The crack of the bat, smell of the leather mitt and running of the bases are a few of the things players love about baseball and softball. More than 33 million Americans play organized baseball and softball each year, with nearly 6 million of these players being children from 5 to 14 years old. According to the U.S. Consumer Product Safety Commission, in 2003 more than 200,000 of these kids were treated in hospitals, doctors’ offices, clinics, ambulatory surgery centers and hospital emergency rooms for baseball-related injuries. That is why the American Academy of Orthopaedic Surgeons recommends that children use caution when partaking in youth baseball, particularly year-round.

“I continue to see increasing numbers of injuries related to youth baseball. I attribute this to the steady progression toward year-round participation and the addition of spring and fall leagues. The drive to compete can lead to overuse and result in minor pain or less commonly to major injuries,” explained Frank Norberg, MD, orthopedic surgeon specializing in the treatment of shoulder and sports medicine injuries. “Children involved in overhead hitting and throwing sports should have a break from these activities for 2-3 months out of the year. It benefits kids to cross-train and change sports throughout the year to avoid overuse injuries and help with balanced physical development. While pitch counts can help avoid overuse, it is more important to make sure players are not throwing with pain.  Persistent pain with throwing is a sign of muscle, ligament or bone injury and should be evaluated by a medical professional.”

The American Academy of Orthopaedic Surgeons offers the following tips to help keep your child off the injured list:

• Always take time to warm up and stretch before and after play. Research studies have shown that cold muscles are more prone to injury.
• If a child is pitching, he should concentrate on stretching his arm and back muscles.
• If a child is catching, the focus should be on the legs and back.
• Children should not be encouraged to play through pain. It is important that they take breaks if tired.
• Limit the number of teams your child is playing on in one season. Kids who play on more than one team are especially at risk for overuse injuries.
• Equipment should fi t each player properly and be worn correctly.
• A batting helmet should be worn at the plate, when waiting a turn at bat and when running bases.
• Facial protection devices that are attached to batting helmets should be worn by children, when available. These devices can help reduce the risk of a serious facial injury if you get hit by a ball.
• Players should wear molded baseball shoes with cleats that fit comfortably.
• Children need to wear the appropriate mitt in each position.
• Catchers should always wear a helmet, face mask, throat guard, long-model chest protector, protective supporter, a catcher’s mitt and shin guards.
• Inspect the playing field for holes, glass and other debris.
• Drink plenty of fluids.
• Supervising adults should be prepared for emergency situations and have a plan to reach medical personnel to treat injuries such as concussions, dislocations, elbow contusions, wrist or finger sprains, and fractures.
• To prevent sliding injuries, install breakaway bases in the playing fields and an extra large first base to avoid the runner stepping on the first baseman’s foot.

While there is no concrete guideline for the number of pitches allowed, reasonable limits are 80 to 100 pitches in a game and 30 to 40 pitches in a single practice session, depending on the child’s skeletal maturity, muscle strength and pitching techniques.

Additional pitching recommendations for young baseball players include:

• 8-10 year olds should only throw from 37 to 67 pitches in approximately 1.4 to 2.6 games per week.
• 11-12 year olds should only throw from 50 to 86 pitches in approximately 1.4 to 2.6 games per week.
• 13-14 year olds should only throw from 60 to 92 pitches in approximately 1.4 to 2.6 games per week.
• 15-16 year olds should only throw from 75 to 107 pitches in approximately 1.4 to 2.6 games per week.
• 17-18 year olds should only throw from 90 to 122 pitches in approximately 1.4 to 2.6 games per week.

With 30 locations in the greater Minneapolis area and more than 79 highly trained physicians, TCO is the largest, most comprehensive and prestigious orthopedic practice in Minnesota and the Midwest, and is one of the largest in the United States. The practice provides conservative, top-quality care and research and uses state-of-the-art technology and procedures to help return each patient to an active, pain-free lifestyle.

TCO was formed between 1996 and 2003 when five orthopedic practices, each of which began nearly 60 years ago, combined. TCO has three goals: 1) To provide worldclass, compassionate care to individuals of all ages with musculoskeletal injuries and conditions; 2) improve the musculoskeletal health of our communities through research and education; and 3) be the orthopedic provider and employer of choice for Twin Cities residents.

New Physicians
Joining the practice in 2008 are Jay Johnson, MD, Christie Heikes, MD, and Erik Wetter, MD. Dr. Wetter specializes in general orthopedics and sports medicine, while Dr. Heikes’ emphasis is in women’s orthopedics and sports medicine. The addition of Dr. Heikes will be of particular benefit to those who prefer to be seen by a female physician. Dr. Johnson, who has been practicing in the Twin Cities for several years, specializes in total joints and general orthopedics.

Additional locations
TCO also is in the midst of an ambitious expansion program in the following locations:

Maple Grove: To meet the demands of a growing market (with a 90-bed hospital that is expected to open its doors in February 2009), TCO has opened a full-service clinic that includes physical therapy, orthotics and prosthetics.

