teams holding the advantage five games to three since 2000, including the Sydney Olympic Games. Most recently, Team USA defeated Cuba, 10-5, to take home the gold medal from the 2009 World Cup in Italy.

TODAY’S OTHER ACTION (Round 2 records):
1:00 p.m. ET (Ponce) – Venezuela (3-2), Panama (1-4)
5:00 p.m. ET (Ponce) – Dominican Republic (3-2), Nicaragua (0-5)
7:30 p.m. ET (San Juan) – Cuba (4-1), Puerto Rico (2-3)

Dr. Mattalino's travels with USA Baseball in Puerto Rico, October 2010- Entry 7

Team USA defeated Venezuela, 6-3, on October 9th in San Juan, Puerto Rico. This win meant that Team USA moved to 7 game wins - 0 losses in the Pan Am Qualifying games.

*Highlights from this game are below

FORMIDABLE OPPONENT: Team USA faced off against Venezuela today. Venezuela, the IBAF 9th ranked team in the world, is the last team to beat Team USA at the professional level when it outlasted the U.S., 13-9, in 11 innings on September 10, 2009 at the IBAF World Cup in Regensburg, Germany. Since then, Team USA professional teams have won 21 straight games in tournament play.


ANDRE THE GIANT: Milwaukee Brewers prospect Andre Lamontagne pitched three shutout innings in relief for Team USA. Lamontagne yielded just two hits while striking out four for the red, white and blue. Andre pitched at the Double-A level in Huntsville for the Brewers in 2009.

TROUT POWER: Mike Trout led off the game today for Team USA with his second home run of the tournament. Trout’s homer was a blast to centerfield that traveled approximately 415 feet. Trout, 19, hit 10 homers this season during stints in the Angels’ High and Low-A affiliates.

RAINING K’s: After a two-hour and two-minute rain delay, Team USA and Venezuela pitchers combined for 24 strikeouts with Venezuela striking out 13 U.S. hitters and the U.S. fanning 11.

TIEBREAKER RULE IN EFFECT: The international extra-inning tie-breaker rule, which was established by the IBAF in 2008, was put into play in the 12th inning of today’s game. The rule has each team start its half of the inning at any point in their lineup and with runners on first and second base. In the top half of the 12th, Team USA scored four runs, two coming on a Cord Phelps double, while Venezuela plated one in its half.

TODAY’S OTHER ACTION:
Canada 9 – Panama 5
Nicaragua vs. Puerto Rico – 7:30pm
Cuba vs. Dominican Republic – 4:00pm

Dr. Mattalino's travels with USA Baseball in Puerto Rico, October 2010- Entry 6

On October 8th, Team USA shutout Nicaragua with a final score of 5-0 in the opening game of Round 2 of the Pam Am Qualifying games. USA now holds 6 wins and zero losses in the tournament. The victory over Nicaragua qualified the USA team for 2011 Pan American games in October.

*Highlights from this game are below

PAN AM BOUND: With today’s victory the U.S. clinched a spot in the 2011 Pan American Games which will be held in Guadalajara, Mexico next October. The U.S. took silver at the 2007 Pan Am Games in Rio De Jainero, Brazil. Since 1951, with teams comprised mostly of collegiate level players, Team USA has won gold only once (1967), while winning the silver medal nine times (1951, 1955, 1963, 1971, 1975, 1987, 1999, 2003, 2007) and the bronze three times (1959, 1983, 1991).


COACHES CORNER: Philadelphia Phillies Minor League Manager Roly de Armas is in his fifth stint as bullpen coach for Team USA. Roly, a member of the 2008 Philadelphia Phillies coaching staff that won the World Series, has been with team USA since 2006. de Armas has helped lead the U.S. to World Cup gold medals in both 2007 and 2009, a bronze at the 2008 Beijing Olympic Games and first place at the 2006 COPABE Olympic Qualifier in Havana, Cuba.

REDMOND DOMINANT: USA starter Todd Redmond moved to 2-0 in tournament play, pitching seven shutout innings while holding Nicaragua to just four hits and striking out six. Redmond, a member of the gold medal-winning 2009 World Cup squad moves his record to 5-0 with a 1.25 ERA in his two seasons with the Team USA.

ELECTRIC CORD: U.S. second baseman Cord Phelps went 2-for-4 with an RBI and two runs scored to lead Team USA to victory. Phelps, a prospect in the Cleveland Indians organization, played his college baseball at Stanford.

TODAY’S OTHER ACTION:
Dominican Republic 5 – Canada 2
Cuba 4 Panama 1 – 7th inning
Venezuela vs. Puerto Rico – 7:30pm