Medical Moneyball - The Rise Of Injury Analytics

Robert Griffin III
What if?  It’s a question that many of the world’s top teams asked in the last year when faced with ill-timed injuries to key players.  What if Derrick Rose of the Chicago Bulls, Robert Griffin III of the Redskins, Derek Jeter of the Yankees or Lionel Messi of Barcelona could have avoided their season ending injuries?  

Some are just the result of unlucky, violent contact but others have their origin from a combination of fatigue and overuse.  What if athletic trainers and team physicians could find early clues and signals that an athlete was at risk of breaking down?  Now, with the use of data analytics, that crystal ball may have finally arrived.

Stan Conte, VP of medical services for the Los Angeles Dodgers, 
declared last year, "in a post-Moneyball world, injury risk assessment is the final frontier."  At this year’s Sloan Sports Analytics Conference, he presented some surprising data to reinforce the rising toll of injuries;  just over 50% of all starting pitchers in the MLB had some type of injury during last season, lasting an average of 65 days on the disabled list.  Across all MLB players in 2012, the salaries of injured players plus the players that replaced them cost their teams almost $600 million.

Even at the Olympics, the world’s premier athletic showcase, the impact of injuries is significant.  Big names like Paula Radcliffe, Asafa Powell, and Rafael Nadal could not complete their gold medal quest.  Lars Engebretsen, a physician and professor at the University of Oslo and chief physician of the Norwegian Olympic team, has been tracking injuries and illness at the Games for over a decade.  His latest report, released this month on the 2012 London Olympics, recorded 1,361 injuries and 758 illnesses among the 10,568 athletes, which equates to injury and illness rates of 11% and 7%, respectively.  Unfortunately, these percentages are similar with the last two Summer Olympics in Beijing and Athens, highlighting the lack of progress in reducing lost time in competition.

In this Scientific American graphic, Engebretsen’s data from the 2008 Summer Olympics and the 2010 Winter Olympics shows that overuse caused 22% of summer athletes' injuries while 54% of winter athletes were injured in training.

Like the Dodgers, teams across the globe are beginning to search for answers.  As Big Data creeps into all aspects of athlete development, injury analytics is the new secret weapon.  That is what pushed the Leicester Tigers rugby union club to dig into the details.  Leicester, 9-time English champions, faces the challenge of tight budgets that requires keeping the best players on the field.

According to Andy Shelton, Leicester’s head of sports science, strength and conditioning, any competitive edge is worth the investment.  "It gets more competitive every year and our focus must be on helping our players stay injury-free for longer," he told the BBC. "When we have our key players available against the top European sides, we can compete and we will win, so the question is how do we keep key players on the pitch?"

Metrifit Predictive Analytics
Factoring in variables like fatigue, stress, sleep and training intensity into a predictive algorithm can yield what may have been hidden trends and combinations that cause injuries. 

“Similarly we also collect data on previous injuries that they had and what they are doing in the gym, ­basically everything they do from when they walk in the door of the club in the morning and leave in the evening is collected,” Shelton added. “The aim is to be able to affect a player’s lifestyle through the week. For example, if they recorded a very good night’s sleep, then their risk of injury could go down from ‘predicted injured’ to ‘not-predicted injured.’”

Some coaches and trainers still feel that using predictive analytics to create an injury model based on volumes of underlying data seems a little over the top.  But if your job is to develop healthy, productive athletes that win, then any tool that provides an edge is worth a look.

"Traditional baseball types tell me to just give up, that this is a waste of time because injuries are mostly bad luck,” Conte commented. "Twenty-five years ago no one listened to Bill James either."

Andy Shelton agrees, "There is no point in collecting stats unless you can know what to do with it. But by predicting things before they happen is where we can make gains, and considerably enhance performance."

Body Checking In Youth Hockey Causes More Brain Injuries

Youth hockey players in the Atom division of Hockey Canada are more than 10 times likely to suffer a brain injury since bodychecking was first allowed among the 9 and 10-year-olds, says a study led by St. Michael's Hospital neurosurgeon Dr. Michael Cusimano.

The findings, published online in the journal Open Medicine, add to the growing evidence that bodychecking holds greater risk than benefit for youth and support widespread calls to ban the practice.

According to the researchers, led by Cusimano, director of the Injury Prevention Research Centre at St. Michael's Hospital in Toronto, the odds of visiting an emergency department due to a brain injury from bodychecking increased significantly among all minor hockey players after Hockey Canada relaxed bodychecking rules in the 1998/1999 season. At that time, the organization allowed, for the first time, body contact among 9 and 10 year-olds in the Atom division.

