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Arm Care in Baseball is More Than Pitch Counts

The number of shoulder and elbow injuries in youth baseball pitchers is on the rise and we consistently see these injuries for performance physical therapy. In response, consistent efforts have been made to better monitor the amount of stress taken by pitchers after each visit to the mound.

For many years, this was done by simply limiting the number of innings an athlete could pitch and setting a specific number of rest days between outings. More recently, pitch counts have become the standard for tracking a pitcher’s workload. However, while this change is an improvement, pitch counts do not tell the entire story.

What pitch count fails to account for is the varying intensities between throws. For example, a throw at 100% effort has a very different intensity than a throw at 50%. This is why efforts have been made in recent years to more accurately track the intensity, or workload, of a pitcher while on the mound.

A Better Method to Track Stress: Workload

According to athletic physical therapy, a more reliable measure of stress is the acute to chronic workload ratio (ACWR). Acute workload refers to the average workload of a single day over the past 9 days, whereas chronic workload refers to the average one-day workload over the past 28 days.

Research by sports scientist Tim Gabbett has shown that spikes in acute workloads, such as quickly increasing pitch count to more than the body is used to, can increase the risk of injury.

Calculating Your ACWR

There are two main ways to calculate the acute to chronic workload ratio.

The first is to use a series of formulas using pitch count and a subjective rating of perceived exertion (RPE), ranging on a scale of 1–10.

  1. Calculate acute workload by multiplying the number of high-intensity throws (around 70% of full effort or more) by the athlete’s RPE.
  2. Calculate chronic workload by calculating the weekly acute workload average of the past four weeks.

Once you have the acute and chronic workload, divide the acute workload by the chronic workload to get the ACWR.

The second and perhaps much simpler method is to use wearable technology. For example, in recent years, technology has become available to track the stress on a pitcher more accurately after an outing.

Sensors such as the MotusTHROW can accurately measure the amount of force placed on an athlete’s elbow during each throw. This data can be applied to calculate the ACWR to safely and effectively determine when a pitcher needs rest or is ready for their next high-intensity outing.

If you’d like to learn more about keeping your son or daughter safe on the mound, our experienced athletic physical therapy and injury rehabilitation team in Bethesda can help!

Debunking the Bone on Bone Myth

“Best Walking Shoes for Knee Pain for Women” by gm.esthermax is licensed under CC BY 2.0

I’m sure you’ve heard someone say it before:

“My knees are in such bad shape. It’s pretty much just bone on bone down there.”

Although this is a commonly held belief, athletic physical therapy speaks to the truth: “bone-on-bone is largely a myth.

Many patients complain of knee pain because they are “bone-on-bone” assuming there is nothing they can do but get surgery.

Fortunately, this common misconception just isn’t true. If a person is experiencing joint pain, one of the first treatment measures is X-rays or another imaging study of the joint. If the joint damage on the X-ray is severe, you may be told you are “bone-on-bone.” However, all that term means is that there is some amount of cartilage loss in the joint.

As the cartilage deteriorates, there is less cushioning between the ends of the bone that form the joint. This “rubbing” of bones against each other with less cushioning causes pain and discomfort. However, rarely, if ever, is the cartilage of the joint completely destroyed.

A doctor at the Core Medical Center in Blue Springs, MO, conducted more than 1,000 knee X-rays and discovered only one case where the cartilage of the knee joint was completely destroyed. The other 999 cases were simply deterioration of the cartilage, but it remained intact and functioning.

The truth is that “bone-on-bone” is just a fancy way of saying the cartilage is slowly deteriorating. Very seldom does it ever completely disappear. This term is used by doctors and physical therapists to better describe the situation to patients and the severity of their pain points.

If you’re experiencing joint pain or discomfort, our injury rehabilitation clinic in Bethesda/Chevy Chase can help! Whether you’re looking to overcome a recent injury or sick of joint pain preventing you from enjoying an active lifestyle, our team of physical therapists can help!

Why Mouth Breathing Can Be a Problem

There are a variety of circumstances that can contribute to increased levels of stress. Some common examples include work pressures, family problems, money issues, and health concerns. But in recent years, athletic physical therapy has proven that a lesser-known stress contributor is actually how you breathe.

According to Seth Oberst, DPT, there are two primary ways humans breathe — either through the mouth or the nose. When mouth-breathing is your primary mode of respiration, you are actually stressing your system more than if you were to breathe through your nose.

When you breathe through the mouth, your head is forced to move forward to maintain an open airway. Unfortunately, this causes a cascade of negative effects that can put even more stress on the body:

  • Taking air in through the mouth isn’t effectively mixed with nitric oxide, so you have to inhale more air than necessary.
  • This over-breathing increases your sympathetic nervous system (fight or flight) activity.
  • As you inhale more and more air, your heart rate increases, along with muscle tension and stress levels.
  • While you may be physically or mentally exhausted at night, you end up tossing and turning — waking up feeling more tired because your brain is starving for oxygen.

All this to say, how you breathe is important. While you can certainly survive by mouth-breathing, it will be difficult to thrive. If nose breathing is difficult for you, start by doing 3–5 minutes of dedicated nose-breathing per day to increase your comfort levels.

