Knee Pain in Catchers: A Brief Introduction to Patellofemoral Pain Syndrome by Chris Schattinger M.S., CSCS, CISSN

Of all the sports-related knee injuries we have discussed it would seem as though none occur in baseball. This is obviously not the case If you happened to see what occurred to Bryce Harper this weekend.

Recently one of our followers reached out to us and mentioned that those who are catchers in baseball are “guaranteed to have knee problems”.

If you think about it this seems probable. The excessive amount of time spent in the squatting position certainly places excessive force on the knee.

After a few quick searches the term “Patellofemoral Pain Syndrome (PFPS)” came to light. Simply put this is pain that occurs at the meeting of the knee cap and femur, even more commonly referred to as “anterior knee pain”.

This diagnosis is given when all other causes of knee pain have been ruled out, this including ligament injuries and other chronic conditions.

Overuse is believed to be one of the main causes of PFPS though a sole cause has yet to be identified.

Going on this tangent it is understandable how this can become a chronic issue in baseball catchers. The picture below can help to visualize this.

 Force on the knee changes from standing to squatting position.

Force on the knee changes from standing to squatting position.

When in the standing position your body pushes down on the ground and is opposed by the same force pushing up. The same applies in the squatting position however now all the pressure is fixated on the knee.

So, if someone has been a catcher for many years imagine how much longer that person’s knees are under excessive force as opposed to average Joe.

Taking that into consideration it becomes plausible that, at the very least, catchers are susceptible to PFPS.

This week we will dive further into the knee problems that an occur with catchers and take an in depth look at those problems, such as PFPS. Stay Tuned!

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Blog #23: Incidence of Knee Replacements by Chris Schattinger, MS, CSCS, CISSN

We have discussed numerous statistics on knee injuries ranging from the ligaments to the knee cap. But, what if these injuries cause chronic issues and a knee replacement must be done?

Approximately 600,000 knee replacements occur each year and this is estimated to increase to over 3 million by 2030.

The most knee replacements occur in those ages 50-80 years with age 70 being the average age of knee replacement. Knee replacements were found to be higher in females than males by considerable margin (68% vs. 31%).

Nearly ½ of all American adults develop knee osteoarthritis which is one of the main causes of knee replacement.

The average cost of a knee replacement is $20,704.

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References:

Khatod, M., Inacio, M., Paxton, E. W., Bini, S. A., Namba, R. S., Burchette, R. J., & Fithian, D. C. (2008). Knee replacement: epidemiology, outcomes, and trends in Southern California 17,080 replacements from 1995 through 2004. Acta orthopaedica, 79(6), 812-819.

 

Blog #22: Incidence of Patellar Dislocation by Chris Schattinger, MS, CSCS, CISSN

Up to this point we have discussed the numerous injuries that occur to the ligaments of the knee. There are other injuries that can occur to the knee outside of ligament injury.

An example of this is patellar dislocation aka dislocation of the knee cap.

Patellar dislocation occurs at a rate of 33 per 100,000 females, 25 per 100,000 males and is most common is those ages 10-17.

Risk of patellar dislocation is 33% higher in females and 61% of patellar dislocations occurred while participating in sports.

Sports were also the most common activity that caused re-injury to the patella.

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References:

Fithian, D. C., Paxton, E. W., Stone, M., Silva, P., Davis, D. K., Elias, D. A., & White, L. M. (2004). Epidemiology and natural history of acute patellar dislocation. The American journal of sports medicine,32(5), 1114–1121. doi:10.1177/036354650326078

Blog #21: Incidence of Meniscus Injury by Chris Schattinger, MS, CSCS, CISSN

Injury to the meniscus seems to occur almost as frequently as injury to the ACL.

Injury to the meniscus occurs at a rate of 60-70 per 100,000 people and are most common in men ages 21 to 30 and women ages 11 to 20.

Meniscal tears are more common in males with the male: female ratio ranging from 2.5:1 to 4:1.

Activities with highest incidence of meniscal injury are sports or jobs with excessive time spent in the squat position.

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References:

Greis, P. E., Bardana, D. D., Holmstrom, M. C., & Burks, R. T. (2002). Meniscal injury: I. Basic science and evaluation. Journal of the American Academy of Orthopaedic Surgeons, 10(3), 168-176.

 

 

Blog #20: LCL Injury Incidence by Chris Schattinger, MS, CSCS, CISSN

Of all knee ligament injuries LCL injury may be the most uncommon. Injury to the LCL accounted for only 1.1% of 2,673 knee arthroscopies in data by Majewski et al. (2006).