The team examined the records of 8,552 male youth 6-17 years-old who attended one of five emergency departments in Ontario for hockey related injuries that occurred before and after the rule change. Researchers found more than half of hockey-related injuries were a result of bodychecking. What's more, the risk of a head or neck injury, including concussions, increased across all minor hockey divisions.
"Our work confirmed the fact that body checking is the most common cause of injury in hockey. While proponents argue lowering the age for bodychecking helps players learn how to properly bodycheck and reduces injuries at older ages, our study clearly showed the opposite ― the risk of all injuries and especially, brain injuries, increases with exposure to bodychecking," Cusimano said. "While all age groups showed increases in injuries, the youngest were the most vulnerable and that bodychecking puts youth unnecessarily at the risk of the long-term effects of brain injuries, such as cognitive and social-behavioural problems."

For some time, researchers like Dr. Cusimano have called on organizations like the NHL to take more leadership in reducing the incidence of brain injuries. In recent weeks, pressure has mounted on the NHL after Pittsburgh Penquins captain Sidney Crosby and Montreal Canadiens' Max Pacioretty suffered serious concussions that sidelined both players.

"Ice hockey is a sport with great potential to increase the health of individuals but practices that increase the risk for the vast majority of players must be minimized," Cusimano adds. "It is now very clear that there is no benefit to any one or any group to continue to allow bodychecking. Hockey organizers, sponsors, the media, coaches, trainers, and players and parents must come together to advocate for multifaceted approaches that include changes to the rules to reduce the risk of injury."

Source: St. Michael's Hospital and Michael D Cusimano, Nathan A Taback, Steven R McFaull, Ryan Hodgins, Tsegaye M Bekele, Nada Elfeki; Canadian Research Team in Traumatic Brain Injury and Violence. Effect of bodychecking on rate of injuries among minor hockey players. Open Medicine, Vol 5, No 1 (2011)

See also: New Return-To-Play Guidelines For Sports Concussions and Youth Sports Concussions Double In Last Ten Years

Research Says Don't Bother With Stretching Before You Run

Stretching before a run neither prevents nor causes injury, according to a study presented at the 2011 Annual Meeting of the American Academy of Orthopaedic Surgeons (AAOS).  More than 70 million people worldwide run recreationally or competitively, and recently there has been controversy regarding whether runners should stretch before running, or not at all.

This study included 2,729 runners who run 10 or more miles per week. Of these runners, 1,366 were randomized to a stretch group, and 1,363 were randomized to a non-stretch group before running. Runners in the stretch group stretched their quadriceps, hamstrings, and gastrocnemius/soleus muscle groups. The entire routine took 3 to 5 minutes and was performed immediately before running.

The study found that stretching before running neither prevents nor causes injury. In fact, the most significant risk factors for injury included the following:
  • history of chronic injury or injury in the past four months;
  • higher body mass index (BMI); and
  • switching pre-run stretching routines (runners who normally stretch stopping and those who did stretch starting to stretch before running).
"As a runner myself, I thought stretching before a run would help to prevent injury," said Daniel Pereles, MD, study author and orthopaedic surgeon from Montgomery Orthopedics outside Washington, DC. "However, we found that the risk for injury was the same for men and women, whether or not they were high or low mileage runners, and across all age groups. But, the more mileage run or the heavier and older the runner was, the more likely he or she was likely to get injured, and previous injury within four months predisposed to even further injury," he added.

Runners who typically stretch as part of their pre-run routine and were randomized not to stretch during the study period were far more likely to have an injury. "Although all runners switching routines were more likely to experience an injury than those who did not switch, the group that stopped stretching had more reported injuries, implying that an immediate shift in a regimen may be more important than the regimen itself," he added.

The most common injuries sustained were groin pulls, foot/ankle injuries, and knee injuries. There was no significant difference in injury rates between the runners who stretched and the runners who didn't for any specific injury location or diagnosis.

Source: American Academy of Orthopaedic Surgeons

See also: Get Off The Treadmill And On The Trail and High Intensity Workout Gets The Job Done

Youth Baseball Pitchers Need To Stay Under 100 Innings Per Year

For years, sports medicine professionals have talked about youth pitching injuries and the stress the motion causes on developing bones and muscles. In a new, 10-year study published in the February issue of the American Journal of Sports Medicine, researchers showed that participants who pitched more than 100 innings in a year were 3.5 times more likely to be injured.

"The study proved a direct link between innings pitched in youth and adolescent baseball and serious pitching injuries. It highlights the need for parents and coaches to monitor the amount of pitching for the long-term success and health of these young athletes. We need to all work together to end the epidemic of youth sports injuries, and education through campaigns like STOP Sports Injuries is in excellent first step," said lead researcher, Glenn S. Fleisig, PhD, of the American Sports Medicine Institute in Birmingham, Alabama.

