Recovery from Hamstring Injuries in Major League Baseball

By Jerome Enad, MD

This study examined 58 Major League Baseball players who sustained a hamstring injury over four seasons. Number of games played and official at-bats were analyzed for 2 seasons before injury, the season of injury, and 2 seasons following injury. Games played for each season before injury were significantly greater than for the season of injury (p = 0.002 and p = 0.003 respectively). Games played for each season following injury were not significantly different than for the season of injury (p = 0.26 and p = 0.08 respectively). At-bats for each season before injury were significantly greater than the season of injury (p = 0.01 and p = 0.007 respectively). At-bats for each season following injury were not significantly different than the season of injury (p = 0.26 and p = 0.07 respectively). Seventeen players played one or less seasons after injury and were already playing less in 2 seasons before injury. If a hamstring injury occurs in a player with fewer games and at-bats in the 2 seasons before the injury, his career is at risk for ending soon after the injury. However, if the injury occurs in a player with high participation in games and at-bats in the 2 seasons leading up to the injury, he has a good chance of returning to the same level of participation after injury.

Keywords: hamstring; baseball; Major League; athletic injuries

1. Introduction

Hamstring injuries are a common in sports. A recent report of Major League Baseball (MLB) players estimated that among position players hamstring injuries are the most common lower extremity injuries, and second most common overall [1]. These injuries often result in a significant length of stay on the disabled list. Purported risk factors for hamstring injuries across all sports include previous injury [2-6], reduced hip flexor flexibility [4], hip weakness [7, 8], and reduced core stability [9, 10].

Earlier reports have suggested that injuries in MLB are not decreasing [1, 11]. Most of the injuries reported on the disabled list occur early in the season or pre-season [1, 12], which can potentially effect a player’s overall performance for the remainder of the season. In this report, we sought to characterize the epidemiology of hamstring strains occurring among position players in MLB and its association with future return to play.

2. Methods

2.1. Data

The Major League Baseball disabled list (DL), which is publicly available, was reviewed retrospectively from 2002 to 2005 [13]. The DL is an injury database verified by the trainer and team physician from each team. According to MLB rules, to be placed on the disabled list, the player must be certified as unable to play, with a specific diagnosis made by the team physician[14]. Once on the disabled list, the player cannot return to the active roster for a minimum of 15 days. The player can remain on the disabled list for as many days as necessary for him to return to play.

All players on the DL from 2002 to 2005 with a listed injury as “hamstring strain,” “hamstring pull,” “hamstring tear,” or “hamstring” injury were identified as the initial subject population. Seventy-six total players were identified. Since hamstring injuries occurred much less commonly in pitchers (3.3% of all injuries) compared to all other position players (13.7% of all injuries) [1], all of the pitchers were excluded from the analysis. If a player was placed on the DL for a hamstring injury more than one time on non-consecutive occasions during the study period, only the initial injury was included in the analysis.

Height, weight, position played, hand dominance, and age at time of injury were recorded, and each player’s body mass index (BMI) was calculated. Number of days on the DL for the hamstring injury were recorded. Number of MLB game appearances and official at-bats were recorded for each of the 2 seasons prior to injury, the season of injury, and the 2 seasons following the injury.

Totals are reported as means with standard deviation. Analysis of variance was conducted to compare age and BMI with the number of days on the DL. Paired t-tests were used to compare game appearances and official at-bats between seasons before the injury and seasons after injury with the season of injury.

3. Results

During the study period, 75 players were identified on the DL to have a hamstring injury of any kind. Fourteen were pitchers and subsequently excluded. Three players were placed on the DL for hamstring injury on two non-consecutive occasions during the study period and so the second injury was excluded from the analysis. Therefore, 58 position players met the inclusion criteria and form the basis of the analysis. Twenty-six players were outfielders, 25 were infielders, 5 were catchers, and 2 played first base and outfield.

The mean age at time of injury was 30.7 + 4.1 years (range, 21 to 39). Twenty-eight players were left hand dominant and 30 players were right hand dominant. The mean height was 183.5 + 6.0 cms (range, 168 to 201). The mean weight was 90.4 + 7.9 kgs (range, 75 to 105). The mean calculated BMI was 26.9 + 2.6 (range, 22.4 to 38.1). The mean length of stay on the DL was 15.9 + 5.9 days. However, 56 of 58 players were on the DL for 15 days, while the 2 others were on the DL for 23 and 60 days, respectively. Therefore, there was no significant correlation between age or BMI with length of stay on the DL.

