What is the Risk of Tearing Your ACL on Synthetic Surfaces?

The risk of tearing your ACL on synthetic surfaces has become a hot debate among physicians, coaches, and players.

With the level of competition improving and more year-round programs developing, synthetic surfaces are becoming the arena for many sports. In an American Journal of Sports Medicine article, published in July, 2015, Dr. George Balazs and his team looked at 963 ACL injuries. These injuries were reported on soccer or football fields. These reports were used to determine if synthetic surfaces increased the risk of tearing your ACL.

They stated that since the introduction of artificial turf in the 1960s, use has been a source of controversy. In trying to determine whether they are placing the athletes at increased risk, they looked at many factors. For one, artificial turf has largely been used as a secondary option to grass fields; however synthetic surfaces have increased durability, equate less cost, and present more consistent field conditions than natural grass. They also noted there’s been a steady increase in the use of artificial turf among  competition levels since the ’60s.

Over the past five decades, manufacturers have made significant changes to synthetic field surfaces. Some changes include: the fiber type used and its density, an increase in under-field padding, and the addition of rubberized soles to give the surface a more natural feel. All these changes have been made to ideally decrease field-related injuries.Tearing Your ACL

The authors noted that biomechanical studies have generally supported increased friction force on all types of artificial turf.

Theoretically this increases the risk of injury relative to natural grass. The potential elevated risk of tearing your ACL is a critical concern to athletes, coaches, team trainers, and physicians. The authors also stated that their study would evaluate data related to the effect plain surfaces had on the ACL. After reviewing journal articles, they found  there was an increased risk in American football players, but not in soccer players.

Part of the issue on evaluating whether artificial turf is the cause of lower extremity injuries is the result of multiple factors that may influence athlete injury rates. These include: field moisture, precipitation, and the temperature. Other factors like player position, types of play, period in the game, timing of the game within the season, legal or illegal play by an opponent, and type of shoe wear also affect study results.

The authors stated that there are so many different variables outside of just “artificial turf” that there were some tentative conclusions that could be drawn from this review article. They stated that earlier generations of artificial turfs (densely woven nylon fiber carpets placed on shock absorb with padding) appeared to have an increased risk of ACL injury. They also stated that there is an observed increased risk of ACL injury for football players on modern artificial turf (which is synthetic fibers with rubberized infill) and this seems to increase with higher levels of competition.

In Conclusion

There was no indication that an athlete participating in soccer had increased risk of ACL injury on modern artificial turf. The authors felt that more comprehensive studies looking at other factors needed to be completed to give a better answer as to whether artificial turf does increase the risk of tearing your ACL. But, based on the literature they reviewed in their analysis study, they noted that American football players are at increased risk while soccer players are not at increased risk for tearing their ACL based on turfs types. So good news for soccer players, but not the best news for football players!

If you are on a sports team and want to learn more about this study – call Dr. Stacie Grossfeld of Orthopaedic Specialists in Louisville, KY today at 502-212-2663. If you have suffered a tear in your ACL and are in need of orthopedic care, visit Orthopaedic Specialists today.

How fast can you run a mile? Find out on July 20 at the Parkway Mile!

The Louisville Sports Commission originally shared this information through an email. As a member of the Louisville Sports Commission board, Dr. Stacie Grossfeld is sharing this information on her personal website.

Registration is now open for Louisville’s newest summer race, the Louisville Active Parkway Mile.

parkway mile

We’ve all trained and run 5Ks, half marathons, and some even triathlons. But have you ever wondered how fast your time would be if you ran just mile? Now you can find out. The Louisville Sports Commission has created the Louisville Active Parkway Mile, a fun one-mile run/walk taking place on Southern Parkway.

Beginning at 6:30 p.m. on Thursday, July 20, participants can take off from Southern Parkway and Woodlawn Avenue and take a straight and fast route down Southern Parkway to the finish line outside of Olmsted Academy South.

