“Little League Elbow”: Is Your Baseball Player Complaining About Elbow Pain? Here’s What to Look For

“Little League Elbow” Overview

As the name suggests, “Little League Elbow” is a common injury among young baseball players, especially pitchers. Understanding the risks and listening to your child’s complaints are vital steps in identifying the issue and seeking appropriate treatment.

This term encompasses a range of elbow injuries affecting young players who pitch frequently. Pain is typically reported on either the medial (inside) or lateral (outside) side of the elbow. Below, I’ll outline the key diagnoses and their respective age ranges.

1. Medial Epicondyle Apophysitis

Overview:

This condition causes pain on the medial (inside) side of the elbow, often due to:

• A rapid increase in workload, or

• Chronic, high-volume throwing with minimal rest.

In this age group, growth plates and bones are softer than in fully mature individuals. Repetitive throwing stresses the area where tendons attach, leading to inflammation.

Age Range:

Typically affects players aged 9–14, representing 70–95% of reported elbow injuries in young athletes.

Diagnosis & Treatment:

• X-rays are used to confirm severity and determine rest requirements.

• Treatment involves relative rest, non-steroidal anti-inflammatory (NSAIDs) medications, and physical therapy.

• Physical therapy focuses on strengthening, flexibility, and correcting mechanical flaws if identified.

• Surgery is rare.

2. Medial Epicondyle Avulsion Fractures

Overview:

Similar to Apophysitis, this injury often results from high pitch counts. Unlike Apophysitis, firmer bones in older kids can fracture under repetitive stress.

Age Range:

Typically affects players around 13 years old.

Symptoms:

• Pain and tenderness on the medial elbow, often during a specific point in throwing.

• Players may report an audible “pop.”

Treatment:

• This injury usually requires surgical intervention due to the fracture’s proximity to nerves and joint instability.

• Recovery includes at least one year before returning to performance.

3. Capitellar Osteochondritis Dissecans (OCD)

Overview:

This condition affects the lateral (outside) side of the elbow. Forces from repetitive throwing can pull cartilage away from the bone, leading to inflammation and lesions.

Age Range:

Occurs in players older than 10 years old.

Symptoms:

• Lateral elbow pain and swelling during activity.

• Clicking or popping sounds in the joint.

• Inability to fully extend the elbow.

Treatment:

• Non-surgical treatment depends on lesion classification, but severe cases may require surgery, which can be challenging.

4. Panner’s Disease

Overview:

Panner’s Disease is similar to OCD but occurs in younger children. It disrupts cartilage formation (chondrogenesis) due to reduced blood flow to the elbow.

Age Range:

Typically affects children aged 5–10 years.

Symptoms:

• Pain and stiffness in the lateral elbow.

• Limited range of motion.

Diagnosis & Treatment:

• MRI imaging confirms the diagnosis.

• Treatment involves cessation of all throwing activities and a gradual return under supervision.

• Surgery is not typically required.

5. Ulnar Collateral Ligament (UCL) Rupture – “Tommy John Injury”

Overview:

The UCL is a critical ligament in the elbow, resisting the valgus forces during pitching. Over time, repetitive microtrauma can cause it to stretch, leading to instability and, eventually, rupture.

Symptoms:

• Pain and swelling on the medial elbow.

• An audible “pop” during throwing.

• Bruising (“black and blue”) on the medial elbow.

Treatment:

• Diagnosis is confirmed with MRI.

• Surgery (Tommy John procedure) is required for rupture, with a long recovery period.

Preventative Measures:

While UCL ruptures can’t be completely prevented, risk can be reduced by managing:

• Pitch count and selection.

• Throwing mechanics.

• Training volume, recovery, and range of motion.

• Strengthening wrist and forearm muscles, which share attachments with the UCL.

Summary

Elbow injuries in young athletes can be minimized through collaboration between parents, players, strength coaches, physical therapists, and physicians. By addressing modifiable risk factors, we can reduce injury rates and ensure long-term athletic development.

Major League Baseball has invested heavily in research to reduce injury risks for children. Let’s prioritize developing young athletes first—becoming great baseball players will come with time.

