Tag: Dr. Andrew Fagan

Dr. Andrew Fagan Article

Little league elbow a common problem for young pitchers

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Little league elbow is an overuse injury linked with throwing sports such as baseball.

The problem can occur in any baseball player, but is most common in young pitchers.

The cause of the injury is a result of repetitive stress to the inside of the elbow, at the growth plate of the bone, while throwing. During the throwing cycle, there is a great amount of stress generated during the acceleration phase, which translates to the structures on the inside of the elbow.

While athletes are going through growth and development, their bones are more likely to be injured at this growth plate than the surrounding muscles or ligaments attaching to it. Once the growth plates fuse later in life, pitchers are more likely to injure the ligaments and tendons of the elbow.

Little leaguers will usually begin to feel an occasional, painful, distinct pop or click on the inside of the elbow that starts without a specific injury.

Over time, swelling, aching and sharp pains can be felt. At first, symptoms will only be felt with pitching. However, as symptoms progress, any throwing motion may cause pain.

The most common age group to experience this problem is between eight and 15 years. The primary cause of the problem is a high volume of throwing.

Studies have shown there is a direct link between pitch count and elbow pain felt by athletes. Minor leagues have rules about the number of pitches young people should throw in a game.

It is important that a coach or parent count the number of throws by the athlete. Pitches that seem to create the most amount of strain on the elbow are curveballs and sliders. These options are not recommended to pitchers until ages 14 and 16, respectively.

It is important for young athletes to consult with a manual health professional if they are feeling inner elbow symptoms with throwing. Basic treatment includes a period of complete rest from throwing. Length of time depends on the severity of the problem.

 After a progressive rehabilitation of both range of motion and strength, a return-to-pitching program is the best course of action for return to play.

Dr. Andrew Fagan is a licensed chiropractor, kinesiologist and clinical acupuncture provider. You can reach him at dr.fagan@porthopehealthcentre.com or 905-885-5111

Dr. Andrew Fagan Article

Seek help for female athlete triad syndrome

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The present young generation has seen a huge spike in the number of elite female athletes.

A lot of these young females are pushing to excel physically in sport, while at the same time dealing with social pressures.

Female athlete triad is a syndrome that can affect physically active young girls. The primary cause of the syndrome involves dietary energy availability, defined as caloric intake minus energy physically expended.

Energy is taken into the body via food consumption. Our bodies use the energy consumed through participation in activity and sport. If energy taken in is not equal to or higher than used, a deficit will occur.

There are various reasons why an energy deficit may arise. Low energy availability may be due to an eating disorder, but on a regular basis this is not so.

Often female athletes experience low availability of energy because an increased amount of exercise is not matched with an increase of calories taken into the body.

It is paramount to change eating habits to meet physical requirements in order to avoid a deficit. Having low dietary energy due to excessive exercise or nutritional restriction leaves too little energy for the body to function properly, such as maintaining a regular menstrual cycle or upholding healthy bone density.

Amenorrhea is the second disorder in the triad. It is defined as the cessation of a woman’s menstrual cycle for more than three months. For younger women, it is characterized by delayed menarche.

With a low amount of dietary energy, female bodies have difficulty developing estrogen from the ovaries. Without proper estrogen release, the menstrual cycle is disrupted; this can lead to irregularity or stopping altogether.

Osteoporosis is the third disorder in the triad; this is characterized by compromised bone strength.

Low estrogen levels due to low dietary energy can cause cells in our body called osteoclasts to live longer. These cells are responsible for bone reabsorption, or breakdown, and can lead to bones being more brittle and therefore more susceptible to fracture.

If you suspect this triad in a young female, consultation with your health care professional is strongly recommended.

Dr. Andrew Fagan is a licensed chiropractor, kinesiologist and clinical acupuncture provider. You can reach him at dr.fagan@porthopehealthcentre.com or 905-885-5111

Dr. Andrew Fagan Article

Proper stretching crucial for hypermobile athletes

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We all know how important flexibility is in sport.

Athletes who are tight around functional joints used at play have a higher chance of suffering from sprain and strain injuries. This is why dynamic stretching before and static stretching after sport is practised by many.

However, there is a significant portion of the population who actually have too much motion available around their joints. This is called joint hypermobility syndrome.