Parkway Mile Heats Include:

  • Elite Male (must meet qualifying standard of 5:00 mile)
  • Elite Female (must meet qualifying standard of 6:00 mile)
  • Open Male
  • Open Female
  • Masters Male (“Master” is anyone 40 years old and up, per USATF.)
  • Masters Female
  • Family Fun Mile (Not timed.)
  • High School Male
  • High School Female
  • Youth Mile (“Youth” are kids in middle school and younger.)

All heats, excluding the family fun mile, will be professionally timed. Awards will be presented to the fastest, and all will receive post-race refreshments including Powerade, water, fruit, and other goodies.

Register today for only $20 to participate in Louisville’s newest and fastest race! Visit https://runsignup.com/Race/KY/Louisville/ParkwayMile to find out more information and sign up. Also follow us on Facebook for race updates at https://www.facebook.com/ParkwayMile/.

Ulnar Collateral Ligament Injuries: An Overview

ulnar collateral ligament injuriesThe human elbow is an intricate part of the body. While it is essentially a hinge joint and looks fairly straightforward – the elbow is made up of a complicated series of bones, joints, and ligaments. Within the elbow the radius and ulna must rotate and slide with the humerus to bend or straighten the arm. These movements are possible with the help of ligaments and there are two main ligaments that are important in order to achieve optimal elbow maneuverability: the lateral collateral ligament and the ulnar collateral ligament.

Both ligaments work together to keep the humerus connected to the ulna and to keep the ulna in place. Elbow stability depends on these two ligaments and when one is injured, it seriously affects how the elbow functions. Often, the ulnar collateral ligament is hurt through overuse or repetitive use. Not surprisingly, athletes who often depend on throwing motions are most likely to report ulnar collateral ligament injuries. This especially applies to baseball pitchers, quarterbacks in football, and softball players in the outfield. There are three phases to ulnar collateral ligament injuries and being aware of the stages can help to prevent further damage from occurring.

3 Phases to Ulnar Collateral Ligament Injuries

Phase 1: Microtearing

Microtearing is the first phase to a full blown ulnar collateral ligament injury. If it can be prevented then the injury has a better chance of being prevented. The small tears through the ligament occur when the force that the tissues are handling is heaving than the strength of the ligament. When the ligament starts to tear, it is not extremely noticeable. Often it takes months or years of repetitively hard throwing motions to begin the microtearing process.

Phase 2: Degeneration

Degeneration occurs after microtearing when the build-up of minute tears starts to wear away at the ulnar collateral ligament and leaves lasting damage that the body cannot keep up with repairing. When degeneration sets in, pain may start to occur in the elbow and swelling is often seen from the outside. If ulnar collateral ligament injuries are detected in this phase, the healing process can remain nonsurgical. Often, even when ulnar collateral ligament injuries have reached the degenerative stage, rest and modification of activity can stop the injury from worsening and allow the body a chance to start healing.

Phase 3: Rupturing

When an ulnar collateral ligament ruptures, it is accompanied by a loud pop and immediate pain. When an ulnar collateral ligament ruptures, the elbow will lose most of its stability. Sometimes a rupture can occur from just one powerful ligament tearing throw by an athlete; however, more often, the ligament will rupture after years of micro tears and degeneration has already weakened the ligament. When a rupture occurs, surgery is the main option for recovery and a board certified orthopedic surgeon can tell if an ulnar collateral ligament rupture will require repair or reconstruction.

Athletes who often use their arms to pitch, throw, or launch repetitively should be aware of the three phases that lead to ulnar collateral ligament injuries and seek qualified medical attention if they start to feel any of the following symptoms:

  • Pain throughout the inside (side closest to your body) of the elbow
  • Any popping sounds or grinding noises
  • Swollen areas or bruising along the inside of the elbow

A simple MRI can detect any potential ligament injuries. If ulnar collateral ligament injuries are detected an orthopedic physician can help to set up a treatment plan. However, if the damage is too far along then surgery may be the only option.

