Spring spts newsletter ezine by SPTS

DIVERTED. (OR, MAKING FRIENDS FROM FOG) By Heidi Edwards, PT, MPT, OCS, SCS, COMT, CSCS SPTS Member Heidi Edwards was heading to Team Concept Conference 2014 when her carefully planned schedule took a turn. But was it really for the worse? See how one member turned a challenge into a great experience... and was presented with the opportunity of a lifetime due to her perseverance!

Life is full of diversions. We order pizza after the chicken dinner burns. We resolve to lease the basic car model, but go for the upgrade (I don’t regret getting the sunroof!). Flying to Team Concept Conference was no exception. I, along with a plane full of cowboys, was diverted to Albuquerque after circling over foggy Las Vegas for several minutes. “Sin City” had turned to “Soup City.” Albuquerque International Airport is not your hotbed of activity and flight options. I was told I could try my luck flying standby on flights not headed to Las Vegas. Maybe in two or more stops I could get to my destination. The other option was to cross my fingers for an available flight to Las Vegas the next morning (fog was predicted again). If not by air, then by road! Splitting costs with cowboys anxious to see the National Finals Rodeo, we rented a van. The most backward way ever of getting to Las Vegas had begun!

Our author, SPTS member Heidi Edwards, starts off on an adventure...but not the adventure she planned than morning!

You learn a lot about people during an eight-hour road trip. I learned that my

Welcome to...Arizona? front seat cowgirl should not consume two Red Bulls in an enclosed space! We were thankful to learn that none of us was a serial killer. We also learned a laptop will recharge your phone in the absence of a car charger. But, more importantly, we learned to make the most of the crummy situation. We laughed. We sang along to “Feliz Navidad” and country songs on the radio. We learned each other’s story. We joked about having a re-

How Heidi reached Las Vegas. Red= air Blue = automobile Her fellow travelers are shown below left.

Heidi Edwards, shown above in China. Watch for her adventures working in Shanghai in an upcoming SPTS E-magazine! cessful career in Sports PT, I needed more guidance. Through her, I became more involved with SPTS. She also taught me the steps I needed to take in order to work with athletes.

union every year at the Albuquerque airport. What if I had not attended TCC this year? Then another life diversion would not have occurred. I would have missed an opportunity to work with elite level athletes at the Shanghai Research Institute of Sport. That opportunity occurred by speaking with the conference sponsors. (I also won a raffle prize for visiting with the sponsors. But, I digress!) Prior to

TCC, my life was headed in one direction. Now my life is headed in another direction towards a foreign land! The Shanghai opportunity really began long before that thirteen-hour trek. I am grateful to our Sports Section Secretary, my mentor and friend, Teresa Schuemann. She taught me to make the most of my attendance at TCC and CSM. Sure â&#x20AC;&#x201C; I would have attended the conference lectures and labs. But, to have a chance at a suc-

Bottom line-get involved! Attend conferences, find a mentor, join committees, meet the speakers, visit the booths, and attend the SPTS public business meetings. Take some risks, too! Not all diversions are bad. You just might make some cowboy and SPTS friends along the way! Watch for Heidiâ&#x20AC;&#x2122;s Shanghai story soon! See the next pages for TCC coverage.

TEAM CONCEPT CONFERENCE 2015 By Carol Ferkovic Another fantastic Team Concept Conference took place at the Green Valley Ranch Resort from December 4-6, 2014. Over 250 sports physical therapists and other healthcare professionals learned about new concepts in sports medicine from some of the biggest names in the field. The event started with a pre-conference workshop on ACL injuries. This full day of programming was sponsored by the Sports Health editorial board. Current research and knowledge of all aspects of ACL injury, examination and rehabilitation were presented. Hollis Potter, MD, also presented a primer for orthopaedic MRI to attendees. Other talks included topics such as functional testing for return to play after ACL surgery, management of pediatric ACL injury, and revision ACL reconstruction. The first day of the conference concluded with an event sponsored by TheraBand™, where the new CLX was demonstrated to guests. The program included lectures and demonstrations by Sue Falsone, Bart

Matthew Winters demonstrating a soccer heading exercise with the Theraband™ CLX.

