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.

Calculate acute workload by multiplying the number of high-intensity throws (around 70% of full effort or more) by the athlete’s RPE.
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!

Can Hiking Make You A Better Runner?

If you’re running is starting to feel stale or boring, it might be time to switch things up. Officially known as “cross-training” in sports physical therapy, hiking can be an effective training strategy to help prepare for running. From both a physical and mental standpoint, there are several benefits that hiking will have on your running performance.

Aerobic gains with less chance of injury

Hiking is the perfect low-impact cardio alternative to running that vastly decreases the impact on the joints and muscles. Doing this low-intensity activity over long periods can help improve your aerobic engine, which helps new runners.

Engage different muscle groups

In our experience with performance physical therapy in Bethesda and Chevy Chase, we’ve noticed that runners can sometimes rely heavily on certain muscle groups while ignoring other important ones. The uneven terrain of hiking requires lunging and squatting movements, which help activate different muscle groups. Adding hiking to your training can help to utilize less-utilized muscles.

Improves balance and leg strength

Hiking, specifically on uphill climbs, requires you to use your glutes and quads to get over hills. This motion is similar to the act of running and gives the body a chance to exert itself without the added stress of actually running. Maintaining a steady pace while hiking also engages the core and stabilization muscles, improving balance and running form.

Stress relief

Let’s be honest — most runners choose time-saving routes in the neighborhood or treadmill rather than getting out on a trail. Though this is great in a pinch, being in nature can help alleviate stress and anxiety, improve productivity, and increase creativity. By cross-training with a hike, you’ll not only improve your performance but your mental health as well.

3 Critical Questions To Ask Your Physical Therapist on the First Visit

Physical therapy (both in person and virtual physical therapy) is most effective when you are actively involved. While the physical therapist is responsible for identifying issues and developing a plan, the patient should be actively involved by asking questions and providing necessary background information. Here are three important questions to ask your physical therapist to get the most out of your session in Chevy Chase or Bethesda.

1. Why did this happen, and how can we ensure it doesn’t happen again?

Solving the underlying issue and resolving any pain or discomfort is essential when working with a physical therapist. But beyond that, you also want to ensure that the problems don’t resurface. By asking about the root cause of the injury or pain, you’re able to better prevent the problem from becoming a long-term issue.

2. What do I need to be doing at home?

Unfortunately, time with a physical therapist is limited. Outside of a few hours a week, most time is spent away from your PT. When meeting with a physical therapist, it’s vital to clarify any exercises you should or shouldn’t be doing at home. A great physical therapist will make sure you have the tools and exercises needed to take control of your health, both inside and outside of the session.

3. How can you be sure I’ll make progress?

If you decide to work with a physical therapist, the intention should be to progress towards your goal. Oftentimes the healthcare system will establish general objectives, such as reaching a “baseline” or returning to ADLs (active daily activities). Although these standard guidelines are a good starting point, the purpose of physical therapy is to reach your goals, not the goals of the insurance companies! By asking this question directly, you set a clear intention for the results you desire.

Physical therapy works best when there’s an active partnership between you and the PT. The more engaged you are in your health, the more progress you will make. By asking these three essential questions, you’ll set clear intentions for your physical therapy and build a better working relationship as a result.

Why the rates of athletic injuries are on the rise

With the weather warming up, COVID-19 cases decreasing, and spring sports starting up again, many young athletes are looking forward to making their return to sport. While excitement is high to get back out there and compete, it is important to prepare your body correctly to avoid injuries and stay healthy. Proper performance training in the Bethesda and Chevy Chase area can be the difference between a dream season and being forced to watch from the sideline!

After a long layoff from sport, the inherent risk of sustaining an injury is high, as one’s body is not used to performing sport-specific athletic activities. That’s why it is important to take some time before the season starts to get your mind and body ready for healthy peak performance.

Studies show that strength and conditioning training in athletes reduces sports injuries by 33% and overuse injuries by nearly 50%. So, it is important to get started with some simple, comfortable exercises in order to get back into playing shape and stay healthy.

A great way to start preseason training is with individual sport-specific drills with an emphasis on conditioning. From here, the athlete can progress into sport-specific drills with a partner or opponent. Then, go ahead and ramp up the activity into team drills, scrimmaging, and finally, game play. You see this progression in professional and collegiate sports, as activity is gradually increased as the body is able to adapt to the increased culminating stress.

The best way to get a sport-specific program that meets the needs of an individual athlete is to see a professional who can create a program based on his/her unique strengths and weaknesses. So, if you’re looking for optimized programs after a long offseason or injury, look into performance training in Bethesda or Chevy Chase and get that dream season off to the right start!

Cheers to a great new season and be sure to have some fun!

An Essential Part of Athletic Physical Therapy: Strength Training for Runners

Many of the runners that we work with at CHP supplement their running with strength training. Strength training is a large component of athletic physical therapy and provides a host of benefits including, but not limited to; reduced injury risk, increased muscular endurance, and faster running times. Research shows that regular strength training improves a runner’s speed and VO2 max. VO2 max is a measure of the maximal amount of oxygen that a person can use during exercise.

However, there is one important caveat to all of these great benefits. A runner’s strength training program must be designed and executed appropriately, and according to the runner’s goals and individual characteristics.

Luckily, most runners have similar goals. They wish to run faster and/or farther, and avoid injury.

Strength training programs for runners should consist of exercises that improve qualities specific to running.

When running, there is never a time when both feet are touching the ground simultaneously. The arms and legs are constantly moving in opposite and alternating directions as the body transitions from one foot to the other.

Therefore, we commonly advocate for runners to include more single leg exercises into their training.

These exercises include, but are not limited to: lunges, single leg squats, split squats, and single leg RDLs (Romanian deadlifts). Simply adding one of these activities into each of your strength training sessions can have a large impact. Take a look at the videos below for examples of these activities.

https://www.youtube.com/watch?v=aazACzyUR-Q

https://www.youtube.com/watch?v=KK05iugeIDE

https://www.youtube.com/watch?v=EjDtPek261c

Furthermore, runners should not neglect upper body training. Arm drive is an essential component of running and helps to drive leg action. An effective runner cannot have one without the other!

A thoughtful and more scientific approach to strength training, specifically designed for runners, may be all that is needed to drastically improve your running performance.