LCL injury is most common in those ages 20-40 and occurs more frequently in men than in women (4.5:1 male to female ratio)

The specific activities with the highest incidence of LCL injury are skiing and soccer.

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References:

Majewski, M., Susanne, H., & Klaus, S. (2006). Epidemiology of athletic knee injuries: A 10-year study. The knee, 13(3), 184-188.

Blog #19: PCL Injury Incidence by Chris Schattinger, MS, CSCS, CISSN

Posterior cruciate ligament injury, in addition to the lateral cruciate ligament injury, is an injury heard about much less often than the ACL. Many may not realize that up to 40% of all knee injuries involve injury to the PCL.

The average age for occurrence on PCL injury is 27.5 years and injury is much more common in males (79.4% of PCL injuries) than females (20.6% of PCL injuries).

Unlike injuries to other knee ligaments the most common cause of PCL injury is traffic accidents (45%) not sports (40%).

The specific activities with the highest incidence of PCL injury were motorcycle accidents (28%) and soccer (25%)

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References:

Schulz, M. S., Russe, K., Weiler, A., Eichhorn, H. J., & Strobel, M. J. (2003). Epidemiology of posterior cruciate ligament injuries. Archives of orthopaedic and trauma surgery, 123(4), 186-191.

Fanelli, G. C., & Edson, C. J. (1995). Posterior cruciate ligament injuries in trauma patients: Part II. Arthroscopy: The Journal of Arthroscopic & Related Surgery, 11(5), 526-529.

Fanelli, G. C. (1993). Posterior cruciate ligament injuries in trauma patients. Arthroscopy: The Journal of Arthroscopic & Related Surgery, 9(3), 291-294.

 

Blog #18: MCL Injury Incidence by Chris Schattinger, MS, CSCS, CISSN

The medial collateral ligament, while not heard about as much as the ACL, has an injury incidence of 24 per 100,000 in athletes.

Occurrence of MCL injury is most common in those ages 16-19 with males having a higher incidence of injury (7.3 per 1,000 exposures) than females (5.6 per 1,000 exposures).

Most do not know that injury to the ACL can be accompanied by injury to the MCL (2 per 1,000 exposures).

Activities in which the most injuries occurred were skiing, football, soccer and ice hockey.

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References:

Roach, C., Haley, C., Cameron, K., Pallis, M., Svoboda, S., & Owens, B. (2014). The Epidemiology of Medial Collateral Ligament Sprains in Young Athletes. The American Journal of Sports Medicine42(5), 1103–1109. doi:10.1177/0363546514524524

Silvis, M. (2014). Common Musculoskeletal Problems in the Ambulatory Setting, An Issue of Medical Clinics, E-Book (Vol. 98, No. 4). Elsevier Health Sciences.

             

Blog #17: ACL Injury by Sport by Chris Schattinger, MS, CSCS, CISSN

Yesterday we discussed the incidence of ACL injury and have previously mentioned that knee injuries, particularity ACL, have the highest occurrence in sports. Today we will aim to dive deeper into this claim by establishing the rate of ACL injury occurrence in males and females based on the sport they participate in.

Moses et al. (2012) conducted a meta-analysis that determined ACL injury per 1,000 exposures. Exposures were defined as games or practice for the specific sport.

Three of the most common American sports (soccer, football and basketball) displayed the following rates in accordance to skill level (high school, collegiate and professional):

Basketball:

o High School- 414,493 exposures: Incidence: female rate 0.09/1000 male rate was 0.02/1000.

o College- 15,420,034 exposures; Incidence: 0.29/1,000 female, male 0.08/1000

o Professional- 115,221 exposures; Incidence: female 0.20/1000 male incidence was 0.21/1000.

Soccer:

o College- 11,754,568 exposures; Incidence: female 0.32/1000 male 0.12/1000.

o Indoor Soccer- Female rate was 5.21/1000 and the male rate was 1.88/1000.

Football:

o High School & Professional- 1,227,469 total exposures. The athletes were all male. The overall ACL incidence was 0.08/1000.

 

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References:

Moses, B., Orchard, J., & Orchard, J. (2012). Systematic review: annual incidence of ACL injury and surgery in various populations. Research in Sports Medicine, 20(3-4), 157–179. doi:10.1080/15438627.2012.68063

Blog #16: ACL Injury Incidence by Chris Schattinger, MS, CSCS, CISSN

The first thought that most have when hearing or seeing a knee injury is “ACL”. This is with good reason as the ACL, along with the meniscus, seem to be the most common knee injuries across America.