The SPTS Traveling Fellows also spoke on their experiences during the program. The newest addition to TCC was the presentation by the first annual #teammember winner, Brett Bousquet, with his entertaining video to promote SPTS (see next page). The last day of TCC consisted of programming on the shoulder. Management of rotator cuff, articular cartilage, and labral injury was presented. Surgical and conservative management as well as rehabilitation considerations were all discussed. The afternoon programming entailed a discussion of muscle injuries, Dr. Brian Cole presenting on Clinical Decision Making and Surgical Management of Rotator Cuff Lesions. Bishop, Phil Page, Tim Tyler, and Mike Reinhold. Attendees had a chance to try the new CLX and compete for prizes. Following the event, TheraBand™ sponsored a cocktail party and SPTS TeamMates networking session. New SPTS members, student members, and first time attendees, or “Rookies” were paired with “Captains,” classified as experienced SPTS members. TCC continued programming on days two and three with instructional course labs. These breakout sessions included examination of the hip, return to play criteria for the athlete, manual techniques for the shoulder, on-field clinical decision making, and dry needling. Programming on day two focused on articular cartilage lesions and knee meniscus pathology in the morning followed by a keynote presentation by John Feagin, MD. The afternoon focused on lower leg injuries and running mechanics.

Ryan Leaver presenting on his experiences as an SPTS Traveling Fellow.

focusing on the pectoralis major and hamstring. Team Concept Conference wrapped with breakout sessions on examination of runner’s injuries, performance enhancement for the athlete, core stability training in scholastic athletes, and alternative therapy techniques in sport. Thank you to Walt Jenkins, Team Concept Conference Chair, the TCC

During rare down time, it’s great to connect with your fellow members. Left to right, Rob Manske, SPTS Vice President; Blaise Williams, Running SIG Chair; Erik Meira, Programming Chair; Ross Nakaji; Dan Lorenz, Sports Performance Enhancement SIG Chair; Dave Knoeppel; Mary Wilkinson, Director of Marketing; Walt Jenkins, Team Concept Committee Chair; Mark Reinking. committee, the SPTS Executive Board, Executive Director Mark De Carlo, Director of Marketing Mary Wilkinson, and all of the sponsors and exhibitors who made this event possible. Thank you to all who attended the conference as well!

MY TCC EXPERIENCE By Brett Bousquet

Time to relax before TCC starts! Ladies on the left: Stacey Pagorek, SPTS Representative at Large and Board Member; Barb Hoogenboom, IJSPT Senior Associate Editor; Mary Wilkinson, Director of Marketing; former executive assistant Tammy Jackson.

Wow! I honestly cannot say enough about my experience at the Sports section’s Team Concept Conference in Henderson, Nevada. Before I get into details, I want to thank the SPTS for the opportunity to attend the conference and everyone involved behind the scenes that not only put on an exception education event, but made my experience a memorable one.

Men on the right: Mark De Carlo, SPTS Executive Director; Rob Manske, SPTS Vice President; Bryan Heiderscheit, SPTS Treasurer; Tim Tyler, SPTS President enjoy the evening at Hank’s Steak House at the Green Valley Ranch Resort.

Each year, the SPTS hosts a meeting that encourages its members, along with countless prestigious sports medicine professionals, to get together as a team and promote interprofessional relationship building. This collaboration encourages better communication among all members of the sports medicine team, and therefore better management of our athletes. This year’s 37th annual event lead host to some of the forefront leaders in the sports medicine field, who covered a wide variety of topics. Apart from being at the leading edge of research and sports medicine intervention, this years’ TCC encouraged both experienced and rookie conference goers to collaborate as part of its Teammates networking initiative. Pairing newbie’s with knowledgeable veterans was another facet aimed at further promoting teamwork and relationship building. As part of an initiative that worked towards promoting younger member

involvement, the TCC held a video competition to encourage students and new grads to creatively portray why they chose to be members in the SPTS. This is where my story begins. While driving up to “My home and native land” one weekend, I stumbled across an email (while I was filling my gas tank of course), that explained how I could have my conference fees paid for the upcoming TCC in Nevada. Since I always have a back-up plan on hand, my skills as a rhyming sports enthusiast were on point should my life as a physical therapist not pan out. Thirty minutes down the road, I had something I was ready to record and submit. As a new professional, graduating in 2013 from Pacific University in Oregon, I entered as part of the early career member division, and won. After having some time to reflect on my experience, I still am struggling to take it in. I cannot even begin to explain how my time spent at the TCC is going to pay dividends well into my future. For no other reason that three being my college jersey number, I will break it down into my three take home points from the conference. 1. Teamwork. To be honest, the name of the conference is what it is all about. There were no individuals at this conference. Each and every speaker discussed athletic management from a team approach. They all had an understanding of their role, and the roles of the other professionals on their team. The athlete is the centerpiece, and everyone fills in appropriately around them. 2. Passion. Not only did the conference have presenters who are at the forefront of the profession and literally writing the book on athletic management, but those in attendance were all just as zealous about

