Mukilteo Little League Safety Clinic 2018 Joe Gizzi, DPT - - PowerPoint PPT Presentation

Mukilteo Little League

Safety Clinic 2018

Joe Gizzi, DPT Physical Therapist 12121 Harbour Reach Dr., Suite 100 Mukilteo, WA 98275 (425) 493-8313

MLL Safety Clinic

• Review the most common issues that affect safety in

little league baseball and softball.

• Updates from Little League Baseball

Disclaimer

• This is a review of basic first aid management. It is not a

substitute for First Aid Certification.

• CPR/AED/SCA/Concussion Awareness (additional training)
• The Safety Manual may give basic guidelines for CPR/AED but

it is not a substitute for certification

• I. Developmental

Issues and Safety

Developmental Issues - Highlights

 A child can not learn specific skills until they are ready.  It is normal for same aged children to be at different skill levels.  Children are not adults.  There is no research that shows you can groom a toddler to be an elite athlete.  A child with advanced motor skills may not have advanced learning skills.

Developmental Issues - Highlights

• Ages 10 – 12, during pubertal growth, you can see a

decline in coordination and balance.

• Be cautious not to interpret this as a lack of effort and/or

talent.

• 13 – 15 y/o rampant growth spurts occur – setting stage

for injury.

• Lots of “aches and pains” – be cautious about dismissing

them as growing pains.

• II. Safety in Baseball

Is baseball safe??

As with any sport there are safety concerns-Compared to other sports baseball is considered a relatively safe sport.

Baseball is safe; however …

 In general, youth baseball is a safe sport with a relatively low injury rate including severe injuries.  Little League International has been very proactive in making changes to ensure the safety of the players.  Pitch counts; concussion guidelines; break away bases; and the USA baseball certified bats, etc.

Safety Equipment Discussion

• All equipment will be inspected by the League’s Equipment

Manager prior to distribution

• All managers, coaches, and umpires will check questionable

equipment to ensure it meets safety guidelines.

Causes of Injuries

• Overuse is the leading cause of 30 – 50% of all pediatric sports

injuries.

• One study reports 20-40% reported elbow pain in 9-12 year
• ld baseball players – annual incidence.
• A young pitcher has 5-10% chance of developing a serious

arm injury within 10 years

• Improper warm-up, lack of conditioning , and ignoring early

signs and symptoms leads to overuse injury, and much more likely to reoccur if not promptly treated.

Causes

• For pitchers, the major cause of injury:
• improper technique,
• too many pitches thrown, and
• too advanced pitches for the athlete’s

developing muscles and bones.

• III. Safety Issues and

Pitching

Pitchers and Injuries

Statements from ASMI Injuries in Baseball Conference

• A recent 5 year study, concluded that overuse and cummulative

stress, were the primary cause of injury in pitchers versus the type

• f pitch
• Up to approximately age 12 (onset of puberty), growth plates in

the elbow and shoulder are still developing and are more susceptible to injury.

• Important for coaches and parents to understand the long term

effects of cumulative stress and overuse.

• In general, youth baseball pitchers pitch too much. Pitch count

rules are helping reduce cumulative overuse injuries.

Pitchers and Injuries

• Study that followed Little League pitchers (8 – 13 y/o) for 4 years;

High School pitchers; and College pitchers: – Previous HX of injury predisposed young athlete to 5x greater risk of injury – Avg. number of innings pitched was risk factor – Pitch count reduced risk in Little League baseball by 50% – Increased risk of elbow/shoulder injury with those who also pitch in select programs.

Pitchers and Injuries

• To help reduce the risk of injury in the young pitcher, training

should focus on: Control – proper mechanics Command – placing the pitch in different areas of the strike zone Speed/Velocity – emphasizing proper mechanics Movement – breaking pitches at 14 y/o and above.

American Sports Medicine Institute Recommendations

Age Guidelines for Pitch Types Fastball ……………….. 8 y/o Change Up …………… 10 y/o Curve ………………….. 14 y/o Knuckle ……………….. 15 y/o Slider ………………….. 16 y/o Forkball ……………….. 16 y/o Splitter ………………… 16 y/o Screwball ……………… 17 y/o

Little League International Pitch Count Rule

( “The Pitch Count Regulation Guide for Parents, Coaches and League Officials” at www.littleleague.org)

7 – 8 y/o ………………………… 50 pitches/day 9 - 10 y/o ..……………………… 75 pitches/day 11- 12 y/o ………………………. 85 pitches/day 13 -16 y/o ………………………. 95 pitches/day 17 -18 y/o ………………………. 105 pitches/day

The pitcher may continue beyond the maximum until the batter reaches base, is put out, or the third out is completed. If pitching over 40 pitches in a game, the player may not play catcher the remainder of the day.

