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Competitive Edge, Winter 2012

Should I See a Primary Care Sports Medicine Physician?

By Richard Figler, MD

Confused about whether you ought to go see a primary care sports medicine physician (PCSM)? Here, we take a look at what PCSM physicians are and what they treat to help you decide if you’ll benefit from their expertise:

What is a PCSM physician?

Physicians specializing in primary care sports medicine undergo their initial training and board certification in a specialty such as family medicine, pediatrics, internal medicine, emergency medicine or physical medicine and rehabilitation. They then complete a one- (or sometimes two-) year training fellowship in sports medicine. This branch of medicine is dedicated to the comprehensive care of athletes and active individuals, promoting lifelong fitness and wellness, and encouraging the prevention of illness and injury.

What do they treat?

A PCSM physician’s scope of care includes diagnosing and managing acute injuries, a variety of musculoskeletal conditions, as well illnesses (both chronic and acute) that can potentially affect performance.

Common conditions treated and services provided include, but aren’t limited to:

  • Acute injuries (ankle sprains, muscle strains, fractures, knee, hand, finger or shoulder injuries)
  • Overuse injuries (tendonitis, stress fractures)
  • Injections of numerous joints (cortico-steroid or viscosupplementation)
  • Concussions in athletes
  • Injury prevention
  • Return-to-play decisions for the sick or injured athlete
  • Athletes with chronic or acute illnesses (such as mono, asthma, hypertension or diabetes)
  • Athletes with chronic musculoskeletal conditions (chronic muscle injuries, arthritis of various joints)
  • Nutrition, supplement or ergogenic (performance-improving) aid and other performance issues
  • Healthy lifestyle promotion
  • Exercise counseling, whether it's starting a program, or modifying one

Some PCSM physicians are trained further in specialized procedures, such as:

  • Platelet-rich plasma (PRP) injections
  • Ultrasound-guided injections
  • Shock wave therapy
  • Chronic exertional compartment pressure testing
Who should see a PCSM physician?

Patients can be anyone: recreational athletes, weekend warriors, and athletes at the high school, collegiate or even professional ranks who want to be treated by someone with specific sports medicine training.

If there is an injury or an illness that is getting in the way of an athlete’s performance, from a skin infection in a wrestler to a nagging tendonitis in a figure skater to knee pain in a power walker, it is the job of the PCSM physician to develop a plan to get them back performing quickly and safely.

PCSM physicians work side by side with orthopedic surgeons in the office and on the sidelines. Both specialize in the diagnosis and management of musculoskeletal injuries that occur acutely and over time. More than 90 percent of all sports injuries are non-surgical, and can be treated by both specialties. PCSM physicians don't just treat the symptoms, they take a "CSI" approach to investigate why the injury or problem occurred, how to properly treat it, and work at preventing it from happening again by addressing any conditions or ailments that may have played a role int he injury in the first place. PCSM physicians can help guide and expedite referrals to the appropriate surgeon, rehabilitative therapy and other services, such as nutrition or sports psychologists, if needed.

Richard Figler, MD, is a primary care sports medicine physician. He is board-certified in family medicine with a Certificate of Added Qualification in Sports Medicine. He is the primary care sports medicine physician for John Carroll University and Solon High School. To make an appointment with Dr. Figler or any of our primary care sports medicine physicians, please call 877.440.TEAM.

What You Should Know About Youth Baseball Pitching

By Gary J. Calabrese, PT

Many youth baseball coaches and parents have questions about pitching. The two most common are: “How many pitches should a player throw?” and “What types of pitches are safe?”

It is well known that injuries at a young age mean a higher risk of injury in the players when they reach the high school and college levels. Baseball has evolved into a year-round sport, exposing young players to risks associated with muscle and tendon overuse as well as bone stress.

The shoulder and elbow are the most commonly injured areas since pitching places high stress upon these joints. To prevent injury in youth baseball and improve performance, it is important to follow these tips when working with players:

  • Adherence to pitch-count guidelines
  • Teach proper pitch mechanics
  • Avoid breaking ball pitches at a young age, especially the slider
  • Discourage players from playing on multiple teams in one season, and not allowing themselves enough recovery time between pitch outing or seasons

Cleveland Clinic Sports Health pitch count guidelines by age group and necessary recovery time are:

Age # of pitches/game Days recovery # of pitches/year
8 -10 60 - 65 4 1,800
11 -12 70 - 75 4 2,800
13 -14 80 - 85 4 3,000

The pitch counts above track pitches thrown in game situations and should not include practice or lessons. It is also important to note that each pitcher is different. A pitcher’s count/game may need to be adjusted while keeping the recovery period constant.

