The results were published in the Orthopaedic Journal of Sports Medicine on December 10, 2020.

“This is an important topic as we continuously look to refine and develop evidence-based injury-prevention and recovery guidelines for baseball pitchers,” said Joshua S. Dines, MD, sports medicine surgeon at HSS and senior author. “Creating data-driven programs requires us to have a better understanding of the kinetic and kinematic implications of a variety of throwing programs.”

Both elbow and shoulder injuries such as ulnar collateral ligament (UCL) tears continue to be on the rise in all baseball players but especially those at the high school level. UCL treatment (also known as Tommy John surgery) has increased sixfold over the last 20 years among this age group. To try to combat this, coaches and clinicians monitor workload, making constant adjustments to keep players healthy.

While workload has been a highly researched topic, the effects of mound height and distance to home plate have not been studied.

“As we’re monitoring pitchers’ workloads, we need to be aware of the stress being placed on the throwing arm elbow during training and rehabilitation in order to make the right adjustments to that individual pitcher’s training regimen,” added Dr. Dines.

Twenty-one healthy high school pitchers wore a sensor arm sleeve while pitching from four different conditions. The sensor and a radar gun were used to record data such as arm speed, arm slot, shoulder rotation, elbow varus torque and ball velocity. The results showed that there is no statistically significant difference between these variations.

“In the past, it has been assumed that throwing from flat ground was safer than throwing off of a mound due to increased elbow torque,” said study co-author Kathryn D. McElheny, MD, primary sports medicine physician at HSS. “Our study findings did not support this notion. Furthermore, we saw that elbow stress and ball velocity may not have a perfect correlation.”

The researchers concluded that pitchers were using similar mechanics (arm speed, shoulder rotation, elbow varus torque) whether throwing from the mound or flat ground, so this knowledge can be factored into player workload calculations.

COVID-19 is primarily a respiratory illness. Most individuals who become sick experience mild to moderate pulmonary symptoms, such as dry cough and shortness of breath lasting about six weeks. However, it has become increasingly clear that COVID-19 can have a significant impact on multiple body systems, most frequently the cardiac, musculoskeletal, gastrointestinal and hematologic systems.

For example, in addition to continued breathing difficulties, some patients experience extreme fatigue, irregular heart rhythms, inflammation of the heart muscle, muscle aches, gastrointestinal upset and blood clots. These symptoms have occurred even in previously healthy individuals and elite athletes who suffered mild to moderate COVID-19 and did not require hospitalization. Some individuals, called “long-haulers,” have lingering symptoms for weeks or even months after they clear infection by SARS-CoV-2, the virus that causes COVID-19.

“As sports medicine doctors we are always encouraging our patients to be active, but we realized that a one-size-fits-all plan for return to sport would not work well for those who had COVID-19,” said Jordan D. Metzl, MD, a sports medicine physician at HSS and lead author of the guidelines. “We’re excited to share this evidence-based framework to help recreational athletes resume activity safely.”

Dr. Metzl and five colleagues with experience treating recreational and professional athletes across various sports at the HSS Sports Medicine Institute created the new guidelines, published August 10, 2020, online in the HSS Journal.

According to the guidelines, patients who want to return to exercise should be aware that there is no typical recovery pattern after COVID-19. The severity of disease appears to affect the duration of recovery, but this has not yet been proven scientifically.

The guidelines recommend patients with COVID-19 should not resume exercise if they still have COVID-19 related symptoms. Those with an underlying cardiovascular or pulmonary condition should consult with their doctors before returning to any physical activity, even if COVID-19 symptoms have resolved.

Otherwise healthy patients who had mild or moderate COVID-19 and have not had symptoms for seven days may consider resuming physical activity by starting at 50 percent of their usual frequency and intensity. They should approach their return to exercise in a gradual, stepwise fashion, listen to their bodies, and speak with their healthcare providers if they develop chest pain, fever, palpitations or shortness of breath.

Physicians writing exercise prescriptions should take into account any symptoms affecting any of the involved body systems. They should carefully monitor patients who had respiratory symptoms. Patients with cardiac symptoms should rest for two to three weeks after symptoms resolve, except those with inflammation of the heart muscle (myocarditis), who should rest for three to six months and have their readiness to return to exercise confirmed with echocardiography, rhythm monitoring and exercise testing.

Patients with musculoskeletal issues can return to exercise after their symptoms resolve and gradually progress to normal activity levels. Low-intensity exercise and less time sitting may reduce the risk of blood clots in patients with mild clotting issues. Finally, fluid and calorie intake must be monitored carefully upon return to activity for patients who experienced gastrointestinal problems.

The guidelines are intended for recreational athletes of all ages. “I anticipate an increase in pediatric patients who will want to know when they can go back to organized sports after testing positive for COVID-19 as return to various forms of school and the availability of COVID-19 testing increases,” said guidelines co-author Kathryn McElheny, MD, a primary sports medicine specialist at the HSS Sports Medicine Institute who has a particular interest in the youth athlete. “These guidelines will serve as a useful tool for patient discussions and managing individual expectations for returning to play safely.”

“As a new disease, the landscape around COVID-19 has been changing rapidly,” said Dr. Metzl. “We plan to update these guidelines as our understanding of the disease evolves.”

Kathryn D. McElheny, MD, primary care sports medicine physician at HSS, quotes a recent study that found that 18 percent of 500 healthy adults reported easy bruising.

As there are a variety of reasons why bruises occur, Dr. McElheny recommends trying to pinpoint what trauma may have caused the bruise, how often the bruises are appearing and what they look like. Some causes for concern include getting five or more bruises that are larger than one centimeter in diameter without any known trauma, experiencing associated bleeding from other sites (i.e. nose or gum bleeds), or having a history of abnormal lab tests that suggest a bleeding disorder. If you experience any of those situations, bruising may be indicative of an underlying problem so it's best to visit your doctor.

There are some adjustments around the house that you can make to try to avoid bruising altogether. "Maintain good lighting and keep the stairs and walkways uncluttered to avoid falls and trauma," said Dr. McElheny.

Read the full article at mindbodygreen.com.