Little League International Pitch Count Rule

League age 14 and younger: 66+ pitches …………………………. Four (4) calendar days of rest 51 – 65 pitches ……………………..Three (3) calendar days of rest 36-50 pitches ……………………..Two (2 ) calendar days of rest 21-35 pitches……………………….One (1) calendar day of rest 1 – 20 pitches ……………………….No (0) calendar days of rest

Recommendations

• Throwers should have 2-3 months off from throwing each
• year. No year round baseball
• Be cautious with high velocity throwers, and catchers
• Softball pitchers (Currently 12 innings in a day max, over

7 requires 1 day of rest)

• Coaches and parents need to understand:

» Need for rest » Maximum pitch counts » Importance of proper warm-up » Guidelines for when to start breaking pitches (14 y/o)

Other Recommendations

• No more than 100 innings per year
• 1000 pitches per season
• 2000/yr (9-10) 3000/yr (11-14 year old)
• Never throw when fatigued
• Refer to MLB/USA Baseball Pitch Smart

Program (www.littleleague.org website link)

• IV. Little League Elbow and

Shoulder

The most common sites of injury in baseball – elbow and shoulder. The primary cause - OVERUSE

Not just Little League- “Should be called youth thrower’s shoulder or Elbow”

“Little League Elbow”

Pain in the elbow from the throwing motion, usually at the growth plate (multiple sites)

• The throwing motion:

– Traction/separation stress

• n the medial elbow.

– Compression stress on the lateral elbow.

“Little League Elbow”

• Injuries at the elbow:

– Micro tears/strains of the forearm musculature – Medial ligament damage (Ulnar Collateral Ligament) – Avulsion fractures – Ulnar nerve inflammation – Loose fragments in the elbow – Osteochondritis dissecans

• Typical complaints:

– Pain at the inside of the elbow with throwing – Gradual onset – no specific injury – Increase in soreness with harder and farther throws – Pain lasting longer than 24 hours – “Tight” elbow – difficulty loosening up – “Clicking” with throwing

“Little League Shoulder”

Pain at the shoulder from throwing stresses

• Injuries at the shoulder:

– Shoulder Impingement – Tendonitis/Bursitis – Sprains – AC joint – Rotator Cuff Tears – Labral Tears

• Typical complaints:

– Pain at the proximal shoulder with throwing – Gradual onset – no specific injury – Increase in soreness as velocity and duration increases – Loss of velocity and control

• f pitches noticed

“Little League Elbow and Shoulder” Safety Guidelines

• “Listen” (watch/observe) to your athlete.
• Athlete must report pain or soreness early.
• Athlete should never pitch, throw, or play through pain.
• Monitor pitch type and count.
• Necessary that athletes use good mechanics and proper

technique.

“Little League Elbow and Shoulder” Safety Guidelines

• Pain during a game (especially pitchers) is cause for

immediate removal.

• Rest (if severe – up to 6 -12 weeks), ice, range of motion, and

gradual return to throwing.

• If pain persists for more than 3-4 days or increases with

throwing/pitching, athletes need to see a physician. (X-ray, anti-inflammatories, splint)

• Early intervention is key to prevention !!!

• V. Baseball Injury

Recognition and Basic First Aid Management

Common Injuries in Baseball

• Sprains
• Strains
• Contusions/Impact Injuries
• Dislocations/Fractures
• Eye/Dental Injuries
• Simple Wounds and Nose Bleeds
• Insect Bites/Stings
• Heat Illness
• Concussions

Not so common but possible…….. Sudden Cardiac Arrest

Injury Assessment

• History - Make sure you know how the injury happened.
• Observation – Look for deformity, swelling, and or

discoloration.

• Palpation – Palpate around the injury to identify the

injured area.

• First Aid - Apply first aid as indicated.

Sprains

• Sprain – damage to a ligament that supports a joint.
• Ligaments are tough bands of tissue that connect bone to
• bone. They restrict excessive movement at a joint.
• Sprains are caused by excessive force put through a joint.
• Sprains are classified as Grades 1,2, or 3.

Common Sprains

• Lateral/Outside of Ankle –

– base running; – uneven playing surface; and – quick uncontrolled movements.

• Fingers

Care of Sprains

• “RICE”

– Rest – Ice – Compression – Elevation “PRICES” (Protect and Support)

• Gradual return to sport if the athlete can perform sport

specific movements without pain or hesitation.

