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.

Jay S Johnson, MD
For Jay S. Johnson, MD, an orthopedic surgeon in Edina, the call to serve meant traveling to Antigua, Guatemala, once with his wife and a second time with his entire family through the non-profit organization called Common Hope.

Dr. Johnson’s wife, Sue Dittmanson, MD, is an OBGYN physician at United Hospital. During their week-long mission at Hermano Pedro Hospital in Antigua, each operated on approximately 20 people. While in Guatemala, his daughters participated in non-medical social work visiting homes and educating the community.

 “The biggest challenge of the mission is that it is physically very demanding. You are operating all day long. And also you have to manage your time and figure out what you can do well with the equipment,” Johnson said.

In the United States, Dr. Johnson would have his choice between 20 and 30 bone rods when caring for a non-union fracture. In Guatemala, he had only three. When asked what he took away from his trip, Dr. Johnson replied. “We have it really good here.”

One of his highlights for Johnson included performing an ACL reconstruction on one of the Guatemalan World Cup Soccer players.

William Lundberg, MD
Orthopedic Surgeon, William Lundberg’s overseas trip wasn’t a typical medical mission, it was a military one. 

Dr. Lundberg, a member of the Army Reserve, has been deployed three times, twice to Germany and once to Iraq. By day in Iraq, Dr. Lundberg was caring for wounded soldiers in a “pop-up hospital” and by night he was sleeping in a tiny barracks with no windows and walls made of cinderblock with just single light bulb hanging from the ceiling. 

The “pop-up hospitals” had pretty much everything Dr. Lundberg needed to care for wounded soldiers. One of the major differences Lundberg cited while caring for soldiers is that follow-up care was not an option. It was an order, therefore the outcomes were highly successful. “The patients are young and active. They follow orders and tend to get better a lot faster than the average patient in the United States,” Lundberg said. 

When asked what he learned from his time in Iraq, Lundberg said, “It makes you more thankful for the soldiers that protect us. The stuff they do for us is dangerous. How good our troops work and how hard they work and the dangers they are exposed to all the time. They are all young kids; 20-something-year-olds. We should all be proud and thank them.”

Anthony Brown, MD
Through the non-profit group, Surgical Implant Generation Network (SIGN), Dr. Anthony Brown, an orthopedic surgeon in Robbinsdale, Minn., traveled to Vietnam and Indonesia in 2004 and 2005 to assist orthopedic surgeons in caring for patients with traumatic injuries.

While in Vietnam and Indonesia, Dr. Brown said that he was learning almost as much as he was teaching. He described the hospital environments at each location as very collaborative. At first glance that might seem difficult with an obvious language barrier, however according to Dr. Brown, “The good thing about orthopedics is that a picture is worth a thousand words and an x-ray always tells the story.”

According to Brown, the cases he had during each of his two-week long trips were more extreme than those that he typically sees in the United States. Instead of taking care of a fracture that occurred a day ago, he was taking care of ones that happened two months ago.

Additionally, Dr, Brown said he had to learn to do more with less. “In surgery they have much less resources than we have here, therefore you have to be more creative and more technically skilled,” Brown said. “I just think it is fun and interesting.”

Patrick Kraft, MD
Dr. Patrick Kraft, an orthopedic surgeon also practicing in Robbinsdale, Minn., has traveled to Guatemala eleven times. The trips, part of the ministries at Wooddale Church in Eden Prairie, Minn., helped a church in the Lake Atitlan area reach out to the community through providing general health and wellness and other services.

During the first few years of mission work, health education was focused on teaching the Guatemalans how small lifestyle changes could drastically improve their quality of life. Teaching people to cook outside and drink filtered water, vastly decreased the high incidence rate of pulmonary and digestive conditions. 

In later years of his mission work, Dr. Kraft spent his time traveling to more remote villages. “People would hear that we were coming to their village and they would wait in line all day to be seen.” Kraft said.

In treating Guatemalans, Dr. Kraft had to adapt to the local culture. For example, the Guatemalan people believe that in treating fractures the Shaman, an intermediary between the human and spirit worlds that can treat illness, must come in the middle of the night to strike the broken bone before it can heal.

“Patients had a feeling that we had an ability to cure them, but the spirits were just as important in the healing process.” And so over an 11-year period, many Guatemalans were treated by Dr. Kraft and the local Shaman.

UPDATE: Since this article was written, Dr. Brown and Dr. Anderson have traveled to Haiti to care for those injured during the earthquake that ravaged the country on January 12, 2010. Look for their stories and others in an upcoming eNewsletter. Sign-up at www.tcomn.com.

Support the Work
Twin Cities Orthopedics would like to encourage anyone interested in supporting physician mission work to contact the Twin Cities Orthopedics Foundation at www.tcofoundation.org or by phone at (952) 927-2989.

All-American Determination
Last May, Patrick Jager of St. Thomas University had a lot to smile about while standing with his teammates on the podium at the 2009 NCAA Division III Outdoor Track and Field Championships in Marietta, Ohio.

Jager had just finished anchoring the first place teams in both the 4×100 and 4×400 meter relays.  

His journey to the top wasn’t easy. Ankle problems plagued Jager since his freshman year of high school when he suffered an ankle injury that ended his freshmen season and kept him out for his entire sophomore year.

Jager, who also competed in soccer and basketball in high school, returned to track his junior year excelling in his events, but still dealing with persistent ankle pain.  

After high school, Jager decided to continue his track career while studying at St. Thomas University in St. Paul, Minn. He was running well, but the pain just wouldn’t go away.

“Every once in a while I had flashes of me doing really well, and something bad would happen, so I knew I had never really reached my potential,” said Jager.

Most of Jager’s sophomore year at UST he spent confined to wearing a boot. He tried to come back a couple of different times, only to find out that his foot had not fully healed. He decided to see foot and ankle specialist, J.Chris Coetzee, MD at the Minnesota Orthopedic Sports Medicine Institute at Twin Cities Orthopedics.

“Nobody could figure out why it didn’t heal. Dr. Coetzee was actually the one who figured out that I had a bone spur in my ankle that was limiting my motion. I was putting a lot of pressure on the top of my foot and that is why it wouldn’t heal,” said Jager.

“After the consultation, which included a trip to Baltimore for a special test on my ankle, Coetzee did surgery and it got back to where the pain was at least bearable.”

Jager’s last surgery was in 2007. Afterward he was prescribed 12-weeks of physical therapy. “That was the hardest part; keeping up with all of those little exercises. You don’t feel like you are doing much, but you are really helping yourself out.”

After therapy, Jager continued to work hard with his team, steadily improving with each day, each workout and each meet.

“It was all about staying motivated and continuing to work hard,” said Jager.

Winning
All of Jager’s hard work started to pay off when in mid-May, Jager’s 4×100 meter relay team set a school record time of 40.75. “When everything kind of started to come together, it was like ‘whoa, this is really cool.’” said Jager

Just a couple of weeks later his team won the NCAA Division III national championship 4×100 meter relay with a time of 40.76. It was the first time a men’s track and field team from Minnesota had won an NCAA relay championship.

Later on that same day, about three hours later, Jager anchored the NCAA Division III national championship 4×400 meter relay team. That being just the second time a men’s track and field team from Minnesota won a NCAA relay championship.

The Future
Jager is a finance and accounting major at St. Thomas University. He hopes to continue his career in public accounting, but that may be on hold for a little while as he petitions the NCAA for an extra year of competition. No matter what his future holds, we’ll sure he’ll do well.