Do You Have Adrenal Fatigue? Probably Not…

The Adrenal Fatigue Myth: A Closer Look

You’ve likely heard the term “adrenal fatigue” tossed around, especially in wellness circles. It's often blamed for a laundry list of symptoms like fatigue, anxiety, and brain fog. But is it a real medical condition? Let’s dive into the science.

What is “Adrenal Fatigue” AF?

Adrenal fatigue (AF) is a term coined by alternative medicine practitioners to describe a state of adrenal exhaustion caused by chronic stress. Proponents claim that the adrenal glands, which produce stress hormones like cortisol, become overworked and unable to keep up, leading to a cascade of health problems. However, there is a rare disease coined Addison’s Disease which causes the adrenal glands not to produce enough cortisol and aldosterone.

In my practice, clients who've reported symptoms consistent with “adrenal fatigue” typically present with histories of chronic stress, overtraining, and insufficient caloric intake. These individuals often engage in demanding physical activities such as CrossFit, marathons, or triathlons, while simultaneously managing full-time jobs and family responsibilities

The Science Says Otherwise

Despite its popularity, there is no scientific consensus supporting the existence of Adrenal Fatigue. Numerous studies have failed to find consistent evidence for this condition. In fact, a systematic review published in 2016 concluded that there is no substantiation for the existence of adrenal fatigue.

Common Symptoms Attributed to Adrenal Fatigue

Many symptoms are often associated with adrenal fatigue, including:

• Fatigue

• Anxiety

• Difficulty concentrating

• Low libido

• Food cravings

• Insomnia

However, these symptoms can be caused by a variety of other conditions, such as:

• Sleep disorders

• Thyroid dysfunction

• Anemia

• Depression

• Anxiety disorders

Why the Myth Persists?

Several factors contribute to the persistence of the adrenal fatigue myth:

• Subjective Symptoms: Many symptoms associated with adrenal fatigue are subjective and can be difficult to diagnose.

• Lack of Specific Tests: There is no single test to definitively diagnose adrenal fatigue.

• Appeal of Simple Solutions: Alternative medicine often offers simple solutions to complex health problems.

The Importance of Evidence-Based Medicine

It’s crucial to rely on evidence-based medicine when seeking a diagnosis and treatment for health concerns. Self-diagnosing adrenal fatigue can lead to delayed treatment for underlying conditions and potentially harmful side effects from unproven therapies.

If you’re experiencing symptoms of fatigue, anxiety, or other health concerns, it’s important to consult with a qualified healthcare professional for a proper diagnosis and treatment plan.

Disclaimer: This blog post is for informational purposes only and is not intended as medical advice. Always consult with a qualified healthcare professional for any health concerns.

References:

Cadegiani FA, Kater CE. Adrenal fatigue does not exist: a systematic review. BMC Endocrine Disorders. 2016;16(1).

Link

Brain Rewiring After an Injury

Introduction

Have you ever wondered why you instinctively limp after injuring your knee? It's not just the pain; your body is actively compensating to avoid further discomfort. This process, known as cortical remapping or brain rewiring, involves your nervous system adapting to the injury by creating new movement patterns. While these adaptations may help you temporarily, they can also hinder your performance in sports. Let's delve into how this occurs and explore the factors that influence recovery.

Central Nervous System (CNS) and Peripheral Nervous System (PNS)

Your brain and spinal cord make up the Central Nervous System (CNS), which controls various bodily functions. The Peripheral Nervous System (PNS) connects the CNS to your body, transmitting sensory information (like pain and temperature) and controlling motor functions.

Post-Injury Challenges

After an injury, factors like inflammation, swelling, and disuse can disrupt the nervous system's communication. This makes it difficult for the brain to receive accurate information from injured joints like the knee or ankle. Inflammation can also alter peripheral nerve function and how the brain interprets signals, a phenomenon known as denervation.

Psychological Factors: The ACL Example

For those with Anterior Cruciate Ligament (ACL) injuries, psychological factors often pose significant barriers to returning to sports. Up to two-thirds of ACL patients do not regain their pre-injury level of performance due to emotional factors, decreased confidence, and perceived risks. Studies have shown that athletes who successfully return to sports not only have greater strength but also higher confidence in their injured knee.