Besides pitch-count adherence, you should also monitor the types of pitches thrown. Research shows the type of pitch thrown is directly related to the risk of injury. USA Baseball guidelines make the following recommendations for appropriate time frames to throw pitches: fastball (8 to 10 years old), change-up (10 years old), curve ball (14 years old), slider (16 years old).

Finally, there’s also the question of whether pitch mechanics affect risk of injury. While the answer is unknown, there are several theories about the biomechanics of the throwing motion in youth baseball being studied at Cleveland Clinic Sports Health. Utilizing our motion analysis system in the biomechanics lab, we are collecting information on the ability of youth players to maintain mechanical changes in pitching motion over time.

Gary Calabrese, PT, is the Director of Rehabilitation and Sports Therapy at Cleveland Clinic Sports Health. He sees patients at Cleveland Clinic Sports Health Center. For more information about biomechanics evaluations or our pitch study, please call 877.440.TEAM.

Preventing Stress Fractures

By Carly Day, MD

No runner wants to be told they have a stress fracture. The rest required to treat this diagnosis may interfere with training and cause significant frustration. The following tips can decrease your chances of getting a stress fracture and keep you running stress-fracture free:

Avoid training errors. Start your program with short runs at a low intensity. Gradually increase your mileage and speed at a rate of approximately 10 percent per week. Consider running on softer surfaces, if possible.

Proper footwear. Change shoes every 350 to 400 miles. Shoes have a shelf life so if they are sitting in your closet for too long, the midsole can lose its shock-absorbing properties. Buy shoes immediately before you intend to use them. Certain foot shapes may benefit from over-the-counter or custom orthotics. To find the best shoe for you, go to a physical therapist or running store. Either can examine your feet, the way your run and recommend appropriate shoes for you.

Muscle strength. If you are new to exercise, consider a weight training program in addition to running. Not sure where to begin? An exercise physiologist or physical therapist can provide exercise counseling. If you are training hard, make sure your muscles aren’t too fatigued when you run. Strong, healthy leg muscles can help decrease the force felt in your bones.

Proper nutrition. Female runners with irregular or absent menses may not be consuming enough calories. Consider consultation with a nutritionist. Youths nine to 18 years old should have a calcium intake of 1,300mg a day and adults should have at least 1,000mg daily. Foods rich in calcium include yogurt, milk, cottage cheese and fortified orange juice.

Don’t run with a limp. If another injury is changing your gait, make sure you have fully recovered before returning to running. An abnormal running pattern can place atypical loads on your bones.

Don’t ignore shin pain. The most common site of stress fracture in runners is the tibia (shin bone). If you have pain in the lower leg that gets worse as you run or hurts at rest you should see a sports medicine physician. They should evaluate your leg alignment and length as well as your strength and flexibility. Early stress fractures often cannot be seen on X-ray, so an advanced study like an MRI or bone scan may be ordered. Treatment varies based on the location and severity of fracture.

Carly Day, MD, is a member of Cleveland Clinic’s Department of Orthopaedics who is board-certified in Sports Medicine and Physiatry. She treats patients with sports injuries and joint pain and has a special interest in running injuries. Dr. Day sees patients at Chagrin Family Health Center and Twinsburg Family Health and Surgery Center. To make an appointment with Dr. Day or any of our other sports medicine physicians, please call 877.440.TEAM.

dr day

In her free time, Dr. Day enjoys running, hiking and playing soccer.

Meet One of Our Newest Team Members

We asked:

What is your favorite thing about helping runners recover from their injuries?

“My patients range from ultramarathoners to people training for their first 5K. They are motivated to recover and want me to help them stay healthy and competitive. It is very rewarding when I hear a former patient has reached his or her goal, which may mean finishing a race or even winning it!” – Dr. Day

What is sports chiropractic? Is it right for me?

By Thomas B. Torzok, DC, CCSP

Sports Chiropractic (or Chiropractic Sports Medicine) is a rapidly emerging chiropractic subspecialty. With its emphasis on the conservative care of musculoskeletal injuries, including injury prevention and performance enhancement, it is clear why so many athletes seek the expertise of a sports chiropractor.

How new is the field?

Historically, including chiropractors on sports medical teams has been driven by athlete demand. In 1980, this led to the assignment of the first chiropractor to the U.S. Olympic medical team. Since that time, the subspecialty of chiropractic sports medicine has grown not only within the U.S. Olympic Committee, but throughout sports in general.