bettering their treatments and interventions. In my interactions and conversations with other, I found out that good was never enough for many of these people. Despite being highly credentialed and experienced in the profession, those who attended never seemed content with their current abilities. They wanted to continually refine their craft and better serve their patients. Being surrounded by so many like minded individuals truly motivated me to continue my pursuit of education. 3. Networking. I think the thing that I was most surprised with about throughout my attendance at the TCC was the networking opportunities that presented themselves. Honestly, everyone that I met was so eager to help in any way possible, and was quick to offer guidance and assistance through a variety of avenues. The respect and comradery that was on display was something I haven’t experienced before, and feel rarely presents itself in other social gatherings. There is no other time throughout the year that this many focused sports physical therapy professionals are gathered in one place, and the opportunity shouldn’t be missed. I honestly cannot say that had this opportunity not presented itself to me, I likely wouldn’t have attended the TCC. Now, after having the experience that I had, and meeting the people that I met, there is no way I can miss it in the future. With so many great opportunities and educational experiences for a sports section member, students, new grads and experienced members have no excuse for sitting out on future events.

OUR SPONSORS

Silver Sponsor SPTS Supporter for over 20 years

Gold Sponsor

Silver Sponsor

Silver Sponsor Titling Sponsor for TCC Welcome Event

Bronze Sponsor

SPTS CELEBRATES CSM

Only the hardiest souls participated in the inaugural Move4PT. Held at 5:30 PM on a cold (15 degree!) evening, SPTS welcomed 100+ hardy registered participants. Despite the small crowd, fun was had by all. Want to see all the wonderful photos of participants captured by Michael Wellsandt, Joe Black and Barb Hoogenboom? Go to the SPTS Facebook page! http://www.facebook.com/ sportssection

IN INDIANAPOLIS

AT LUCAS OIL STADIUM It was an amazing evening in an exciting setting when over 400 SPTS members came together at Lucas Oil Stadium, home of the Indianapolis Colts, to celebrate an evening of homecoming, featuring the annual business meeting, awards ceremony and party. For more photos, go to the SPTS Facebook page. For a list of winners, see the next page!

SPTS AWARDS 2015 OUTSTANDING STUDENT AWARD Presented to Christa Wille by Bryan Heiderscheit LYNN WALLACE CLINICAL EDUCATOR AWARD Presented to Robert Panariello, MS, PT, ATC, CSCS by Timothy Stump

JOSPT EXCELLENCE IN RESEARCH AWARD Presented by George Davies Comparison of the Short-Term Outcomes Between Trigger Point Dry Needling and Trigger Point Manual Therapy for the Management of Chronic Mechanical Neck Pain: A Randomized Clinical Trial. Rocio Llamas-Ramos, PT, Daniel PecosMartín, PT, PhD, Tomás GallegoIzquierdo, PT, PhD, Inés Llamas-Ramos, PT, Gustavo Plaza-Manzano, PT, Ricardo Ortega-Santiago, PT, PhD, Joshua A. Cleland, PT, PhD, César Fernández-de-las-Peñas, PT, PhD, DMSc JOSPT GEORGE DAVIES-JAMES A. GOULD EXCELLENCE IN CLINICAL INQUIRY AWARD Clinical Rehabilitation Guidelines for Matrix-Induced Autologous Chondrocyte Implantation on the Tibiofemoral Joint. Peter K. Edwards, PT, MSc, Timothy Ackland, PhD, FASMF, Jay R. Ebert, PT, PhD IJSPT ACHIEVEMENT OF DISTINCTION OUTSTANDING ORIGINAL RESEARCH MANUSCRIPT EXCELLENCE AWARD Presented by Mike Voight, Editor and Barb Hoogenboom, Senior Associate Editor, IJSPT A speed distanced-based classification system for injury prevention and research in international and domestic youth baseball Michael J. Axe, MD | Michael Stube, PhD | David Osinki James R. Andrew, MD | Lynn SynderMackler PT, ScD IJSPT ACHIEVEMENT OF DISTINCTION CASE REPORT MANUSCRIPT AWARD Diagnosis and expedited surgical intervention of a complete hamstring avulsion in a military combatives athlete: a case study. Shaun J. O'Laughlin. PT, DPT, OCS | Timothy W. Flynn. PT, PhD Richard B. Westrick, PT, DSc | Michael D. Ross, PT, DHSc

