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Advancements In ACL Surgery

By Frank Alexander
Baseball Health Network

Frank AlexanderPreviously, we’ve discussed anterior cruciate ligament (ACL) reconstruction surgery and the importance of prehab after sustaining an injury to your ACL. No athlete wants to injure their ACL but there is good news for athletes who may have injured their ligament. There have been advancements in ACL surgery that Dr. Ahmad and Team Ahmad are at the forefront of that can help get athletes back to playing sooner!

Knee jointIt was first reported in 1903 by Mayo Robson that the ACL could be surgically repaired and patients could remain hopeful that they’d have a good outcome. Over a century later, surgeons are able to perform 3 different types of surgery to help a patient with an injured ACL: primary repair, repair with augmentation, and reconstruction. Typically, after a reconstruction, athletes return to sport-specific activity around 6 months post-operatively with full participation on the horizon. Complete, unrestricted return to play may take up to a year. After a repair, return-to-play is nearly half that of a reconstruction!

The ACL is the main stabilizing ligament of the knee. When it tears, the knee may feel unstable or loose. The athlete or patient may not be able to fully bear weight on the injured knee. If they try to participate in athletic events, further injury may occur such as cartilage damage or meniscus tearing. The way the ACL tears plays a role in surgical intervention. Think of the ACL as a rope attached to two bones. If the rope tears through the middle completely, it creates two free ends that are like the ends of a mop. This type of tear will not lend itself to a repair and requires a reconstruction for the ACL to work again. Should the rope tear off the bone rather than in the middle, a repair is possible.

ACL Repair

If the ACL is able to be repaired, physical therapy is able to progress much quicker when compared to a traditional reconstruction. Patients that have a repair could return to sport specific activity potentially as early as 4 months after surgery! ACL repairs are an innovative surgery and can only be used in certain situations as previously described. Our Team is working on new research to help healthcare professionals have a better understanding of ACL repairs and returning athletes to play!

Tagged With: ACL, Dr. Christopher Ahmad, Team Ahmad

BHN Interview With Mike Reinold

By Frank Alexander
Baseball Health Network

Frank AlexanderMike Reinold, PT, DPT, SCS, CSCS is the President and Co-Founder of Champion Physical Therapy and Performance in Waltham, Massachusetts. He is a world-renowned expert in physical therapy and sports performance. He uses his background in sport biomechanics, movement quality, muscle imbalances, and manual therapy to help some of the most elite athletes return to the sport they love. Currently a consultant for the Chicago Cubs, Mike played a key role in 2007 as he led the efforts in keeping the Boston Red Sox healthy on their way to a World Series Championship! He has been featured in ESPN, Sports Illustrated, Men’s Health, and peer-reviewed publications such as The American Journal of Sports Medicine and the Journal of Athletic Training, among many others.

Mike was kind enough to talk with Team Ahmad’s Frank Alexander, MS, ATC about his background and how his team at Champion Physical Therapy and Performance keep their athletes healthy.

Mike Reinold
Mike Reinold

Frank Alexander: What made you want to become a physical therapist?
Mike Reinold: I always liked science and sports, but then I took an anatomy class in high school and knew I wanted to get into medicine. I was fascinated by how the body works. I chose physical therapy as a way to integrate my passion for sports medicine, human biomechanics, and helping athletes return to the field.

FA: What advice would you give to someone looking to work with elite athletes?
MR: To get into sports, especially at the elite level, you need to intimately understand the sport. Volunteer your time to work with people that work with elite athletes in the field you are most passionate about. For me, it was baseball. I moved to Alabama in the ‘90s to work with Dr. James Andrews and the team at ASMI. Surround yourself with the best and learn from them. This will put you in a much better position to succeed.

Champion logoFA: How do you help keep your athletes healthy after they’ve completed their formal physical therapy?
MR: Our model at Champion is an integrated approach to performance-based physical therapy and sports performance training. The two areas often overlap and merge. They should be coordinated together. With athletes, our philosophy is that they actually “micro” injure themselves each event, so we encourage proactive performance therapy to help them maintain performance and reduce injuries. This is the model I developed for the Red Sox that we performed throughout the entire system. We were very proactive in maintaining the appropriate physical characteristics throughout the season versus retrospectively waiting for injuries to occur.

