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Don't push through pain: Avoiding overuse injuries

As warm weather gets young runners outdoors and opening day inspires young ball players, sports medicine specialists warn against the dangers of pushing too hard and developing over use injuries. Most common in sports with repetitive motion such as baseball or running, over use injuries can lead to permanent damage and surgery, according to Dr. Brian Polsky, an orthopedic surgeon with the Centers for Advanced Orthopedics, who practices in Eldersburg.

"An overuse injury is kind of just that — it's going past the point of where muscles and tendons around a joint are comfortable," Polsky said. "You are doing an activity, be it running or throwing, where you are constantly using a joint. At some point in time, the muscles around that joint will fatigue and then the joint itself and the ligaments start seeing more stress than they should."

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That stress begins to be perceived as pain, Polsky said, and not the "good pain" of mere muscular exertion, but often a stabbing pain, or a persistent pain that inhibits performance. This is "bad pain," he said, and it should not be ignored.

"If folks get that kind of pain, what I tell them is, you've got stop what's causing it, first and foremost. You can't ignore it," he said. "Then it's the classic RICE: Rest, Ice, Compression and Elevation. And call and make an appointment."

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Sometimes, especially with high performers, Polsky said there is a pressure to push through over use injuries. Whether it comes from the athletes themselves, or coaches, teammates or parents, it is counterproductive.

"There's strain and then there's stress and then there's sprain and then there is tear or rupture, so there is a progression if you ignore the symptoms," Polsky said. "If it goes beyond a certain point, then you start getting damage."

Overuse injuries for runners can range from everything from the lateral knee pain of Iliotibial Band Syndrome, or ITBS, to foot and ankle pain to hamstring and even lower back pain, according to Polsky.

In throwing sports, especially baseball, Polsky said overuse injuries tend to manifest as elbow or shoulder pain. In fact, he said, the percentage of high school athletes now receiving Tommy John surgery — a procedure that reconstructs elbow ligaments damaged by overuse — is greater than the percentage of professional baseball players undergoing that operation.

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"The guys you see in the pros, as far as throwing goes, are super human. I mean really super human. They are huge outliers in the capability of doing what they do. They are genetic freaks, they really are," Polsky said. "The human shoulder and elbow were not built for throwing even 60 or 70 miles per hour, frankly."

Even for those that have hit the genetic lottery, overuse injuries can still occur, and ignoring the signs and pushing through can lead to damage that will curtail an athletes inherent potential, according to Polsky. Tommy John surgery is completely avoidable, he said, and people must learn to, "recognize the bad signs in order to avoid a bigger surgical problem, or career ending problem."

Unfortunately, Polsky said, there are greater pressures on young athletes today — in throwing sports more so than running — to compete harder, for longer, and earlier, and this can lead to problems both for athletes whose arms just cannot take that level of stress, and those with who could make it to the pros — if they avoid serious injury. Young ballplayers who play only baseball, playing on travel teams year round, as early as age 12 or 14; is a new phenomenon, he said, not necessarily something that will improve that athlete's game.

"When I did my training, one of my mentors took care of Curt Schilling, the pitcher," Polsky said. "Curt Schilling didn't throw a baseball until after he was 13 years old. Even then he played three or four sports a year and didn't even focus on baseball and he thinks that really helped him."

Whatever the sport, whatever the level of talent or drive, Polsky said the important thing is to realize that ignoring overuse injuries will never be a winning strategy.

"The take-home message is you really have to know the difference between good pain and bad pain," he said. "Muscle ache or fatigue, that's fine. But if there is pain beyond that, or sharp stabbing pain, or pain that consistently effects performance; that should be evaluated."

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