EXCELLENCE IN EDUCATION AWARD Presented to Terry Grindstaff, PT, PhD, ATC, SCS by Deborah Givens JACK C. HUGHSTON AWARD Presented to Dr. Richard Steadman by Dirk Kokmeyer and Luke O’Brien HALL OF FAME TURNER A. BLACKBURN LIFETIME ACHIEVEMENT AWARD Presented by Tab Blackburn to Mark S. DeCarlo, PT, DPT, MHA, ATC, SCS

Mark De Carlo accepts the Hall of Fame Turner A. Blackburn Lifetime Achievement Award. LEGACY FUND GRANT AWARDS Presented by Chuck Thigpen Lower Extremity Injury Risk following Anterior Cruciate Ligament Reconstruction and Return to Major League Soccer Amelia Arundale, PT, DPT, SCS, University of Delaware Prospective Study of the Impact of Quadriceps Femoris Strength at Return-toSport on Long-Term Knee Joint Mechanics and Performance in Young, Active Individuals after Anterior Cruciate Ligament Reconstruction Matthew P. Ithurburn, PT, DPT, OCS SPTS EXCELLENCE IN RESEARCH AWARD Achieving Symmetry in ACL Return to Sport Testing Does Not Represent Prior Functional Levels Elizabeth Wellsandt, University of Delaware NEW HORIZON AWARD Presented to Catherine Quatman-Yates, PT, PhD by Mark Paterno OUTSTANDING SERVICE AWARD Presented to Michael Mullaney, PT, DPT, SCS by Marissa Pontillo

Mike Rosenthal accepts the Peyton Award on behalf of Joe Moore. 2015 RONALD G. PEYTON AWARD Presented to Colonel Josef H. Moore, PT, PhD, SCS MEMBERSHIP TRIBUTE Presented by SPTS President Tim Tyler to Mark S. DeCarlo, PT, DPT, MHA, ATC, SCS

EMR COURSES: MORE ACCESSIBLE THAN EVER! Preparing to sit for the SCS exam? Want to work on the field or on the court? Or would you just like to expand your skills as a sports physical therapist? SPTS EMR courses, presented by CogentSteps, are the perfect answer. SPTS offers more courses than ever, covering more of the country, so there is bound to be one convenient for you. Full courses, as well as recertification courses and challenge courses for those less than 60 days out from last certification, are available at various locations. Check out information in this newsletter, or at www.spts.org/emrcourses/upcoming-emr-courses! SPTS/CogentSteps courses combine lecture, video education, demonstrations, hands-on experiential learning, and real-world testing to help assure your skill on the field, on the court, and in real life. Even if you are not planning to sit for the SCS or to work in an on-field setting, these courses are essential for the well-rounded and top notch sports physical therapist.

ELECTIONS OPEN THROUGH APRIL 30: VOTE FOR THE FUTURE OF THE SECTION Elections for SPTS offices are now open to members. Voting will be open through 11:59 EST April 30, when they will be automatically closed by the election system. It’s so easy to vote. Simply login to the website (very important!) then click on the tab in the left menu marked ELECTIONS. www.spts.org/elections-2015 Follow the simple instructions and you are finished. You may view the individual candidates’ platforms as part of the voting

module before you place your vote, or you can view them through the dropboxes from the election tab. Having problems logging in? See the troubleshooting guide in this issue. Or email Mary Wilkinson at mwilkinson@spts.org for assistance. FOR PRESIDENT-ELECT Barb Hoogenboom Walt Jenkins FOR VICE PRESIDENT Phil Page Blaise Williams

FOR SECRETARY Joe Black Mitch Rauh Bart Bishop FOR NOMINATING COMMITTEE Terry Grindstaff John Heick Mike Keirns Janice Loudon

TACTICAL ATHLETE SPECIAL INTEREST GROUP NOW PART OF SPTS What are the goals of the SIG? The goal of the Tactical Athlete Special Interest Group is to support and expand the knowledge and understanding of Sports Physical Therapy members working with tactical athlete communities. The SIG will serve to facilitate collaboration and communication between researchers, clinicians, and tactical athletes regarding various aspects of training, injury prevention, performance, and physical therapy unique to this population.

