Before ultrasound became a revolutionizing staple in the field of pain medicine, some brilliant, forward-thinking doctors used X-Ray (fluoroscopy) to add vision to their pain injections. But with these tools came drawbacks. Firstly, while fluoroscopy is excellent for viewing bones and spread of contrast, they do not let us see the intricate detail of muscles, tendons and ligaments. Secondly, they emit radiation, which means that they should only be used on an ‘as necessary’ basis. In our effort to provided safe, accurate and effective injections, about 10-15 years ago our field began using ultrasound to make major improvements. Not only is it 100% safe, ultrasound immediately transformed pain medicine patient outcomes.
Way before I became I pain physician I was acutely aware of a particular maxim: an ounce of prevention is worth a pound of cure. Despite its triteness, in this expression I found unbounded wisdom: wearing knee pads while rollerblading averted nasty knee cuts and ripped jeans, while a napkin in my lap discouraged tomato sauce stains. Back in my own days as an athlete – a batting helmet defended my skull from menacing fastballs. These days, this aphorism’s weighs heavily on my shoulders when I am confronted by yet another patient who is an athlete with an injury resulting from poor to complete reckless abandonment of sports nutrition. Many such patients have suffered muscle injuries and/or severe cramping that has resulted from dehydration, electrolyte abnormalities and/or potassium and magnesium deficiencies. This is not just frustrating because these kinds of injuries are extremely avoidable through a proper sports nutrition-inspired diet, but also failure to acquire the full range of protein, carbohydrates, micronutrients and vitamins an athlete requires will severely limit the ability to reach maximum performance. To put it in laypersons terms, without sports nutrition athletes will increase the likelihood of debilitating injury and will also be actively hampering their ability to perform to their full potential.
If you are considering back surgery because of a pain issue, it might not even be the most expedient treatment for you as it will not always alleviate or mitigate pain. Unless your back issue is neurological or an instance of instability of the spine, surgery simply is not your best course of treatment. If you suffer from muscular or myofascial pain, lumbar facet arthropathy or lumbar disc herniation, amongst other back pain issues, your best bet is to treat your back pain without surgery. Read my blog for the full details of the non-surgical treatments I recommend.
Musculoskeletal Ultrasounds (MSUs) are my go-to when attempting to pin down an issue that we don’t believe to be bone related. That means they are perfect for diagnosing muscle, tendon, and ligament injury – as this dynamic investigative and explorable procedure tells us in seconds the make-up of your musculoskeletal system. We have found that MSU has been pivotal in helping diagnose sports injuries and others who find they are in pain when they move a joint. Traditional analysis like x-rays and MRIs take static images where MSUs create dynamic images in motion. Let’s explore that some more.
Most things are easier said than done. Hitting a home run is no different. There are two key aspects when trying to become a Yankee superstar. Firstly, you need to hit the sweet spot - and secondly, you need to hit it hard. Hitting the right spot is achieved by the movements I’m going to outline below. The great thing is, good technique will inadvertently make you hit the ball harder as well. By following these instructions, you won’t waste energy, and your entire swing will focus your power on the bat.
Get Comfortable
Identify if you feel more comfortable with a narrow or wide stance when getting into position. Your knees should be inside your feet and you should be looking at the pitcher (who is about to get a shock when you smash his ball out the park). Your feet and body should be facing away from the pitcher at a perpendicular angle, with your head turned facing the pitcher.
Negative Mode
Next, we go into the Negative Move. As the ball approaches and you begin your swing, load your weight onto the back foot (remembering to keep the knees inside the feet). The bat should be slightly behind but parallel with the shoulder. As the ball approaches, you want to dip into negative mode before shifting your weight forward.
Spin the Back Toe
Now we shift our weight onto the toe of the foot. As the ball approaches get onto the toe of your front foot releasing the weight from your back foot. Your weight should be shifting from back to front. As your front heel goes down your back knee should start to turn – ending with the laces pointed toward the pitcher. You should be doing this alongside the bat movement.
The batters laces are facing the pitcher.