If you are feeling any significant pain in either of your elbows, regardless of if you are an athlete or not, visit Dr. Stacie Grossfeld of Orthopaedic Specialists, PLLC in Louisville, KY. With the help of Dr. Grossfeld, you can prevent further damage to your ligaments, joints, and bones while starting a treatment plan to fix any existing damage. Contact Dr. Grossfeld here or by calling 502-212-2663 today!

Why Do Female Athletes Tear Their ACL at a Higher Rate Than Male Athletes?

There is a lot of debate over the causes of ACL tears among women and the difference when compared to male athletes. It is proven that women tear their ACLs at a higher rate than men; however, the cause has not be pinned down. While the cause hasn’t been determined yet, there are many theories surrounding this type of injury and why it is so frequent among female athletes.

Dr. Grossfeld explains ACL tears in girlsThe Theory

One theory focuses on the fact that as girls go through puberty, they develop strength differences in their hamstrings versus the quads. This change effects the way females land from a jump and causes some loss of hip strength. This theory has inspired many scientific studies including one in May of 2016. In May, the American Journal of Sports Medicine published a study from Dr. Catherine Wiles – out of Australia – where she specifically looked at how young girls changed their landing technique throughout the adolescent growth spurt.

The study was very unique in the sense that Dr. Wiles followed the girls as they went through puberty and measured then studied the way their lower extremities matured during this time period. Dr. Wiles measured ground reaction forces, lower limb muscle activity, and kinematic data while the girls performed horizontal leaps. The authors noted that during the adolescent growth spurt, girls experienced a vast number of rapid insightful changes to the musculoskeletal system including the structure and the function.

The Findings

Through puberty, there is an increase in height and lower limb length as well as increases in anterior knee laxity. There is a lack of hamstring strength development that is relative to the strength of quadriceps. After four different test periods, Dr. Wiles and researchers found that over the course of puberty Test #1 produced completely different results compared to Test #4. This is in reference to the less flexion that the girls had in their knee when they landed their horizontal jump. They found that as the girls went through maturity, they displayed a greater hip external rotation, also.

When specifically looking at the knee, the researchers determined that the girls experienced a decrease in external rotation moment as they matured. It is possible that increased knee flexion acts as a landing strategy to protect the internal structures of the knee. This then decreases the risk of ACL injuries. A knee flexion that goes less than 22 degrees during landing can increase the potential that an athlete’s quadriceps will strain the ACL. This then increases the likelihood of an ACL rupture.

They found that with an isolated quadricep load of 200 Newtons in ACL loads with the highest at 45 Newtons at 15 degrees of knee flexion that the force on the ACL decreased by approximately 10 to 15 Newton’s with every 15 degree increase in knee flexion. This means that researchers found female athletes with a higher amount of knee flexion during a horizontal jump produce less force on the ACL.

However, as the girls matured in this study, the amount of knee flexion reduced as they did the horizontal jump. This could explain why female athletes are more prone to ACL injuries than their male counterparts.

Healthy Bones: Osteoporosis

Bone Health and Osteoporosis This month we are focusing on bone health. Unless you have recently sustained an injury to your bones, then it’s unlikely you’ve been putting much thought into their health. Since we can’t see our bones, it is much more difficult to remain aware and alert to their needs. For example, osteoporosis, which is a condition that degrades bones, is a common disease and yet most people aren’t aware of its serious effects on bone health.

Effects of Osteoporosis on Bone Health 

According to the National Osteoporosis Foundation, about 54 million Americans have osteoporosis. Approximately one in two women and up to one in four men age 50 and older will break a bone because of osteoporosis. The condition typically appears in women when they start menopause at age 50-55 . Male osteoporosis tends to occur after age 70. The start of osteoporosis is related to a reduction of the hormones estrogen and testosterone.

Osteoporosis is a silent disease. The first sign of the condition may only appear after a fragility fracture has already occurred. These kinds of fractures are most common in the wrist, spine, and hip. Studies show that someone who has had a fractured hip due to bone density decrease has a much higher risk of fatality because of the injury than someone else with the same fracture unrelated to osteoporosis.