The study followed 481 pitchers for 10-years (1999-2008). All were healthy, active youth (aged 9 to 14 years) baseball pitchers at the beginning of the study. Every year each participant was asked whether he played baseball in the previous 12 months and if so what positions, how many innings pitched, what types of pitches he threw, for what teams (spring, summer, fall, winter), and if he participated in baseball showcases. Each player was also asked every year if he had an elbow or shoulder injury that led to surgery or retirement from baseball.

During the 10-year span, five percent of the pitchers suffered a serious injury resulting in surgery or retirement. Two of the boys in the study had surgery before their 13th birthday. Only 2.2 percent were still pitching by the 10th year of the study.

"It is a tough balancing act for adults to give their young athletes as much opportunity as possible to develop skills and strength without exposing them to increased risk of overuse injury. Based on this study, we recommend that pitchers in high school and younger pitch no more than 100 innings in competition in any calendar year. Some pitchers need to be limited even more, as no pitcher should continue to pitch when fatigued," said Fleisig.

The study also looked at the trend of playing pitcher and catcher in the same game, which did appear to double or triple a player's risk of injury but the trend was not statistically significant. The study also could not determine if starting curveballs before age 13 increases the risk of injury.


Source:  American Orthopaedic Society for Sports Medicine and K. E. Wilk, L. C. Macrina, G. S. Fleisig, R. Porterfield, C. D. Simpson, P. Harker, N. Paparesta, J. R. Andrews. Correlation of Glenohumeral Internal Rotation Deficit and Total Rotational Motion to Shoulder Injuries in Professional Baseball Pitchers. The American Journal of Sports Medicine, 2010; DOI: 10.1177/0363546510384223

See also: Do Young Athletes Need Practice Or Genetics? A Conversation With Peter Vint and  Breaking Curveballs And Rising Fastballs Are Optical Illusions

ESPN Study Finds Retired NFL Players Are Heavy Users Of Pain Meds

Retired NFL players use painkillers at a much higher rate than the rest of us, according to new research conducted by investigators at Washington University School of Medicine in St. Louis.  The researchers say the brutal collisions and bone-jarring injuries associated with football often cause long-term pain, which contributes to continued use and abuse of painkilling medications.

The study is published online in the journal Drug and Alcohol Dependence. It involved 644 former NFL players who retired from football between 1979 and 2006. Researchers asked them about their overall health, level of pain, history of injuries, concussions and use of prescription pain pills.

The study found that 7 percent of the former players were currently using painkilling opioid drugs. That's more than four times the rate of opioid use in the general population. Opioids are commonly prescribed for their analgesic, or pain-relieving, properties. Medications that fall within this class of drugs include morphine, Vicodin, codeine and oxycodone.

"We asked about medications they used during their playing careers and whether they used the drugs as prescribed or whether they had ever taken them in a different way or for different reasons," says principal investigator Linda B. Cottler, PhD, professor of epidemiology in psychiatry at Washington University. "More than half used opioids during their NFL careers, and 71 percent had misused the drugs. That is, they had used the medication for a different reason or in a different way than it was prescribed, or taken painkillers that were prescribed for someone else."

Those who misused the drugs during their playing days were more likely to continue misusing them after retiring from football. Some 15 percent of those who misused the drugs as active players still were misusing them in retirement. Only 5 percent of former players who took the drugs as prescribed misused them after they retired from the NFL.

Cottler, director of the Epidemiology and Prevention Research Group in the Department of Psychiatry, says it's not clear from the study whether retired players became dependent on the drugs. What is clear from the survey, she says, is that retired NFL players continue to live with a lot of pain.
"The rate of current, severe pain is staggering," she says. "Among the men who currently use prescription opioids -- whether misused or not -- 75 percent said they had severe pain, and about 70 percent reported moderate-to-severe physical impairment."

Pain was one of the main predictors of current misuse. Another was undiagnosed concussion. Retired NFL players in the study experienced an average of nine concussions each. Some 49 percent had been diagnosed with a concussion at some point during their playing careers, but 81 percent suspected they had concussions that were not diagnosed. Some players believed they may have had up to 200 concussions during their playing days.

"Many of these players explained that they didn't want to see a physician about their concussions at the time," says Simone M. Cummings, PhD, a senior scientist in psychiatry who conducted phone interviews with the former players. "These men said they knew if they reported a concussion, they might not be allowed to play. And if you get taken out of a game too many times, you can lose your spot and get cut from the team."