Rich Westrick, the chair of the new Tactical Athlete SIG, is shown with his IJSPT award at this year’s Homecoming Event in Indianapolis. The SPTS is excited to announce the official acceptance of a new special interest group to the diverse ranks of SPTS endorsed SIGs: the Tactical Athlete SIG! In a brief interview, the Tactile Athlete SIG Chair, Richard Westrick, PT, DPT, DSc, OCS, SCS, discussed the inception, goals, and exciting visions for the future of this new, unique group. What inspired you to create the Tactical Athlete SIG? Over the past year, there has been growing interest to create a Special Interest Group for physical therapists working with law enforcement, firefighters, special operations, and military “tactical athletes”. Creating a new SIG is the perfect opportunity to support PTs interested in working with this community and facilitate communication between those already caring for tactical athletes.

What hot topics do you feel will be most pertinent to target with SIG activities and sponsored educational sessions in the near future? Stay tuned! We will survey our SIG members to get a better idea of the most pertinent “hot topics” in the coming months. We will be seeking input from members as we define the important role of physical therapists for tactical athletes. Musculoskeletal injuries continue to create the largest burden in this community & understanding return-to-duty considerations will of utmost importance. Who is the targeted population for membership into the SIG? Sports Physical Therapy members with a particular interest in law enforcement, fire and rescue, special operations and military “tactical athletes” are the target population for this Special Interest Group. Do you have to have a military background to be a part of the SIG? Absolutely not! We actually anticipate the number of members working with law enforcement and firefighters to outnumber those who work with the military. I am an active-duty Army officer and Sports

Physical Therapist and have been afforded the opportunity to support military Tactical Athletes around the world over the past 20 years. During this time I’ve recognized the unique considerations relative to this population, but I also recognize the potential to collaborate and learn from those with work with various types of tactical athletes. Are there any upcoming sponsored SIG events that you would like to note? Since the SIG is just getting started, we will be actively seeking opportunities to sponsor events and activities and will be looking for ideas from our growing membership roster. We are already discussing collaboration with our colleagues at the NSCA’s Tactical Strength and Conditioning Program. We have programming being developed for the 2016 Combined Sections Meeting and are excited about the future for this SIG! To join the Tactical Athlete Special Interest Group, contact Richard Westrick at rbwestrick@gmail.com.

FALL TRAVELING FELLOWSHIP APPLICATIONS DUE JUNE 1! The SPTS Kevin Wilk Traveling Fellowship There’s no question that residencies and fellowships help develop sports physical therapists’ abilities for advanced competencies in the field. These programs allow professionals to develop their skills under the mentorship of a recognized clinical expert. Residencies and fellowships require the dedication of many hours of time toward the program...something that can be difficult to arrange in the postgraduate world. SPTS Kevin Wilk Traveling Fellows will spend a single week traveling to three educational sites, spending one to two days each with noted leaders in our field. At each site, fellows will be involved in various activities:

• Observation of the host therapist in the clinic • Surgery observation • Didactic component • Social activities to expand the fellows’ professional network The SPTS Traveling Fellowship is funded by SPTS and corporate sponsor DJO Global, which will allow one to two SPTS members to participate each year. To apply for the SPTS Traveling Fellowship, follow the links for an application packet. Please forward packet to Mark De Carlo, Executive Director, at mdecarlo @spts.org. If you have any questions regarding the fellowship or the application process, please contact Rob Manske, SPTS Vice-President at robert.manske@wichita.edu.

Fall 2015 class dates are September 17-26, 2015. Fall 2015 Sites University of Cincinnati Cincinnati, Ohio Bob Mangine, host Stanford University, Stanford, CA Floyd Vito Cruz, host University of Wisconsin Madison, Wisconsin Bryan Heiderscheit, host Applications for Fall 2015 are due no later than June 1, 2015. Application Form for Fall 2015 FAQ

SUBMIT NOW FOR THE IJSPT SPECIAL ISSUE: STRENGTH AND CONDITIONING Be a part of the special November IJSPT issue! Submit your strength and conditioning articles now...submissions are due by May 1. Submitting is simple...follow the instructions for submission on the IJSPT portal.