Other than broken bones, osteoporosis can cause height loss or curvature of the spine. If you are experiencing either of those symptoms, it could be wise to get in contact with a healthcare professional.


Prevention is the best form of treatment of osteoporosis. A few ways you can work to prevent the condition is by incorporating more calcium and vitamin D supplements into your diet. Some foods rich in calcium include dark leafy greens, cheese, yogurt, broccoli, and almonds. Sunlight is the vitamin D source most people know, but there are also other ways to incorporate vitamin D into your life even if you can’t get outside for lengthy periods of time. Foods such as salmon and other fatty fish, egg yolks, and portobello mushrooms are also good sources of vitamin D.

Other forms of prevention include frequent exercise, reducing caffeine and alcohol intake, as well as eliminating any smoking habits. These activities not only help prevent osteoporosis but also help to improve general bone health.

If you think you may be at risk for osteoporosis, there is also a bone density screening you can opt for. It is called a DEXA scan and is somewhat similar to an x-ray.


There is no explicit cure for osteoporosis, however there are medications that can help reduce loss of bone density. Calcium and vitamin D supplementation can only go so far to help prevent the onset of osteoporosis, but they cannot help to reverse the effects of the condition. Only the group of FDA approved medications for treatment of osteoporosis can be used to rebuild bone mass such as: Prolia  and Forteo. Only an FDA approved medication for treatment of osteoporosis can improve and rebuild the bone density and strength. Ask your healthcare provider which agent they recommend before you try to self-prescribe.

Subchondroplasty or SCP for Bone Marrow Edema or Insufficiency Fractures

subchondroplastyMany people suffer from bone marrow edema or insufficiency fractures. And the long term effects of these conditions can be serious. Edema and insufficiency fractures can injure a person’s bone marrow and cause a long list of medical complications.

Fortunately, there are a variety of medical treatments available to treat bone marrow edema and insufficiency fractures. People with the most chronic and severe cases may benefit from subchondroplasty, a treatment provided by a board certified orthopedic surgeon like Dr. Stacie Grossfeld. Subchondroplasty can improve a person’s pain and also decrease the number of physical limitations often associated with bone marrow edema or insufficiency fractures.

What are Insufficiency Fractures?

Insufficiency fractures are a type of stress fracture. They happen due to normal stress on a bone that is weak. Insufficiency fractures are more common in older people, and particularly in older women.

What Causes Bone Marrow Edemas?

When you suffer from edema, your blood cells go to the injured site, causing a pooling of fluids. Injuries such as fractures or broken bones result in bone marrow edema. They may also be the result of ligament injuries, bruising on bones or inflammation. Osteoarthritis and osteoporosis are regularly associated with bone marrow edema. Bone marrow edemas can negatively impact a person’s overall health. If you are suffering from this condition, seeking treatment is very important.

An Overview of Subchondroplasty as a Treatment for Edema

If you are experiencing edema, and you have not gotten better from medications and rest, you may benefit from subchondroplasty. Subchondroplasty, also known as SCP, is a procedure done for patients that have insufficiency fractures or bone marrow edema. Typically it occurs in patients with osteoarthritis. An MRI scan diagnoses it.

The surgical procedure is an outpatient procedure that takes about 20 minutes to complete. It involves a knee arthroscopy where a high definition television camera is inserted into the knee joint. A trocar, which is like a large needle, is injected into the area where bone marrow edema was identified on the preoperative MRI scan. Then a special type of bone graft is injected. The bone graft instantly heals the bone marrow edema or insufficiency fracture.

What to Expect after Subchondroplasty?

Following subchondroplasty, patients are able to bear weight immediately. And generally within 24 to 36 hours, people also experience a noticeable reduction in pain. Dr. Grossfeld has been performing subchondroplasty for about a year and while doing so has had excellent results. For more information and to schedule an appointment with Louisville orthopedic Dr. Stacie Grossfeld, call 502-212-2663.