She says players with suspected-but-undiagnosed concussions reported they borrowed pills from teammates, friends or relatives to treat the pain themselves, thus misusing opioids in an attempt to remain in the NFL. Although 37 percent of the retired players reported that they had received opioids only from a doctor, the other 63 percent who took the drugs during their NFL careers admitted that on occasion they got the medication from someone other than a physician.

Retired players currently misusing opioid drugs also are more likely to be heavy drinkers, according to Cottler.  "So these men are at elevated risk for potential overdose," she says. "They reported more than 14 drinks a week, and many were consuming at least 20 drinks per week, or the equivalent of about a fifth of liquor."

The ESPN sports television network commissioned the study, which also was funded by the National Institute on Drug Abuse. The ESPN program "Outside the Lines" spoke informally to many retired players about their use of painkillers. One reported taking up to 1,000 Vicodin tablets per month. Another reported ingesting 100 pills per day and spending more than $1,000 per week on painkillers.
Former St. Louis Rams offensive lineman Kyle Turley said in a statement to ESPN that he knew of many players who took drugs to help them deal with the pain inflicted by the injuries they sustained in the NFL.

"I know guys that have bought thousands of pills," Turley said. "Tons of guys would take Vicodin before a game."

The researchers say offensive linemen had particularly high rates of use and misuse of opioids.
"The offensive linemen were twice as likely as other players to use or misuse prescription pain medicines during their NFL careers," Cottler says. "In addition, this group tends to be overweight and have cardiovascular problems, so they represent a group of former players whose health probably should be monitored closely."

In fact, Cottler says it would be a good idea to continue monitoring everyone who has played in the NFL. She says this study revealed that some 47 percent of retired players reported having three or more serious injuries during their NFL careers, and 61 percent said they had knee injuries. Over half, 55 percent, reported that an injury ended their careers.

"These are elite athletes who were in great physical condition when their playing careers began," she says. "At the start of their careers, 88 percent of these men said they were in excellent health. By the time they retired, that number had fallen to 18 percent, primarily due to injuries. And after retirement, their health continued to decline. Only 13 percent reported that they currently are in excellent health. They are dealing with a lot of injuries and subsequent pain from their playing days. That's why they continue to use and misuse pain medicines."

Source:   Washington University School of Medicine and Linda B. Cottler, Arbi Ben Abdallah, Simone M. Cummings, John Barr, Rayna Banks, Ronnie Forchheimer. Injury, pain and prescription opioid use among former NFL football players. Drug and Alcohol Dependence, 2011; DOI: 10.1016/j.drugalcdep.2010.12.003

See also:  NFL Concussions Taking Bigger Toll On Players and NFL Linemen Trade Health For Super Bowl Rings

Kicking Style Of Women Soccer Players May Cause Injury

Significant differences in knee alignment and muscle activation exist between men and women while kicking a soccer ball, according to a study published this month in the Journal of Bone and Joint.

Data reveal that males activate certain hip and leg muscles more than females during the motion of the instep and side-foot kicks -- the most common soccer kicks -- which may help explain why female players are more than twice as likely as males to sustain an Anterior Cruciate Ligament (ACL) injury.

Soccer is one of the fastest-growing sports in the United States with approximately 20 million registered players and an annual participation increase of more than 20 percent , according to statistics from the National Collegiate Athletic Association (NCAA) . Women also are playing this sport on more competitive levels. Prior research shows that females are more prone to non-contact ACL injuries than males and though many theories exist, a direct cause for the disparity is unknown.

"By analyzing the detailed motion of a soccer kick in progress, our goal was to home in on some of the differences between the sexes and how they may relate to injury risk," said orthopaedic surgeon Robert H. Brophy, MD, study author and assistant professor of orthopedics, Washington University School of Medicine in St. Louis. "This study offers more information to help us better understand the differences between male and female athletes, particularly soccer players."

Dr. Brophy and his colleagues from the Motion Analysis Laboratory and Sports Medicine Service at the Hospital for Special Surgery in New York used 3-D video-based motion analysis and electromyography to examine the differences between 13 male and 12 female college soccer players during the action of kicking a soccer ball.

Using eight to 10 video cameras, 21 retroreflective markers and 16 electrodes simultaneously, researchers measured the activation of seven muscles (iliacus, gluteus maximus, gluteus medius, vastus lateralis, vastus medialis, hamstrings and gastrocnemius) in both the kicking and supporting legs; as well as two additional muscles (hip adductors and tibialis anterior) in the kicking leg only. Five instep and five side-foot kicks were recorded for each player. Muscle activation was recorded as a percentage of maximum voluntary isometric contraction.