The mean number of MLB game appearances during the season of injury was 87.6 + 40.1 games (Figure 1). The mean number of MLB game appearances for one and two seasons prior to injury were 105.1 + 44.1 and 108.6 + 45.0 games, respectively, and significantly greater than for the season of injury (p = 0.002 and p = 0.003 respectively). The mean number of MLB game appearances for one and two seasons after injury were 82.2 + 52.1 and 75.6 + 57.4 games, respectively, and not significantly different than for the season of injury (p = 0.26 and p = 0.08 respectively). Nine players did not play another season after the season of injury, and 8 other players only played one more season after the season of injury.

The mean number of official MLB at-bats during the season of injury was 289 + 163 (Figure 2). The mean number of official MLB at-bats for one and two seasons prior to injury were 348 + 187 and 371 + 187, respectively, and significantly greater than the season of injury (p = 0.01 and p = 0.007 respectively). The mean number of official MLB at-bats for one and two seasons after injury were 269 + 199 and 247 + 212, respectively, and not significantly different than the season of injury (p = 0.26 and p = 0.07 respectively). Nine players did not play another season after the season of injury, and 8 other players only played one more season after the season of injury.

If the 17 players who did not play for 2 seasons after hamstring injury were excluded from the analysis, mean age and BMI of remaining players were not significantly different (30.5 + 4.0 years, and 27.0 + 2.7, respectively). If the 17 players who did not play for 2 seasons after hamstring injury were excluded from the analysis, there was no significant differences between the mean number of MLB game appearances before, during, and after the season of hamstring injury (0.09 < p < 0.42), nor any significant differences in the number of official MLB at-bats before, during, and after the season of hamstring injury (0.28 < p < 0.82). However, for these 17 players, the mean number of game appearances and official at-bats during the season of hamstring injury and in each of the 2 previous seasons did demonstrate significantly lower totals than the other players ( p < 0.006 across all parameters).

4. Discussion

To my knowledge, this is the first descriptive study analyzing hamstring injuries in MLB players. Because the incidence of hamstring injuries is more prevalent in position players[1], pitchers were excluded in the present study. The data shows that the length of stay on the DL is relatively short, with the typical MLB player spending only 15 days on the DL for most hamstring injuries. However, our data demonstrate that the number of MLB games played and official at-bats during the season of injury is significantly reduced. Furthermore, when all injured players are taken into account, our data shows that the reduced number of MLB games played and official at-bats appears to persist for the next 2 seasons after the injury. Certainly, there are numerous factors other than physical well-being that influence the number of games played and the number of official at-bats taken throughout a MLB season (e.g., manager’s decisions, in-game strategies, historical performance against specific opponents, other injuries, etc). Similarly, there are non-physical factors that influence length of stay on the DL (e.g., performance of replacement player, clubhouse social and general managerial issues [15]. However, our data shows that 9 out of 58 players (15.5%) did not play another MLB season following the season with hamstring injury, and that another 8 players only played one more MLB season following the season with hamstring injury, for a total of 17 players (29.3%) who were out of MLB by 2 seasons after hamstring injury.

Only one player demographic variable was associated with the incidence of hamstring injury. The average age of the players who sustained a hamstring injury was 30.7 years - older for a MLB player when considering the data of Witnauer et al that suggests that a normal MLB career lasts until the age of 30 years [16]. However, there was no correlation between age and length of stay on the DL or whether the player continued playing professional baseball after the hamstring injury. The BMI of the players who sustained a hamstring injury is not dissimilar to the average BMI of all MLB players[17, 18]. There was no correlation between BMI and length of stay on the DL or whether the player continued playing professional baseball after the hamstring injury. Hand dominance was not predictive of injury incidence, length of stay on DL, or continuance of playing.

The data seems to suggest that the 17 players (i.e., 29%) who were out of MLB by 2 years after hamstring injury were already on the decline in their career. While their mean age and BMI were the same as the other injured players, their pre-injury levels of performance, as measured by MLB games played and official at-bats, were significantly lower than the other injured players during the 2 seasons leading up to the season of injury. Moreover, the lower statistics of these 17 players directly skew the calculations for games played and official at-bats during the season of injury and the following 2 seasons. The remaining players managed to maintain the same number of games and at-bats throughout their 5 seasons studied. Therefore, a hamstring injury in a player on the decline seems to hasten the end of his career, while a player who is demonstrating more consistency in games played and at bats prior to the injury may not suffer a significant decline in participation upon recovery. Further research is needed to determine what associated factors contribute to the injured players decline in performance and eventual retirement from MLB.

