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22and25 you are in the medical field I take it?  I'd love to find a trainer or pt here like Cressey. Socal I'm sorry about your son. You're right though at least you know what you're dealing with. Colby has had 1 mri back in Sept.  I have a feeling if there is still trouble in a few months there may be another one coming. I do think he'll take the summer off and focus on healing up

@edcoach posted:

22and25 you are in the medical field I take it?  I'd love to find a trainer or pt here like Cressey. Socal I'm sorry about your son. You're right though at least you know what you're dealing with. Colby has had 1 mri back in Sept.  I have a feeling if there is still trouble in a few months there may be another one coming. I do think he'll take the summer off and focus on healing up

I would definitely, 100% get another MRI to be on the safe side.  The Dr's can only go by what they see in the MRI and the symptoms.  

When we started the process with my son his labrum tear appeared to be small, by the time we got around to surgery it was almost a 50% tear.  

If your son had a very small tear that didn't show on the MRI the first time, perhaps it is more visible now.  

Edit: and thank you.  He is all good and now a sophomore in college still playing ball!

Last edited by SoCal OG
@edcoach posted:

22and25 you are in the medical field I take it?  I'd love to find a trainer or pt here like Cressey. Socal I'm sorry about your son. You're right though at least you know what you're dealing with. Colby has had 1 mri back in Sept.  I have a feeling if there is still trouble in a few months there may be another one coming. I do think he'll take the summer off and focus on healing up

I am not a physician, I work in healthcare on the commercial side.  I have taken my son to both Boston and Florida to work with Cressey for a pitcher specific training program.  He is the best in the business, in my opinion, at assessing and programming the individual needs of pitchers.

@SoCal OG posted:

I would definitely, 100% get another MRI to be on the safe side.  The Dr's can only go by what they see in the MRI and the symptoms.  

When we started the process with my son his labrum tear appeared to be small, by the time we got around to surgery it was almost a 50% tear.  

If your son had a very small tear that didn't show on the MRI the first time, perhaps it is more visible now.  

Edit: and thank you.  He is all good and now a sophomore in college still playing ball!

Definitely get the MRI. It is only way to know for sure. Speaking from experience of watching 2021 do 3 months of PT, just to find out it was a tear. 2 x-rays showed nothing. Insurance was our biggest hurdle—they required the PT prior to MRI.

Just a little inside knowledge when it comes to repeat radiological studies. Sometimes the real reason for a repeat scan is because a different radiologist is reading on that day. Not my intention to call anyone out, because I know from experience that very subtle changes can be very easily misread and/or overlooked. From a legality standpoint things can get very muddy when it comes to what should or shouldn't have been seen on certain films. Reading scans at times it isn't as black and white as a lay person would like to believe. As to life, there is quite a bit of grey area.

Just a little inside knowledge when it comes to repeat radiological studies. Sometimes the real reason for a repeat scan is because a different radiologist is reading on that day. Not my intention to call anyone out, because I know from experience that very subtle changes can be very easily misread and/or overlooked. From a legality standpoint things can get very muddy when it comes to what should or shouldn't have been seen on certain films. Reading scans at times it isn't as black and white as a lay person would like to believe. As to life, there is quite a bit of grey area.

This is my understanding as well, the images are interpreted.  Much like cancer, you want the right person doing this.

@22and25 posted:

Or, just as likely, the ortho group has a cheap low gradient open MRI in their office so they can do their own scans and make money.  The scanner sucks and you get crappy images that miss pathology.

If you get a chance, look into perceptual vs cognitive errors when it relates to radiology. There has been a ton of studies on this topic, and it's really interesting how the human mind works while trying to decode raw information. "Crappy scanner" is usually a scape goat as the abnormality is often seen in retrospect, especially after being pointed out by another Radiologist. This ties back to a perceptual error.  @Smitty28 Those that keep making cognitive errors tend to loose their licensure pretty quickly

If you get a chance, look into perceptual vs cognitive errors when it relates to radiology. There has been a ton of studies on this topic, and it's really interesting how the human mind works while trying to decode raw information. "Crappy scanner" is usually a scape goat as the abnormality is often seen in retrospect, especially after being pointed out by another Radiologist. This ties back to a perceptual error.  @Smitty28 Those that keep making cognitive errors tend to loose their licensure pretty quickly

Yes, I am aware.  I am also aware that an outdated .5 Tesla open scanner shoehorned into an office produces substandard imaging.  It does however provide the same reimbursement as the 1.5T or 3T magnet at the imaging center down the street but the ortho practice keeps the money😉

Don’t get me started on the ortho doc doing a wet read to make treatment decisions.....

I am not suggesting anyone is a quack, selling snake oil or scamming anyone.  I am only suggesting that, if an MRI is needed I would take my son to a center with modern equipment and insure that the scans are read by a radiologist before making any treatment decisions.  Plain X-ray in a doctors office, sure.  MRI in a doctors office, hard pass.

You guys might as well be speaking greek, lol!  

For the OP, I think it's been long enough and the situation hasn't improved or changed much.  Probably well past time for a 2nd MRI.  Hopefully, its conclusive and the Ortho can give a solid diagnosis and recovery plan, even if that involves surgery.  

Just my opinion, but I did stat at a Holiday Inn Express once.  

https://vimeo.com/51166685

@9and7dad posted:

I'd add that the player's positioning of the shoulder during the scan can potentially impact the results of what can be seen.  Yet another reason to have care managed by a doc who routinely works with overhead throwing athletes.

The biggest factor in MRI is the coil.  Do they have a dedicated shoulder coil?  How many channels in the coil?  Do they try to get by with a flex coil to keep from buying a dedicated shoulder coil?  