They found that male players activate the hip flexors (inside of the hip) in their kicking leg and the hip abductors (outside of the hip) in their supporting leg more than females.

* In the kicking leg, men generated almost four times as much hip flexor activation as females (123 percent in males compared to 34 percent in females).
* In the supporting leg, males generated more than twice as much gluteus medius activation (124 percent in males compared with 55 percent in females) and vastus medialis activation (139 percent in males compared with 69 percent in females).

"Activation of the hip abductors may help protect players against ACL injury," said Dr. Brophy, a former collegiate and professional soccer player and past head team physician for the former St. Louis Athletica professional women's soccer club. "Since females have less activation of the hip abductors, their hips tend to collapse into adduction during the kick, which can increase the load on the knee joint in the supporting leg, and potentially put it at greater risk for injury."

Brophy said that although the study does not establish a direct cause-and-effect relationship between muscle activation and knee alignment and ACL injuries, the finding "moves us toward better understanding of what may contribute to differences in injury risk between the sexes and what steps we might take to offset this increased risk in females."

The current research in the area of ACL injury prevention has shown some promise. For example, in 2008, the Centers for Disease Control and Prevention published a study that found a new training program called the Prevent Injury and Enhance Performance (PEP) program, was effective in reducing ACL injuries in female soccer players. Developed by the Santa Monica Orthopedic and Sports Medicine Research Foundation and supported by the American Academy of Orthopaedic Surgeons (AAOS) among other medical and athletic associations, PEP is an alternative warm-up regimen that focuses on stretching, strengthening and improving balance and movements and can be conducted during regular practice time and without special equipment.

"Programs focusing on strengthening and recruiting muscles around the hip may be an important part of programs designed to reduce a female athletes' risk of ACL injury," said Dr. Brophy. "Coaches and trainers at all levels, from grade school through professional, should consider using strategies that demonstrate potential to prevent these injuries."

He said that additional research is warranted to investigate how the differences in hip muscle activation and alignment between the sexes may relate to differences in the risk of lower extremity injury among athletes in soccer and other sports.

Source:  American Academy of Orthopaedic Surgeons

See also: Goalkeepers Use Clues To Guess Direction Of Penalty Kick and Youth Sports Coaches Should Prioritize Teaching Over Winning

Body Checking Not The Main Cause Of Youth Hockey Injuries

Hockey fans likely would assume that body-checking -- intentionally slamming an opponent against the boards -- causes the most injuries in youth ice hockey. But they would be wrong.  Findings from a new study, the largest and most comprehensive analysis to date of young hockey players, show that 66 percent of overall injuries were caused by accidentally hitting the boards or goal posts, colliding with teammates or being hit by a puck.

Only 34 percent of the injuries were caused by checking. Moreover, the accidental injuries were more severe than those from body checks.

These results, which appeared in June issue of the British Journal of Sports Medicine, were a surprise to many, including the researchers at the University at Buffalo who conducted the five-year study.

"There is an image of body checking as a form of violence that is condoned by the game of hockey," says Barry Willer, PhD, UB professor of psychiatry and rehabilitation sciences and senior author on the study.  "However, this study found that body checking did not account for a large proportion of injuries. Perhaps as important, body checking did not lead to a rise in intentional injuries."


The youth ice hockey program in Burlington, Ontario, Canada was the base of the study. The researchers compared injury rates overall for the three levels of competition: "house leagues," where there is no body checking; "select," in which checking is allowed at age 11 and older; and "representative," for the most skilled players, which allows checking in all divisions at age nine and above.
 
They also examined injury rates as level of competition and players' age increased, and how injury rates varied in games versus practices. The data covered 3,000 boys ages four to 18 for a total of 13,292 player years. Only injuries that kept a player off the ice for at least 24 hours were included.
Their analysis of the data shows that there were three times more accidental injuries than body-checking injuries in the house leagues -- 92 versus 30. Willer says accidents at this level of competition primarily are caused by players watching the puck instead of what's in front of them, of not playing "heads-up," which coaches try to instill at all levels.

The "select" level tallied the least injuries (28) with more than half intentional, as players first experience checking. In the most experienced league, however, 59 percent of the 96 injuries were unintentional, but the number of intentional injuries (39) was the highest of all the categories, as competition level increases.

As the researchers predicted, as the level of competition and players' age increases, so did injuries. "Game injuries were much more frequent among the highly skilled players on rep teams," says Willer. Rates during practice were low across all age groups and divisions.  Willer notes that this study doesn't answer two important questions: at what age should body checking be allowed in youth hockey, or should it be allowed at all?