4.1 Limitations

My analysis has several limitations. First, although our data were collected from an official MLB source, it was done retrospectively. Another weakness of this study stems from our use of the disabled list as our source of injury data. Although the likelihood is low, there may have been an untold number of hamstring injuries that were not severe enough to require the baseball player to be placed on the DL. Players with minor injuries can miss up to 2 weeks of the season without being placed on the disabled list. Furthermore, length of stay on the DL cannot be used as a true measure of healing or “return to play,” as 56 of 58 of the injured players were taken off the DL after the first 15 days. Specific treatment modalities and rehabilitation regimens were not examined. Moreover, seasonality of these injuries was not analyzed, such that players who were injured during the month of September may not be placed on the disabled list because of MLB rules permitting teams to expand their rosters to include 40 players. Finally, we did not define a true incidence of hamstring injuries because the changing number of active players on MLB rosters during a season and the varying level of exposure to injury conditions in practice and games were not analyzed. Despite these limitations, the present study is the first to examine hamstring injury patterns among MLB players and these data may provide guidance to medical staffs for players with this type of injury for their long term prognosis.

5. Conclusion

Hamstring injuries mostly occur in older MLB position players. If the injured player had been declining in MLB games played and official at-bats in the 2 previous seasons leading up to the injury, his future career may be in jeopardy of ending after the injury. However, if the injured player had relatively consistent participation in MLB games played and official at bats in the 2 previous seasons leading up to the injury, he has a good chance of returning to and maintaining the same level of participation up to 2 seasons following injury.

The author declares no conflict of interest.

References

1. Posner M.; Cameron K.L.; Wolf J.M.; Belmont P.J.; Owens B.D. Epidemiology of Major League Baseball Injuries. Am. J. Sports Med. 2011, 39, 1676-1680.
2. Arnason A.; Sigurdsson S.B.; Gudmundsson A.; Holme I.; Engebretsen L.; Bahr R. Risk factors for injuries in football. Am. J. Sports Med. 2004, 32, 5S-16S.
3. Engebretsen A.H.; Myklebust G.; Holme I.; Engebretsen L.; Bahr R. Intrinsic risk factors for hamstring injuries among male soccer players: a prospective cohort study. Am. J. Sports Med. 2010, 38, 1147-1153.
4. Gabbe B.J.; Bennell K.L.; Finch C.F.; Wajswelner H.; Orchard J.W. Predictors of hamstring injury at the elite level of Australian football. Scand. J. Med. Sci. Sports. 2006, 16, 7-13.
5. Hagglund M.; Walden M.; Ekstrand J. Previous injury as a risk factor for injury in elite football: a prospective study over two consecutive seasons. Br. J. Sports Med. 2006, 40, 767-772.
6. Orchard J.W. Intrinsic and extrinsic risk factors for muscle strains in Australian football. Am. J. Sports Med. 2001, 29, 300-303.
7. Croisier J.L.; Ganteaume S.; Binet J.; Genty M.; Ferret J.M. Strength imbalances and prevention of hamstring injury in professional soccer players: a prospective study. Am. J. Sports Med. 2008, 36, 1469-1475.
8. Yeung S.S.; Suen A.M.; Yeung E.W. A prospective cohort study of hamstring injuries in competitive sprinters: preseason muscle imbalance as a possible risk factor. Br. J. Sports Med. 2009, 43, 589-594.
9. Chumanov E.S.; Heiderscheit B.C.; Thelen D.G. The effect of speed and influence of individual muscles on hamstring mechanics during the swing phase of sprinting. J. Biomech. 2007, 40, 3555-3562.
10. Schache A.G.; Blanch P.D.; Rath D.A.; Wrigley T.V.; Bennell K.L. Are anthropometric and kinematic parameters of the lumbo-pelvic-hip complex related to running injuries? Res. Sports Med. 2005, 13, 127-147.
11. Conte S.; Requa R.K.; Garrick J.G. Disability days in Major League Baseball. Am. J. Sports Med. 2001, 29, 431-436.
12. Chambless K.M.; Knudtson J.; Eck J.C.; Covington L.A. Rate of injury in minor league baseball by level of play. Am. J. Orthop. 2000, 29, 869-872.
13. MLB.com. Major League Baseball Transactions. http://www.mlb.com/mlb/transactions/index.jsp (accessed on 11 July 2008).
14. MLB.com. MLB Miscellany: Rules, regulations and statistics. http://mlb.mlb.com/mlb/official_info/about_mlb/rules_regulations.jsp (accessed on 18 March 2011).
15. Bryan W.J. Letter to the Editor. Am. J. Sports Med. 2001, 29, 830-831.
16. Witnauer W.D.; Rogers R.G.; Saint Onge J.M. Baseball Career Length in the Twentieth Century. Population Research and Policy Review 2007, 26, 371-386.
17. Hoffman J.R.; Vazquez J.; Pichardo N.; Tenenbaum G. Anthropometric and performance comparisons in professional baseball players. J. Strength Cond. Res. 2009, 23, 2173-2178.
18. Saint Onge J.M.; Rogers R.G.; Krueger P.M. Major League Baseball Players’ Life Expectancies Soc. Sci. Q. 2008, 89, 817-830.