The Journey Begins
The bat should find itself coming from that starting position (parallel to shoulder), through the body motion, and hitting the ball with the shortest distance traveled from the starting position. All of your energy should be focused on shifting power through this small point. With practice, your feet, torso, and “third arm” will all move in harmony making for a high-intensity swing that pumps all your power into that one little point between your bat and the pitcher's ball.
Following Through
Once the ball is hit, the journey isn’t over. You need to continue to bring the bat around and end with it behind the front shoulder. Following through is key in all sports – from baseball – to soccer – to football. Any motion that requires maximum power (like a free kick in soccer) requires the player to follow through with their foot (or whichever limb). This allows the player to exert all their power through the ball.
Start Slow
All good things take time. Get the technique right before you exert all your force into a shot. Slowly build up using power in your shot so that your body has the correct mechanics and muscle memory. Hitting a home run requires patience both during a game and in training. After some practice, you will master the solid path to the baseball.
Practice Practice Practice
Batting is difficult because it requires your whole body to synchronize and rally its effort through a foreign object – i.e. the baseball bat – which becomes an extension of the body. Ensuring the upper body and lower body works together is key to hitting a home run.
Practice is the key to learning how to shift your weight with the upper body movement while the ball flies toward you. There are three things going on, it’s a lot to take in. As you repeat the motion again and again, your body begins to remember how it should behave without you telling it what to do and your swing becomes second nature. Your knees know to not step outside the feet without you thinking about it and you won’t overshoot your back foot's twist. When you do all these things without thinking, you’re on the money.
The approach of Spring can only mean one thing in New York City – baseball season. The beginning of April brings the season home opener of both the Yankees and the Mets, two of our finest, home-grown sports teams.
As sports injuries go, Major League Baseball is at lower end of the risk spectrum out of the big four, but it is by no means injury-free. From home plate collisions to fractured skulls to even the odd foul ball in the groin, there has been some fairly dramatic damage done on the diamond. However, the most common injuries seen tend to be a little less theatrical – such as tendonitis or ligament and rotator cuff tears.
Normally, baseball injuries can be avoided by doing simple things such as warming up properly and not pitching on consecutive days or playing all year round, but if you are a pro player, some of these are impossible to avoid. So this month, we are taking a look at three major New York baseball players and their most famous injuries.
First up is Mets third baseman David Wright. Captain of the Mets since 2013, Wright has sustained his fair share of injuries in his time, from concussions to contusions. Most recently the 33-year old was placed on the disabled list for sixty days to deal with his spinal stenosis. Spinal stenosis involves an abnormal narrowing of the spinal canal and can be congenital or more commonly caused by aging and arthritis. With symptoms including pain, numbness, and loss of motor control, it is really pretty amazing to see such a productive comeback helping to lead the Mets to the World Series.
Next is Alex Rodriguez, considered by many to be one of the greatest baseball players of all time. A-Rod’s stellar career has been somewhat marred recently by hip and knee injuries and most recently had hip surgery to correct this. 40-year-old Rodriguez was suffering from a misshapen femur which, for 20 years, hasn’t fit perfectly into his hip socket. A common defect which the infielder has had since birth or childhood, which limits the movement he could achieve in his hip. Thankfully he underwent arthroscopic surgery to repair a torn labrum and had the femur shaved down to fit better into the socket and now is back and playing as well as ever.
Finally, we have Matt Harvey, the Mets’ 26-year old pitcher. Harvey recently missed the whole of the 2014 season due to surgery, despite being one of the most dominant young pitchers in Major League Baseball. Every time he pitches, his fans refer to it as “Harvey Day”, but he’s not the only Major League pitcher to have something named after him. Towards the end of 2013, Harvey had Tommy John Surgery, a procedure most commonly performed on baseball players and named after ex-Yankees pitcher Tommy John who first had the surgery in 1974. The procedure involves ulnar collateral ligament (UCL) reconstruction, where the UCL (in the elbow) is replaced with a tendon from elsewhere in the body. Although it took longer than Harvey had anticipated for it to heal, he was back throwing a baseball just 4 months after the surgery and came back on top form for the 2015 season. He is on the verge of dominating baseball in 2016.
If you want to learn more about any of these injuries – or you suffer from elbow problems, hip and knee problems, or chronic back pain (like these baseball superstars) get in touch here.