Not long ago, sports chiropractic was a profession that was considered taboo – and even illegal to practice. But today, sports chiropractors are commonly found on sports medical teams, ranging from those at high schools to the Olympic and professional levels.

What type of training does a sports chiropractor have?

Sports chiropractors must first complete a doctorate program in Chiropractic Medicine (DC). Then, they have the opportunity for postgraduate education, resulting in either the designation of Certified Chiropractic Sports Physician (CCSP) or Diplomate of the American Chiropractic Board of Sports Physicians (DACBSP).

This subspecialty training provides intimate knowledge of sports and sport-specific injuries. It supplies sports chiropractors with the unique experience necessary to diagnose and treat sports-related problems from a non-invasive perspective, without using drugs or surgery. This is a particularly attractive benefit to athletes subject to the drug testing rules set forth by the World Anti-Doping Agency (WADA) and the U.S. Anti-Doping Agency (USADA).

What type of conditions do they treat? And how?

Sports chiropractors use a multidisciplinary approach to treat athletic injuries, provide pain relief for acute injuries, identify faulty movement patterns (which may lead to future injury) and expedite safe return to sport through manual (hands-on) treatment. Some of the most common conditions they treat include acute and chronic muscle strains, tendon injuries, ligament sprains and overuse injuries in runners and endurance athletes.

Various techniques are used to treat sports injuries. These include:

  • Osseous (bony) manipulation – to restore normal motion in the spine and extremities
  • Manual or instrument-assisted soft tissue mobilization (IASTM) – used within the soft tissues to help break up scar tissue and adhesions (previously damaged tissue) in muscles, tendons, ligaments and fascia
  • Therapeutic taping techniques – to help ease pain, reduce inflammation and provide support to injured areas. Several of these popular techniques were actually developed by chiropractors, including Active Release Techniques(ART) and Kinesio Taping.

As part of a multidisciplinary team, sports chiropractors also provide referral, when necessary, to Primary Care Sports Medicine, Orthopaedic Surgery and Physical Therapy colleagues.

Thomas B. Torzok, DC, CCSP is a Sports Chiropractor who sees patients at the Sports Health Center in Garfield Heights and at the Willoughby Hills Family Health Center. If you have questions about sports chiropractic or want to make an appointment, call 877.440.TEAM.

Battling Her Way Back on the Court

Cleveland State University's Brandee Kelly thought the pain she felt in her lower back during the start of games in her first season might just be due to the grind of a Division I women’s basketball career.

Intense pain sent her to the emergency room where a battery of tests revealed abnormal growths in Brandee’s back, pelvis and leg. After seeing the images, head team physician, Susan Joy, MD, of Cleveland Clinic Sports Health, arranged a biopsy of Brandee's pelvic bone and referral to an oncologist.

Cleveland Clinic oncologist Brad Pohlman, MD, shared with Brandee the news that the pain was being caused by the mass in her back, which was lymphoma, a type of blood cancer that affects cells of the immune system. In her case, it was found in her bone marrow, and it was spreading throughout her body.

Lymphoma found in young patients can be aggressive and deadly. Treatment would require an intensive regimen of chemotherapy, but there was hope for a full recovery.

Brandee says at first she was devastated. She could not understand why a young, active woman would have cancer. But the somberness didn’t last long. The winning spirit that led Brandee to be valedictorian of Beaumont High in St. Louis and a prized recruit for the Vikings defined her cancer treatment.

Accompanied by family members and close friend Monica Daniels, Brandee began the first in a series of chemotherapy treatments that would span four months. Brandee battled through the side effects: intense nausea, vomiting, fatigue and hair loss. Each time she finally began to feel better, she would return to the clinic for another round of treatment.

She said she has always been a positive person. Her cancer experience was a test of that attitude, and she did not waver. Brandee missed only a few weeks of school; she even returned to take final exams and she passed them all.

For her final treatment, with her prognosis for beating cancer seemingly strong, Brandee’s Cleveland State teammates and coaches joined her as she rang the ceremonial bell at Taussig Cancer Institute. The bell gives notice to everyone in the building that a patient has completed a final treatment session. It also signaled to Vikings fans that a healthy, in-remission Brandee would be returning to the floor for her sophomore season.

2011 Courage Award Winner – Brandee Kelly

Brandee’s determination in overcoming lymphoma earned her the admiration of her teammates, coaches, family, friends and medical team at Cleveland Clinic and led to her receiving the 2011 Cleveland Clinic Courage Award. The award recognizes exceptional student athletes who face difficult medical challenges with courage and determination.

Nominate an athlete you know for the 2012 Courage Award.

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