Dr. Stacie Grossfeld of Louisville’s Orthopaedic Specialists PLLC Named 2017 Volunteer of the Year by the YMCA at Norton Commons

ymca at norton commons

Dr. Grossfeld accepts her award for the 2017 Volunteer of the Year from Mike Bramer, the District Executive Director at the YMCA at Norton Commons.

Louisville, KY – April 27, 2017 – Dr. Stacie Grossfeld, orthopedic surgeon at Orthopaedic Specialists, PLLC, has been named Volunteer of the Year by the YMCA at Norton Commons in Louisville, Kentucky. Since 2015, Dr. Stacie Grossfeld has served on the Board of Directors for the organization, and has regularly connected the YMCA with potential business partners since joining.

Since joining the Norton Commons YMCA Board of Directors, Dr. Stacie Grossfeld has been happy to help fundraise for the Y at Norton Commons.

Some examples of Dr. Grossfeld’s involvement with the YMCA at Norton Commons include:

  • Finding and giving the Y a $4,000 blood pressure machine for members to use
  • Securing donations and contributions to the YMCA at Norton Commons
  • Encouraging individuals and families to join the YMCA through her orthopedic and sports medicine practice

Describing their experience with Dr. Grossfeld, leaders at the YMCA at Norton Commons explain: “Stacie is a tremendous asset to the YMCA at Norton Commons and she is very deserving of our Volunteer of the Year Award!”

The YMCA at Norton Commons is one of the newest YMCA facilities to open in the Greater Louisville area. At the Norton Commons YMCA, families can take advantage of a wide variety of programs including:

  • Nutritional Consultation
  • Personal Training
  • Youth Fitness Fundamentals
  • YMCA Weight Loss Challenges
  • Fundraisers through the YMCA Teen Leaders Program

The YMCA at Norton Commons also offers a warm water pool for recreational activities, a lap pool for exercise, a sauna, spa, group exercise and cycling classes, a fitness center, supervised Kid’s Club, Club Y for preteens, a full gymnasium, and more.

To read more about how Dr. Stacie Grossfeld helps give back to her Louisville, KY community and what the YMCA at Norton Commons has to offer to children and adults alike, click here.


Manage Knee Osteoarthritis: Study on Nonsurgical Solutions

The experience of knee osteoarthritis is extremely common for active individuals. It is especially common in those that have suffered previous injuries, those with extra weight, and those that are older in age. There seem to be several precursors to developing this debilitating and degenerative disease, but there are also ways to manage knee osteoarthritis.

According to the American Journal of Bone and Joint Surgery, Dr. Gwi-Chin Lee has a new update on the nonsurgical management of knee osteoarthritis. This information is in the January 2016 edition of the American Journal of Bone and Joint Surgery.

According to Dr. Lee, there are seven effective and scientifically proven ways to reduce and manage knee osteoarthritis pain. The following solutions are for those struggling to manage knee osteoarthritis.

Low Impact Aerobic Exercises

These exercises can reduce the pressure and impact felt when working out. Low impact aerobic exercises include: swimming, biking and yoga. These are great ways to maintain a healthy, pain-free lifestyle while continuing to do the things that you love. Manage Knee Osteoarthritis

Weight Loss

Knee osteoarthritis affects individuals that are typically overweight. Combining exercises with weight loss will only improve your chances of managing your osteoarthritis pain. By losing weight, you will take added pressure off of your joints. This pressure loss will reduce the stress placed on these bones and joints.

Bariatric Surgery

Bariatric surgery is proven to reduce knee pain, improve knee function, and decrease stiffness. This surgery is often required for people carrying extra weight, but it has shown to be effective for managing osteoarthritis as well.

Pharmacological Agents

This report found that patients taking non-steroidal anti-inflammatory drugs and steroids were able to manage their knee pain and increase their level of activity. Take these oral medications as recommended by a physician.

Intra-articular Injections

Patients receiving cortisone or hyaluronic acid injections saw significantly decreased levels of pain. A physician administers these injections by placing a needle in or around you kneecap. These tend to offer quick relief while offering short-term benefits.