Waconia: TCO is expanding its presence in the Waconia market by providing physical therapy, orthotics, and prosthetics programs and by adding a spine specialist and MedX, a back pain rehabilitation program. The
goal of MedX is to strengthen the back using preventive-type medicine to help the patient avoid undergoing invasive spinal surgery. The new Waconia location has additional space to accommodate the possibility of adding future orthopedic surgeons.

Coon Rapids and Burnsville: Expansions similar to Waconia have already taken place in these two communities. In Coon Rapids, one of TCO’s two offices has moved into a larger building that also houses a clinic, a physical therapy center, magnetic resonance imaging (MRI), and MedX. In Burnsville, the new building houses a surgery center, physical and hand therapy centers, an MRI, and orthotics and prosthetics services.

Edina: With a long-standing presence of four sites in this city, TCO plans to consolidate them into one orthopedic “Center of Excellence” during the next two years, said Troy Simonson, TCO administrator. To enhance the continuity of care for patients it will include every orthopedic specialty and sub-specialty at one convenient location. Plans for the Edina center also include a surgery center, physical therapy, hand therapy, MRI, orthotics, prosthetics, and MedX. Once the center is complete, patients will be able to have all their orthopedic needs met at one central location housing as many as 30 physicians. “We’ve been there (Edina) for many years, but we’ve been fragmented,” Simonson said. “Now, we’re looking to provide improved customer service to our patients and provide those services more efficiently.”

The common goal driving much of the expansion is improving patient satisfaction. “For example, to improve the convenience and continuity of care we are striving to provide the full spectrum of orthopedic care patients desire at one convenient location,” Simonson said.

Patient satisfaction
To better gauge patient service, TCO has begun a patient satisfaction campaign. Patients were asked to complete questionnaires and, to date, more than 1,600 responses have been obtained. Survey feedback indicates that 96 percent of patients either agreed or strongly agreed that “I would rate my overall care at TCO as excellent.” On a second question — “Was staff helpful, courteous and did staff treat me respectfully?” — 97 percent either agreed or strongly agreed. “We are looking to gather this data continually,” Simonson said. “We are constantly going to measure and maintain that high level of service.”

What begins as a gradual onset of dull, achy pain in one knee, can also feel like the knee is giving way. Patients have also said that knee pain increases with prolonged sitting or when climbing the stairs, kneeling, squatting, or running up an incline.

Causes and precautions
Many doctors suspect that changes to the surface of the patella – the kneecap or bone at the front of the knee – cause the pain. Pain may also result from irritation to the tissue around the knee. While the precise mechanism of injury and pain remains unknown, several factors contribute to development of the condition. Overuse of the joint often leads to runner’s knee. In addition, the kneecap may be out of alignment; thigh muscles may be tight, out of balance, or weak; or the patient may have flat feet. Sometimes an injury will precipitate the pain.

To avoid runner’s knee, individuals should maintain a healthy weight. They should also warm up, and stretch before running or engaging in other physical activity. Runners should wear shoes with good shock absorption and train at a gradually increasing pace. They should also lean forward, keeping their knees bent as they run. Jogging on a smooth, resilient surface, such as a cushioned track rather than the road, is also a good idea, as is walking down steep hills or running downhill in a zigzag pattern to put less stress on the knee joint.

Diagnosis
When assessing runner’s knee, physicians inquire about the onset of symptoms, type of activities, and the types of running and playing surfaces. They perform a physical exam and watch how the patient walks, squats, sits, and moves. Often, individuals with runner’s knee favor the injured leg. Doctors also examine the knee and note any fluid or swelling; check joint alignment; evaluate muscle tone, strength, and flexibility; and assessfor tenderness when they touch or move the knee.

X-rays may be ordered to rule out other conditions such as arthritis. Doctors might also ask for a computed tomography (CT) or magnetic resonance imaging(MRI) scan to check for abnormalities.

Treatment
Treatment of runner’s knee aims to decrease pain and improve function. Initial therapy may involve elevating the knee, wrapping it in an elastic bandage, and applying cold packs several times a day to help decrease the pain and swelling. Physicians may have the patient tape the knee or wear a brace to support the joint. After the initial swelling goes down, doctors may suggest heat to relax muscles and increase blood flow. Alternating heat and cold can increase flexibility in a stiff joint. In addition, physicians may recommend a nonsteroidal anti-inflammatory medication. Once the pain and swelling decrease, doctors may also suggest a rehabilitation program to stretch and strengthen the supporting muscles and improve range of motion, agility, and coordination.

To aid in recovery, patients should avoid any activity that increases the pain until the action can be completed without discomfort. Patients may swim or try another low-impact activity instead of running or jumping until the problem resolves. Patients can participate in sports again once the injury heals and the doctor gives the go-ahead, but they should resume athletic pursuits gradually. It’s also important for runners to wear proper shoes to reduce or prevent knee pain. They can also place custom orthotics – or sometimes an off -the-shelf arch support – in their shoes to help relieve knee discomfort.

While most patients respond to conservative treatment with time, some cases may require surgery to remove debris from the knee or return the kneecap to proper alignment. Runner’s knee usually responds well to treatment and an active rehabilitation program. If athletes stick to sensible training schedules, wear supportive shoes, and use proper running technique, they can help alleviate the condition – and may even prevent its onset.