FA: What new modalities are you using to help your athletes get the most out of their physical therapy session?
MR: We are always experimenting with new techniques and modalities with the goal of helping athletes stay on the field and get back from injury as fast as possible. We proudly throw the kitchen sink at our athletes. Both instrument assisted soft tissue mobilization (IASTM) and cupping are deeply integrated into all our techniques now. The athletes love it and we often get immediate improvement in how they feel and move. It has been a changer. Lately, we have started to integrate blood flow restriction (BFR) training into our postoperative rehabilitation. This allows us to have a more robust physiological response when loading the body at a lower percentage of their maximum load, which is required in rehab. The results have been promising but we are still developing our specific applications.

Frank J. Alexander, Jr., M.S., ATC, is a Physician Extender to Dr. Christopher Ahmad, Department of Orthopaedic Surgery at Columbia University Medical Center.

You can learn more about Mike Einold and his approach to keeping athletes healthy on his website and Champion’s site.

Tagged With: Baseball Health Network, Champion Physical Therapy and Performance, Mike Reinold, Team Ahmad

How To Help Prevent Overuse Injuries

By Frank Alexander
Baseball Health Network

Frank AlexanderIf you play competitive sports, injuries are always a possibility. Nobody knows exactly when or how they will get hurt. Unfortunately, there is no way to predict injuries. Even the most elite athletes fall victim to injuries and spend time on the disabled list or have to sit a few matches out.

While we cannot predict much about injuries, we can avoid many of them. All athletes can prevent a group of injuries called “overuse” injuries. Overuse injuries are just that – when you over use a body part such as an elbow, shoulder, or knee without adequate rest.

golf swingMany overuse injuries happen in adolescent athletes that are still growing. These injuries are fairly common and you may have even heard of a few such as: Little Leaguer’s Shoulder, Little Leaguer’s Elbow, or Jumper’s Knee. Adolescent athletes are not the only population that succumb to overuse injuries. Weekend Warriors, runners, frequent golfers and tennis players also develop overuse injuries. Common overuse injuries in the skeletally mature population include: Tennis Elbow, Golfer’s Elbow, and IT Band Friction Syndrome.

Nobody wants to hear they are injured but the good news is you can recover from them. You have an excellent chance of making a full recovery if you let your body rest and correct any asymmetries and muscle imbalances. Many athletes will not want to “rest” but rest does not mean you cannot exercise or play sports. It just means you have to adjust your routine.

tennis elbowAthletes that have overuse injuries can still participate in sports but may have to stop the sport they got injured playing. If you have Little Leaguer’s Shoulder, it doesn’t mean you have to stop everything for the whole spring or summer, it just means you should take a break from throwing a baseball. Depending on the severity of the condition, some athletes may be allowed to play basketball, soccer, or even swim in a pool. For patients suffering from Golfer’s or Tennis Elbow, a simple adjustment of how you hold a club or a racket may be all it takes to alleviate your symptoms. Any runner with ITB Friction Syndrome may have to take a break from running, but they can still get in the pool or ride a bike. There are plenty of ways to make minor adjustments to exercise routines and still be active while injured!

The best way to prevent these injuries is to make sure you give your body a break every now and then from the demands you place on it. This is especially important for our young and growing athletes. Baseball and tennis players should give themselves a break from throwing or competing after their season ends. Runners can hop on a bike or elliptical every once in a while to avoid injury as well. There are many ways to avoid overuse injuries so if you think you may be prone to them, feel free to ask any expert on our Team and we’ll be happy to help you stay on the court, field, or track!

Frank J. Alexander, Jr., M.S., ATC, is a Physician Extender to Dr. Christopher Ahmad, Department of Orthopaedic Surgery at Columbia University Medical Center.

Tagged With: Baseball Health Network, Little League Elbow, Little League Shoulder, overuse injuries, Team Ahmad, Youth Baseball

Returning To Exercise After Shoulder Or Elbow Surgery

By Frank Alexander
Baseball Health Network

Frank AlexanderWhen someone is injured and needs surgery, the hard part is not undergoing the surgery itself. The hard part is being patient and maintaining the drive to get through each physical therapy session. For our patients with active lifestyles, the desire to get back to the activities they love may feel far away. But there is light at the end of the tunnel. Many patients want to get back to playing their sport or even just get back into the weight room or gym. In some cases, getting on a stationary or recumbent bike is possible within days of surgery. However, that may not be enough. The type of surgery a patient has determines the length of time away from the gym and sports.

