Wayne HealthSportsRehabilitation & Sports Medicine

Athletic Trainers, Rehabilitation Therapyand Orthopedic Services

Upcoming Events

PASP Course

The next PASP Courses will be on Monday, May 18, 2015 andMonday, July 13, 2015 from 6:00pm to 8:30pm.

Course locationWayne HealthCare Outpatient Rehabilitation Center1111 Sweitzer St.Greenville, OH 45331

Please call Jim Beyke, PT at (937) 547-5941 or email james.beyke@waynehealthcare.orgto register.

Sports Physicals

DateMay 7th and May 20th

Time6:00 PM - 9:00 PM

LocationFamily Health5735 Meeker Rd.Greenville, OH 45331

Cost - $10(Cash or check only)

Volume 1, Issue 2 - April 2015Wayne HealthSports - Outpatient Rehabilitation - Greenville, OH 45331 - 937-547-5714 1

Wayne HealthSports is a division of the rehabilitation and sports medicine services o�ered by Wayne HealthCare.

Wayne HealthSports will be collaborating with Orthopedic Associates of Southwest Ohio and Family Health to provide a full, comprehensive sports physical on May 7th and May 20th for Darke County athletes at Greenville, Versailles and Ansonia schools entering grades 7-12.

We are excited to o�er this convenient service for athletes and parents at our contracted schools. We encourage the athletic department at each school to have athletes sign up and bring completed paperwork with them to the physicals.

Don’t forget to meet members of our team! Our monthly team member spotlight is Jim Beyke, Director of Rehabilitation Services and Dr. Safet Hatic, Wayne HealthSports Medical Director and Orthopedic Surgeon at Orthopedic Associates of Southwest Ohio.

The goal of the Wayne HealthSports program is to provide high quality athletic training services that will enhance the medical care for our student athletes.

The term “shin splints” has been often overused over many years to describe any sort of lower leg pain or soreness resulting from any number of potential orthopedic injuries. In a majority of these cases, the term medial tibial stress syndrome (MTSS) is a more appropriate choice of words to describe these types of less severe injuries so as to distinguish them from other, more serious lower leg injuries such as compartment syndrome or stress fractures. There are gener-ally two possible causes for medial tibial stress syndrome. In some cases, MTSS is caused by chronic strain, repetitive overuse, or microtrauma to the soleus muscle in the calf along the origin of the muscle on the tibia, or shin bone. Other times the condition develops as a result of deep in�ammation to the periosteum (the connective tissue membrane covering the outer surface of the bone) of the tibia underneath the posterior tibialis muscle. In either case, medial tibial stress syndrome most often develops in unconditioned people who begin a running or jumping intensive program without �rst preparing their bodies adequately to handle the type of stress being put on them. MTSS can also be a problem for well-conditioned runners who implement a dramatic increase in their mileage or training intensity or who have recently changed their training footwear or terrain. In most cases, early detection of this injury and appropriate rest and treatment are the most e�ective ways to alleviate the symptoms associated with MTSS.

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Photo Courtesy of the Hughston Clinic.

What Are “Shin Splints” and How Do We Treat Them?

3

There are many potential ways to e�ectively treat MTSS but all of the solutions involve adequate rest �rst and foremost. For unconditioned runners this may mean complete rest from all running and jumping activities, while for more conditioned athletes this may simply mean a decrease in training mileage or intensity. Another way to treat these symptoms is to reevaluate the training surface on which a person is running or the footwear they are training in and alter it in an appropriate manner to cater to their speci�c needs. This could include measures such as running on grass or dirt more than roads or a track or researching a more appropriate pair of running shoes for an athlete’s unique foot type. The most common way to alleviate the immediate pain and soreness associated with MTSS is ice massage. In order to do this you will need to �ll a few paper cups ¾ of the way full with cold water and put them in the freezer for a few hours. Once frozen, you can peel back the paper to expose the ice and begin rubbing the ice over the area of pain. You can begin with light pressure initially until the area starts to feel numb after a few minutes and then put a slowly increasing amount of pressure over the region to create more of a massaging stroke with the ice. This treatment should last between 8-10 minutes in total or until the ice cup is no longer usable. In some cases, over-the-counter NSAIDS such as ibuprofen can also help to alleviate some of the pain and in�ammation associated with MTSS when used as directed.

Volume 1, Issue 2 - April 2015Wayne HealthSports - Outpatient Rehabilitation - Greenville, OH 45331 - 937-547-5714

What Are “Shin Splints” and How Do We Treat Them?

With the weather warming up, it just means that baseball and softball season is right around the corner. Whether you play for your local high school, little league, or travel ball team, shoulder injuries can really impede your skills on the �eld. Baseball and softball are among the sports with the highest rate of shoulder injuries during the spring and summer seasons. As a coach, parent, or player how can we prevent or reduce the risk of our athletes obtaining shoulder injuries? The �rst step is understanding which risk factors attribute to these shoulder injuries. Some predisposing factors are uncontrollable, such as, age, gender, and the anatomical makeup of the athlete. However, other factors like throwing mechanics, overuse injuries, types of pitches thrown, and muscle weakness are controllable to an extent. Proper training in the o�season and preseason are very important. Increasing pitch counts gradually and performing strength conditioning programs can minimize many issues with the shoulder. Conditioning programs should incorporate strength, stability, �exibility, and coordination. It is also important that the athlete performs core and leg exercises.