Signs and symptoms of hypermobility can include joint pain, joint instability, clicking or popping of joints, increased dislocations and or subluxations.

The main cause of joint hypermobility is thought to be genetic in nature. Specific genes are passed on from parents to their children. Genes that produce collagen, an important structural protein in our bodies, play a role. As a result hypermobility tends to run in families.

The most common way of assessing for hypermobility syndrome is using the Beighton score. One point is given if the person is able to do the following: place hands flat of the floor with legs straight; hyperextend the left and/or right knee; hyperextend the left and/or right arm; have either thumb extend back to touch the forearm; extend right and/or left little finger bend back past 90 degrees.

If the person is able to do four or more of the nine they are positive for hypermobility syndrome using this method.

If a person is identified as having joint hypermobility syndrome, it is important that the individual remain physically fit even more so than the average individual. Regular exercise can help reduce symptoms as strong muscles around the joints increase dynamic joint stability.

Recommended exercises include low-impact endurance exercises such as swimming or elliptical training. Weight training should focus toward closed chain movements such a plank or a squat, instead of open chain exercises that are more likely to injure a hypermobile joint.

Exercises such as yoga that look to further lengthen the functional neuromuscular system is not usually recommended to hypermobile athletes.

If you have hypermobility syndrome, I recommend seeing a functional movement professional for advice on stabilization exercises.

Dr. Andrew Fagan is a licensed chiropractor, kinesiologist and clinical acupuncture provider. You can reach him at dr.fagan@porthopehealthcentre.com or 905-885-5111

Dr. Andrew Fagan Article

A solid core crucial for healthy athletes

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Athletes in nearly any sport can benefit from having well-functioning core musculature.

Having a solid core allows us to avoid injury. Whether you are taking a slap shot, rebounding a basketball, swinging a golf club or picking something up off the ground, your core is there to support you.

The core is made up of a group of muscles around your mid to lower torso. These muscles include the rectus abdominis, external oblique, internal oblique, transverse abdominis, quadratus lumborum and the set of gluteus muscles. This group of muscles act in concert to support your spine during movement to maintain functional stability.

The main goals when working on this core group of muscles are to increase endurance and strength, and allow you to exercise in a safe manner for your spine. I do not recommend traditional sit ups or crunches for athletes, as this puts a tremendous amount of strain through the joints and discs of the lower back (lumbar spine).

To get started, often what’s known as “the big three core exercises” from spine researcher Dr. Stuart McGill are given. These are safe core exercises for your lower back.

First, the modified sit up. While lying on your back, one knee is bent and the other straight. This locks your pelvis into a neutral position. The athlete will stiffen the abdomen, then lift the head and shoulders as a unit off the ground two to three inches while keeping the chin tucked. During the movement it is important to maintain the arch in the lower back.

Second, the side bridge consists of stiffening your abdomen while in a side propped position on your elbow and feet, then lifting your hips off the ground. It is important to keep your body and spine straight while maintaining the natural spinal curve.

Third, the bird dog starts in the hands and knees position. Start again by stiffening the core, maintaining a neutral spine. Lift your right arm directly in front of the shoulder, followed by lifting the left leg directly behind and level with the hip. Alternate this motion from side to side while maintaining a neutral spine.

Dr. Andrew Fagan is a licensed chiropractor, kinesiologist and clinical acupuncture provider. You can reach him at dr.fagan@porthopehealthcentre.com or 905-885-5111

Dr. Andrew Fagan Article

Take the right steps to healing a sprained ankle

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Recently I have noticed a number of young athletes coming into the clinic with acute ankle sprains.

For those young people who have sprained the same ankle in the past, usually our discussion will reveal what type of rehabilitation they completed before returning to sport after the previous sprain. It amazes me how often no progressive functional rehabilitation is completed before return to play.

Here is a basic game plan for a young athlete sustaining an ankle sprain.

Always have a health professional rule out fracture first. Missed fractures can cause long term functional problems later in life.

At this point, assuming a grade 1-2 sprain is sustained, the first step is called PRICE: Protection to prevent further damage; Rest from sport to allow recovery time; Ice; Compression; Elevation to help keep joint swelling down.

After following PRICE for three to five days, introduce basic range of motion exercises while the ankle is elevated.