Once being cleared to return to working out, there are a number of exercises we would like our patients to steer clear from. Whether you are recovering from surgery or not, we strongly advise our overhead athletes to avoid these exercises.

free weightsExercises to avoid include: dips, chest flyes, lat pull-downs behind the neck, heavy-weight overhead shoulder presses and wide-grip bench presses. Patients should also avoid allowing the shoulders to be stretched to the extreme end range of motions. While these exercises are discouraged, there are variations and other exercises that can be substituted. Variations include: lat pull-downs with the hands in front of the body, using a medium grip for chest press and lat pull-downs, and using dumbbells for bench pressing. Substitutions include: the Thrower’s Ten exercises (internal/external rotation with TheraBands) and lying light dumbbell exercises such as Y’s, T’s, and A’s.

Upon being cleared to return to the gym or weight room, it is best for a gradual return to activities. For example: when returning to cardio, avoid using the moving arms on the elliptical for a number sessions or stick with the bike a little longer. As for weight training, it is suggested to start with light weights and gradually progress to heavier weights. If you are not sure if you should progress, feel free to ask in the office or check in with your physical therapist. Your physical therapist is a great resource for guidance when returning to unsupervised exercising.

Thrower's TenWhile some exercises should be avoided, many should be done regularly. The Throwers Ten Exercises are a staple of all throwing athletes’ shoulder programs and should be done throughout the off-season and regular season to help keep the shoulders healthy. Core and leg exercises are integral for any throwing athlete. When performing lower body exercises with a load, be sure to listen to your body. If soreness is present, modify the lift or avoid it if possible.

If you are ready to return to weightlifting, our office has a handout with guidelines that you should follow as well as the Thrower’s Ten. Following these guidelines and the advice of our team and your physical therapist will help ensure the ability to safely return to the gym and sports!

Frank J. Alexander, Jr., M.S., ATC, is a Physician Extender to Dr. Christopher Ahmad, Department of Orthopaedic Surgery at Columbia University Medical Center.

Tagged With: Baseball Health Network, Dr. Christopher Ahmad, Team Ahmad, Thrower's Ten, Tommy John Surgery

Seasonal Timing For Baseball Players

By Frank Alexander MS, ATC
Baseball Health Network

Frank AlexanderWith the winter season approaching, many baseball players take this time to ready themselves for the upcoming season. While strength and conditioning training and a throwing program are essential to improve skills, a period of rest is imperative. This down time gives the athlete’s body the recovery time it desires and can even help with achy and sore muscles. A period of rest can vary depending upon the athlete’s level of competition or how prone to injury they may be. For example, an athlete coming off of a shoulder injury or surgery may want a longer period of rest in the off-season. However, an athlete that made it through the previous season healthy may want to shorten their rest. Again, these time frames are dependent on skill levels and individual health.

As the holidays rapidly approach, this is an optimal time for athletes to take their break from training and throwing. High school athletes may want to take month or so off since their season typically does not start until late February or early March. Conversely, collegiate athletes may want to take a few weeks off since their season starts not long after the New Year arrives. Once you resume your throwing program, start with a simple flat-ground throwing program. Be sure not to confuse flat-ground throwing with flat-ground pitching! Having access to a well-versed pitching coach can greatly help achieve optimal throwing after a period of rest.

Flat ground throwing
Flat ground throwing
When it comes to strength and conditioning, make sure your core, legs, and shoulder are strong enough to take you through the spring season and into the summer and fall. Many athletes are specializing in a single sport at an alarmingly young age and maintenance programs are often neglected, leading to younger athletes needing career-altering surgeries such as Tommy John. Upon resuming a conditioning program, be sure to include the Thrower’s 10 exercises on a regular basis!

Off-season training is great for athletes of all ages and skill levels. Having access to well-versed coaches, such as pitching and strength-and-conditioning coaches, can help an athlete achieve longevity in their career. Additionally, periods of rest built into a training regimen can do the body some good and allow aches and soreness time to resolve. While some of your teammates may be training every day without a break, remember that a few weeks off now can save your career down the road!

Frank Alexander, a member of Team Ahmad, is a Physician Extender to Dr. Christopher Ahmad at Columbia University Medical Center.

Tagged With: Baseball Health Network, Dr. Christopher Ahmad, high school baseball, Pitching Healthy, Team Ahmad, Tommy John Surgery

“Team Ahmad” Checks In With BHN Founder Steve Hayward

Team Ahmad’s Frank Alexander sat down with Baseball Health Network founder Steve Hayward for a timely conversation!