"The study does suggest," says Willer, "that, regardless of whether young players are allowed to body check, unintentional contact with the board, the ice or other players are important sources of serious unintended injury. To avoid these accidents, hockey coaches must teach players to keep their heads up, rather than looking down at the puck."

Sources: University at Buffalo and Darling et al. Intentional versus unintentional contact as a mechanism of injury in youth ice hockey. British Journal of Sports Medicine, 2010

See also: Science Fair Project Leads To New Sports Concussion Test and Lifting The Fog Of Sports Concussions

Little League Arm Injuries Jump Up

Throwing arm injuries are on the rise in Little League and other youth baseball programs. After these injuries occur, many players are out for the season; others require surgery and must refrain from play for an even longer duration; still others sustain injuries so severe that they cause permanent damage and are unable to continue playing baseball.

Three new studies presented at the at the 2010 Annual Meeting of the American Academy of Orthopaedic Surgeons (AAOS) address this critical issue, each offering new solutions to help prevent these injuries.

Pitchers and catchers under the age of 15 often experience tightness of a shoulder ligament known as the posterior-inferior glenohumeral ligament. If this ligament is not stretched, it will become increasingly tighter and more prone to pain or injury as the player ages, if that player continues to play baseball.

A study of 1,267 youth baseball players, led by Charles Metzger, MD, an orthopaedic surgeon specializing in upper extremities in Houston, Texas, found that a simple stretch known as the posterior capsular stretch can help.



"A posterior capsular stretch is done after play and since it is different from the general stretches players already know, it must be taught," says Dr. Metzger. "Once learned, however, it is very simple, and takes only five minutes to complete. Nearly 97 percent of young players who performed the stretch properly and consistently reported shoulder improvement."

Dr. Metzger supports Safe Throw, an injury-prevention and rapid return-to-play program. Instructions and diagrams showing how to perform the posterior capsular stretch can be found on www.safethrow.com.


The elbow is the most frequently reported area of overuse injury in child and adolescent baseball players. One type of overuse includes osteochondral lesions, which are tears or fractures in the cartilage and underlying bone, covering the elbow joint.

In a study led by Tetsuya Matsuura, MD, Department of Orthopedics, The University of Tokushima Graduate School, Institute of Health Bioscience in Tokushima, Japan, 152 baseball players were observed (ranging in age from 8 to12) for one season to study the injury incidence in relation to their playing positions. These players had no history of problematic elbow pain.

The results were as follows:

* 38 players, or 25 percent complained of elbow pain
* 26 (68.4 percent) had limitations of range of motion and/or tenderness on the elbow, and/or valgus stress pain (a stressful force placed upon the ligaments on the inner side of the elbow joint); and
* 22 (84.6 percent) had osteochondral lesions including:
  • 12 pitchers (54.6 percent)
  • 6 catchers (27.3 percent)
  • 3 infielders (13.6 percent)
  • 1 outfielder (4.5 percent).

Dr. Matsuura concluded, "Twenty-five percent of child and adolescent baseball players have elbow pain and nearly 15 percent sustain osteochodral lesions per year and pitchers have the highest rate of osteochondral lesions. If overuse injuries such as osteochrondral lesions occur, prompt diagnosis and treatment can prevent this injury from causing long-term damage. Better awareness and education among parents, players and especially coaches about risk factors can help prevent these injuries."

Reviewing -- and adhering to -- youth baseball throwing guidelines can help prevent injury

In another presentation, led by George A. Paletta, Jr., MD, an orthopaedic surgeon at the Orthopedic Center of St. Louis and Medical Director/Head Team Physician of the St. Louis Cardinals, discussed the increase in elbow injuries of young baseball players, including the increasing number of ligament reconstruction or "Tommy John" procedures performed.

Despite these increases, Dr. Paletta says there are identifiable -- and controllable -- risk factors of which young athletes, parents and coaches should be aware, to help reduce injury.

"A young athlete should never throw through pain or continue to pitch when he or she is obviously fatigued," says Dr. Paletta. "Additionally, parents should familiarize themselves with the recommended single game, weekly and season total pitch counts, suggested recovery times, and recommended ages for learning various pitches."

Dr. Paletta stresses that there must be a greater focus on education and research in this area, or more young baseball players will sustain serious injury.

Source: American Academy of Orthopaedic Surgeons

See also: Kids' Baseball Injuries Down But Some Still Play "Until It Hurts" and Baseball Brains - Pitching Into The World Series

Cyclists' Sore Seats Signal Serious Symptoms

For any guy who has endured more than thirty minutes on a road bicycle seat, there is usually some concern over the strange numbness that occurs in places that should not go numb. Well, a new study has some good and bad news.