Figure 1. Mean number (+ standard error) of MLB games played each season (before, during and after the season of hamstring injury).

Figure 2. Mean number (+ standard error) of official MLB at-bats each season (before, during and after the season of hamstring injury).

Can your SmartPhone help you treat a Concussion?

Football season is in full swing, and the hottest issue the past few years are concussions. Linebacker Brian Cushing of the Houson Texans and Wide Receiver Stephen Hill of the the New York Jets are the latest NFL players on the Injured List with concussions, but there are others at all levels of football. I recently wrote an article discussing the various SmartPhone apps available to help parents, coaches, and athletic trainers decide whether an athlete has sustained a concussion and what to do about it. Let me know what you think. 

Doctor, when will I be able to drive after surgery?

Don't Get Behind the Wheel Too Soon After Surgery By Michael J. Smith, MD A common patient question involves when driving is safe following a surgical procedure or injury.  As a rule, the day of an outpatient surgical procedure, the patient should not drive.  Most surgery centers require an escort be present to take the patient home and document that the patient is not driving.  Studies have shown that a person usually has some motor deficit following general anesthesia for 24 hours following a procedure.  Driving should not be undertaken until at least this time. Some narcotics can remain in the body for extended time periods and most people should not return to driving until at least 24 hours after narcotic usage has stopped. Cast and Braces Any injury or surgery that requires a brace or cast that would interfere with the use of the hand or right foot would easily impair someone’s ability to drive safely.  The National Highway Transportation Safety Administration (NHTSA) advises that the use of the left foot and leg to use the accelerator and braking pedals is not a safe alternative for drivers that are unable to use their right leg due to casting.   The NHTSA also notes that drivers with a right leg cast should avoid driving until after the removal of the cast and until the mobility of the joint is adequate for safe driving. Knee Surgery Following left knee surgery, with use of an automatic transmission, driving would be permissible after the initial 24 postoperative hours.  For a right knee arthroscopy, a return to driving may take days to weeks until the patient is off narcotics and pain and swelling in the right knee has diminished. An ACL reconstruction requires a longer recovery before the pain and swelling have decreased and safe driver reaction times have returned.  Two studies examining brake reaction time, showed safe reaction times resuming following ACL surgery took  between 4-6 weeks.  Return to driving recommendations should also be individualized. Shoulder Surgery For shoulder surgeries, the usual advice to patients is not to return to driving until two hands can be placed on the wheel. Following a rotator cuff or labral repair, the usual postoperative physical therapy regimen is for passive range of motion only for the first four to six weeks.  Using the operative arm and shoulder to actively turn a vehicle especially around a corner could jeopardize the surgical repair. In summary, driving after a surgical procedure should not be done for at least 24 hours.  Any brace or cast that affects limb mobility could prevent safe driving, therefore patients should be advised not to drive accordingly.   REFERENCES Chung F, Kayumov L, Sinclair DR, Moller HJ, Shapiro CM. What is the driving performance of ambulatory surgical patients after general anesthesia? Anesthesiology. 2005.103:951– 6. Dalury DF, Tucker KK, Kelly TC. When can I drive? Brake response times after contemporary total knee arthroplasty. Clin Orthop Relat Res. 2011. 469(1): 82-86. Driver Fitness Medical Guidelines. September 2009. Gotlin RS, Sherman AL, Sierra N, Kelly M, Scott WN. Measurement of brake response time after right anterior cruciate ligament reconstruction. Arthoscopy. 2000.16(2):151-155. Hau R, Csongvay S, Bartlett J. Driving reaction time after right knee arthroscopy. Knee Surg Sports Traumatol Arthrosc. 2000. 8(2):89-92. Nguyen T, Hau R, Bartlett J. Driving reaction time before and after anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc. 2000.8(4):226-230.

