Sometimes it is Simple

This time of year is an interesting one in my clinical practice. We have 86 students from grade 9-12 and a track and field team with 35 student athletes. Baseball and softball have 13 each. Junior high basketball season also runs through late March. On March 12th we received a fresh two inches of snow, leaving the one gymnasium, one cafeteria that doubles as a secondary gymnasium at the elementary school, and one batting cage set up in the district maintenance garage quite crowded. Baseball and softball do anything and everything they can to practice, however, in my experience, these are two of the more difficult sports to work with.

There is a pervasive culture of superstition and 'this is the way we've always done it' coupled with a general approach dated to roughly WWII. Short of 'A League of Their Own' this is not positive. These sports do not seem to enjoy training. It is difficult to help prevent injury when you do not see a particularly poorly trained subset of your population. It is shoulder and elbow pain city in my clinical practice from mid March to early May. Last season this was the most obnoxious portion of my clinical practice. No matter how much Mulligan, TMR, PRT, PRRT, IASTM, Rehab (non-compliant), Prehab (non-compliant), RockTape, Massage, Heat, MyoFasical Decompression, Chanting, Essential Oils, Hypnotism, Ice, etc. myself or these patients utilized, their bloody arms are going to hurt if they are physical weak, open up their chests early, drag their arms, and forget that they have hips. I will give credit where credit is due, while I am not a coach, my attempts in this realm did not appear to annoy my coaches much and my patients did show up for treatment more often than I might have imagined. However, this year has already trended toward the obnoxious with regard to baseball and softball.

That is until Monday March 15 when I decided to try to repurposed something old in what, to me at least, is a new area. A pitcher, and recurrent patient, reported to our facility after practice Thursday March 14 with complaints of elbow and shoulder pain rated 3/10 at rest and 5/10 while throwing. Evaluation revealed no structural issues with pain and hypertonicity over the distal and proximal biceps tendons of the dominant arm. On Monday March 18 the patient reported late to heat his elbow/shoulder leaving little room for further treatment. In an effort to allow him to be more comfortable through practice I elected to create a pre-wrap band similar to those used at the knee in the case of patellar tendon pain mimicking a Cho-Pat strap. I placed one above the elbow at the distal biceps tendon, and one at the proximal bicep distal to the deltoid while joking with the patient that if this didn’t work at least he would look like the Ultimate Warrior. While I was relieved that a 17yo understood my bad late 80s reference, I was happier that his pain dropped to 0 immediately. He, in classic baseball fashion, expressed some concern that his arm felt weird and his mechanics felt ‘off’. I joked a bit more saying, “hey I am not sure if this has ever been done before, try it out, maybe you have helped me make my millions”. The patient laughed and went to practice. The following day on March 19 I did not see the patient as the team was in batting practice. However a teammate was excited to tell me that the ‘new trick’ had worked and that his teammate had a great practice. On March 20 the patient reported claiming 90% improvement after we initially tried the ‘Ultimate Warrior’ wrap with similar results after practice on March 20. I will continue to helplessly monitor this patient, hopeless in the knowledge that he will likely not change his mechanics or training habits. While this was not the most elegant or permanent solution, I found the simplicity and effectiveness of this particular band-aid interesting.