Next, standing weight bearing on the ankle, perform slow calf raises on flat ground to activate the surrounding muscles, followed by walking if the athlete is able. It is important that tissues start to heal under lines of stress, but at the same time pain levels must be monitored as the athlete does not want to sustain a setback.

Once the above exercises are fairly pain-free, proprioceptive exercises should begin. This involves different combinations of balancing on the ankle using the muscles and tendons crossing the joint. These exercises help to further activate and strengthen the stabilizing muscles. This is an important step that is usually missed that helps to prevent the reoccurrence of ankle sprains.

The athlete should further progress through jogging, followed by running in a straight line.

Next, the athlete should start running in large figure eights. If no pain is felt, the figure eights should shrink in size to challenge the lateral stabilizers of the ankle.

Finally a shuttle run should be completed with stops and starts on either end of a 15-20 metre length.

If athletes are able to progress through these steps pain-free, they are ready to return to play.

Dr. Andrew Fagan is a licensed chiropractor, kinesiologist and clinical acupuncture provider. You can reach him at dr.fagan@porthopehealthcentre.com or 905-885-5111

Dr. Andrew Fagan Article

Proper sleep, stretching and diet crucial to avoiding sports injuries

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Dr. Andrew Fagan says many young athletes not getting enough rest

Many young athletes are full swing into their hockey season.

Evenings and weekends, after-school life can consist of multiple practices, games and tournaments.

With these busy schedules for months on end, young people start getting physically and mentally run down. Sport fatigue elevates the chances of players sustaining injuries on the ice.

 There are a few basic, yet important, things young athletes and parents can do to avoid sport injuries.

A lot of school-aged young athletes are not getting enough sleep. Late evening practices and games combined with homework can often cut into sleep hours.

Athletes need to get enough sleep in order for their bodies to recover from the physical exertion they consistently give through the week.

The recommended range for school-aged children between the ages of 6 and 13 is 9 to 11 hours of sleep. For teenagers aged 14 to 17, the number slightly decreases to 8 to 10 hours of sleep. If young athletes are not getting enough sleep, they create a sleep debt, and muscles do not get enough rest time to recover fully.

Young athletes, especially hockey players, are not stretching enough and when they do stretch they are often using erroneous methods.

Before practice or games, athletes should utilize dynamic stretching. This form of stretching uses momentum to move body parts through ranges of motion used during play. Dynamic stretches aide in increasing blood flow to the muscles while they are being lengthened and shortened.

At the end of the practice session or game, athletes as a team need to make the time to do static stretching of main muscle groups being used during play. This will help with recovery and general flexibility.

Lastly, along with rest and stretching, young athletes need to eat proper foods that are going to intellectually get them through the day at school, prep them for evening activity, and help with muscular recovery after play.

This does take some planning by parents, but will help young athletes’ bodies physically perform better and help prevent sport injuries.

Consulting a dietitian or sport-focused health-care provider can assist with specific dietary requirements.

Dr. Andrew Fagan is a licensed chiropractor, kinesiologist and clinical acupuncture provider. You can reach him at dr.fagan@porthopehealthcentre.com or 905-885-5111

Dr. Andrew Fagan Article

The importance of medical responders in sport

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Everyone has witnessed it in sport: an athlete goes down during the play, the game is stopped and a member of the team’s staff is rushed on the field to assess the player’s status.

After a period of time when an injury is present, a decision is made whether the player can get off the playing surface bearing weight, or if assistance is required. In serious cases, 911 could be called to address a sports injury emergency.

Who are the people making these decisions for the best interest of the athletes? What type of sport or medical training do they have to make the call on what happens?

Depending on the sport organization and/or the level of play, a person with trainer/medical certification is present for the best interests of everyone involved.

Some sport organizations state there must be a certified person on site, while other organizations recommend someone with trainer or medical certification is present, but this is not mandatory.

For instance, the Ontario Minor Hockey Association provides a hockey trainer certification program to educate laypeople on the safety, prevention, recognition and management of hockey-related injuries. The course can be completed online and is a good baseline certification for someone on the bench to have at a minor league game.

Unfortunately, the majority of other sporting organizations do not have these programs in place to educate laypeople on the management of injuries. More often, recently, many teams bring in outside people with sport-specific first responder training. These first responders assist with medical situations on field and sideline care serving the best interests and well-being of the athletes.

This is seen especially in tournament situations where many games are running in a short period of time.