@Dallas2020 posted:

Another root cause of impingement is poor posture. Pretty common these days with the use of cell phones, iPads, video games, online classes...

While this thought process is common, especially in the general population, it doesn't actually hold much validity. Posture isn't causative of pain and shouldn't be vilified (this doesn't mean you can't modify symptoms by changing positions or postures, rather just because you can change something doesn't mean that it was the cause of the issue to begin with [post hoc ero propter hoc fallacy]). It definitely isn't causative of impingement, and impingement (as a pathoanatomical diagnosis) does not exist.

Last edited by XFactor
@edcoach posted:

Xfactor great post thank you....let me ask you...why would ortho have diagnosed that? Laziness? Lack of knowledge? What if the specialist tomorrow says the same thing? Just trying to get some knowledge to know how to respond and question.  The initial diagnosis per mri was strained bicep

It's difficult to stay up on current literature. If you were to ask me 10 years ago I would be fully on board with GIRD being the cause of pain. So I'm not going to throw the ortho under the bus and just say they're lazy or stupid or whatever. It can be difficult to stay up to date on things. And there's also bias involved that shades things.

It may very well be that there is decreased range of motion, but GIRD isn't pathological. However they may have a rationale of, "Let's calm things down a bit, and build up from where he's at." and whether they call it GIRD or SHITS (something hurts in the shoulder) or whatever, if they have a good treatment plan that aligns with what's important to you and your son, then that's awesome.

Bottom line I'd want to know is,

What's the prognosis?

What will be done to help my son be able to handle the volume of throwing and will the tissues be trained appropriately so they can handle throwing 70/80/90+ MPH?

@edcoach posted:

Thx for all the responses. GIRD is different than the sick scapula correct? I'm really concerned about finding a pt that works with overhand athletes exclusively.  Would a good trainer be able to strengthen the scapula and rear shoulder muscles?

Depends. Cressey is one of if not the best with this. A close friend owns another facility close to Cressey and the first thing he did when my son started there was put him on a scap/shoulder plan to strengthen those areas. Still has a basic scap workout to do everyday. I would look for a trainer who focuses on athletes/sports, not a trainer focused on fitness and weight loss.

Have you given any thought to going to see Cressey?  Flights and hotels are cheap right now.  An in person assessment, initial programming and a few days of in person training with his staff is around $400.  Your son will leave with a written program tailored specifically to him and a video library of all of the exercises.  

Add flight, food and hotel for two and you are maybe $1,500 all in. Not insignificant money but compared to what we spend on baseball, not crazy money either.

@edcoach posted:

Tbpt I'm going to go get son those bands and show him that workout. It looks Excellent.

We have a guy in town that used to be strength and conditioning for several different D1s and now he has a private gym he trains athletes. Im going to contact him today.

My trainer friend told me right away a couple years ago he had to develop his scaps more. He does that stuff almost everyday.

Also, 22&25 is 100% right. If you can swing it I’d bring him to Cressey. I live here so we’re there all the time. They will find every weak part of the body/kinetic chain and program to strengthen it. It is truly amazing to see what they can do.

If you go now there will be a ton of MLB guys there training.  My son went last January and had Mad Max and Klubber there every day.  Just call them and see if he can get on Eric’s schedule to do the assessment, tell them you will wait if necessary to have Eric do the assessment and write the program.  He is at the Florida location now.

Can’t hurt. My son’s right side of his body was much stronger than his left in the core and back. The trainer added exercises that made the left side stronger (in addition to the scap work). The weak left side wasn’t able to pull to match the right resulting in hitting and throwing with his left shoulder up. That resulted in the Teres Major/Minor scap area getting sore and vulnerable. Had he continued without fixing it he would have likely made his own adjustments resulting in a different injury.

Good trainers will evaluate the entire body and chain to see where you are going to break down. Then they plan to strengthen those areas before implementing things like velo programs.

Is he in 8th grade? I’d say now would be a great time. He could get the workout plan and have several months to implement and see the progress. What position does he play? They also provide hitting and pitching instruction. Friday night my son was taking turns in BP with a big time MLB slugger. It’s funny to see them getting tips and drills that my son does.

Just for a little fill in information - Cressey Sports Performance home is actually in Hudson, Mass.  The second location is Florida.  I have no idea how he's splitting his time, in addition to his duties with his new position with the Yankees.  For what it's worth the Yankees pitching coach, Matt Blake, was pitching coordinator at Cressey's in Massachusetts up until about 2015 when he got into professional baseball with the Indians.

To All those familiar with Cressey,

We have family members in Florida and would love to combine a trip there to see Cressey , as well as our extended family. My son is 14 . What age, time would you recommend, to get the most out of the visit( and the $400)?

This is very much dependent on your son’s physical and mental maturity and to some degree your ability to support and sometimes supervise the training.  It’s a 6 day per week commitment on top of anything else he is doing.  There are equipment requirements that necessitate a commercial gym or a heavy financial commitment and space to outfit your home gym.

If he isn’t starting to mature physically I would wait.

if he is not abnormally disciplined and self motivated for a 14 year old I would wait.

If there is not an adult in the house with the time and resources to support him daily I would wait.

My wife put in countless hours charting workouts, helping with manual resistance exercises and driving back and forth to the gym before COVID hit and we built the home gym.

Ok, thx. I think i Will wait. I've got a "little" gym at my house, but it seems to be making a difference. There is a Sports Specific GYM just down the block that i think we'll join as soon as we have the time. He's physically developing very rapidly , but i'm not sure he ready to add that much time to an already crowded schedule ( private lessons, Select team practices, 8th grade swim team, school, etc.)

Thx

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