Choosing the Right Physical Therapist

When selecting a physical therapist, it's crucial to find someone experienced in working with athletes and who understands the holistic nature of recovery. A therapist who can address both the physical and psychological aspects of your injury can help you achieve optimal outcomes.

• Liew Id B, Feller J, Webster K. Understanding the Psychological Mechanisms of Return to Sports Readiness after Anterior Cruciate Ligament Reconstruction. https://pmc.ncbi.nlm.nih.gov/articles/PMC8946672/pdf/pone.0266029.pdf

• Rosen, Adam B., et al. “Alterations in Cortical Activation among Individuals with Chronic Ankle Instability during Single-Limb Postural Control.” Journal of Athletic Training, vol. 54, no. 6, 1 June 2019, pp. 718–726, https://doi.org/10.4085/1062-6050-448-17

- Josh

Nutrition After Surgery or Injury: What You Need to Know

Undergoing surgery or experiencing an injury can significantly impact both physical and mental aspects of recovery. While we often focus on physical recovery, the role of nutrition in the healing process is equally important. Beyond simply consuming "anti-inflammatory foods," let's delve into the broader picture and explore how diet can profoundly influence your recovery journey. From providing essential nutrients for tissue repair and immune function to supporting mental well-being and energy levels, nutrition plays a vital role in optimizing your healing process.

Understanding the Surgical/Inflammation Cascade

When you undergo surgery or incur an injury, your body undergoes a significant stress response. This response, often referred to as the "surgical cascade," involves a complex interplay of inflammatory, immune, and metabolic factors. The body's energy demands skyrocket to meet the needs of wound healing, tissue repair, and overall recovery. As a result, the body goes under what’s called hypermetabolic-catabolic state: INCREASED metabolism, BREAKDOWN of muscle. Some hormones that play a role:

• Glucagon

• Cortisol

• Cytokines (Inflammation mediator)

I also want to point out that inflammation is NOT an enemy during the post-surgical or injury process. Taking NSAIDs (Non-Steroidal Anti-Inflammatory Drugs) have been shown to lead to post-surgical complications. Consult with your physician.

The Impact of Poor Nutrition on Muscle Atrophy Post-Surgery

Muscle atrophy, or muscle wasting, is a common occurrence after surgery or injury due to a combination of factors, including inactivity and stress. Poor nutrition can significantly exacerbate this muscle loss which ultimately leads to reduced muscle strength and slower recovery.

Post-surgical and Injury Muscle Loss is a Common Challenge

Let's explore some key approaches:

Protein:

• Essential amino acids: Ensure your protein intake includes all essential amino acids to support whole-body protein synthesis.

• Counteracting catabolism: Adequate protein intake helps counteract the catabolic effects of surgery, injury, and illness, which can break down muscle tissue.

Carbohydrates:

• Glycemic regulation: Carbohydrates can assist in regulating blood sugar levels, especially important during the hypermetabolic state and inflammation following surgery.

• Insulin sensitivity: The body's reduced insulin sensitivity post-surgery can be mitigated with appropriate carbohydrate intake, preventing excessive blood sugar fluctuations.

Conclusion

Remember, every individual's recovery journey is unique. What works for one person may not work for another. By prioritizing nutrition, you can support your body's healing process and optimize your recovery outcomes.

References

1. Hirsch KR, Wolfe R, Ferrando AA. Pre- and Post-Surgical Nutrition for Preservation of Muscle Mass, Strength, and Functionality Following Orthopedic Surgery. Nutrients. 13:1675. 2021.

2. Zhao-Fleming H, Hand A, Zhang K, et al. Effect of non-steroidal anti-inflammatory drugs on post-surgical complications against the backdrop of the opioid crisis. Burns & Trauma. 2018;6(1). doi:https://doi.org/10.1186/s41038-018-0128-x

Is Creatine Really Bad for You Kidneys?

Creatine and Kidney Health: A Closer Look

Is Creatine Bad for Your Kidneys?

Creatine is one the most studied supplements, and a popular supplement among athletes and fitness enthusiasts, has been touted for its ability to enhance muscle mass and strength. However, there has been growing concern about its potential impact on kidney health. Many people have wondered if taking creatine could lead to kidney problems.