Physical Therapy

These individualized sessions have found to be more effective at treating osteoarthritis of the knee than those attending exercise classes or those exercising alone. Physical therapy is personalized, controlled and evaluated regularly which allows you and a professional to manage specific pain.


Platelet rich plasma has been studied in the management of osteoarthritis and it appears to be equally as effective as hyaluronic injections. This is an aggressive and also invasive option. You should consult your physician before receiving this treatment.

These seven options offer nonsurgical methods of managing and also reducing osteoarthritis of the knee. There are several positive approaches to treating osteoarthritis. Three options that are clinically proven to not be successful include: laser or needle acupuncture, Tylenol, and undergoing a knee arthroscopy. All of these options should be avoided. Only consider further treatment if the other seven solutions have failed to alleviate pain.

If you are experiencing knee pain or have been diagnosed with osteoarthritis of the knee, there are treatment options available. Call Orthopaedic Specialists at 502-212-2663 to schedule an appointment with Dr. Grossfeld today.


When is it too Early for Youth Sport Specialization?

Dr. Brian Feeley considers sports specialization to be intensive, year-round training in a single sport with the exclusion to other sports. There was a concern that early single sport specialization may lead to increased rates of overuse injury and psychological burnouts.

Dr. Brian Feeley, Julie Angel, AT-C and Dr. Rob LaPrade have come together to publish an article in the American Journal of Sports Medicine in January, 2015. They specifically addressed the question, “When is it too early for single sport specialization?” They noted that these activity levels in the United States today include extremes of inactivity versus overactivity in sports. Greater than any time in history we are seeing more children who are morbidly obese with earlier onset diabetes.

And on the flipside, we are also seeing kids who participate in one sport year-round or multiple sports year round under the guidance of a coach and on a specific team. The authors felt that the coach is a primarily driving influence on the decision to specialize in a single sport. An article described that this decision may establish a fundamental early disconnect where the interest in the goals of the parents and child are not the same as those of the youth coach whose focus is on success in a single sport.

Research Findings

Youth Specialization in HockeyThe authors also noted that over the past 20 years there has been a shift in emphasis from youth group and recreational sports activities, to skill development with an emphasis on achieving a high level of accomplishment in a single sport.

The evidence for contribution of an early sport specialization to mastering a particular sport is not clear. It makes intuitive sense in early development of a skill set in sport such as golf, tennis, and gymnastics where post-pubertal size and strength gains are not as important or could actually be detrimental may be beneficial in those sports. The authors noted there is not clear literature to support this. They noted that some studies have suggested that late specialization in a particular sport with a child greater than 12 years of age, may actually result in better achievement than early specialization.

Gullich and Emrich studied more than 1,500 German Olympic athletes and found that the lead athletes specialized later and were more likely to participate in one or more sports over age 11. They noted that Olympic athletes played multiple sports up to age 12 and then started to specialize after that. There was little evidence for and against early specialization in many sports that have a high level of early year round participation in the United States. Athletes are at risk, especially the young athletes for overuse injuries in sports such as baseball, gymnastics, swimming, and ice hockey.

Overuse Injuries

The concern about overuse injuries in the youth athletes relate to the fact that they have open growth plates in their bones, ligaments that are changing size, and muscles that have not reach full maturity.

Youth Pitchers

They noted that youth pitchers face the issue of overuse injuries. These athletes depend on rotator cuff musculature and trunk rotation to throw a baseball which in combination with excessive torque on their humerus which is their upper arm bone, underdevelopment on their muscles, and open growth plates predisposes these athletes to shoulder instabilities, stress fractures through the top part of the humeral bone, and rotator cuff tears and tendonitis.

Youth Baseball Players and Shoulder InjuriesIt has been documented that a youth baseball player pitching more than 100 innings per year resulted in a 3.5 fold increase in risk injury that resulted in time loss from competition in the 9 to 14 year old age group. It is important that parents and physicians consider participation times outside of competitions that occur with private coaches, parents, teammates, and count these athletic exposures as part of the overall time spent in training.

