What We Can Learn From Angels Pitcher Shohei Ohtani’s Elbow Injury

Written by Boris Gilzon, PT, DPT, OCS, CHT and Alex Ariza

If you’re a fan of baseball you may have heard that New Los Angeles Angels pitcher, Shohei Ohtani, has a damaged Ulnar Collateral Ligament (UCL) in his pitching arm.

This is bad news for Ohtani, as his career relies heavily on the function his elbow. Although reports show that Ohtani only has a first-degree sprain, consistent use of his elbow can present serious problems down the line.

In the world of physical therapy, elbow pain does not get enough exposure and is often ignored. More often than not, people continue performing their daily activities that can exacerbate injury to the elbow and cause damage to the joint and ligaments.

Ulnar Collateral Ligament (UCL) Injury

As Physical Therapists, we see sports injuries in a different light, especially when they make the news. This post will share some of the intimate knowledge we possess from years of treating a number of injuries and conditions that athletes may face.

The Ulnar Collateral Ligament, located in the elbow, is a complex structure consisting of three bands. It is challenged more when the elbow is in flexion. During full elbow extension, the bony congruity provides additional stability.

Ulnar Collateral Ligament Anatomy

Ulnar Collateral Ligament injury is common in many overhead sports. The forces that can lead to injury on the elbow are generated when the elbow goes from flexion to extension at a high velocity. In Ohtani’s case, this would be frequently pitching at a consistent speed of 100 mph.

This injury occurs from repetitive valgus (a condition in which the bone segment distal to a joint is angled outward) stress on the medial (inner aspect) of the elbow. This kind of elbow sprain commonly occurs in baseball pitchers. It is less frequent in racket sports, volleyball, and hockey, but can still occur in athletes playing those sports.

Damage to the ligament can be caused by sudden trauma or a gradual stress. The most typical sign is a pain in the inner elbow while performing a physical activity. Patients commonly describe an elbow sprain as a twinge or sharp pain when pushing up, such as getting up from the chair.

If a ligament is compromised a patient may develop:

  • A sense of looseness or instability in the elbow.
  • Irritation of the ulnar nerve (aka the “funny bone”): This is felt as a tingling sensation or numbness in the small finger and ring finger.
  • Decreased ability to throw a baseball or other object overhead.

Treatment for Ulnar Collateral Ligament Injury

Ulnar Collateral Ligament injury can happen to anyone at any age. Parents and coaches should be aware of the issue and be alert if the child complains of the pain in the elbow.

Physical Therapy is the best first line of defense following this diagnosis. At Park Sports Physical Therapy, our Physical Therapists are skilled and experienced in treating elbow instability and ulnar collateral ligaments tears.

The treatment approach is based on thorough examination and biomechanical analysis of the activity that caused the condition.

It includes:

  • Strengthening weak muscle group
  • Activity modification.
  • Manual therapy and therapeutic modalities.

Post-Surgical Recovery

In cases of severe damage and instability, the ligament is reconstructed in what is commonly known as a Tommy Johns procedure. Physical Therapy treatment in this case follows an established post-surgical protocol. Our therapists work closely with an Orthopedic Surgeon to optimize post-surgical recovery and achieving the highest functional outcomes.

Do you suffer from Ulnar Collateral Ligament Injury? Take the first step to get out of pain by scheduling your appointment.

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Scoliosis Specialist in Brooklyn

Scoliosis affects 2-3% of the American population. The most common form being idiopathic scoliosis which affects children ranging from ages 10-15 years old. Idiopathic means the causes are unknown. It is typically detected by school screenings or a physician visit. Patients with idiopathic scoliosis rarely experience pain and the curve is usually minor enough that treatment isn’t needed, but this can change with time. If your child has scoliosis our certified Schroth therapists can help treat and teach your child how to counteract the imbalances caused from the abnormal curvature of the spine.

In this article, Park Sports founder and physical therapist Boris Gilzon, PT DPT, OCS, CHT describes how our therapists utilize conservative methods such as breathing techniques, exercise, and body awareness to address Scoliosis and Kyphosis.

Originally developed in Germany by Katharina Schroth in the early 1920’s, the Schroth method has become one of the most effective and safest approaches to treating Scoliosis.

The Schroth method focuses heavily on rotational breathing, stabilizing and balancing the spine, chest expansion, derotation and reduction of the spine’s irregular curvature, elongation of the spine, hands-on treatment to correct the body’s posture, and educating the patient on exercises and techniques they could use for life.

There are numerous Schroth Method exercise. The combination of exercises our physical therapists prescribe is based on each patient’s body and the curves of their spine.

Unlike most other exercises, which are completed on both sides of the body, scoliosis exercises are generally executed on one side only. This is in order to correct the imbalances of the spine by lengthening and strengthening the muscles in this area.