If you want to learn even more about proper breath-form and reducing stress, our experienced athletic physical therapy team in Bethesda/Chevy Chase can help!

What Is Blood Flow Restriction Training? Can It Help You Overcome Your Injuries?

“Running by Coolidge Corner” by jpo.ct is licensed under CC BY-NC-ND 2.0

Since the beginning of performance training, athletes have searched for the most effective training methods out there. Although there are countless strategies available, blood flow restriction training, or BFR for short, has been used for more than 20 years in physical therapy and performance training.

What Is Blood Flow Restriction Training?

Blood flow restriction is a training technique that involves performing exercises with a reduced amount of blood flow to the arm or leg. Using a cuff or strap placed tightly around the limb, blood flow is reduced to that specific area. BFR training combines low-intensity exercise with blood flow restriction to produce similar results to high-intensity training.

In recent years, blood flow restriction training has become popular for both athletes and patients recovering from injuries. Mike Reinhold, a leading physical therapist, describes the various benefits as:

  • Provides a great workout with smaller weights and fewer reps or time
  • Can help with rehab from injuries
  • Improve strength for clients with physical limitations
  • Pain reduction after ACL surgery or knee osteoarthritis
  • Relieve pain and treat functional scores for older patients

Is BFR Training Right For You?

Much like anything, it’s important to educate yourself before trying any new training method. For example, blood flow restriction training is commonly used in performance training and physical therapy because it allows patients to develop strength and stability without requiring a lot of weight. 

Although it is within the scope of practice for physical therapists and athletic trainers, our PTs at CHP are certified specifically in blood flow restriction training. If you’re returning from a recent injury or want to learn more, contact us to set up an initial consultation

What Should You Be Drinking Before, During, and After a Run?

Much like other areas of performance training, proper hydration as an essential aspect of a comfortable, enjoyable run. Although it’s normal for runners to experience a small amount of dehydration, drinking enough fluids can significantly reduce the chances of any adverse effects. On top of that, proper hydration can improve your energy and endurance and even minimize recovery times.

Here are some general hydration recommendations to maximize run performance.

1. Pre-Run

Your hydration strategy should begin long before you start putting on your running gear. What you drink in the hours before a run is perhaps one of the most important aspects of hydration. Be mindful to drink plenty of fluids throughout the day before your run. Then, about 15–30 minutes before heading out the door, drink 250–500ml of fluids.

2. During The Run

The general rule of thumb is to drink 5–10 fl. oz. every 15–20 minutes while you are running. Again, this requirement can vary based on your individual needs or the temperature at the time of your run. However, this is a great general rule to set a baseline for how much water to bring along for your run.

If you don’t like carrying a water bottle or wearing a hydration belt, you can plan out a running route with access to water fountains along the way.

3. Post-Run

Post-run hydration is essential to get your fluid levels back to normal and helps prepare you for the next run. The general rule of thumb is to drink 16–24 fl. oz. of water for every pound lost during your run. 

Final Thoughts

Everyone — and every run — is different. Some days it’s hot and humid, and you’ll likely want to increase your fluid consumption. Other days you may only be running for 20 minutes, in which case you might not even need to bring water on the run. The more you experiment with different hydration techniques, the more in-tune you’ll be with your body and its unique hydration needs. 

Get The Most Out of Your Runs!

Whether you’re an elite runner or weekend warrior, rest days are equally important. In our years as a physical therapy clinic in Bethesda, we’ve taught our patients that the rest days are a crucial component of any good running program.

Resting is necessary to recover appropriately, avoid burnout, and develop as a runner. On days off, your body repairs and rebuilds broken-down muscle tissue from strenuous runs and training sessions. Without proper rest, you may end up needing a physical therapist in Chevy Chase or Bethesda.

Here are three simple things you can do to optimize your days off.

Catch Up On Sleep

Sleep is one of the most important aspects of recovery. During sleep, your muscles relax, and hormones that promote tissue recovery are produced. 

Without sufficient sleep, your muscles might remain tense and sore, which can even lead to chronic pain. On your days off, try getting to bed an hour earlier to catch up on this vital muscle recovery component.

Perform Light Movement

One of the most important things you can do on a rest day is perform a relaxing home exercise routine to address any inflammation or muscle tightness. Examples include light mobility work, yoga, or whatever else you may enjoy. This will help reduce muscle soreness and improve your range of motion. They’ll help your legs feel fresh and get you ready to run hard the following day.

Fuel Your Body

Another important aspect of rest and recovery is nutrition and hydration. Just because you aren’t running on a rest day doesn’t mean you should deviate from your normal nutrition strategy.

On rest days, it’s essential to fuel your body with foods that support muscle recovery and growth. This means prioritizing protein-rich foods, complex carbs, healthy fats, and plenty of fruits and vegetables. Focus on healthy, nutrient-dense foods to help improve muscle recovery. 

Final Thoughts

Just as your training runs are vital to your running performance, so are your rest days. Without taking the proper time to rest and recover, you’re putting your body at greater risk for injury or burnout. These three simple techniques can help optimize your rest day and improve your recovery. If you want a customized approach to optimizing your rest days, our sports physical therapy clinic in Chevy Chase can help!