Baseball pitchers are exposed to extremes of stress, imposed in throwing a ball at speeds over 100 km per hour. These movements subject a number of anatomical regions to repetitive motion type injuries, including the shoulder, elbow, cervical and thoracolumbar spine. As might be anticipated, the most common and most serious injuries sustained by pitchers involve the shoulder joint. The reasons for this are quite obvious. From an anatomical perspective, the shoulder joint and the surrounding tissues are structurally complex, highly mobile and involved in most upper body movements.

Initially, the pitcher complains of pain and subsequently undergoes examination and treatment by the trainer. Ultrasound studies, X-rays, MRIs and PET Scans follow, often on an all too frequent basis and clearly without any significant clinical benefit. Therapy almost invariably consists of a combination of treatments designed to alleviate the symptoms. These include exercise, interferential current, ultrasound, massage and the inevitable application of ice.

Essentially, ice is a counter-irritant and is not beneficial with regard to cellular function or structure. It should be noted that these therapies modulate symptoms in contradistinction to Laser Therapy which is designed to heal tissue at the cellular level, thereby restoring normal cell structure and function. In essence, this technology cures the existing pathology and thereby achieves the desired result.

Generally, conventional therapies relieve symptoms temporarily and as the inflammation subsides, the pitcher resumes throwing. In my experience, rest, gentle stretching and the application of some heat accomplishes the same objective, probably more rapidly. Subsequent to the institution of modulation therapies, pitchers undergo a course of rehabilitation, primarily based on exercise, which may be counter-productive with regard to the healing process.

The institution of surgery following unsuccessful rehabilitation almost invariably results in permanent failure. For surgical repair to be successful, at least from a theoretical perspective, complete immobilization of the shoulder for six weeks or more would be required. This measure is seldom observed, therefore the repair is subject to technical breakdown.

At Meditech, we feel a more rational and elegant therapy would be to adopt the following strategy:
• Rest (during early phase of injury)

• The administration of Laser Therapy daily

• Massage as indicated

• The initiation of gentle stretching 1-2 weeks post injury

The incorporation of this relatively simple approach to all shoulder injuries sustained by baseball pitchers would lead to a cure in over 90% of all cases; a player’s career would therefore be extended. For example Duane Ward and a host of other pitchers that have labored for the Toronto Blue Jays and other baseball organizations in the past, are prime examples of the results produced utilizing the surgical approach for shoulder injuries. All too frequently, subsequent to surgery, pitchers will seldom throw the ball again – certainly not at the professional level.

Combining the healing potential of laser, nature (i.e. time) and other conservative measures, over 90% of all pitchers post injury could be returned to a normal functional levels, if the Meditech strategy is followed.

Fred Kahn, MD, FRCS(C)

Read the article on the Financial Post web site

In the practice of laser medicine, it has come to our attention that on occasion, patients that should respond to Laser Therapy are either slow to do so or do not improve to the degree anticipated.

We have reviewed a representative number of cases with respect to this issue and have found that in almost all instances the lack of success can be ascribed to the patient self-directing the frequency of treatment sessions, duration and other aspects of treatment. This is counter-productive for everyone concerned.

Accordingly, we make available this directive, to be distributed to each patient on the institution of therapy.

Patient Compliance – Therapeutic Implications

At this time, we wish to emphasize a number of factors regarding the administration of Laser Therapy.

The therapy team that attends to your medical problems will advise you regarding the frequency and duration of treatments. This may vary from one patient to another and also with respect to the condition being treated.

For travel and work reasons deviations from the treatment schedule are permissible. Generally, however, patients are advised to follow the course of treatment outlined, in order to produce optimal clinical outcomes. Significant deviation from that course can impede the healing process.

Our experience over the course of almost twenty years has proven conclusively that patients who comply with their prescribed therapeutic schedule achieve their objectives more rapidly than those who do not.

Once again, in order to achieve maximum benefit, patients must be encouraged to follow the treatment schedule outlined by the healthcare professional managing their case.

•  Allowances with regard to frequency of treatments may be made depending on geographic considerations and the time factor involved. For best outcomes however, a relatively structured therapeutic programme is essential.

•  In some patients, improvement may be evident after only 1-2 treatment sessions, in others however, secondary to genetic factors, chronicity, etc. 8-12 treatments may be required before significant improvement is experienced.

•  It is always stressed that patients should adhere to the programme recommended, in order to achieve the desired objective.

•  Adverse effects resulting from Laser Therapy are negligible and are not significant in our extensive experience. Nevertheless, if any should occur bring them to the immediate attention of the medical staff in order that the therapy may be modified accordingly.

•  It is essential that patients be reassessed by the healthcare professional directing their therapeutic programme every 2-4 visits, to effect protocol changes that will advance the healing process.

•  Customization of the protocols for each individual patient is an important aspect of Laser Therapy.

•  If patients need to be seen more frequently by the supervising clinician, they should so indicate when registering or notify the attending therapist, prior to the initiation of treatment.

Fred Kahn, M.D., F.R.C.S.(C)