On the whole, the exercises consist of a combination of stretching, strengthening and breathing techniques, which follow this three-step exercise process:

  1. First, make sure the pelvis is properly aligned
  2. Then, do exercises to lengthen the spine, followed by breathing techniques to move the spine and ribs into the best possible posture
  3. Finally, tense the muscles of the trunk, which will strengthen weak muscles and preserve the posture that has now been corrected

The benefits of the Schroth Method are highlighted in the findings of this recent study:

According to these results, Schroth PSSE (physiotherapeutic scoliosis-specific exercises) added to the standard of care were superior compared to standard of care alone for reducing the curve severity in patients with AIS (adolescent idiopathic scoliosis). Reference: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5198985/

So if you or your child are dealing with scoliosis, the Schroth Method may be your best option to address its symptoms and prevent the condition from progressing further.

Do you or your child suffer from scoliosis or kyphosis? We can help. Schedule your evaluation today.

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Hamstring Injury

You are probably watching the World Cup 2014. Did you notice that there are several elite players injuring their hamstring muscle in a seemingly innocuous situation? In fact, hamstring injuries are very common. It is a tear in a fleshy muscle behind the thigh. Depending on severity of a tear, the injury classified from mild to severe using a grading system. The tear is caused by sudden acceleration in sports like running, soccer, tennis. It can also happen in a routine situation as in trying to catch your toddler, or running after a bus. There is a sudden, sharp pain behind your leg and the person cannot straighten his knee without pain.

I noticed in the early morning on my way to my office in Clinton Hill, groups and individual runners from Fort Greene and Prospect Heights are dashing toward Prospect Park dodging traffic on Atlantic Avenue and Grand Army Plaza. Sudden accelerations and stopping probably is not the most ideal way to start your work out.

There is no foolproof way to completely avoid hamstring injuries. However, the risks can be minimized by paying attention to the principles of muscle strength and flexibility. Individual flexibility should be maximized by a regular stretching program as well as a period of warm-up and stretching before the intended athletic activity. Park Sports Physical Therapists are experts in designing such a program. Our Clinton Hill location has space and equipment for assessment and rehabilitation of sports related injuries like a hamstring pull. Carefully designed individualized stretching routine will address imbalances that may lead to a hamstring pull. Optimal individual hamstring strength is at least half of the strength of the quadriceps muscle (muscle of the front of the thigh). Also, there should be minimal imbalance in strength between the right and left legs (the injured hamstrings should be about 90% as strong as the uninjured hamstrings). If necessary, a weight-training program should be instituted to optimally achieve these goals. In an evaluation of an injured athlete, particular attention is paid to the relative flexibility of opposing muscle groups, not just the hamstrings and quadriceps pair.

An additional aspect of recovery is proper nutrition. A well-balanced diet and appropriate fluid intake are essential to avoid electrolyte imbalance. It is even more important when exercising in a hot weather. Dehydration can lead to muscle cramping, thereby increasing the chance of muscle injury. Overweight people have a higher risk of muscle injuries in the lower extremities. Some experts have also advocated the use of nutritional supplements, such as antioxidants. Unfortunately, despite the best efforts at prevention and treatment, hamstring injuries will continue to be a common bane of the high-performance athlete as well as the “weekend warrior.”

Ankle Sprains

As a former competitive athlete, I sustained multiple ankle sprains. My personal experience and my knowledge acquired through my profession puts me in a good position to give an expert advice on ankle sprain. Ankle injuries has become one of the most common conditions we treat in our clinic. Several factors contributed to such an occurrence. One of them is an increase in sports activities and sports participation. Ankle sprains in general by far the most common sports related injury. In fact there are more than 30,000 ankle sprains in the US per day. Most of those sprains are mild GradeI type that will go away in 2-4 weeks. I am concerned about more severe sprains, approximately 25% of injured persons will go on to develop chronic ankle instability. Surgery may be appropriate in those cases. There are several risk factors for developing ankle sprains. Probably the biggest factor is a history of a previous sprain. In an ankle that has been already sprained the ligaments are less taut, resulting in the ankle feeling less stable. A typical mechanism of an injury is "rolling" on the outer surface of the foot and causing quick and sudden stretch to the lateral ligaments. Other risk groups are people with stiff ankles, athletes in contact sports. Women are 25% more likely to sprain their ankle than man. In more severe cases, Grade III sprains, the ligaments are completely torn. In some cases surgery is required. The person may have difficulties putting weight through their ankle, and in many instances this condition makes performing recreational activities impossible. It may lead to a development of premature arthritis, since the normal distribution of forces acting on the joint are disrupted, the articular cartilage wears out much faster. MRI examination is the most useful tool in determining the degree of ligament injury. For GradeI and GradeII sprains Physical Therapy is most helpful. The therapist cannot make your ligaments tighter, but he can teach you specific exercises to improve muscular support around the ankle joint, thus providing dynamic stability. Physical Therapy for all ankle sprains will focus on balance training and proprioceptive control, that is an awareness of your ankle joint position in space. Our goal is to decrease your chances of re-injury and return to your fun activities.