First responders are trained in techniques for sustaining life, preventing further injury, and caring for illness and injuries until the next level of medical personnel arrives.

Many sport-focused manual and medical providers complete this additional training to become a first responder as a requirement to help with teams at national and international levels.

Dr. Andrew Fagan is a licensed chiropractor, kinesiologist and clinical acupuncture provider. You can reach him at dr.fagan@porthopehealthcentre.com or 905-885-5111

Dr. Andrew Fagan Article

Tommy John surgery a pain in the elbow to baseball players

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Pitchers most commonly affected

We have all heard baseball announcers talk about players who have undergone Tommy John surgery after a throwing injury at the elbow.

But what is it, exactly?

Over the course of time, a baseball player’s elbow withstands a lot of force from repetitive hard throwing. This is most common in pitchers.

The ligament on the inside of the elbow, the ulnar collateral ligament (UCL), can become stretched, frayed and torn over time. This can cause irritation of the neighbouring ulnar nerve on the inside of the elbow, and thus cause pain with throwing.

As the body goes through the throwing cycle from the acceleration phase to the deceleration phase, force is transferred from the arm through to the baseball. This transfer of force creates torque at the UCL and leads to the injury.

The surgical procedure involves grafting a tendon from the athlete’s own body or using a tendon from a cadaver.

Holes are drilled on either side of the elbow joint. The tendon is woven into a figure eight pattern through the holes and anchored into place to simulate the UCL ligament.

Normally the ulnar nerve is slightly moved to prevent future pain symptoms as scar tissue can accumulate in the area and cause pressure on the nerve.

The surgery was named after the first Major League Baseball (MLB) player to have the procedure successfully completed. Tommy John returned after rehabilitation to win 164 additional career MLB games.

The problem can also occur in mature children and collegiate-aged athletes.

Studies show that the greatest determinant of sustaining the injury has to do with the amount of pitches thrown by an athlete. There are different guidelines to suggest how many pitches an athlete should make in a game, and how much rest time they should have between games.

After an athlete has the procedure done, rehabilitation takes about six months for position players, and at least a year for pitchers.

Over time, results have shown that 80 per cent of MLB players who have the procedure completed have returned to the same level of pitching as before the injury.

Dr. Andrew Fagan is a licensed chiropractor, kinesiologist and clinical acupuncture provider. You can reach him at dr.fagan@porthopehealthcentre.com or 905-885-5111

Dr. Andrew Fagan Article

Good posture a benefit to athletes

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Athletes from young to old, recreational to expert, can benefit from having good posture.

Having an upright posture not only makes us feel better about ourselves, it also helps to prevent injuries in sport.

I often see young athletes from various sports coming in to the clinic because their shoulder, neck or lower back are generally achy and sore.

Often these young people are sitting slouching in a chair with their shoulders rounded, head and neck forward, and lower back slumped, regularly with a cellphone in hand. At this point I usually ask the athletes if they sit like this all the time. Almost always I am given an affirmative response, as they simultaneously try to sit up straighter in the chair.

These young athletes during the evening and weekends storm playing surfaces for one to three hours, then afterward sit or stand the remainder of their day in poor postural positions. These positions cause various forms of muscle tightness, imbalances and joint creep, leaving their bodies more prone to injury.

There are two common postural positions athletes find themselves in.

The first is forward (anterior) rolling of the head and shoulders. This can cause chest (pectoralis) and neck (cervical) muscular shortening. This combination of positions can lead to an increased prevalence of shoulder, upper back, neck and headache symptoms.

The second common position athletes find themselves in is forward (anterior) pelvic tilt. This involves the front of the pelvis rotating forward and downward, while the rear side of the pelvis rotates back and upward. This can cause a number of problems including low back pain, hip flexor strains and decreased biomechanical efficiency with movement.

Various strategies can help avoid these common undesirable postures. Stretching of shortened musculature can help avoid progression of the imbalances. Activating opposing muscle groups using corrective exercises helps to reposition body parts back to where they are supposed to be. Also making a conscious effort to sit and stand with proper positioning makes a pronounced difference.

If you are struggling with any of the above problems I suggest consulting a functional movement professional.

Dr. Andrew Fagan is a licensed chiropractor, kinesiologist and clinical acupuncture provider. You can reach him at dr.fagan@porthopehealthcentre.com or 905-885-5111