Spanish researchers have found that active male cyclists have lower quality sperm to the point of infertility risk. Among other things, they blame the painful "function over form" design of the wedge bicycle seat.

The good news is that unless you're training to be in the next Tour de France with Lance Armstrong, your time on the saddle shouldn't do any long-term damage.

A team led by professor Diana Vaamonde, from the University of Cordoba Medical School, tracked the workout regimen of 15 Spanish triathletes, with an average age of 33 who had been training for at least eight years, while also monitoring their sperm morphology.



For those in the test group that covered more than 180 miles per week on their bikes, the percentage of normal looking sperm dropped from a group average of 10 percent to 4 percent, a rate where infertility problems begin. Increased swimming or running did not affect sperm quality.

"We found a statistically adverse correlation between sperm morphology and the volume of cycling training undertaken per week," Vaamonde said. "We believe that all the factors inherent in this sports activity, especially with regards to the cycling part, may affect sperm quality," she added. "Moreover, we think that normal physiological homeostasis – the body’s ability to regulate its own environment – may become irreversibly altered, therefore resulting in complex anomalies."

Vaamonde cited three possible reasons for the results: the increased heat during exercise, the friction and pressure against the seat causing microtrauma on the testes, and the overall rigor of intense exercise.

The study was released last week in Amsterdam at the annual conference of the European Society of Human Reproduction and Embryology (ESHRE).

The Spanish researchers were following up on research from 2002 that showed similar results for mountain bikers. In that study, Austrian researcher Ferdinand Frauscher tested 40 active (two hours per day) mountain bikers with 30 non-bikers. He found that the bikers had about half the sperm count of the non-bikers. Frauscher explained (as only a medical doctor can) the possible reasons: "The exact causes for the decreased sperm motility are unclear. We believe that repeated mechanical trauma to the testicles results in some degree of vascular damage, and may thereby cause a reduction in sperm motility." Ouch.

For casual bike riders, the risk is still quite low. Allan Pacey, senior lecturer in andrology at the University of Sheffield, told BBC News, "It is important to stress that even if the association between cycling and poor sperm morphology is correct, men training for triathlons are spending much more time in the saddle than the average social cycler or someone who might cycle to and from work."

For those that are still not okay with the "saddle sores," there are always the anatomically correct seats and the padded biker shorts, not to mention recumbent bikes. Beyond that, maybe a nice jog would be better.

Kids' Baseball Injuries Down But Some Still Play "Until It Hurts"

At a recent baseball game, the 12-year-old second baseman on my son's team had a ground ball take a nasty hop, hitting him just next to his right eye. He was down on the field for several minutes and was later diagnosed at the hospital with a concussion.

Thankfully, acute baseball injuries like this are on the decline, according to a new report. However, several leading physicians say overuse injuries of young players caused by too much baseball show no signs of slowing down.

Our unlucky infielder's hospital injury report may become part of a national database called the National Electronic Injury Surveillance System (NEISS), part of the U.S. Consumer Product Safety Commission. It monitors 98 hospitals across the country for reports on all types of injuries.

Bradley Lawson, Dawn Comstock and Gary Smith of Ohio State University filtered this data to find just baseball-related injuries to kids under 18 from 1994-2006.

During that period, they found that more than 1.5 million young players were treated in hospital emergency rooms, with the most common injury being, you guessed it, being hit by the ball, and typically in the face.

The good news is that the annual number of baseball injuries has decreased by 24.9 percent over those 13 years. The researchers credit the decline to the increased use of protective equipment.

"Safety equipment such as age-appropriate breakaway bases, helmets with properly-fitted face shields, mouth guards and reduced-impact safety baseballs have all been shown to reduce injuries," Smith said. "As more youth leagues, coaches and parents ensure the use of these types of safety equipment in both practices and games, the number of baseball-related injuries should continue to decrease. Mouth guards, in particular, should be more widely used in youth baseball."

Their research is detailed in the latest edition of the journal Pediatrics.

The bad news is ...
 
While accident-related injuries are down, preventable injuries from overuse still seem to be a problem, according to author Mark Hyman. In his recent book, "Until It Hurts," Hyman admits his own mistakes in pressuring his 14-year-old son to continue pitching with a sore arm, causing further injury.

Surprised by his own unwillingness to listen to reason, Hyman, a long-time journalist, researched the growing trend of high-pressure parents pushing their young athletes too far, too fast.

