Be your best: Shoulder injuries common in sports such as swimming, baseball

(Dr. Brian Sokalsky, DO, is at the helm of Jersey Shore Sports Medicine in Ocean City and is a board certified family physician with special training in sports medicine. Once per month, Glory Days Magazine publisher Dave O’Sullivan will talk with Dr. Sokalsky about various sports injuries, treatments and prevention methods.) With the swimming season coming to an end and baseball and softball gearing up with their preseasons, I wanted to talk with Dr. Sokalsky about shoulder injuries, particularly involving the rotator cuff and labrum. The sports are similar in that there is heavy use of the shoulder joint. “For the most part, they are very similar. With both you see overuse and pain in the shoulder. There are a lot of similarities,” Sokalsky said. “In the younger athletes, high school and college age, for the most part if there is no actual trauma that causes the pain, it’s usually the rotator cuff.” When you hear about pitchers getting injured, many times the rotator cuff is involved. But Dr. Sokalsky said that very rarely does a young athlete actually tear the rotator cuff. Most times it is more of an overuse injury, or what is commonly referred to as tendinitis. “Usually surgery is only required for full tears with either the labrum or the rotator cuff. As long as the structures are intact, they can often times be treated without surgery,” Sokalsky said. “The most frequent injury we see is rotator cuff tendinitis, and that does not need surgery. It’s extremely rare for a young athlete to tear their rotator cuff. That requires some type of major trauma. Very rarely with an overuse situation do we need to do surgery.” That’s the good news. The bad news is that if an athlete, say, a swimmer, is dealing with shoulder tendinitis, the best thing is rest. That can be tricky for swimmers who also play a spring sport such as baseball or softball. Dr. Sokalsky said that if there is a problem, and the swimmer fought through it to make it to the end of their season, it’s not likely to get better in the spring unless they can afford the time needed to rest the joint. Brian Sokalsky is a doctor specializing in sports medicine. His office is located in Ocean City. To contact Dr. Sokalsky, call 609-545-8553 “The biggest thing is rest. It’s an overuse injury, so if you continue to use it, it’s not going to get better. If they made it through their season and have some time off, resting is the key,” Sokalsky said. “We also have to strengthen the rotator cuff so it can tolerate the extended usage that swimmers put it through. The third thing we have to do is look for any muscle imbalances or weaknesses, both in the shoulder and around the shoulder blade or in the core muscles.” Injuries to the labrum can be tricky. Dr. Sokalsky likened the shoulder joint to a golf ball sitting on a tee. He said imagine the labrum as a lip of cartilage surrounding the golf ball, and what would happen to that cartilage if the golf ball were to fall off the tee. That is pretty much what happens with a dislocation, you get the golf ball falling off the tee and stretching that cartilage until it tears. “Usually it takes some kind of trauma to tear the labrum. We see that more in the contact sports, like football, when you have arm tackling and your arm gets forced out to the side or backward. Or when you have a fall and a dislocation where the arm pops out of the socket it and goes back in it will tear the labrum,” Sokalsky said. By and large, he said, in late March and early April he is dealing with a lot more rotator cuff tendinitis. Dr. Sokalsky said there are a number of factors that can cause the tendinitis, such as an athlete not having a strong enough core or not doing enough offseason work to strengthen the muscles needed to throw a baseball or softball, including the legs, core and shoulder. “If they haven’t done anything yet, they are already way behind where they should be. The offseason is the time to build the strength and perfect the mechanics so that they are ready to hit the ground running,” Sokalsky said. “Right now the key would be to get a strengthening program to prevent any overuse injuries. Where a lot of baseball players lack strength is in their core. Their strength comes from their legs when they throw, so that power has to be transferred from their legs to their arms and that goes through the core. So if you have a weak core, you lose that power and end up compensating by using your arm more.” Dr. Sokalsky said that, by and large, coaches these days do a great job with setting players up with detailed offseason conditioning and throwing programs that allow them to be ready to pitch or throw in April after just a three-week preseason, which usually involves a lot of bad weather. He said another asset local high schools have is outstanding athletic trainers, and that parents and athletes should not hesitate to tap into their knowledge if they feel any kind of pain. “Their coach needs to have them on a good throwing progression the first couple of weeks so they are not over-doing it. To go from nothing to throwing full speed every day is just a setup for tendinitis,” Sokalsky said. “We always talk about the difference between pain and soreness. Pain is usually more of a sharp pain with certain movements, where as soreness is more of a dull ache, particularly after a workout. So you are looking out for pain that doesn’t go away with a day or two of rest, or pain that gets worse with activity. The athletic trainers at the high schools do an outstanding job of evaluating the kids and picking out the ones who need to get further evaluation.” For more information, contact Dr. Sokalsky at 609-545-8553, or visit jerseyshoresportsmedicine.com