• Bracing/supports can help support the injured area.
• Taping techniques (see appendix)

Strains

• Strain – injury to a muscle from overstretching or forced

contractions and/or stretch of a muscle against too much

• resistance. Tearing of muscles fibers will result.

Common Strains

• Hamstring/Adductor/Calf

– Sprinting/quick movements – Muscle tightness, weakness, or lack of proper warm-up.

• Rotator Cuff –

– overuse or improper mechanics.

• Strains heal with irregular and inelastic scar tissue, which

decreases mobility of the injured site.

• The greater amount of scar tissue, the greater the chances are

for re-injury.

Care of Muscle Strains

• “RICE”

– Rest – Ice – Compression – Elevation

• Stretching
• Bracing/sleeves in some cases
• Strengthening

Proper warm-up and stretching is the best form of prevention.

Contusions/Impact Injuries

• Severe impact of a relaxed muscle,

compressed against the bone.

• The deeper the injury, the more

structural and functional disruption in the muscle.

• Early detection and avoidance of

profuse internal bleeding are vital in a fast recovery, and in the prevention of scarring of the muscle tissue.

Care of Contusions/Impact Injuries

• Ice
• Gentle stretching/ROM
• Compression
• Pad the area for play
• Refer to physician

Dislocations/Fractures

• Dislocations – joint
• Fractures – bone

– Closed = “Simple” – Open = “Compound”

Closed “Simple” Fractures

• No open wound.
• Athlete can’t move the hurt body part.
• Body part may look bent or shortened compared to

the opposite side.

• If touched, person has increased pain.
• Body part is beginning to swell.

Management of Closed “Simple” Fractures

• Recognize and treat for shock.
• Immobilize or splint body part.
• Transport to physician for x-ray (depending on body

part)

• Call 9-1-1 if an emergency.

Open “Compound” Fractures

• Open wound
• Bleeding
• Shortened or deformed limb
• Broken bone end may or may not be visible
• Typically in long bones or fingers

Management of Open “Compound” Fractures

• Call 9-1-1.
• Cover the wound and stop the bleeding.
• If blood is gushing from an artery, stop it with direct

hand pressure. – Use free hand or an assistant to get a dressing in place over the wound.

• Put dressing on the wound.
• Tie firmly in place to control bleeding.

“Do’s and Don’ts” for Serious Fractures

• DO call 911 – depending on body part (i.e. leg vs. finger).
• DO keep the victim comfortable.
• DO treat for shock.
• DON’T move them, if they are safe (especially neck)
• DON’T bundle and transport to the hospital.
• DON’T try to move or “set” the broken bone.

Incorrect handling of a fracture by a well- meaning person may turn a closed fracture into an open fracture.

Splinting

 Support the broken limb between well-padded splints in order to prevent movement.  Splints

• Boards
• Sticks, tongue depressor, umbrellas, rolled newspaper,

cardboard  Padding

• Clothing/pillows
• Crumpled paper
• Grass/moss

 If the injury is serious, do not move the athlete before splinting is complete.

Orbital Blowout Fracture/Eye Contusions

• A fracture to the bones of

the eye "socket". This may involve the orbital floor, the walls, or the roof.

Symptoms of Blowout Fracture

• Double vision, decreased vision or blurry vision
• Difficultly with eye movement
• Numbness in the forehead, eyelids, cheek, upper lip or upper

teeth

• Swelling and deformity of the cheek or forehead
• An abnormally flat looking cheek
• Eyes are not symmetrical

Treatment of Blowout Fracture

• Apply ice pack for 15 minutes.
• Refer to a physician if athlete is experiencing fracture

symptoms, even if you are unsure.

Avulsed (Knocked Out) Tooth

• A tooth that has come out of the socket and is no

longer attached.

Treatment of Avulsed Tooth

• Replace tooth back in its socket. If dirty, rinse with water.
• If unable to place in socket, use the next best medium:

– Milk – Saline – Between cheek and gum (athlete’s or willing adult) – If nothing else available- tap water

Simple Wounds

Clean It - Cover It – Bind It

• Clean It

– Best way to clean a would is with soap and water. – If you can’t wash it, cover the wound with a dressing until it can be cleaned.

• Cover It

– Dressing for a wound must be sterile. – Open the dressing envelope carefully. – Use Universal Precautions (i.e. gloves). – Apply carefully and avoid touching anything to ensure clean application

Simple Wounds

Clean It - Cover It – Bind It

• Bind It

– Adhesive tape – Gauze – Triangular bandage – Clothing

• Have athlete and his/her parent monitor the wound over the

next several days to check for infection (low grade fever, redness, swelling, pus).

