Submitted by Martin Jacobson, D.C., P. A. Marty plays in the Palm Bay Senior League and is a Chiropractic Physician
SPORTS INJURY CORNER:
As we all know, playing senior softball is a lot of fun, but, as most of us have already experienced, there can be a lot of heartbreak also. The attrition rate due to injury is very high and I'm sure the amount of Advil and Naprosyn consumed by senior softball players is helping to keep Walgreen’s in business.
Unfortunately, many of the aches and pains we all experience are unavoidable because we're playing a very demanding sport with bodies that, to some degree, have lost flexibility and strength because of deconditioning and the aging process. However, for those of us interested in playing to the best of our present abilities, as well as prolonging our playing days, there are options.
First of all, it should be understood that if you simply show up on game days without any physical preparation during the week, you probably will not approach your potential as a player and your chances for debilitating injury will be great. Seniors who are just returning to the game after not playing for many years are especially at great risk for injury.
Too many times we have seen new players injure themselves early in their first season and never recover. Muscles that have not been subjected to the stresses of softball are suddenly being asked to propel the player around the bases and that player, not wanting to disappoint himself or his teammates pushes himself beyond safe limits. He then limps or is carried into the dugout and this very often is the end of his senior softball career. This is sad for the player but also sad for his teammates and the rest of the league. Our goal in managing our league is to incorporate and encourage as many new players as we can. As most of us know, there's something addictive and intoxicating about playing senior softball and it is always enjoyable to see new players become part of our group.
What I would like to do in these articles, is to share some of my knowledge and expertise in regard to conditioning and rehabilitation so that we can perhaps prevent some of these disabling and career ending injuries that we see happen all too frequently.
As a young person, I never was too concerned with warming up prior to playing and can't recall suffering pulled muscles or aching bones. Now as a 60 year old, I can hardly move unless I warm up for 20 minutes before playing. Everyone should have their own routine to prepare themselves for playing. If you're having problems with your legs you might need to spend additional time getting them warmed up and stretched so you will be ready to run when the game starts. Cold muscles will be much more prone to injury than muscles that have been activated and warmed up through some repetitive exercise.
I think a key to pre-game warm-ups should be going through some of the movements that you will have to do during the game. I have noticed that one thing most of us have trouble doing is reaching down to catch a ball while moving. This requires not only coordination and flexibility but muscles strong enough to support us while we lean forward. Doing forward and side lunges helps to develop and strengthen our thigh and abdominal muscles which are very important in those movements.
There are numerous web sites that we can use to see illustrations and explanations for different exercise. One web site that I find helpful is www.coreperformance.com. They have developed training regimens for athletes, as well as the average person, that are helpful in improving our movement capabilities. As you can tell from the name of that web site, they focus on development of the core muscle groups which are very important in athletic movement.
One of the most common maladies we deal with as senior softball players is pain and stiffness in our shoulders, especially in the shoulder we use to throw. Many players must undergo surgery because of injuries to their rotator cuff. But even those of us who don't require surgery will often have trouble throwing or experience some level of pain while throwing.
There are many reasons for this and most of them relate to the degenerative affects of aging. Often there are arthritic changes in the acromioclavicular (AC) joint that can not only cause discomfort in the joint but contribute to impingement and abrasion of the rotator cuff tendons. The rotator cuff is actually a point of attachment in our shoulder of those tendons that are involved in lifting the arm as well as holding the shoulder joint together. Tendonosis, or tendon degeneration, occurs often in the rotator cuff tendons because of the decreased circulation in that region. Over the course of our lifetime our tendons in that area become weaker because of the almost constant stress we put on our shoulders. Even as we stand or walk, the weight of our arms is putting stress on those tendons in the shoulder region. If we work with our arms over our head, this often results in compression of the tendons within the shoulder region. Also, we may have suffered some trauma that has resulted in structural damage to the shoulder joints. Most of our tendon related problems, however, are the result of chronic degeneration related to frequent micro trauma, leading to a gradual weakening of the tissue that makes up the tendons. Remember, tendons are the attachment points of muscle to bone.
As senior softball players, we obviously are very vulnerable to these types of shoulder problems because of our age, and the wear and tear we have experienced over our lifetimes. Prevention of injury should be our first concern. Therefore, adequate warm-up and good mechanics are very important in prevention of shoulder injuries. By warming up adequately, we bring more blood into those tissues and allow for greater flexibility. Cold muscles and tendons will be more inflexible and more vulnerable for injury. In addition to simply playing catch prior to game activity, the use of elastic tubing along with exercises performed with dumbbells can be very helpful in strengthening our shoulder muscles and tendons to help prepare us for the stresses of actual games.
A comprehensive orthopedic shoulder evaluation will test for active and passive ranges of motion as well as grade all muscles in the shoulder region for strength. A determination can be made whether the problem is related to muscle and tendon (contractile tissue) or (noncontractile tissue) bone, ligament or cartilage. MRI studies of the shoulder can detect tendon tears as well as other types of structural damage. X-ray studies primarily are used to evaluate the bony structures of the shoulder for evidence of arthritic changes, fracture, dislocation or pathology.
Treatment options for shoulder injuries include surgery, steroid injections, rest, as well as soft tissue treatments intended to promote healing of the injured or degenerative tissue. If tendons are completely torn surgery might be the best option, but for less severe conditions conservative treatment should always be considered. Corticosteroid injections are used to decrease inflammation in tissues, but do not stimulate healing of tissue. Studies have shown an increased incidence of tendon rupture subsequent to corticosteroid injections.
Previously referred to as Achilles tendinitis, this is a problem involving injury to the tendons in the lower leg and will often involve pain in the heel and back of the foot, which is where the tendons that allow us to stand on our toes, attach. It is a common problem with runners and others who participate in athletic activities. Individuals who spend a great amount of time on their feet while working can also develop this problem. It can become a chronic problem that will often improve with rest and then return when strenuous activity is resumed.
The term tendonosis describes a chronic degenerative condition involving a tendon. The term tendinitis implies an inflammatory process involving a tendon, which is sometimes seen following an acute injury. When a condition becomes painful due to long-term stress on tissue, it is described as tendonosis.
Conditions such as overpronation (fallen arches or flat feet) can also predispose a person to this problem. Frequently, orthotics which are placed in the patient’s shoes can provide support which reduces some of the stress on the foot and leg. Additionally, a method of treatment that involves eccentric contraction of the tendon has been developed that has proven to be very effective.
The treatment involves the patient standing on the edge of a step and rising up on his toes and slowly dropping down allowing his weight stretch the Achilles' tendon against resistance. This can be repeated in sets of 15 repetitions, up to 3 times, twice daily. They can be initially performed with a straight knee, and then performed again with a slightly flexed knee. These exercises will be performed eight to 12 weeks. The patient should gradually add weight to increase the stress on the tendon. This can be accomplished by utilizing a backpack to which weights are added incrementally.
Wearing a heel lift in both shoes can also be helpful, and that it takes pressure off of the tendon by flexing the foot slightly.
Game day warm-up stretching exercises include sitting on the floor with your legs straight out from you. Using a towel wrapped around your toes or upper foot, stretch the foot back and hold for 20-30 seconds. Repeat this 2-3 times per foot. This helps loosen the tendons and muscles of the leg, foot and heel. Many people have also found that their shoes are the problem – arch locations differ in different shoes and orthitic inserts can help make sure the arch has plenty of support.