JOIN SPTS AS WE ROCK LAS VEGAS! SAVE THE DATE NOW! Be sure to save the date for Team Concept Conference 2015 at the Red Rock Resort and Casino, December 3-5! This yearâ&#x20AC;&#x2122;s conference will include a pre-conference day on the topic of running, before we launch into two additional days of head-to-toe programming for sports physical therapists and the entire sports medicine team. Red Rock is situated directly across from the entrance to the fabled Red Rock Canyons. The resort features free WiFi, access to the fitness center, shuttle service to the Strip and more! Registration opens May 1. Exhibitor registration is now open...contact Mary Wilkinson at 317.501.0805 or mwilkinson@spts.org for more information.

THE CURVEBALL: Could it be more of a solution than a causative factor for elbow and shoulder problems in youth baseball pitchers? HISTORY OF RECOMMENDATIONS ON THE CURVEBALL: For decades the type of pitch thrown, including the curveball, has been implicated as a causative factor for the development of elbow and shoulder dysfunction among youth baseball pitchers. Over the last 20 years, orthopaedic surgeons, physical therapists, athletic trainers, and coaches have advised youth baseball pitchers to avoid throwing curveballs until they reach physical maturity. Often the recommendations included not throwing curveballs until the pitcher is 14-16 years old or “is shaving”, or “has hair under his arms”. While these recommendations have been very well intended, the evidence has been lacking to support the recommendations. More recently, the recommendations from the medical community have been changing but the widespread “accepted truth” by coaches, players, and parents remain that the curveball is a big source in youth pitching injuries involving the elbow or shoulder (ASMI). A recent systematic review of the literature on the curveball as a risk factor for injury, highlights the lack of evidence to support these established recommendations despite “widespread acceptance of this idea among baseball trainers, coaches, and physicians” (Grantham et al.). DOES THE CURVEBALL ACTUALLY INCREASE RISK OF INJURY? While there has been a reported increase in overall ulnar collateral ligament reconstructions performed on throwers, the cause of the increase may have less to do with the type of pitch thrown and more related to pitch volume and intensity (Dun et al., Fleisig et al). Recent evidence

suggests that more valgus stress is placed on the elbow when throwing a fastball when compared to a curveball (Nissen et al.) Throwing a baseball in general is stressful on the shoulder and elbow. Throwing a baseball excessively, with high velocity, seems to be the most stressful activity. Some pitchers break down and others do not. The reasons at this time are not fully known but the two main culprits coming under more scrutiny are volume and velocity. TIMING IS EVERYTHING! The purpose of this article is not to replicate a literature review on the subject matter, which others have previously published (Grantham et al.), but to challenge the thought process regarding pitching recommendations. The value of the curveball to a pitcher can be remarkable. Warren Spahn (MLB Hall of Fame

Pitcher) once said, “Hitting is timing. Pitching is upsetting timing”. Anything a pitcher can do to upset the hitter’s timing will improve success as a pitcher, and likely decrease the overall volume of pitches needed to complete an inning or even a game. COACHING YOUTH BASEBALL My background not only includes a sports physical therapy practice for the last 19 years (including a high volume of youth baseball players), but also coaching youth baseball at a recreation, all-star, travel, and elite travel level over the most recent 10 years. Many youth pitchers learn to successfully throw a curveball as early as 9 or 10 years old with sound biomechanics. While coaching or treating youth baseball pitchers, the curveball hasn’t been a recognized contributing factor for development of shoulder or elbow problems. On a youth level, the players that more

FRIEND OR FOE? often seem to have shoulder or elbow problems are the ones who throw a lot of pitches in a season and/ or throw with high velocity (maximum effort) on a high percentage of pitches. The two main successful factors from a coaching standpoint, that have been implemented to prevent injuries, are controlling pitch volume (pitch count) and allowing for adequate rest between pitching outings. A discussion about adding the curveball to the youth pitcher’s repertoire is very controversial and goes against the grain of established youth pitching guidelines. Based on the current medical evidence, and my experience coaching youth baseball, the curveball and the change up should be taught at an early age to youth baseball pitchers for the following reasons 1. Early motor control learning of physical movements facilitates safe mastery of a movement. 2. Early motor control learning of a movement adequately prepares the tissue for future stress and demands placed on that tissue. What other sport and physical movement does an athlete wait to learn once he is older than the age of 14? Most physical athletic movement skills need to be learned at a very early age for safe mastery of the movement. 3. Changing velocity and types of pitches is very effective when trying to get hitters out at the plate. 4. The more a pitcher varies his pitch type (fastball, curveball, change up), the fewer number of pitches are needed to get hitters out at the plate. Varying pitches will likely facilitate less required pitches for each at bat, each inning, each game, and ultimately each season. By the time most youth players reach 10 years old, the fastball is hit very easily and often, regardless of its velocity. The 10 year old age matches the developmental require-