Nose Bleeds

• Pinch bridge of nose
• Gauze between upper lip and nose
• Ice pack
• DO NOT swallow blood (could lead to vomiting)
• Nose plug with Vaseline or Neosporin

Insect Bites/Stings

• Remove stinger if possible
• Bee sting kit
• Ice bite/sting site to control swelling
• Monitor signs of allergic reaction
• Administer medicine

– Epi-pens – Benadryl

Hydration

• Average person needs 8-10 cups of water per day.
• Average adult can loose 1.5L of sweat during physical

activity.

• Signs of dehydration:

– Thirst (first sign of dehydration) – Nausea – Vomiting – Fainting – Concentrated/strong urine

• Management of dehydration

– Proactive drinking of water before feeling thirsty. – Take water breaks.

Awareness of Medical History

• Diabetes (sugar)
• Asthma (inhalers)
• Food Allergies
• Other?

Concussions

Concussion Definition

• A concussion is a complex pathophysiologic process affecting

the brain, induced by traumatic biomechanical forces.

• May be from a direct blow to the head, face or neck, or elsewhere to the body

with an impulsive force to the head

• Typically results in the rapid onset of short lived neurologic impairments that

resolve spontaneously.

• May result in neuropathologic changes with early symptoms reflecting a functional

disturbance rather than a structural injury

• Graded set of clinical symptoms that may or may not involve LOC. Resolution of

the clinical and cognitive symptoms usually follow a sequential course, however in a small percentage of cases, post-concussive symptoms may be prolonged.

Concussion Facts

• Brains of kids are different

and respond differently to concussions compared to adults.

• Young brains:

– are more vulnerable to diffuse injury. – take longer to heal compared to adults

• Concussions are usually

under reported.

• A concussion is defined as

impact involving the head.

Signs and Symptoms of Concussion

Signs Observed

• Appears dazed
• Vacant facial expression
• Confused
• Forgets plays
• Unsure of game, score, opponent
• Moves clumsily/incoordination
• Answers questions slowly
• Slurred speech
• Behavior/personality changes
• Can’t recall events prior to or

after the hit

• Seizures/convulsions
• Loss of Consciousness

Symptoms Experienced

• Headache/”Pressure in head”
• Nausea or vomiting
• Neck pain
• Balance problems or dizziness
• Blurred, double, fuzzy vision
• Sensitivity to light or noise
• Feeling sluggish, foggy, groggy
• Drowsiness
• Change in sleep patterns
• Amnesia
• Doesn’t feel right or confusion
• Fatigue or low energy
• Sadness, nervousness or anxiety,
• r irritable

Grades of Concussion

American Academy of Neurology Grading Scale Grade I

No loss of consciousness Transient confusion Symptoms less than 15 min

Grade II

No loss of consciousness Transient confusion Symptoms greater than 15 min

Grade III

Any loss of consciousness (less than 10% of concussions) brief (seconds) or prolonged (minutes)

Management of Concussions

• Survey the scene and the athlete.
• Call 911 if you think that the victim has a head, neck or back

injury.

• Minimize movement of the head, neck and back – stabilize.
• Remove from practice or play
• Do not leave the player alone
• See a licensed healthcare provider trained to evaluate and

manage concussions

Zachery Lystedt Law (House Bill 1824)

May 14, 2009

• All student athletes and parents/guardians sign an

information sheet regarding concussion prior to each season.

• Education of coaches, youth athletes and parents about the

nature and risk of concussion.

• Any athlete suspected of suffering a concussion is removed

from play until they receive written clearance for return to practice and play by a licensed health care provider trained in the evaluation and management of concussions.

When In Doubt, Take them Out!

Return to Play (RTP)

• Return to play guidelines were not developed specifically for

the youth athlete

• With youth athletes – the safest course of action is to hold

the athlete out. With the new law, you as a coach, are required to hold them out until released by a licensed healthcare provider.

• The younger the athlete, the more conservative the

treatment.

• There is no simple test. Based on clinical judgement.
• Time line for return to play can range from 1 week to 1 month

– depending on severity.

Return to Play

• Typically 7-10 days minimal in youth athletes
• Each stage a minimum of 24 hrs, if symptoms must return to

previous stage. – Rest (physical and mental rest) – Light aerobic exercise – Sport specific exercise – No contact training drills – Full contact – Return to competition

Second Impact Syndrome

• When a young person receives a second blow to the head

before complete recovery from the first blow, there is a higher risk of serious injury.

• After an athlete suffers their second concussion in a season,

they usually are out for the season.

Shock

• Every accident is

accompanied by some level

• f shock, depending on the

severity of the injury.

• Shock is usually caused

from trauma, but can be associated with heat exhaustion or dehydration.