Shoulder Management

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In any event it is important to recognize the signs and symptoms of chronic shoulder injuries as they develop. Issues like a gradual onset of pain, sti�ness or aching after/during training or competition, increasing periods of time for pain to resolve, point tenderness, or visible swelling are all indications of more serious problems. Taking care of your shoulder before and at the early stages of these symptoms, may be the di�erence between sitting out a couple weeks due to muscle soreness or continuing to play at your best.

With baseball and softball there are several shoulder management techniques that may be performed to help reduce risks. Light jogging, dynamic stretching, theraband exercises, and core activation prior to activity properly warms up muscles and prepares them for activity. Also, refueling your body with balanced meals, monitoring pitch count during and the day after games, and proper cool down after activity can help minimize problems from starting. The USA Baseball Medical & Safety Advisory Committee constructed pitch count guidelines to help coaches and young athletes.

Sometimes proper training and management just isn’t enough. If ever an athlete is experiencing the signs and symptoms described above, it is important that they seek the proper treatment. The best treatment for these problems is simply rest. Continuing to play through soreness and arm fatigue increases the chance to develop future shoulder injuries that require surgery. If there are ever questions or concerns about an athlete’s shoulder consult with your athletic trainer or orthopedic physician.

Shoulder Management

Age Pitches/ Game 7-8 50

9-10 75 11-12 85 13-16 95 17-18 105

Pitch Counts

Ages 14 and under (pitches)

Ages 15–18 (pitches)

# of Rest Days

66+ 76+ 4 calendar days 51–65 61–75 3 calendar days 36–50 46–60 2 calendar days 21–35 31–45 1 calendar day

Rest Periods

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Overhand throwing places extremely high stresses on the elbow. In baseball pitchers and other throwing athletes, these high stresses are repeated many times and can lead to serious overuse injury. Unlike an acute injury that results from a fall or collision with another player, an overuse injury occurs gradually over time. In many cases, overuse injuries develop when an athletic movement is repeated often during single periods of play, and when these periods of play — games, practices — are so frequent that the body does not have enough time to rest and heal. Although throwing injuries in the elbow most commonly occur in pitchers, they can be seen in any athlete who participates in repetitive overhand throwing.

Common Throwing Injuries of the ElbowWhen athletes throw repeatedly at high speed, the repetitive stresses can lead to a wide range of overuse injuries. Problems most often occur at the inside of the elbow because considerable force is concentrated over the inner elbow during throwing. Flexor TendinitisRepetitive throwing can irritate and in�ame the �exor/pronator tendons where they attach to the humerus bone on the inner side of the elbow. Athletes will have pain on the inside of the elbow when throwing, and if the tendinitis is severe, pain will also occur during rest. Ulnar Collateral Ligament (UCL) InjuryThe ulnar collateral ligament (UCL) is the most commonly injured ligament in throwers. Injuries of the UCL can range from minor damage and in�ammation to a complete tear of the ligament. Athletes will have pain on the inside of the elbow, and frequently notice decreased throwing velocity. Ulnar NeuritisWhen the elbow is bent, the ulnar nerve stretches around the bony bump at the end of the humerus. In throwing athletes, the ulnar nerve is stretched repeatedly, and can even slip out of place, causing painful snapping. This stretching or snapping leads to irritation of the nerve, a condition called ulnar neuritis. Throwers with ulnar neuritis will notice pain that resembles electric shocks starting at the inner elbow (often called the "funny bone") and running along the nerve as it passes into the forearm. Numbness, tingling, or pain in the small and ring �ngers may occur during or immediately after throwing, and may also persist during periods of rest. Ulnar neuritis can also occur in non-throwers, who frequently notice these same symptoms when �rst waking up in the morning, or when holding the elbow in a bent position for prolonged periods.

Treatment Nonsurgical TreatmentIn most cases, treatment for throwing injuries in the elbow begins with a short period of rest. During this period of rest patients may receive physical therapy to help restore �exibility and strength which also would include a gradual return to throwing. Anti-in�ammatory medications such as ibuprofen and naproxen may help reduce pain and swelling, and can be provided in prescription-strength form.

Elbow Injuries in the Throwing Athlete

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Contact Info

For more information about Wayne HealthSports or Wayne HealthCare Outpatient Rehabilitation, please contact Jim Beyke at james.beyke@waynehealthcare.org or (937) 547-5714.

Visit us online at www.waynehealthcare.org.

