OA Update: Injury Prevention, Athletic Performance and Orthopedic Procedures

Maine Orthopedist Selected to Accompany U.S. Ski Team For the Cross Country World Cup Final Races in Sweden

OA Centers for Orthopaedics’ Dr. Michael Pleacher to Help Keep Athletes ‘In the Game’ as U.S. Men and Women Nordic Skiers Seek to Bring Home the Gold in Sweden

OA Centers for Orthopaedics today announced that Dr. Michael Pleacher has been selected to serve as  team physician for the U.S. Ski Team as it competes in the FIS Cross Country World Cup Final Races in Sweden from March 14-18, 2012. Hosted by the Federation International de Ski (FIS), the World Cup Final opens with a sprint prologue race of 2.5K for women and 3.3K for men at the Royal Palace in Stockholm, Sweden on March 16. Longer distance races follow the prologue in Falun, Sweden on March 17-18. Seven athletes from the United States will compete against a field of 150 athletes from around the world.

“Dr. Pleacher continues a tradition of excellence among our specialty orthopedic doctors of serving as team physicians for United States national teams,” said John Wipfler, CEO of OA Centers for Orthopaedics. “OA doctors have served as team physicians for U.S. Men’s and Women’s Soccer teams at the Olympics and World Championships, the Duathlon World Championships as well as other high level athletic events both nationally and internationally.

Dr. Pleacher’s involvement with the U.S. Ski Team began four years ago when he was nominated and selected as part of a pool of 75-80 physicians from around the country to serve the U.S. Ski Team. As part of his training, Dr. Pleacher attended a medical emergency ski course in Beaver Creek, CO where he was trained by some of the best medical minds in emergency ski medicine. While in Sweden with the U.S. Ski Team, Dr. Pleacher will not only address race day medical encounters involving muscle strains and potential bone fractures and joint injuries, he will also interface with host country medical providers to review emergency evacuation plans in case of major medical emergencies.

“My involvement with the U.S. Ski Team has enhanced my sports medicine practice as I have developed an appreciation for the physiological strains that these extraordinarily fit athletes encounter in competition,” said Dr. Pleacher, who recently joined OA Centers for Orthopaedics to lead OA’s Brunswick office where he serves as team Physician for Bowdoin College

“I am really looking forward to the competition in Sweden,” Dr. Pleacher continued. “I expect #1 ranked Kikkan Randall of the U.S. to do extraordinarily well in the Women’s Prologue in Stockholm.”

At OA, Dr. Pleacher specializes in the diagnosis and non-surgical treatment of sports-related musculoskeletal injuries. He completed his undergraduate studies at Wake Forest University and then earned his medical degree from the Medical College of Virginia in Richmond, VA. After completing a Pediatric residency at Maine Medical Center, Dr. Pleacher went on to complete a Primary Care Sports Medicine Fellowship at Maine Medical Center in conjunction with OA Centers for Orthopaedics. Dr. Pleacher then spent 6 years out west, most recently serving as a sports medicine doctor and team physician for the University of New Mexico in Albuquerque. Dr. Pleacher joined OA in November 2011.

 

NFL Players Cheating on Concussion Baseline Tests?

CBS Sports and ESPN today reported that some NFL players think it's a smart idea to cheat on their baseline concussion tests. Why? Players are concerned that being sidelined by a concussion will hurt their livelihood. The reality is that by cheating on their concussion baseline test, NFL players are potentially planting the seed for long-term concussion consequences. Concussion experts point to conditions such chronic traumatic encephalopathy that is caused by repeated head trauma as cause for concern. Chronic traumatic encephalopathy is linked to depression, dementia and occasional suicide among more than a dozen deceased NFL players, according to the New York Times.

Concussion Management in Maine

7,207 Maine High School Athletes Received Baseline Neurocognitive Concussion Tests in 2010

When Boston Red Sox pitcher Josh Becket sustained a concussion in spring training this past winter, fans knew about it. The same could be said for Minnesota Vikings quarterback, Brett Farve, as the media reported extensively on his season-ending brain injury this past December. But what can be said of the hundreds, if not thousands, of Maine high school athletes sustaining concussions each year?

Thanks to the Maine Concussion Management Initiative (MCMI), the awareness and identification of mild traumatic brain injury among high school athletes has risen dramatically over the past two years. In fact, the 55 Maine high schools participating in MCMI’s program performed 7,207 baseline neurocognitive concussion tests on student athletes during 2010. Among those athletes, 737 athletes or 10.2% of participants were re-tested during the season after incurring a suspected concussion.