"Many of the physicians I spoke with told me of a spike in overuse injuries they had witnessed," Hyman told Livescience. "As youth sports become increasingly competitive — climbing a ladder to elite teams, college scholarships, parental prestige and so on — children are engaging in a range of risky behaviors."

One expert he consulted was Dr. Lyle Micheli, founder of one of the country's first pediatric sports medicine clinics at Children's Hospital in Boston. Micheli estimates that 75 percent of the young patients he sees are suffering from some sort of overuse injury, versus 20 percent back in the 1990s.

"As a medical society, we've been pretty ineffective dealing with this," Micheli said. "Nothing seems to be working."

Young surgeries

In severe overuse cases for baseball pitchers, the end result may be ulnar collateral ligament surgery, better known as "Tommy John" surgery. Dr. James Andrews, known for performing this surgery on many professional players, has noticed an alarming trend in his practice. Andrews told The Oregonian last month that more than one-quarter of his 853 patients in the past six years were at the high school level or younger, including one 7-year-old.

Last spring, Andrews and his colleagues conducted a study comparing 95 high-school pitchers who required surgical repair of either their elbow or shoulder with 45 pitchers that did not suffer injury.

They found that those who pitched for more than eight months per year were 500 percent more likely to be injured, while those who pitched more than 80 pitches per game increased their injury risk by 400 percent.  Pitchers who continued pitching despite having arm fatigue were an incredible 3,600 percent more likely to do serious damage to their arm.

Hyman encourages parents to keep youth sports in perspective. "I think that, generally, parents view sports as a healthy and wholesome activity. That's a positive. But, we live in hyper-competitive culture, and parents like to see their kids competing," he said. "It's not only sports. It's ballet and violin and SAT scores and a host of other things.  It's in our DNA."

Please visit my other sports science articles at Livescience.com.

Thoroughbred Horse Injuries Rise But Race Times Stay Flat

Imagine trying to walk on all fours using just your big toes and your middle fingers. That is similar to what modern thoroughbred racehorses endure when racing around a track at up to 30 mph.

This weekend's Belmont Stakes will be missing one of this year's stars, Rachel Alexandra, on the precaution that she needs to rest.  Just before last month's Kentucky Derby, three top contenders, Quality Road, I Want Revenge and Square Eddie were forced out of the race due to hoof and shin injuries.

Critics claim selective breeding may be producing an unstable horse anatomy that is prone to injury. Yet, a recent study claims that it all may be for naught, as thoroughbreds may have already reached their theoretical upper limits of speed.

Running on their toes
One of out ten thoroughbreds will suffer from some orthopedic problem, including fractures, which often lead to decisions to destroy them. In the United States, for every 1,000 horses starting a race, there will be 1.5 career-ending injuries, which is almost two per day.

By breeding for speed and power, the bulk of the horse increases while the ankles and lower legs do not,according to some veterinarians.

"Anatomically speaking, they run on their toes," said Lawrence R. Soma, professor at the University of Pennsylvania School of Veterinary Medicine. "That makes them very fragile."

The pounds per square inch load that is put on their hoofs would be similar to humans walking on their middle fingers, experts say. One misstep on a soft patch of the turf can cause a break.

So they're faster, right?
Given the large sums of money spent on breeding champion racehorses and the potential health side effects, is it worth it? Are the race times getting faster thanks to these selective genetic performance filters?  The answer is no, according to Mark Denny, Professor of Biology at Stanford University.

In a recent study published in the Journal of Experimental Biology, Denny analyzed the race time records for the three U.S. Triple Crown races; the Kentucky Derby, the Preakness Stakes, and the Belmont Stakes. The plateau for similar times for the Kentucky Derby began in 1949, while the Preakness and the Belmont set their plateaus in 1971 and 1973, respectively, Denny found.

"Evidence from the Triple Crown races suggests that the process of selective breeding of thoroughbreds (as practiced in the US) is incapable of producing a substantially faster horse," Denny writes. "Despite the efforts of the breeders, speeds are not increasing, and current attempts to breed faster horses may instead be producing horses that are more fragile."

The solution
Denny also tried to predict the fastest possible time for these horses. Using statistical modeling, he found that the maximum speed of a thoroughbred would be only 0.5 to 1 percent faster than seen today.

"These results suggest that definite speed limits do indeed exist for horses and that their current speeds are very close to these predicted limits," Denny said.

One reason for the limit may be the gene pool. Today's thoroughbreds descend from a lineage of only 12-29 ancestors, with 95 percent of today's thoroughbreds tracing their paternal roots to a single stallion, The Darley Arabian.

Denny suggests that breeding from outside this line might produce the potential for improvement.

Please visit my other sports science articles at Livescience.com.