Surgical TreatmentIf painful symptoms are not relieved by nonsurgical methods, and the athlete desires to continue throwing, surgical treatment may be considered. Through arthroscopic surgery, the surgeon inserts a small camera, called an arthroscope, into the elbow joint. The camera displays pictures on a televi-sion screen, and the surgeon uses these images to guide miniature surgical instruments. Because the arthroscope and surgical instruments are thin, the surgeon can use very small incisions (cuts), rather than the larger incision needed for standard, open surgery. UCL reconstruction - Athletes who have an unstable or torn UCL, and who do not respond to non-surgical treatment, are candidates for surgical ligament reconstruction. Most ligament tears cannot be sutured (stitched) back together. To surgically repair the UCL and restore elbow strength and stability, the ligament must be reconstructed. During the procedure, the doctor replaces the torn ligament with a tissue graft. This graft acts as a sca�olding for a new ligament to grow on. In most cases of UCL injury, the ligament can be reconstructed using one of the patient's own tendons.This surgical procedure is referred to as "Tommy John surgery" by the general public, named after the former major league pitcher who had the �rst successful surgery in 1974. Today, UCL reconstruction has become a common procedure, helping professional and college athletes continue to compete in a range of sports. Ulnar nerve anterior transposition - In cases of ulnar neuritis, the nerve can be moved to the front of the elbow to prevent stretching or snapping. This is called an anterior transposition of the ulnar nerve.

RecoveryIf nonsurgical treatment is e�ective, the athlete can often return to throwing in 6 to 9 weeks. If surgery is required, recovery will be very di�erent depending upon the procedure performed. If UCL reconstruction is performed, it may take 6 to 9 months or more to return to competitive throwing.

PreventionRecent research has focused on indentifying risk factors for elbow injury and strategies for injury prevention. Proper conditioning, technique, and recovery time can help to prevent throwing injuries in the elbow. In the case of younger athletes, pitching guidelines regarding number of pitches per game and week, as well as type of pitches thrown, have been developed to protect children from injury.

Article written by Brady Boeckman,AT,ATC,PTA

Elbow Injuries in the Throwing Athlete

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Meet Our Team

James BeykeDirector of Rehabilitation

Services

Jim Beyke grew up in Greenville, Ohio graduating from GHS in 1989. In high school, Jim lettered in football and enjoyed power lifting. Jim attended the University of Toledo, earning a Bachelor of Science degree in Exercise Science in 1993. Jim returned to Greenville and began employment at Wayne Hospital as a Physical Therapy Aide in 1993.

Jim then attended Andrews University, earning a Master of Physical Therapy degree in 1996. Jim worked as a sta� Physical Therapist from 1996-2003. In 2004, Jim was promoted to the Director of Rehabilitation Services. Jim started the Wayne HealthSports program in 2011 with the assistance of the Dayton Sports Medicine Institute. The program grew very quickly and now includes Ansonia, Greenville, and Versailles school systems. “ I enjoy working with Dr. Hatic and his sta�. He is very �exible and understands the importance of getting athletes in for evaluation quickly so they can return to playing their sport in the most e�cient manner.” “Our Athletic Trainers are dedicated to their athletes and coaches. It is a very demanding �eld and requires someone that can think quickly on the go. I am very proud of my sta� and the role they play in their schools.”

Jim enjoys working with athletes because of their high motivation and drive to succeed. Jim has been involved in coaching baseball and youth football teams for several years. Jim is married to Michelle and they have two sons, Brandon and Tyler. Jim and Michelle enjoy attending sporting events.

Safet O. Hatic IIOrthopedic Surgeon

As a fellowship-trained orthopedic foot and ankle surgeon, Dr. Hatic focus is on a broad spectrum of foot and ankle disorders and injuries, including sports medi-cine, fracture care, arthritis, Achilles and heel pain, adult �at foot, bunions/ham-mertoes, and diabetic foot and ankle care. Dr. Hatic has a special interest in emerging techniques for cartilage restoration and total ankle replacement.

A�liations/Memberships· American Osteopathic Association· American Osteopathic Academy of Orthopedics· American Orthopedic Foot and Ankle Society

Education· Fellowship, orthopedic foot and ankle· Orthopedic Foot and Ankle Center (Columbus, Ohio)· Doctor of Osteopathic Medicine· Ohio University College of Osteopathic Medicine

Volume 1, Issue 2 - April 2015Wayne HealthSports - Outpatient Rehabilitation - Greenville, OH 45331 - 937-547-5714

Date:Thursday, May 7th

Wednesday, May 20th

Cost:$10

(cash or check only)Pre-registration required!

Location:Family Health

5735 Meeker RdGreenville, OH 45331

Phone:(937) 547-5714

Time:6:00 PM - 9:00 PM

Wayne HealthCare, Orthopedic Associates of Southwest Ohio and Family Health are collaborating to provide a full, comprehensive sports physical for Darke County athletes

at Greenville, Versailles and Ansonia schools entering grades 7-12.

2015-16 School Year Sports PhysicalsSponsored

by

Please contact your Athletic Department to sign up or for additional details.