The Study

To address this question, researchers conducted a comprehensive study involving over 1,000 participants. They surveyed people about their creatine usage, demographics, and any concerns they had about their kidney health. Additionally, they used genetic data to analyze the relationship between creatine levels and kidney function.

Seen here: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11232645/pdf/IRNF_46_2364762.pdf

The Findings

The results of the study were quite reassuring. There was no significant link found between creatine use and kidney problems. In fact, the researchers used a statistical method called Mendelian randomization (to see cause and effect) to further confirm this finding. This method helps to establish a causal relationship between factors, rather than just a correlation.

What Does This Mean?

This study provides strong evidence that creatine is generally safe for your kidneys when used appropriately. It can be a valuable tool for athletes and fitness enthusiasts looking to improve their performance. However, it's important to note that everyone's body is different, and individual results may vary.

Key Takeaways:

• Creatine is generally safe for kidney health.

• There is no strong evidence to support the claim that creatine causes kidney problems.

• Individual results may vary.

• It's always a good idea to consult with a healthcare professional before starting any new supplement.  

Conclusion

If you're considering taking creatine, you can do so with confidence knowing that it is unlikely to harm your kidneys. However, it's essential to use it responsibly and follow the recommended dosage. As always, if you have any concerns about your health or the use of supplements, consult with a healthcare provider.

-Josh

So You Want To Work in Sports Performance?

ב״ה

Introduction

So you want to work in the exciting world of sports medicine and sports performance? I've had the privilege of doing just that, and it's been an great experience you not only learn about yourself but how to teach effectively with different learning strategies. From working with elite athletes to contributing to groundbreaking research, this field offers a unique blend of challenges and rewards. Some challenges that you might face is unpredictable and late hours, client advocacy, speaking with medical staffs of their respective teams, and other individuals that they might be working with as well ie strength coaches, personal trainers, massage therapists, agents, etc. However, it’s truly rewarding to see your players succeed in their respective sport! I wanted to take this blog post to explain some skills and knowledge you shoulder expect to attain.

Understanding Anatomy and Biomechanics

Working with high level athletes will require high level knowledge of anatomy and biomechanics of the body. Mainly because you have to understand what the human body is capable of doing in high performance. Also, knowing the anatomy will allow you to get creative in developing exercises, this will also allow you to know when to progress, regress exercises when need be, but also for injury reduction strategies.

Understanding the Demands of the Sport

Do you know what the 3 Energy Systems of the body are? Do you know what the Stretch Shortening Cycle (SSC) is? Do you know the difference between Strength, Power, Hypertrophy, and Endurance ? Well, if you do not you need to! All of these concepts are required in being able to develop a high performance training program for an athlete. You will need to perform a Needs Analysis which evaluates the requirement of the sport and also position within the sport.

For example, do you know this about a Women’s Division 1 Soccer Player?

· Requires 1.53-4.24x body mass

· Avg. % HR: ~84%

· Distance Covered: 5-6 miles in match

· High Intensity Distance: 0.80-1.0 mile

· Sprint Distance: ~0.3mile

· # of Changes of Direction (COD): 1400x

· # High Intensity Runs (HIT) Runs: 125-150x

· Sprint Bouts: 26-30x

This just and example the of the knowledge one must have of various sports and requirements to be able to design a training programs that focuses not only on performance but also reducing the risk of injury. I do want to say that no injury is preventable, but you can reduce the risk by understanding the requirements of the sport.

In addition to the above, one must be approachable, have good communication/interpersonal skills, be able to problem solve, and continually learn.

Conclusion

Working in performance offers a unique blend of challenges and rewards. To succeed in this field, you must possess a deep understanding of anatomy, biomechanics, the specific demands of various sports, but also the interpersonal skills that develop relationships and trust. By developing these skills and remaining dedicated to your craft, you can help athletes reach their full potential and make a significant impact in the world of sports.

-Josh

Masters Athletes and Active Individuals

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Introduction

As we age, maintaining an active lifestyle becomes increasingly important for both physical and mental health. For masters athletes and older active individuals, proper nutrition plays a crucial role in supporting performance, recovery, and overall well-being. By understanding the unique nutritional needs of this population, we can optimize our dietary choices to fuel our bodies and maximize our athletic potential.