Founded in 2009, MCMI’s primary goal is to educate coaches, parents, trainers and students about concussions and to increase awareness about the seriousness of these injuries. The nonprofit organization also seeks to standardize concussion management throughout the state. Establishing neurocognitive testing in all 155 high schools in Maine is an important component of that goal.

Neurocognitive testing is an objective measure for determining both the nature and extent of an athlete’s concussion. The ImPACT neurocognitive test used by MCMI's concussion experts establishes baseline  brain function by measuring verbal and visual memory, visual motor speed, reaction time and impulse control at a time when the athlete is free of concussion. Then, if a  concussion is sustained during the season, the athlete is tested on ImPact to determine the extent of impairment and when it is safe to return to activities.

The ImPACT Clinical Report above shows the baseline concussion symptom score for an athlete on August 18, 2010. In January 2011, this same athlete experienced a head injury. She was tested on January 10, and a concussion was confirmed. A subsequent test on January 17 shows that the athlete was still experiencing concussion symptoms. After another 10 days of rest and recovery, the athlete was tested and cleared to play on January 27, 2011.

 “Prior to neurocognitive testing, concussion management was inconsistent and poorly defined,” said Dr. William Heinz, co-founder of MCMI and a sports medicine physician at OA Centers for Orthopaedics. “Neurocognitive testing of the kind supported by MCMI, coupled with gradual return to play guidelines as recommended by the Zurich Conference on Concussion Management, assure that our young athletes are fully recovered from concussions prior to resuming full academic and athletic activity.”

With a concussion diagnosis, athletes are placed on a rest and recovery protocol designed to speed their recovery based upon their individual symptoms. The cornerstone of concussion management is physical and cognitive rest until symptoms resolve and then a graded program of exertion prior to medical clearance and return to play. This always means that an athlete refrains from immediate return to an athletic contest, and it often entails missing school and refraining from computer, television and texting activity. The athlete is re-tested every 7-10 days until such time as their concussion symptom score and neurocognitive function returns to normal.

 

Baseball-related injuries are avoided with proper technique and practice

By William Heinz, MD

For many of us, playing baseball or softball is the first true sign of spring. Children and adults across the country anxiously anticipate the first chance to play catch, hit a few balls, or play pickle at the old ball field. While it may seem gentle when compared to some contact and collision sports, baseball can be a demanding sport on the body. Swinging bats, running the bases, and hurling balls at high speeds inevitably lead to some scrapes, bumps, and bruises along the way. Many of the accidental injuries that occur while playing baseball are just that, accidents — an errant pitch hitting a batter, turning an ankle on a base, or a grounder taking a bad hop.

These unfortunate events should be treated properly and immediately to minimize the players’ discomfort. (Think RICE: rest, ice, compression, and elevation.) There are, however, some injuries that can be avoided to keep you and your children in the game. These involve various muscle pulls, shoulder problems, and elbow sprains. The most common baseball injury involves the rotator cuff — a collection of four muscles surrounding the shoulder that functions to maintain correct biomechanics. Tendonitis (inflammation) of the rotator cuff occurs when the tendon is overused, often as a result of repetitive overhand throwing and underdeveloped muscular strength. Pitchers and catchers are most susceptible to rotator cuff injuries because of the amount of throwing involved in those positions, but outfielders and other players also can be affected.

Plan and Prepare

To prevent these injuries, all players are encouraged to develop a regimen of warm ups and stretching before throwing as well as proper throwing mechanics. Unfortunately, because children are often less aware of their physical limitations and sometimes put increased pressure on themselves, it is critical that parents and coaches pay close attention to their children’s play and be aware when their performance may have changed for the worse. For example, a pitcher who throws in control for the first few innings and then starts to throw wild pitches may actually be showing signs of fatigue or early injury to the rotator cuff. To avoid potential injury, this child should be removed from the game as performance begins to deteriorate.

During the game, players also are encouraged to look after themselves by observing the following habits:

• Stay warm: Keep a jacket on between innings.

• Stay loose: Jog out to your position on the field at the change of innings.

• Stay in the game: Keep moving between pitches.

