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health watch: mikel jackson Persistent pain, swelling could be worse than you think A couple weeks ago, a coach friend of mine told me about a sport injury he had that wasn’t going away. He had been scrimmaging with his basketball team when he had felt a sharp pain behind his calf and had to sit down. Initially, he thought the injury was minor and would gradually go away with conservative treatment. A week later, limping and with no relief from the pain or swelling, he explained to me what had happened. I quickly advised him to schedule an appointment with his medical doctor due to the possibility of having a dangerous injury called “acute compartment syndrome” (or ACS) which can have long-term effects if it remains undiagnosed. Compartments are areas of the arms or legs that contain muscles, tendons, nerves and blood vessels wrapped together in a sheath of dense, fibrous connective tissue called fascia. The fascia gives support to the soft tissue and keeps the contained materials from displacing by not stretching very much. When swelling, bleeding or other products of inflammation occur inside a compartment, the increase in pressure on the capillaries, muscles and nerves can result in intense pain and loss of oxygenated blood to the muscle and nerve cells. ACS (such as the kind Los Angeles Dodgers’ second baseman Mark Ellis had last May) can result in necrosis — tissue death so severe that the limb may need amputation if the swelling is not resolved quickly. ACS can occur during sports due to fractures, impact traumas resulting in bruised muscles, or the wearing of constricting bandages or braces. Pain is felt within the affected compartment especially when stretched. Sometimes numbness, tingling or burning pain is felt. The areas will typically feel extremely tight and smooth to the touch. The disease condition is diagnosed by physical examination and usually a doctor will measure the pressure within the muscle or fascia to confirm. ACS is a severe medical emergency that requires a surgical technique called a fasciotomy. A doctor will make an incision to open the fascia tissue and relieve the swelling and pressure. Recovery time can take anywhere from several weeks to a couple months. While most sports-related injuries are not life threatening, ACS can result in amputations or even death. If you have an injury that is more painful than expected, is not healing quickly, or results in dysfunction, always seek medical advice as soon as possible. Mikel Jackson is an athletic trainer for the staff of Sports Medicine For Young Athletes, a division of Children’s Hospital Oakland. rotator cuffs: justin dudley Use caution in rotator cuff strengthening Rotator cuff (RTC) strengthening is something common in many overhead athlete training programs, but many athletes and coaches may actually be doing more harm that good. The RTC is comprised of four muscles responsible for keeping the ball, or humeral head, centered in the socket throughout shoulder range of motion. As the arm is elevated overhead, the ball has a tendency to want to migrate up in the socket based on the direction of pull of the big deltoid muscle. This upward migration can cause pinching of structures within the shoulder joint causing pain and leading to what is known as sub-acromial impingement. It is the responsibility of the RTC to minimize this upward migration. Research has shown that exercising the RTC to failure or doing “burn-out exercises” of these muscles decreases the control of the humeral head. By doing so, a fatigued RTC results in upward migration of the ball in the socket even during the simplest daily tasks that require lifting the arm against gravity, increasing the potential for impingement. This is not to say that the RTC shoulder not be trained. RTC training is an essential component for the health of an overhead athlete’s shoulder. However, training should focus on cuff activation, and caution should be used when building endurance and strength of the RTC to make sure the shoulder workload is not too high. When performing cuff exercises, athletes should feel their muscles working, but should stop prior to fatigue burn. It is important to utilize very light weight, and limit the number of repetitions performed. I typically limit RTC exercises to 8-10 reps. Crossover Symmetry’s muscle activation program does a great job of activating both rotator cuff and scapula stabilizers without working these muscles to the point of fatigue. Justin Dudley is an in-house Physical Therapist for Crossover Symmetry, based in Denver. 32 SportStars™ May 1, 2013 Score Digital Content: Scan SSM With LAYAR Upload photos and team stats!

BA Issue 65, May 1, 2013

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