UCL Injury Risk Reduction Program

 

Background

Through both personal and professional experiences, I have grown to enjoy providing care in the world of sports medicine.  Athletic trainers and physical therapists alike find themselves in a unique position in healthcare, both aiding in injury recovery and working to prevent injuries.  This unique aspect allows us to benefit our patients not only during recovery but also on the front end, before injury occurs.

Among the sports I have had the opportunity to cover, baseball stands out as one of my favorites.  In a sport that causes a relatively high number of both acute and chronic arm injuries, I began to wonder how can we as physical therapists intervene. Yes, rehabilitation after injury is important, but can we make an impact on the front end, reducing the likelihood of injury occurrence? Due to its increasing prevalence and widespread media coverage, I am particularly interested in ulnar collateral ligament (UCL) injuries.

 

Statement of Need

In the world of sports physical therapy, overhead athletes make up a large percentage of patients.  Of these, baseball players are notably susceptible to chronic arm injuries due to their long seasons and high magnitude of force when throwing.  UCL injuries are particularly burdensome, as they have a relatively large prevalence in the baseball population and require extensive time and rehabilitation to heal.  According to a study by Reiman et al., baseball players (all ages and levels of play included) have a UCL injury rate of 15-25%.¹ Another article reported that 25% of major league pitchers have had surgery to repair UCL tears.² Given this high occurrence of injury, there is a great need for injury prevention.  This need can be addressed with a UCL injury prevention plan consisting of therapeutic exercises and stretches.

 

Purpose

The purpose of this project is to create a simplistic exercise plan that is designed to improve the risk factors that are associated with UCL injury, a product that can be provided to athletes and coaches.  Along with this, I have created a handout for clinicians that describes the plan and associated risk factors in greater detail.  These products are accompanied by a presentation that provides information on all things related to UCL injury, including anatomy, pathophysiology, epidemiology, treatment, and risk reduction.  The presentation targets both students and clinicians and is intended for future use as needed.

 

Products

Risk Reduction Plan for Athletes and Coaches

Handout for Clinicians

Presentation on UCL Injury

 

 

Evaluation

While I have not yet presented the PowerPoint I created, I hope to do so in the future.  To evaluate the quality and effectiveness of this presentation, I made a brief quiz to assess learning.  The link can be accessed here.

 

Self-Reflection

In the completion of this project, I learned a great deal about UCL injuries and our role as clinicians when it comes to treatment and risk reduction.  Through the guidance of my co-primary advisors and committee member, I created products that I feel to be both relevant and helpful (and hopefully effective).  I have also come to some realizations along the way that, had they happened sooner, could have steered me to alter certain aspects of this project.

To start, this plan is specifically designed to address UCL injuries, not other injuries that are commonly seen in baseball players.  Having athletes complete an exercise plan that addresses only one type of injury is not efficient, considering they must perform additional exercises to protect other anatomical structures.  A note was made in each product alerting stakeholders to this point.  However, this plan does touch on important components that are beneficial for overall health and function, like posture and scapular strength.  Also, to my knowledge, this is the first exercise plan to address the UCL specifically, potentially leading to more effective prevention of this particular type of injury.

Another downside to this project is the variability of populations found in the literature.  Although this plan is designed to be used at every age level, most of the evidence reflected a very particular population, whether it was young kids, high school students, college players, or professionals.  Such great variability in subjects weakens the strength of the recommendations made.  However, expanding the diversity of subjects allowed for an all-encompassing approach that returned a greater quantity of information, hopefully making an impact at various levels of the game.  Lastly, while the risk factors and related exercises are associated with UCL injury, their connection may be difficult to recognize for players and clinicians alike.  To combat this issue and the subsequent risk of non-compliance, the presentation and clinician handout include detailed explanations of each risk factor.

Despite these issues, I feel that this project can improve the arm health of pitchers and position players alike.  Through the careful review and application of evidence, and implementation on the part of clinicians, coaches, and players, steps can be taken to reduce the risk of this prevalent injury.

 

 

I’d like to give a special thanks to Mike Gross, Josh Torrey, and Terri Jo Rucinski for their time, support, and guidance throughout the process of completing this project.  The materials presented here reflect their expertise and direction.