If a shoulder, elbow, or hamstring begins to hurt, it is important to talk to your family doctor or sports medicine specialist to properly diagnose the problem. They will help develop a plan for resting and then strengthening the trouble spot. For easy reference, I have provided a few Web resources that describe some simple, effective strength exercises specifically targeting the rotator cuff and elbow. While lifting heavy weights will strengthen the large muscles in your body, the only way to strengthen the underlying tendons is through these very specific exercises that target the smaller muscles of the rotator cuff. Often, the only resistance needed is a piece of elastic tubing.

Timing

The USA Baseball Medical & Safety Advisory Committee recommends that the first pitch introduced to Little Leaguers should be the fast ball at 8 years old, followed by the change-up at 10, the curve at 14, the knuckle ball at 15, and the slider and fork ball at 16. Following these guidelines will allow the arm muscles to develop properly to meet the physical demands of each pitch and avoid “Little League Elbow,” a chronic inflammation of the growth plate in the elbow joint. It is also important to note that throwing fast or far is not purely a result of arm strength. Velocity comes from developing good mechanics and strengthening of the trunk, legs, and hips. The stronger you can make these parts of your body, the less stress you will put on your arm. Lastly, although it may seem like many of the players we see take the field at Hadlock or Fenway simply jump off the bus and hit the field ready to go, nothing could be further from the truth. Professional baseball players often reach the park four to five hours before game time and have done two hours of warm ups and stretching before even taking batting practice. Take a page out of their book and give yourself enough time to warm up.

William Heinz, MD, specializes in the diagnosis and treatment of sports-related musculoskeletal injuries. He received his undergraduate degree from Purdue University and graduated from Indiana University School of Medicine. He completed his residency in internal medicine and performed a fellowship in primary care sports medicine where he sub-specialized in shoulder injuries. He is the team physician for the Portland Sea Dogs and a team physician for U.S. Soccer. He is also the company physician for the Portland Ballet and the orthopedic consultant for Bridgton Academy, Gould Academy, and Deering High School.  

Avoiding Overuse Injuries in Young Athletes

A little prevention can keep kids playing for life   

By D. Scott Marr, MD, FACSM  

An increasing number of children are focusing on one sport and training year round for it. While they and their parents may feel that this concentration is necessary to be competitive, it leaves little time for important rest and recovery. I often remark to young athletes that professional athletes all schedule a “down-time,” so why not young athletes?

A recent Youth Sports Injuries public service campaign used the tagline: “What will they have longer, their trophies or their injuries?” While somewhat sensational, the message should be given careful consideration. With 35 million children (6 to 21 years old) in the United States participating in sports, the risk for overuse injuries is high.

According to the U.S. Consumer Product Safety Commission, more than 3.5 million sports-related injuries in children younger than 15 were treated in 2003. Thirty to fifty percent of these injuries were caused by overuse, with the frequency of injury equal among boys and girls.

Sports medicine specialists are now seeing many repetitive strain injuries in young athletes such as tennis elbow and Achilles’ tendonitis that we used to see only in adults. The following is a look at overuse injuries commonly seen in children and their symptoms.

Common Overuse Injuries

Injury                                       Possible symptoms

Tibial stress fracture                  Focal shin pain, worse with activity

Swimmer’s shoulder                   Shoulder pain worse with overhead motion, may feel loose

Little League elbow                   Pain on medial elbow, usually with throwing motion

Runner’s knee                            Pain around kneecap

Shin splints                                Diffuse shin pain, less focal than stress fracture

Sever’s disease                           Heel pain, worse with activity

Osgood-Schlatter disease            Pain, swelling below kneecap at patellar tendon insertion

Apophyseal avulsion fracture      Abrupt onset of pain at tendon insertion on bone

Gymnast’s wrist                          Diffuse wrist pain from repetitive wrist extension loading

(Continued… Preventing Overuse Injuries)

D. Scott Marr, MD, FACSM, graduated from Dartmouth College and the University of Massachusetts School of Medicine. He holds a Certificate of Added Qualification in Sports Medicine. Dr. Marr has a special interest in elite endurance athletics including performance physiology and injury prevention.   

 

 

Training for a Triathlon Swim

By Bernadette Shaw, PA-C

Whether you are an experienced triathlete or a first-time racer, the swimming portion of a triathlon is often the least favorite and the most intimidating. There are several easy steps you can take to make the swim more enjoyable and improve your overall triathlon experience.