ments of baseball for youth pitchers to begin to master the curveball and changeup. Mastering off speed pitches at the age of 10 or younger allows the player to compete at an appropriate level without risking injury at a higher rate. A dad recently said to me, “My son’s elbow is hurting really bad, and he doesn’t even throw a curve ball”. The statement was revolutionary and revealing at the same time. My response was “That’s because the problem is not the curveball, the problem is VOLUME”. RISK FACTORS FOR YOUTH BASEBALL PITCHERS Major Risk Factors for elbow or shoulder injuries in youth pitchers: (ASMI) 1. Pitching while fatigued (Yang J. et al., Register-Mihalik JK. et al., Olsen SJ. et al.) 2. Volume of pitching (Register-Mihalik JK. et al.) 3. Pitching on multiple teams (Register-Mihalik JK. et al.) 4. Pitching year-round (Olsen SJ. et al.) 5. Playing catcher when not pitching (Fleisig GS. et al.) 6. Poor pitching mechanics (Davis JT. et al., Fortenbaugh D. et al.) 7. Poor physical conditioning (Trakis TF. et al., Tyler TF. et al.) RECOMMENDATIONS FOR THE PHYSICAL THERAPIST The physical therapist should focus on recommendations that are supported by adequate evidence. Clear evidence for limiting pitch type (including the curveball), until a certain age doesn’t exist at this time, nor is it advisable for the youth baseball pitcher’s success while competing in the sport. Based on the above risk factors, the recommendations to parents and coaches should include the following: 1. Monitor and limit the number of pitches per outing. 2.

Avoid pitching simultaneously for multiple teams 3. Take 3-4 months off per year and avoid pitching or throwing during that time. 4. Avoid pitching and catching in the same game. 5. Avoid pitching and catching on subsequent days. 6. Prepare to pitch by being in good physical condition. And lastly, consider mixing up your pitch type (fastball, curveball, changeup) as a means to decrease risk of injury. Mixing in some off speed pitches will minimize how many maximum intensity pitches one has to throw. Remember, as Warren Spahn so eloquently stated “Hitting is timing. Pitching is upsetting timing”. CONCLUSION The curveball remains a fiercely debated subject among coaches, youth players, parents, and the medical community alike. At this time, biomechanical studies haven’t produced evidence to recommend or discourage throwing curveballs at a young age. An increased risk has not been clearly demonstrated when compared to throwing the fastball. Throwing a baseball has inherit risk, much like many other repetitive sports movements, but the type of pitch does not seem to increase the risk that already exists. Throwing various types of pitches can improve a youth pitcher’s effectiveness and reduce the overall volume of pitches needed to complete the inning or the game. Since volume is a major risk factor for an arm injury, pitchers should consider ways to decrease their pitching volume, including the infamous curveball! Please feel free to contact me with comments, feedback, or input regarding your thoughts on this article Chris Alford, PT, DPT, SCS, ATC, CSCS

Vice President, Founder, CoOwner Twin Lakes Physical Therapy, Inc. 571 Hammock Rd, Suite 106 Milledgeville, GA 31061 www.twinlakespt.com calfordpt@gmail.com American Sports Medicine Institute (ASMI). http://www.asmi.org/research.php?page=research&section=TJpositionstatement. Accessed April 4, 2015. Grantham JW, Iyengar JJ, Byram IR, Ahmad CS,. The curveball as a risk factor for injury: a systematic review. Sports Health. 2015;7;19-26. Dun S, Loftice J, Fleisig GS, Kingsley D, Andrews JR. A biomechanical comparison of youth baseball pitchers: is the curveball potentially harmful? Am J Sports Med. 2008;36:686-692.

Fleisig GS, Kingsley DS, Loftice JW, et al. Kinetic comparison among the fastball, curveball, change-up, and slider in collegiate baseball pitchers. Am J Sports Med. 2006;34:423-430. Nissen CW, Westwell M, Ounpuu S, Patel M, Solomito M, Tate J. A biomechanical comparison of the fastball and curveball in adolescent baseball pitchers. Am J Sports Med. 2009;37:1492-1498. Yang J, Mann BJ, Guettler JH, et al. Riskprone pitching activities and injuries in youth baseball: findings from a national sample. Am J Sports Med. 2014;42(6):1456-1463. Register-Mihalik JK, Oyama S, Marshall SW, Mueller FO. Pitching practices and self-reported injuries among youth baseball pitchers: a descriptive study. Athl Train Sport Heal Care. 2012;4(1):11-20. Olsen SJ, Fleisig GS, Dun S, Loftice J, Andrews JR. Risk factors for shoulder and elbow injuries in adolescent baseball pitchers. Am J Sports Med. 2006;34(6): 905-912.