It is estimated that approximately 200,000 ACL injuries occur per year at a rate of 69 per 100,000 people. Males ages 19-25 and females ages 14-18 have a significantly higher rate of injury occurrence at 241 per 100,000 and 228 per 100,000 respectively. It is important to note that males have a higher incidence of injury. This is because more males participate in activities, namely sports, that have a higher risk of injury.

The average cost of repairing an ACL injury is $27,000 and can become much costlier depending on the stability of the knee (additional $15,000 for rehab with stable knee, $62,000 with unstable knee). It is estimated that ACL injuries alone cost approximately $500 million per year in the United States.

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References:

Sanders, T. L., Kremers, H., Bryan, A. J., Larson, D. R., Dahm, D. L., Levy, B. A., … Krych, A. J. (2016). Incidence of anterior cruciate ligament tears and reconstruction: a 21-year population-based study. The American journal of sports medicine,44(6), 1502–1507. doi:10.1177/0363546516629944

American Academy of Orthopedic Surgeons

 

Blog #15: Basic Knee Injury Statistics by Chris Schattinger, MS, CSCS, CISSN

Blog #15: Basic Knee Injury Statistics by Chris Schattinger, MS, CSCS, CISSN

Today we begin our next series of blogs in relation to the incidence of knee injury. Before honing in on specific knee injuries lets first discuss knee injuries in general. If you haven’t guess it already sports are the greatest cause of knee injury with an estimated 2.5 million sports related knee injuries per year.

For more clarity on demographics let’s look at a study by Gage et al. (2012) that extracted data from 6 million documented knee injuries. 80% of male knee injuries occurred in those ages 5-44 while 65% of female knee injuries occurred in those ages 15-64. Not surprisingly, 62% of those injuries in males occurred from sports however it is interesting to note that 40% (the majority) of injuries in women occurred from “home structures” not sports.

Men age 5-24 experienced the highest percentage of knee injuries playing football and basketball while those 25-44 experienced the highest percentage from stairs, steps and landings. All women 15-64 experienced the highest percentage of knee injuries from stairs, steps or landings. More men participate in sports than women therefore these findings would be expected.

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Reference:

Gage, B. E., McIlvain, N. M., Collins, C. L., Fields, S. K., & Dawn Comstock, R. (2012). Epidemiology of 6.6 million knee injuries presenting to United States emergency departments from 1999 through 2008. Academic emergency medicine, 19(4), 378-385.

Blog #14: Introduction to the Incidence of Knee Injuries by Chris Schattinger, MS, CSCS, CISSN

It seems that almost everyone knows a person who a suffered a injury. Be it male or female, young or old, playing a sport or miss-stepping on stairs, knee injuries seem to be very common. This may lead you question “exactly how many knee injuries occur per year?”

In short, there is no accurate answer to that question. Approximations of the yearly number of knee injuries are possible but there is no way to account for those injuries that go undocumented (those that aren’t treated). Representative data from studies and estimations from organizations provide the most accurate information.

The goal of our next series of blogs will be to establish the incidence of knee injuries, incidence of injury type, incidence between men and women, age group at highest risk and the activity by which the injuries occurred. Tune in tomorrow as we begin this series!

 

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Blog #13: Lymphedema and Compression by Chris Schattinger, MS, CSCS, CISSN

We have established the very basic physiology of Lymphedema and now we will discuss how compression garments can assist in the treatment of this condition. It is important to note that there is no known cure for Lymphedema and therefore an inexpensive and effective treatment should be explored.

In a study by Damstra et al. (2009) women with breast cancer related arm lymphedema volunteered to participate in bandage compression therapy. The women were divided into two groups each having different levels of compression (20-30mmHg vs. 44-58mmHg). Each group wore the bandages for two hours and then for 24 hours.

The results found the group using the lower pressure significantly reduced swelling after two hours and after 24 hours. The higher-pressure group significantly reduced swelling but only after 24 hours. Therefore, a compression garment that creates either of these pressures could be used to help reduce Lymphedema. Compression garments would also require less time to apply and could allow for greater mobility thus allowing the user to exercise (another treatment method for lymphedema).

 References:

Damstra, RJ, & Partsch, H. (2009). Compression therapy in breast cancer-related lymphedema: A randomized, controlled comparative study of relation between volume and interface pressure Journal of vascular surgery. Retrieved from http://www.sciencedirect.com/science/article/pii/S0741521408022052