Prepare in the pool during the preseason

Sports-specific cardiovascular training is important, especially when it comes to swimming. Some of the most in-shape land athletes feel hopelessly out of shape when they start training in the pool. It is also important to work on stroke technique in order to become more efficient in the water and conserve energy for the rest of the race. Taking a formal swim clinic or incorporating stroke drills into your regular swim routine is a good way to accomplish this. First, concentrate on getting maximum distance per stroke. This means keeping a long bodyline, focusing on hip and shoulder rotation, developing a steady rhythm and minimizing resistance. Try counting the number of strokes it takes you to get to the end of the pool. This is a good task to do regularly during a workout, particularly as you tire and your stroke shortens.

Catch-up

To improve stroke lengthening and body position you can incorporate the catch-up freestyle drill into your workout. Start with your hands in a streamlined position out in front of you. Pull with one arm at a time following the regular freestyle stroke pattern. One arm is always extended forward towards your destination while the other arm performs the stroke. When the arm performing the stroke moves forward and “catches-up” with the stationary arm they change places.

Strength training

Upper body strength is essential to swimming success and injury prevention, just ask our sports medicine specialists. This can be accomplished by several strength training sessions a week, focusing on shoulder stabilization and muscle balance. An easy exercise to perform is the wall push-up.

Wall push-up Keep shoulder blades down and back, and start with your hands at shoulder level. Slowly lower your shoulders towards the wall and return to start position. Avoid shrugging your shoulders. Progress to table-end push-ups and finally to floor push-ups.

Train in your race environment

When the weather allows, it is important to gain some familiarity with your triathlon-swimming venue. If your race is in the ocean or a lake, wearing a wetsuit may be recommended or required. Spend time swimming in your wetsuit so you are comfortable and have a proper fit. It is also essential to test out the cap and goggles you plan to use on race day. Practice sighting buoys or objects when you train in the ocean or lake. In order to make sure you stay on track, try lifting your eyes just high enough off the water every five to six strokes and spot your target.

Race Day

On race day, get to the event a little early to check out the water conditions. Spend some time on the beach and take note of tides and currents. Review the course entry and exit, paying special attention to details such as rocks, wave action and beach slope. Get in the water, test out your gear and warm up. Keep in mind that it can be difficult to catch your breath during the first several minutes of the race due to the cold water and chaotic environment of other swimmers and crashing waves. Take comfort in knowing that your swimming heat will spread out. Focus on getting into your own rhythm. Most importantly, have fun!

 

Bernadette Shaw, PA-C, is a physician assistant and clinical research coordinator who works in the OA Sports Medicine Center. She enjoys competing in local triathlons and open water swim races.

Sports-Related Concussion

By Lucien R. Ouellette, MD

No athlete should return to sport or other at-risk participation when symptoms of a concussion are present and recovery is ongoing. The best way to prevent difficulties with a concussion is to manage the injury properly when it does occur. Here are some commonly asked questions and answers regarding concussion injuries:

What is a concussion?

A concussion is any temporary change in how the brain works caused by injury to the head that may or may not involve a loss of consciousness. This can be a direct blow to the head or a hit to the body causing shaking of the head. Another term for concussion is mild traumatic brain injury (MTBI). A sports-related concussion is specific to an injury while playing sports and will temporarily limit involvement with sports.

Is sports-related concussion common?

Yes, sports-related concussion is common especially in collision sports like ice hockey, boxing and football, but a sports-related concussion can occur in any sport. Estimates are that 5 percent of injuries in high school sports are concussions, with a higher rate in certain sports (60 percent in football).

Unfortunately, many more concussions go unrecognized and untreated.

How do I know if I have a concussion?

Symptoms of a concussion can be very subtle (irritability, ringing in the ears, nausea, difficulty concentrating, difficulty sleeping, personality changes, sensitivity to lights or sounds or just not feeling right). Symptoms can also be more obvious (headache, confusion, loss of memory, clumsiness, change in vision, appearing dazed). ANY change to normal brain function is a concussion no matter how minor the symptom may be or how long the symptoms last. Even a “ding” or getting your “bell rung” is a concussion.

What do I do if I have a concussion?

Tell your athletic trainer, team physician or sports medicine specialist. The only treatment for sports-related concussion is rest. This will involve stopping all sport participation until all symptoms have resolved and to return with a slow increase in activity without symptoms recurring. Sometimes rest needs to include limiting school or work activity. If the symptoms are prolonged (more than seven days), your doctor may be able to help the symptoms with some medications; typically, no medications are needed.

Will my brain return to normal?