Fleisig GS, Andrews JR, Cutter GR, et al. Risk of serious injury for young baseball pitchers: a 10-year prospective study. Am J Sports Med. 2011;39(2):253-257. Davis JT, Limpisvasti O, Fluhme D, et al. The effect of pitching biomechanics on the upper extremity in youth and adolescent baseball pitchers. Am J Sports Med. 2009;37(8):1484-1491. Fortenbaugh D, Fleisig GS, Andrews JR. Baseball pitching biomechanics in relation to injury risk and performance. Sports Health. 2009;1(4):314-320. Trakis JE, McHugh MP, Caracciolo PA, Busciacco L, Mullaney M, Nicholas SJ. Muscle strength and range of motion in adolescent pitchers with throwing-related pain: implications for injury prevention. Am J Sports Med. 2008;36(11):2173-2178. Tyler TF, Mullaney MJ, Mirabella MR, et al. Risk factors for shoulder and elbow injuries in high school baseball pitchers: the role of pre-season strength and range of motion. Am J Sports Med. 2014;6;42(8):1993-1999.

HAVING TROUBLE LOGGING IN TO ACCESS IJSPT? YOU MAY FIND THE REASON HERE... The Section and marketing offices have been seeing a lot of questions about problems logging into the website to access the IJSPT. We asked Mary Wilkinson, the SPTS Director of Marketing and Webmaster, why this is happening. “There are several issues we are finding when we look into the database,” she says, “and this is where members should look first. We receive a report from the APTA every month, which lists those who have joined the Section or dropped their Section membership. Unfortunately, there can be as much as a 60-day lag from the time someone joins or renews their membership in the Section, and when we receive the information. So it is possible that members who renewed late may be removed from our database.

“We are seeing more and more members who are going into the site and changing their usernames and passwords. This will guarantee that you will no longer receive access to the IJSPT, as the formula we set up in the system has been overridden.” Mary encourages all members to leave their sites with the username as their APTA number and the password as their last name. “Sometimes we run into members who have set up separate logins with the same email address during product purchases. Duplicate email addresses also set up a red flag in the database and shut down access.” As always, if you have any issues with the website, feel free to email Mary at mwilkinson@spts.org. We want all members to take advantage of their benefits!

EDUCATIONAL OPPORTUNITIES FROM SPTS AND OUR PARTNERS AND SPONSORS SPTS Educational Partners

Elite Rehabilitation Solutions Online Courses Information and Registration

Evidence in Motion Online and Live Courses Residency and Fellowship Practice Management Information and Registration

Gawenda Seminars and Consulting Information and Registration

Information and Registration

Medbridge Education Online Courses and Home Exercise Programs Information and links to registration

April Functional Assessment and Intervention for Runners | Los Gatos Orthopedic Sports Therapy | April 25, 8:00 am to 5:00 pm | Los Gatos, CA | Information and Registration

Emergency Medical Responder Course: Sidelines Care | June 26-28, 2015 | Sponsored by Children's Healthcare of Atlanta | Registration Link: www.eply.com/emr2015 July Emergency Medical Responder Course | July 10-12 | Texas Children's Hospital | Houston, Texas Comprehensive Evaluation, Treatment, and Management of the Novice to Elite Athlete | Module I: July 25-28, 2014 (3.0 CEU's) Lower Extremity Sports Skills and Fall Sports | Module II: September 26-29, 2014 (3.0 CEU's) Upper Extremity Sports Skills and Winter/Spring Sports | USC, Division of Biokinesiology and Physical Therapy at Herman Ostrow School of Dentistry | Registration August Emergency Medical Responder Course | Presented by ProAxis Therapy | August 28-30 | Full course, refresher and challenge courses will be offered | Contact Brad Eggebraaten for registration September Emergency Medical Responder Course | September 10-12 | Charleston, SC Emergency Medical Responder Course | September 25-27 | USF Health, Tampa, FL | Full Course: September 25-27 | Challenge Course: September 27 SPTS Sponsored EMR Courses | Member discounts apply | Register here