Young Hockey Players

They also noted another area of concern is in hockey players. Studies have documented that the hip position in ice hockey players who are sprinting in the pubic age around 11 years of age tend to externally rotate when pushing off and then internally rotate while increasing hip flexion during the recovery phase. This range of motion creates an impingement on the femoral neck – the top part of the hip bone – and can lead to early stress on the acetabular cartilage and labrum. This can cause potential labral tears and cartilage damage later in life. The youth hockey players’ hip actually develop differently than a child who does not play hockey. These findings have proven to cause problems later on in life.

The authors noted that there is some scientific evidence for early single sport specialization is a risk factor for injury. A case control study of 1,206 7 to 18-year-old student athletes demonstrated that over the course of three years, playing a single sport was an independent risk factor for injury. The authors noted that the age of the athletes in that group and the hours of training per week were not as important as the risk factors of only participating in one sport.

On the flipside, there was also scientific evidence that early single sport specialization has a negative effect physiologically,meaning higher burnout rates.

National Regulations

Some sport organizations are starting to set down rules regarding the amount of time that the youth athlete can participate, such as USA Baseball instituted at pitch count recommendations based on its expertise and review of the literature.

USA Swimming set competition time limits per day for youth 10 years and under. USA cycling hold competitions for youth 10 years and up and has set gear ratio restrictions. These promote positive pedal cadence and reduce the risk of injury.


The authors then specifically looked at youth overuse injury in specific sports. They noted with baseball pitch-count and no routine in youth baseball has become a major factor in major league games as well. Pitch counts have developed around 2001 where it became apparent that 1 to 75 pitches in a game reported increased shoulder pain. However, even with these recommendations, a cross-sectional study of 754 pitcher ages 9 through 18 reported that 45% of the pitchers had no pitch-count in place. They noted that 13% pitch more than recommended eight months in a one year period. Similar studies have shown that the incidence of elbow pain in youth baseball players is between 20 to 30% for 8 to 12 year-olds, approximately 45% for 13 to 14 year-olds, and over 50% for high school, college, and professional athletes.

What is very concerning is a report by Dr. Ahmad that found that 31% of baseball coaches, 28% of players, and 25% of parents do not believe that the pitch count is a risk factor for elbow injury.

An even more concerning statistic is that 30% of baseball coaches, 30% of parents, and 51% of high school athletes, and 26% of collegiate athletes also believe that the ulnar collateral ligament reconstruction also known as a Tommy John procedure, should be performed prophylactically on athletes without elbow injury to improve performance. The Tommy John surgery is done when the athlete has torn, stretched out, or has chronically inflamed interstitial tearing to the ulnar collateral Sports Specialization in Gymnasticsligament. The Tommy John procedure reconstructs the elbow ligament and it is a major surgery. The concern is that baseball coaches, parents, and athletes think that surgery will actually help the players. This shows that there is a lack of information and education among baseball players, coaches, and parents.


The authors specifically looked at gymnastics and noted that spondylolysis, a common finding that is hypothesized to be linked with back walkover type skills or excessive extension of the back, occurs in gymnast and is essentially a stress fracture of the back. Gymnasts also experience stress fractures at the wrist and growth plate injuries in the upper extremity because they are being used as weight bearing joints even though they were not designed to be weight bearing joints.


As mentioned above, the risk of femoral acetabular dysplasia or changes in the hip joint, occur in youth hockey players. Another study noted that hockey players ages 16 to 19 year-old have a higher incidence of labral tears as documented by MRI scan.


In reference to swimmers, these athletes swim between 4 to 9 miles per day and often swim 11 months out of the year beginning at age 10 to 12 years of age. Overuse injuries in swimmers can occur in both sprint and distance events as well as triathlons. The authors noted that a majority of swimmers Specialization in Youth Swimmingbelieve that shoulder pain is a normal process of the training process. This study evaluated 80 lead swimmers between the ages of 13 and 25 years. They found that 91% of the swimmers reported shoulder pain, 84% had positive impingement signs, and 70% had MRI evidence of supraspinatus tendinopathy. Supraspinatus tendinopathy indicates that the rotator cuff is highly inflamed and there are actual tendon changes that an MRI will detect.