With a single concussion and appropriate rest, typically you will regain all your normal brain function within 7–10 days. Sometimes a neuropsychological test (ImPACT) will be used to help determine when normal brain function has returned. We cannot determine how severe a concussion is until all the symptoms have gone away, and we have no way to predict when they will resolve. We do not know how many concussions one person can have in a lifetime before permanent brain injury occurs. This number is different for each person. We only know if the damage is permanent when the symptoms don’t go away.

Can I prevent a concussion?

The only way to prevent a concussion is to avoid injury to your head. No equipment (helmet, mouth guard) has been proven to decrease the rate or severity of concussion, but they do prevent other injuries (cuts, tooth damage, eye injury, etc) and should be worn.

Dr. Ouellette is a sports medicine physician who serves as team physician for Bowdoin College and Old Orchard Beach High School. He assists with coverage for the Portland Pirates (AHL) and the U.S. National Soccer Teams. He utilizes the ImPact test on his athletes to ensure a safe return to sports.

Sprained SC Joint Reported for Brett Favre

Brett Farve went down hard in Sunday’s game against the Buffalo Bills. Bill’s linebacker Arthur Moates tackled Favre from behind on the first play of the game, injuring Favre’s shoulder and ending his game. Subsequent reports from ESPN indicate that Favre sustained a “sprained AC joint” injury. An MRI today is expected to confirm reports.

According to sports medicine specialist, Dr. Tom Murray, the SC Joint, or sternoclavicular joint, is the connection of the sternum (breastbone) to the clavicle. An SC joint injury is not a common injury, and it can be problematic, particularly for an aging NFL quarterback. Dr. Murray notes that usually SC joint symptoms arise from arthritis, a possible consequence but not the cause of Favre’s Sunday injury. Treatment includes cortisone injections, and may be Favre’s only hope of recovering fro the SC joint injury prior to next Sunday’s game against the New York Giants.

 

 

 

 

 

Portland Pirates Choose Maine Orthopedic Sports Medicine Practice as Team Physicians

Focus is on concussion management, illness and injury prevention, treatment, rehabilitation and a quick return to function

OA Centers for Orthopaedics today announced that the Portland Pirates has selected OA as their Team Physicians for the 2010-11 season.

Professional hockey players risk injury every time they step foot on the ice. Throughout the course of the season, players suffer from knee, shoulder, hip, groin and back injuries as well as concussions and lacerations to the head, scalp and face. Among younger athletes, hockey-related injuries have risen by more than 85% since 1990.¹ More is at stake for professional athletes who making a living on the ice.

“Concussions, illness and injury prevention are major concerns for professional athletes today,” said Tom Murray, M.D. of OA Centers for Orthopaedics and Head Team Physician for the Portland Pirates. “So as we begin working with the Pirates, we are bringing their concussion management practices up to NHL standards, making recommendations – including flu shots this week – to reduce the prevalence of illness during the season and providing expedited evaluation and diagnostic services when athletes are injured.”

OA was an early adopter and a longtime proponent of the ImPACT test for concussion management. ImPACT, or Immediate Post-Concussion Assessment and Cognitive Testing, evaluates concussions through computer-based neuropsychological testing. It measures multiple aspects of cognitive functioning in athletes, and provides tools to assist physicians in determining an athlete's fitness to return to play after suffering a concussion. The test provides immediate results for evaluating physicians and indicates whether additional diagnostic action, including a written test and physical evaluation, are required.

As Team Physicians for the Pirates, OA’s sports medicine specialists will be at every home game the Pirates play this year. OA will follow-up with all injuries and recommend treatment and rehabilitation plans to the injured athlete, trainers and coaches.

“We chose OA because they are the best sports medicine practice in Northern New England, offering the most comprehensive, innovative care and solutions for all of our team’s medical needs,” said Brian Petrovek, Managing Owner/CEO of the Portland Pirates. “When our guys get hurt, we want them to have immediate medical attention. OA provides that support for the Pirates, and we are excited about this new relationship moving forward.”

The OA medical team is lead by Head Team Physician, Thomas F. Murray, Jr., M.D., with Assistant Team Physician, Lucien R. Ouellette, M.D., with orthopedic consulting support from OA’s Sports Medicine Center team of medical professionals.

 

OA physicians also serve as the Team Physicians and/or sports medicine consultants for the Portland Sea Dogs, Portland Phoenix Soccer, Bowdoin College, St. Joseph’s College, USM and dozens of area high school sports teams.

¹ Bloomberg Business Week, September 26, 2010: http://www.businessweek.com/lifestyle/content/healthday/643435.html