BREAKTHROUGH — Youth Pitching Injuries: Dr Guettler researches
This three-year national study of more than 750 pitchers, ages 9-18, identified several factors contributing to the problem, according to study leader Dr. Joseph Guettler, an orthopedic surgeon and sports medicine specialist with the Beaumont Health System in Royal Oak, MI.

Dr. Guettler discusses his landmark youth pitching study

Dr. Guettler discusses his landmark youth pitching study

“It became very clear that dangerous pitching behavior is occurring among pitchers as young as Little League all the way through their high school years. And, the blame doesn’t usually lie with the leagues or coaches. Most were found to be adhering to nationally recognized guidelines for pitch limits and rest. It seems much of the blame lies with behavior of parents and their kids,” Guettler said in a health system news release.

Contrary to national guidelines limiting pitches thrown, about 13 percent of pitchers pitched competitively for more than eight months of the year, 40 percent pitched in a league without pitch counts or limits, nearly 57 percent pitched on back-to-back days, and 19 percent pitched more than one game in the same day.

The study also found that nearly one-third of pitchers pitched for more than one team during the same season, one-third played only baseball, and 10 percent also played catcher on the same team. Catcher is another position that requires a lot of throwing.

“The most prevalent reasons for arm pain and tiredness can be boiled down to five major issues,” Guettler said. “The following behaviors can lead to arm pain and tiredness which can then lead to the most significant shoulder and elbow injuries.”

These are:

    Pitching for more than one team during the same season.
    Pitching more than one game during the same day.
    Pitching on back-to-back days.
    Pitching in a league without pitch counts or playing year-round.
    Throwing curve balls before high school.

The first step in reducing the number of pitching injuries can be remembered with a simple, newly coined “Rule of Ones,” Guettler said.

It means one game a day, one day of pitching then rest, one position at a time during a pitched game, one team at a time, only one pitch before high school, and at least one season of some other organized sport. If a young pitcher says his or her arm is sore or tired, parents need to make sure the youngster takes some time off. One complaint of arm soreness or tiredness equals one week off.

Dr Bicos covering Oakland Gymnastics meet
Dr Bicos has been around the world with the USA Gymnastics team, but he also takes the time to cover the local meets.

When asked about why he does it, Dr Bicos states, “These are the kids that someday we might see up on the Olympic podium! I am proud to cover the local events and help the clubs in the area. The kids are amazing and have a fundamental drive to win.”

Dr Bicos covering the Oakland Gymnastics meet< Dr Bicos covering the Oakland Gymnastics meet[/caption]
Have a Blast Skiing this Winter – Not a Blow Out

It’s that time of year – many of us migrate to the snowy ski slopes of the west, or the icy ski slopes of Michigan, to enjoy the invigorating thrill of downhill skiing and snowboarding. When planning out our weekends, we choose Boyne Mountain over Somerset Mall, and when choosing our winter break, we forgo the relaxing “beach somewhere warm” and opt to tackle the mountains of Colorado, the hills of Northern Michigan, or the slope on the side of a landfill right up I-75. With this choice of activities, however, comes risk. We’ve all heard of someone “blowing out” their knee. Generally speaking, this refers to the tearing of one or more ligaments inside the knee. But before we go any further, let’s learn a little more about the ligaments of the knee:

The cruciate ligaments are two ligaments that are located deep inside the knee joint and connect the thighbone (femur) to the shinbone (tibia). They are called “cruciate” ligaments because they “cross” in the middle of the knee. They are instrumental in providing the stability that is needed for proper knee joint movement and stability when you torque on your knees and put them to the test. The cruciate ligament located toward the front of the knee is the anterior cruciate ligament (ACL), and the one located toward the rear of the knee is called the posterior cruciate ligament (PCL).

ACL Injuries

The ACL prevents the shinbone from sliding forwards beneath the thighbone. The ACL can be injured in several ways. Most often this involves a sudden change in direction during which the knee is twisted or during direct contact, such as during a football tackle. ACL injuries are quite common in skiers, particularly if you “wipe out” or “catch an edge” with your ski. Because your ankle is rigidly immobilized in the ski boot, it’s your knee that gets torqued, and if enough force is involved, ligament or cartilage injury can result.

If you injure your ACL, you may feel or hear a pop. The knee will swell and get stiff, and you will often feel pain when you try to stand. Over time, without a functional ACL, the knee may give out, especially when you attempt to change directions. When the knee gives way, this can lead to additional cartilage.

The diagnosis of ACL injury is based on the history, a good physical exam, and often, an MRI. A partial tear of the ACL may or may not require surgical treatment. A complete tear is more serious, and unfortunately, ACL tears do not heal. Complete tears, especially in younger patients, athletes, and active individuals, may require surgery to restore stability to the knee. Operative treatment is most often done arthroscopically and uses a piece of tendon, usually taken from the patient’s knee (patellar tendon), hamstring muscle, or from a cadaver. This “graft” is then passed through the inside of the joint and secured to the thighbone and shinbone. Surgery is followed by a rehabilitation program. Occasionally, complete tears may be treated conservatively in less active individuals or in individuals whose knees remain stable despite the injury.

PCL injuries

The posterior cruciate ligament, or PCL, is not injured as commonly as the ACL. PCL sprains usually occur when the knee is twisted or from a direct blow to the front of the knee. Without a PCL, your knee sags, and there can be increased wear and tear on the cartilage inside the knee. Like the ACL, PCL tears do not generally heal. Fortunately, some patients with PCL tears often do not have as much knee instability as patients with ACL tears, and even high level athletes can return to their sport after completing a good rehabilitation program. For patients who continue to have pain, swelling, or instability of their knee, surgery may be necessary to reconstruct the PCL.

Collateral ligament injuries

The collateral ligaments are located at the inner side and outer side of the knee joint. The medial collateral ligament (MCL) connects the thighbone to the shinbone and provides stability to the inner side of the knee. The lateral collateral ligament (LCL) connects the thighbone to the other bone in the lower portion of your leg (fibula) and stabilizes the outer side. Injuries to the MCL are very common and are usually caused by contact on the outside of the knee and are accompanied by sharp pain on the inside of the knee. The LCL is rarely injured. If the MCL is torn, is does have the ability to heal. Remember the acronym RICE: Rest, Ice, Compression or bracing, and Elevation. Most MCL tears do fine with an initial period of RICE followed by a good rehab program.

Finally, when it comes to the treatment of ligament injuries, it’s a really exciting time in the world of research. We are using more and more growth and healing factors to get ligaments and tendons to heal better and faster. As a matter of fact, we use substances like Platelet Rich Plasma (PRP) to help tendons and ligaments heal faster almost every day over at Beaumont. Additionally, we recently carried out a study where we were able to stimulate ACL tears to heal on their own – in the lab – by adding a “cocktail” of growth and healing factors to the torn ligament. Wouldn’t it be cool if we could get ACL tears to heal without surgery someday? Stay tuned…We’re on it.

There you have it – the “inside scoop” on the ligaments inside your knee. So have fun this ski season, but know your limits. Hopefully, a little knowledge and a little common sense will give you “the edge” when it comes to avoiding knee injuries this ski season.