Steve Hayward photo
BHN Founder Steve Hayward
Frank: Young pitchers want to add depth to their arsenal of pitches they throw. What is the first off-speed pitch you teach to your athletes?
Steve: The first off-speed pitch I teach is a change-up. The change-up is much easier to learn and has a higher percentage for a young pitcher to throw for strikes. The arm and hand speed is consistent with a fastball, creating deception to disrupt a hitter’s timing and increasing the pitcher’s likelihood of getting a hitter out. ANY pitch thrown improperly will add unnecessary stress to the arm. Developing consistent, efficient mechanics is the key to keeping a pitcher healthy.

FA: What is your advice to a player who wants to throw a curveball?
SH: Curveballs have gotten a really bad rap when it comes to arm injuries. A lot of blame has been put on curveballs; but none of the research has proven it is more dangerous than any other pitch. There’s no set age when a player can start throwing a curve. A player can “develop” a curve as young as 10. My criteria to learn is when a player is can consistently control his direction to the plate and throw fastballs for strikes. “Developing” a curveball doesn’t mean throwing them live in competition – it means learning how to spin the ball in bullpens and practice. When they develop consistency, I allow them 5 curves per game. I want to emphasize that this is only for pitchers that are capable of throwing curves safely.

FA: Every athlete varies on stamina and the days they pitch. What is your recommended pitch-count for a high-school-age, multi-position athlete who may be called in to pitch in a game they are also scheduled to play the field?
SH: The problem with generic pitch counts is they are based strictly on age. Not taking the individual’s off-season programs or previous workload into consideration when deciding on a pitch count is irresponsible. In my opinion, it is one of the biggest factors contributing to the arm injury epidemic. Until I have a clear answer on how a player feels on that day, I can’t set a number for that outing. Body language is more of an indicator as he’s throwing more-so than a pitch count. A player can throw 100 pitches with minimal stress where in another outing, throw 50 pitches and struggle with control of both pitches and his body. This can lead to doubling the workload on a given pitch. The point is – the number of pitches won’t always tell the whole story.

Steve Hayward & Dr. Christopher Ahmad
BHN founder Steve Hayward & Dr. Christopher Ahmad
FA: When a pitcher is coming back from surgery, what is your first order of business regarding mechanics since they haven’t thrown in a couple of months?
SH: My initial attention is directed towards making sure they are throwing naturally. I make sure the arm action is clean and smooth. I also check to see if they are creating consistent rotation with a 4-seam fastball, especially for the guys that are returning from Tommy John Surgery. These players have a tough time getting proper extension at the elbow and end up cutting the ball which creates a cutter or slider rotation. If the injury was caused by a mechanical issue, the slow pace of a rehabilitative throwing program allows them to improve where they were deficit at lower intensities.

FA: Dr. Ahmad’s mound throwing programs suggest the use of a radar gun for athletes to estimate their effort. What do you say to those athletes who “want to let it loose”?
SH: If a player focuses heavily on velocity in the rehab process, it creates a recipe for setbacks or re-injury. Either way, it will definitely affect a player’s return date. The daily goal is to complete the day’s throwing with no pain or discomfort. I prefer my guys to make a lot of throws at low to medium intensity. There is healing power in throwing but only when it’s done properly. Each player recovers differently and the decision as to when we start increasing and focusing on velocity is determined by the progress the player has made throughout the program.

FA: What is the best advice you could give to a parent who wants to keep their player’s arm healthy?
SH: First, start with the entire body. Way too many pitchers, at every level, have deficiencies and asymmetries throughout their body causing unnecessary stress on the throwing arm. Most arm injuries have little to do with the arm itself. If the body is functional and the delivery is efficient, the stress is distributed more evenly throughout the body instead of just the shoulder and elbow. Once those issues are addressed, a progressive throwing program is next. The arm needs to be fully conditioned prior to the season, and throwing at various intensities helps this process. Pitchers need to have an in-season maintenance and recovery throwing program as well. The last step is having the ability to communicate to the coaches and athletic training staff exactly how and what they are feeling. If an athlete learns how to listen to their body and pay attention to warning signs, they can stay ahead of potential arm issues.

Frank Alexander, a member of Team Ahmad, is a Physician Extender to Dr. Christopher Ahmad at Columbia University Medical Center.

Tagged With: Baseball Health Network, Dr. Christopher Ahmad, Pitching Healthy, Team Ahmad, Tommy John Surgery

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