 

Total Knee Replacement from a familar patient's perspective

NBC Nightly News Anchorman, Brian Williams, just underwent his first total knee replacement at the age of 54. His story is not unlike many of the "Baby Boomers" I see in the office: played sports at a young age, had a few injuries over the years, now experiencing the price of pain. Although there are some temporary non-surgical things we can do to lessen the symptoms of joint pain, the knee replacement has long been a reliable option to treat severe arthritis. <http://dailynightly.nbcnews.com/_news/2013/08/16/20055492-brian-williams-on-knee-replacement-and-why-he-has-disappeared-from-tv-for-a-while>

"Will I be able to play golf after surgery?"

NBA Hall of Famer Charles Barkley is recovering from a torn biceps tendon that was injured while weightlifting.

The biceps muscle is in the front of your upper arm. It helps you bend your elbow and rotate your forearm. It also helps keep your shoulder stable. If you tear the biceps tendon at the elbow, you will lose strength in your arm and be unable to forcefully flex and turn your arm from palm down to palm up (eg, opening a doorknob, unscrewing a cap, turning a wrench). This is called supination. Significant, permanent weakness during supination will occur if this tendon is not surgically repaired.

There is often a "pop" at the elbow when the biceps tendon ruptures. Pain is severe at first, but it may subside after a week. Other signs include: swelling and bruising in the front of the elbow, weakness in bending and twisting the forearm (supination), a bulge in the upper arm (created by the recoiled biceps muscle) and a gap in the front of the elbow (created by the detached tendon).

Surgery should be performed to repair the torn biceps tendon unless you are elderly, inactive, or have medical problems that are too risky for moderate surgery. Surgical results are excellent in returning strength and range-of-motion after a few months of postoperative therapy. Maybe it will help Charles' golf swing!

A biceps tendon repaired back to bone with the assistance of a button and calcium screw.
(From the files of Dr. Jerome Enad, Orthopedic Surgeon)

Is your Smartphone or Computer causing you injury?

Upper extremity overuse syndromes are making a comeback with modern day technology. For example, one used to suffer from “DeQuervain’s Tendonitis” with gripping activities during manual labor or when first-time mothers would repeatedly carry their newborn. Pain and swelling of the tendons at the bottom of the thumb would occur as the wrist would be overused and become inflamed. Now, we see DeQuervain’s in many people as an overuse syndrome from using smartphones and texting - same tendons, same inflammation, different activity that caused it. Similarly, too much texting can aggravate any pre-existing arthritis at the base of the thumb (i.e., “basal joint arthritis”), also. Surprisingly, we are not seeing an increased incidence of carpal tunnel syndrome related to smartphones and texting, probably because the main nerve is not being compressed with this type of finger motion.

However, other common computer use habits are bringing back old conditions. Touch screens can cause tendonitis at the tip of the finger if striking the screen too hard, or can also cause finger sprains (i.e., “Mallet Finger”) at the fingertip. Further, frequent use of the computer mouse has resulted in a condition recently coined “Mouse Elbow,” which is an overuse tendonitis at the outer part of the elbow that was previously referred to as “Tennis Elbow.” The muscles of the wrist and forearm that help you grab, click, and maneuver the mouse attach to the lateral elbow and can frequently become inflamed with overuse. We also use these muscles for driving, eating, reaching, etc. so it is difficult to give them the proper rest they need.

Fortunately, all of these “modern day technology” conditions can usually be treated by decreasing the amount of time spent on the activity that caused them, using ice and oral or topical anti-inflammatory medication, sometimes a brace helps in properly positioning your hand or wrist to cause the least amount of irritation, or possibly a cortisone injection. Surgery may be recommended for severe cases that do not go away.

See your local orthopedic surgeon if you believe you need treatment for any of these conditions.