The Unique Nutritional Needs of Masters Athletes and Older Adults

Several factors contribute to the unique nutritional needs of masters athletes and older adults:

• Decreased Muscle Mass: Age-related muscle loss, known as sarcopenia, can lead to a decline in strength and functional capacity. Adequate protein intake is essential for preserving muscle mass and supporting recovery.

• Reduced Energy Expenditure: As we age, our metabolic rate may decrease, leading to a lower calorie requirement. However, maintaining an active lifestyle necessitates sufficient energy intake to fuel workouts and support overall health.

• Changes in Nutrient Absorption: The body's ability to absorb certain nutrients, such as vitamin B12 and calcium, may decline with age. Consuming nutrient-dense foods and considering supplementation can help ensure adequate intake.

• Increased Risk of Chronic Diseases: Older adults are at a higher risk of developing chronic conditions like heart disease, diabetes, and osteoporosis. A healthy diet can help manage these conditions and improve overall health.

The Importance of Adequate Nutrition for Osteoporosis

In my experience evaluating hundreds of patients for osteoporosis and osteopenia, a common theme emerged: inadequate nutrition. Many individuals, even those who are active and have good eating habits, are not consuming enough calories to support their bone health.

It's crucial to understand that osteoporosis is primarily a metabolic disease, not solely a bone disease. Changes in hormones and nutritional deficiencies are significant contributors to bone mineral density (BMD). While resistance exercises are strongly encouraged, they are not enough to address the underlying metabolic issues.

Daily Protein Intake for Osteoporosis Prevention and Management

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Conclusion

By understanding the importance of nutrition and lifestyle factors in osteoporosis prevention and management, you can take proactive steps to protect your bone health and maintain a strong, active lifestyle. A well-balanced diet, regular exercise, and appropriate supplementation can help ensure that your bones remain healthy as you age.

Why Choose Concierge Physical Therapy over Traditional Physical Therapy in a Clinic

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Let’s Break it Down in Layman Terms:

We all know how difficult it is to recover from surgery or an injury. The process itself can be complex and frustrating when trying to regain mobility, strength, and performance. Traditional clinic-based physical therapy can be beneficial, but for you’re seeking a more personalized and individualized approach, concierge physical therapy may be the ideal choice for you. Whenever I start working with new clients, the first thing they tell me is that concierge physical therapy offers a higher level of care, tailored specifically to their needs and goals, making it an attractive option for anyone looking to optimize their recovery.

Understanding Concierge Physical Therapy

I’m big on adding a personalized touch and make an effort to take my time with each client. Concierge physical therapy is a premium service that provides patients with exclusive access to highly skilled therapists, personalized treatment plans, and flexible scheduling. Unlike traditional clinics, concierge physical therapy offers a more intimate and individualized experience, allowing patients to receive focused attention and care.

As a concierge physical therapist, I'm committed to providing personalized care that goes beyond traditional physical therapy. Here's why I believe concierge physical therapy is the ideal choice for those recovering from surgery:

• Personalized Treatment Plans: I work closely with each patient to develop a customized treatment plan that addresses their specific needs and goals. This personalized approach ensures that patients receive the most effective care possible, tailored to their unique circumstances.

• One-on-One Attention: Unlike traditional clinics, I offer the luxury of one-on-one attention, allowing patients to receive undivided focus and care. This means no more waiting in crowded waiting rooms or feeling rushed during sessions.

• Flexible Scheduling: I understand that recovering from surgery can disrupt your daily routine. That's why I offer flexible scheduling options to make it easier for patients to fit appointments into their busy lives.

• Faster Recovery: With personalized attention and tailored treatment plans, patients often experience faster recovery times. I'm able to identify and address potential obstacles early on, preventing delays in the healing process.

• Enhanced Communication: I prioritize open communication with my patients, allowing for a better understanding of their needs and concerns. This fosters a trusting and collaborative relationship that is essential for a successful recovery.

• Home Visits: For patients who are unable to travel to a clinic, I offer home visits for added convenience and comfort.

By choosing concierge physical therapy, you're investing in a higher level of care that can significantly improve your recovery process. If you're looking for a personalized and efficient approach to healing, I'm here to help.