In conclusion, the authors felt that it is increasingly important to educate parents, coaches, trainers and physicians on the risk of early single sport specialization. It is their obligation to notice early signs of injury to prevent more serious injuries from occurring. These injuries, if not treated properly could potentially limit the participation of competitive athletes not only at the youth, but as a lifelong athlete.

Dr. Grossfeld is a double-board certified orthopaedic surgeon. She loves to be active and play sports, but she also understands when it is time to give herself a break. As a parent, coach or young athlete, be aware of your pain and stress levels. It is important to take time for recovery and continue to enjoy all of the sports you love!

How Body Weight Affects Your Knee Pain

Knee pain can occur in anyone for a number of reasons. It is a vulnerable joint because of the many ligaments and tendons that work together to allow for full mobility. While anyone may be at risk for knee pain, it is much more likely to occur in people who are overweight. When you are overweight, there is also a greater risk of knee pain leading to more severe injuries. According to the Center for Disease Control, two out of three obese adults will suffer from knee osteoarthritis at some point in their life. Excess weight can also cause existing arthritis to worsen.   

Losing weight is not an easy task. It can be especially tough when you are fighting off knee pain. You may find it easier to lose if you understand exactly how much being overweight can negatively impact the health of your joints and your overall health. It is also important to note that there is no catch-all definition for overweight.

Weight loss can help alleviate knee pain

A chart indicating the levels of Body Mass Index.

If you feel that you may be overweight, you should research what a healthy weight is for your height and gender. So for example, 150 pounds may seem like a lot, but for a man who is 6 feet tall that would be a perfectly healthy weight. To help determine where you fall on the scale of healthy weight to obese, you should also talk with your doctor. An expert who you can speak with in person will have a much better understanding of your body type than any charts you can find online.

Weight Distribution and Knee Pain

Just from walking you are distributing 1.5 times your body weight across your knee joints. Say you weigh 200 pounds. While you’re walking around, you’re placing 300 pounds of force on your knees. That force can double, even triple when you walk up and downstairs. When squatting, the force on your knees can increase as much as 5 times your body weight. Something as simple as squatting down to tie your shoe can become laborious when you are overweight.

Losing Weight with Knee Pain

When walking, climbing up stairs, and squatting are already difficult it may seem near impossible to lose weight. Start out with simple exercises that don’t put too much strain on your knees. For example, a stationary bike on low resistance, or walking on a treadmill at a slow pace. Both forms of exercise are both good way to start out. Then as you build strength and endurance you can work your way up to more challenging exercises. Then you will be able to burn fat more quickly.

While exercise is essential to losing weight, it is not the only factor. Diet also plays a major role in weight loss. For every pound lost, you’re losing approximately 3,500 calories. It can take quite a lot of effort to shed those calories through exercise alone. Portion control in meals can help to decrease the amount of exercise you’ll have to do later on.

The Benefits

As you lose weight, the benefits will become apparent. One pound of weight loss unloads at least 4 pounds of joint stress to the knee. A 2005 study from Dr. Stephen P. Messier of Wake Forest focused on the effects of weight loss on knee pain. According to him, the accumulated reduction in knee load for 1 pound of weight loss is more than 4,800 pounds per mile walked. For people losing 10 pounds, each knee would be subjected to 48,000 pounds less per mile walked. Another report from the 2016 edition of Osteoarthritis and Cartilage showed that a 10 percent reduction of a person’s Body Mass Index over 48 months delayed the progression of cartilage degeneration.

If you’re experiencing pain in your knees and you believe it could be a result of your weight, reach out to your doctor. Here at Orthopedic Specialists we have developed a specific weight loss program to help our patients achieve a healthy lifestyle. For more information give us a call at (502) 212-2663 or visit our program page here.