"It felt like someone kicked me!" - The Achilles Tendon Rupture

Kobe Bryant is now 3 months postop from his Achilles tendon repair after he ruptured it toward the end of the NBA season. Surgery was done by my mentors (Doctors Neal ElAttrache and Stephen Lombardo) at the Kerlan-Jobe Orthopedic Clinic in Los Angeles.

The Achilles tendon connects your calf muscle to the heel and helps you point your foot downward and push off as you walk. If stretched too far, the tendon can tear (ie, rupture), causing severe pain in the ankle and lower leg that can make it difficult or even impossible to walk. An Achilles tendon rupture might occur after repeated stress on the tendon and may be partial or complete, depending on the severity of the injury.

Injuries to the Achilles tendon are common and are usually caused by several different factors, including:

• Overuse
• Poor stretching habits
• Tight or weak calf muscles
• Flat feet
• Wearing shoes that do not fit properly
• Engaging in physical activity after a long break

After an Achilles tendon rupture, people often experience severe pain and swelling, and are unable to walk normally or bend their foot. You may hear a pop or snap with the rupture, or you may feel like someone kicked you in the calf. However, these symptoms are similar to other conditions, such as bursitis and tendonitis, so it is important to seek prompt medical attention in order to determine the correct diagnosis of your condition.

Treatment for an Achilles tendon rupture depends on the severity of the condition, but often requires surgery to repair the tendon and restore function to the foot. Less severe cases may only require a cast or walking boot for several weeks, although the risk of a recurring rupture is higher. Patients can help prevent an Achilles tendon injury by stretching the tendon and nearby muscles before participating in physical activity.

Hoffa Syndrome: Impingement of the Fat Pad of the Knee

Here is a great illustration of the amount of pressure tennis pro Rafael Nadal places on his knee during play.  Impingement of the fatpad behind the kneecap is known as Hoffa Syndrome.

Symptoms & findings include:

• Pain and/or swelling behind or below the kneecap
• Possible history of knee hyper-extension (called genu recurvatum)
• Positive finding on "Hoffa’s test" physical exam manuever by a sports medicine physician

Treatment should start with non-surgical:

• Rest and avoiding aggravating activities
• Ice or cryotherapy
• Anti-inflammatory (pills or injection)
• Physiotherapy modalities such as ultrasound or TENS.
• Muscle strengthening
• Kinesio-Taping

If conservative treatment does not work then surgery may be advised. This may involve the complete or partial removal of the fat pad itself.  See a sports medicine specialist if you think you have Hoffa Syndrome.

You Don't Have to be a Golfer to get Golfer's Elbow

I was recently asked to comment on Cincinnati Reds middle reliever Jonathan Broxton being placed on the Disabled List due to a flexor mass strain in his elbow. This ailment is a type of "Golfer's Elbow" (a.k.a. medial epicondylitis) that occurs in recreational athletes or people who participate in work that requires repetitive and vigorous use of the forearm muscles (for example: painters, plumbers, carpenters, auto workers, cooks, and even butchers). It is thought that the repetition and power grip required in these occupations leads to injury.

Most people who get medial epicondylitis are between the ages of 30 and 50, although anyone can get it if they have the risk factors. In sports like golf, improper stroke technique, poor flexibility, and improper equipment may be risk factors.

Almost always the condition gets better without surgery, but treatment is necessary. Treatment programs include a temporary rest from the offending activity (for example, lay off sports or light duty at work), anti-inflammatories (preferably pills but possibly an injection), checking the equipment you're using for proper size and weight, physical therapy for stretching and pain-relieving modalities, and possible use of a special brace that takes pressure off of the medial epicondyle muscles.

Images from the American Academy of Orthopaedic Surgeons


The condition will usually wax and wane before it goes away with treatment.

Have you ever had Golfer's Elbow? What caused it and what did it take for you to get better?

Why all the Hamstring Injuries in Major League Baseball?