• Typical signs include:

– Loss of consciousness – Confusion – Weak feeling – Pale face – Cold and clammy skin – Shivering and chills – Shallow breathing – Vomiting

Management of Shock

• Keep calm and still.
• Keep warm (or cool if heat illness)
• Elevate feet – 15 degrees to get blood closer to vital organs.
• Control any external bleeding.
• Monitor respiration.

Sudden Cardiac Arrest

• Sudden Cardiac Death is the most common cause of

fatalities in young athletes

• 1-2/200,000 in high school

Sudden Cardiac Death in Young Athletes

• Hypertrophic cardiomyopathy 26.9%
• Commotio cordis

19.9% (mostly 13-16 yrs old)

• Coronary artery anomalies 13.7%
• Left ventricular hypertrophy 7.5%
• Myocarditis 5.2%
• Ruptured aortic aneurysm (Marfan’s) 3.1%
• Others include arrhythmogenic RV cardiomyopathy, tunneled coronary artery,

aortic valve stenosis, CAD, dilated cardiomyopathy, myxomatous mitral valve, long QT syndrome and unknown cause.

Prevention of SCD

• Pre participation evaluation

– Thorough family medical history – Athletes medical history – Careful auscultation of chest – Blood pressure check

• Competition & Practice

– Recognition of Symptoms – Protection from chest impact – Instant AED application

CPR Reminders

• 10 seconds to assess breathing and pulse
• Instant AED as soon as collapse
• 30:2 Compression ratio, 100

compressions/minute “Stayin Alive”

• Compression depth of 2 inches
• Assess pulse every 2 minutes (5 cycles of CPR)

Questions about injury recognition and management?

• VI. First Aid Kits

Contents of First Aid Kits

• Gloves
• 4 x 4 gauze pads
• Rolled gauze
• Band aids
• Hand sanitizer
• Anti-septic wound wipes
• Cotton balls
• Q-tips
• Visine eye wash
• Oval eye pads
• Bee sting kit
• Ice packs
• Tongue depressors
• Finger splints
• Ace wraps (4”, 6”)
• Scissors
• Pre-wrap
• Tape (1”, 1 ½ “, 2”)
• Contents card
• Contact information

• VII. Injury Reporting

Process

How and when to report an injury

• Any injury that needed first aid must be reported.
• Contact the safety officers to report an injury

Daryl Gee – MLL Safety Officer

• Instructions will be given for filling out all appropriate

paperwork.

• VIII. Exercises for Injury

Prevention

(10 – 15 minutes each practice)

Leg Active Warm-Up/Dynamic Stretching

• Jog around field
• High Kicks
• Butt Kicks
• Knee Hugs
• High Knees/Opp. Elbow
• Lunge Walk/Reach Opp. Foot
• Carioca with Arms (Grapevine)
• Lateral (side) Shuffle with Arms

Arm Stretching/Warm- Up

You should never throw a baseball to warm-up – you should warm-up to throw a baseball!

• Progressive Arm Circles – Fwd/Bkwd
• “Yawn” Stretch
• Grip Fig. “8’s”
• Grip Overhead Reach
• Across Arm Stretch – 2 positions

Strengthening

• Exercises for general upper extremity strength should focus
• n the rotator cuff and scapula muscles using proper form,

light weight, and higher repetitions.

– “Throwers 10” – Recognize scapular winging, obvious postural and core weakness, loss

• f shoulder ROM

– Prior neck/shoulder/elbow injuries?

• Lower extremity strengthening should focus on function.

Body weight resistance is appropriate at this age. Movements such as squats, lunges, single leg balance activities are all appropriate.

Phases of Throwing/Proper Kinematics

• Wind-up: Ends when ball leaves the glove
• Early Cocking: Ends when forward foot contacts the ground
• Late Cocking:Ends with maximal abduction/external rotation
• Acceleration: Ends with ball release
• Deceleration: Dissipates excess kinetic energy of throwing

(many injuries developed in this phase/critical for performance)

• Follow through: Ends when all motion is complete

• IX. Concluding Remarks/

Questions

Summary/Bullet Points

• Warm up properly to prevent injury
• Highest risk for injury? (Pitching/overhead

throwing/overuse)

• When in doubt take them out? (Concussions)
• R.I.C.E.
• AED
• Suspected musculoskeletal injuries or

dysfunction- Free injury screen at our clinic!

Appendix

Taping

(from: Athletic Taping and Bracing; David H Perrin, PhD, ATC; 1995)

Thrower’s 10 CDC: Heads Up Concussion Education

Thank you and have a great season !

PLAY BALL !!