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Baseball & it’s classic injury known as the “Tommy John”

goodbaseballpicWith the 2016 baseball in full ‘swing’, it is worth discussing elbow injuries. The classic injury that comes to mind first is the one that requires ulnar collateral ligament (UCL) reconstruction, or more commonly known as “Tommy John” surgery.

The ulnar collateral ligament is an important structure for medial elbow stability. Its fibres are aligned to reinforce the medial elbow (or inner elbow). There are two groups of fibres the UCL; the anterior (front) and posterior (back) fibres. Together, these fibres will resist ‘valgus’ force to the elbow; a valgus force will rotate the forearm outwards relative to the humerus, creating an angle at the elbow where the hand is pointing away from the body. As with any other tissue in the body, if these fibres are stretched beyond their limits, they will become injured. The degree of the injury is dependent on the amount that the tissue is stretched.

Imagine the throwing motion starting from the legs to generate power and transferring to the trunk and core, multiplying through the throwing arm and releasing at the hand to propel the ball in a ‘whip-like’ kinetic chain. Through this pathway, the body needs to resist the amount of force that is being generated. The smallest structures would be in the arm, but it also has the highest demands to resist force without failing (given the multiplication of force down the kinetic chain). Throwing a baseball imparts a significant valgus stress on the elbow, directly applying strain on the UCL. As pitchers try to throw the baseball at higher velocity, the force that is generated is increased, placing the UCL at higher risk for injury.

But, not every pitcher experiences elbow pain or will sustain an injury. So, there must be more at play that determines injury and elbow stability. baseballthrowForearm muscle strength is a critical component in determining elbow injury and pain. There are two muscles in the forearm that were found to be critical in elbow stability; these are the flexor carpi radialis and the flexor digitorum superficialis; both muscles contribute to flexing the wrist. In cadaver studies, the fibres of these muscles were found to cross at the elbow in parallel with the anterior fibres of the UCL, and therefore enhanced the function of the UCL. This means that with increased strength of these muscles, the athlete will be able to produce more force to generate ball velocity, but will also be able to actively resist the amount of valgus force at the elbow. These muscles will contract, providing an opposing and resistive (varus) force to the valgus defmoration that occurs at the elbow during a throw. In fact, the function of these muscles can be so profound that some pitchers (albeit one well-known pitcher is a knuckleballer) can pitch without a UCL on their throwing arm and still perform at a high level.

Of course, in determining injury, there are many other factors that are major contributors including pitch type, pitching mechanics, throwing arm angle, previous injury, elbow flexion contracture, and glenohumeral internal rotation deficit. But this is understandable because throwing is a motor skill that is quite complex and requires considerable practice to master. Be sure that you are ready for this season by training appropriately.

By: Chris Dahiroc, PT, M.Sc., P.T.

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Why you should not self-adjust yourself!

self adjustWhen patients tell me that they crack their own neck and back, it truly makes me cringe. This is a topic that I commonly come across in practice and it surprises me how many people actually do this and how often. If you feel the need to crack your joints consistently, it is because it needs to be adjusted and is stuck.

There can be areas of your spine and into your extremities where there is a lack of motion in one or more direction. This is what is called a restriction or subluxation. There is a certain amount of adaptation where other areas will compensate and pick up the slack for that particular area not moving. These other areas above and below the joint move more and therefore become hypermobile. This hypermobility creates joint laxity and instability due to the stretching of the supportive ligaments. When you self-adjust, you can hear that popping sound and release. The popping noise is created by the negative pressure from the stretching of the joint and releases nitrogen gas.  On your own, it is very difficult to find the end range of motion in order to release the joint in the correct direction it needs. You may feel relief due to the rush of endorphins but that is short lived and can initiate a pattern of becoming a chronic self-adjuster. There is definitely that risk of manipulating the wrong joint.Chiro Page2

As a chiropractor, we are trained to assess the movement and function of the spine at various levels. Then we find the specific restriction regardless of whether it is through manual or instrument adjusting and adjust accordingly. This can help take pressure off the joint and thus allows for proper nervous system communication at the various spinal levels.

 

By: Dr. Teesha Geevarghese (B.Sc., D.C.) Chiropractor

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Compressions socks/stockings are for everyone!

We commonly associate compression socks with the aging population or with pregnancy, however compression socks can be beneficial for just about compression jaanyone. Compression socks provide a controlled gradient of compression with the most compression at the ankle and decreasing compression going up. Compression socks help improve circulation, decrease swelling and provide relief from tired and achy legs. They are also most commonly used for varicose veins.

Whether your lifestyle has you sitting at a busy, standing on your feet or constantly walking on various terrains including hard floors Compression socks may help relieve any swelling or soreness associated with your lifestyle.

Our health practitioners can get you fitted to determine what size, style, and length of compression sock would be best for your lifestyle and conditions/pain. Compression socks can come in either knee or thigh high length as well as various styles and colours to choose from.

Compression socks are sometimes covered by your Extended Health Benefits. A doctor’s prescription for compression socks along with the diagnosis and grad of compression (20-30mmHg) is usually required by insurance companies.

By: Fatima Dias PTA/OTA

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Should you have any questions or concerns or would like to find out coverage please do not hesitate to contact us!