It looks like Los Angeles Dodgers All-Star outfielder Matt Kemp is headed back to the Disable List with a right hamstring injury this year (last year he injured his left hamstring and missed 51 days). Of the 189 players currently on the MLB DL, 19 are for hamstring injuries, greater than 10%.  A study published in the American Journal of Sports Medicine in 2011 noted that hamstring injuries comprised 13.5% of injuries for position players and 8% overall.
So why all the hamstring injuries in baseball? Traditional thinking had blamed tightness, poor warm-up and poor conditioning of the posterior chain of the body (i.e., hamstrings, gluteals, piriformis). However current thinking takes it a step further. Tightness and poor warm-up cannot be overcome with static stretching (like reach-and-hold type of stretching). Only dynamic stretching (flexibility through movement) will condition the muscles to handle the sudden start and stop movements of baseball. Also, single line strengthening, such as hamstring curls and squats, do not adequately prepare the muscles for the twisting/turning/cutting/pivoting movements that frequently cause injury during sports. Therefore, diagonal and multi-directional strengthening is needed to condition the muscles to handle these complex movements. These contemporary approaches are already being incorporated into MLB conditioning programs, and we hope they will result in a decrease in hamstring injuries.

Have you ever had a hamstring injury? What did it take for you to get better?

The Pennants should fly at Half-Mast today

One of the orthopedic surgeons who perfected the Tommy John surgery, and one of my many mentors from the Kerlan-Jobe Orthopaedic Clinic, Dr. Lewis Yocum, died this week. He was one of the most well-like and well-respected surgeons in the United States.
I remember two stories about Dr. Yocum from my year of fellowship. First, was when I gave a lecture to the department that cited one of his earlier studies on the knee. I managed to obtain an old photo of the distinguished white-haired surgeon when he was younger with a thick set of sandy brown hair and a dark mustache, and included it in the slide presentation when his work came up in the talk. His colleagues who actually knew him when he was younger loved it! He was the kind of guy who could take a joke and laugh at himself. Second, was when my friend's mother was struggling with cancer. She was a huge baseball fan, and her favorite player was Mo Vaughn. I mentioned this to Lew and he gave me a baseball autographed by Mo Vaughn that he just happened to have lying around the house and insisted that I give it to my friend's mom. I still get thanked by my friend for that one.
Lew Yocum was one of the good guys. I know he saved many ballplayers' careers with his elbow and shoulder surgeries, but he also touched my life in an unforgettable way. If any of you met Dr. Yocum, I would love to hear any more stories in honor of him.

RG3 and Recovering from Multi-ligament Knee Injuries

Here is an interesting take on the progress of Robert Griffin III and his return to the NFL after a serious knee injury:  Jeffri Chadiha from ESPN.com discusses RG3

This reminds me of the presentation I gave on multi-ligament knee injuries back in 2007 at the Society of Military Orthopaedic Surgeons that won Best Poster. I showed that most sailors & soldiers were able to get back to active duty after injuring more than one knee ligament, but it did take longer than those with only an ACL injury (Return to Duty After Multi-ligament Knee Injuries). These expectations should be kept in mind when judging RG3 or Marcus Lattimore's recoveries from their multi-ligament knee injuries.

Are there other knee conditions that you would like me to discuss in future postings?

Sports Medicine is not just for the Athletes

My Sports Medicine practice at West Florida Orthopedics is not just taking care of athletes but also taking care of the fans. Unfortunately, there have been a few fans attending baseball games for the Pensacola Blue Wahoos who have been inadverdantly struck by foul balls and have suffered significant injury. I know, because I am taking care of one of them.
If you are attending a baseball game at any level, I ask that you be alert as to what is happening when you hear that bat hit the ball. If you see a fly ball coming your way, think safety for yourself and also for those around you. Some of the fans may not be paying attention to what is happening on the field, and you might just save them from further harm.

<FOX Sports Wisconsin sideline reporter is struck by an errant baseball on 5/25/13>

Dr. Enad shares Exercise tips

Orthopedic sports medicine specialist, Dr. Jerome Enad, shared exercise tips to a captivated female audience at West Florida Hospital's "Women's Night Out" last week on May 16, 2013. How to Exercise Safely as You Age was a step-by-step primer on a balanced exercise program for women of all ages. The highlight of the presentation was an audience participation exercise conducted by Dr. Enad.
What other community events would you like to see Dr. Enad attend and speak?

Dr. Enad speaks to first responders at Escambia County EMS Week

I had a great time with the workers at Escambia County EMS Offices this past Tuesday, May 21, 2013 as part of "EMS Week". Over breakfast supplied by West Florida Hospital, I gave a lecture on the Initial Management of Acute Shoulder Injuries. They showed me the amazing command center within their facility. They are truly heroes in my mind and have my loyal support.