Category: Conditioning
Type: Tip
DEALING WITH LITTLE LEAGUE ARM
It's baseball season. A time when all you need is a baseball, a mitt and some decent weather. And if you're lucky, it will always be so simple. For too many baseball players, though, it isn't. It's painful.
More and more young baseball players, especially pitchers, are coming down with "Little League elbow," and to a lesser degree "Little League shoulder." Don't let the names fool you; these are real medical diagnoses with real consequences, from short-lived swelling to fractures to ligament damage.
Among pitchers under 12 years old, as many as 45 percent complain of chronic elbow pain, according to several published studies. At the high school level, nearly six in every 10 pitchers suffer chronic elbow pain. Yet another study -- in the May/June 2005 issue of the Journal of the American Academy of Orthopaedic Surgeons (AAOS) -- showed that it may be even worse than that, with 50 percent to 75 percent of all adolescent baseball players -- not just pitchers -- reporting elbow pain.
"I'll tell ya, there's a lot of this going on," said local pitching guru Dick Schoonover. "It's bad. Many parents -- and coaches -- don't understand how many pitches a kid should throw. They think, they're young, they're healthy, they can't get hurt.
But they can and they do.
Just ask David Redovian.
Elbow injuries sidelined the 15-year-old for large chunks of the past two seasons, starting with a diagnosis of Little League elbow in early 2004, when he was 12, that forced him to miss most of his spring season that year.
Then last spring, in the first inning of the first game, it got even worse. Redovian felt pain unlike he'd ever felt in his throwing elbow. This time, he tore the medial collateral ligament and broke off a piece of bone, requiring surgery and forcing him to miss the entire season.
The doctors told him and his parents that David's problems stemmed from weak shoulder muscles, causing him to put more pressure on the elbow.
"For him, not playing was torture," David's mom, Denise, said of his time on the sidelines. "This child loves baseball. Baseball never ends in this house. Literally."
A year-round sport
And for most young baseball players with throbbing elbows that's the real problem -- the never-ending baseball season.
Boys this age are now playing more baseball than ever before. Even in cold-weather climates like Northeast Ohio, baseball has become a year-round sport --and that more than anything is leading to the increasing number of elbow injuries.
"I tell coaches there are three main causes" said Dr. Joe Congeni, director of Akron Children's Hospital's sports medicine center. "Too much pitching, too much pitching and too much pitching."
It used to be that baseball was relegated to late spring and summer. No more.
"Kids start younger," Congeni said. "They throw more pitches. They play year-round --40, 50, 60 games a year. They play spring ball, summer ball, fall ball. They play tournaments -- three or four or five games in a weekend. And now they play winter ball, either playing games or practicing.
"We strongly recommend kids take off at least one of those four seasons completely."
Injuries increasing
Combine overuse with inherent physical weaknesses and you've created a situation perfect for injury.
Congeni is seeing an increasing number of young baseball players in his office. Most will heal with a combination of rehabilitation and rest -- sometimes two to three months without throwing a baseball. Others will need surgery.
They're typically between 8 and 15 years old. And they're almost exclusively boys, because the round-house motion used by female softball pitchers doesn't create stress on the elbow the way pitching a baseball overhand does.
Little League elbow "is very unique to throwing a baseball," Congeni said. "Quarterbacks don't get it. Softball players don't get it. Just the mechanics of how you throw a baseball puts more stress on the inside of the elbow."
The problem stems from two basic factors -- the physical immaturity of adolescents and overuse.
Between the ages of 8 and 14, boys are still maturing physically. In the elbow, that means the growth plates of the bone are weaker than the tendons.
How to avoid injury
There is good news, though: Little League elbow is largely preventable, if kids follow these tips:
A broad recommendation is that pitchers base their number of pitches each week by multiplying their age by 10, so an 8-year-old would limit his pitches to 80 per week. A 12-year-old would throw no more than 120.
The American Academy of Orthopaedic Surgeons AOS recommends limiting the number of pitches per game to 60 to 100, with no more than 30 to 40 in a single practice session, adding that innings pitched should be limited to about four per week, with a minimum of three days rest between starts. Little League Baseball Inc., has set a limit of six innings of pitching per week and requires pitchers to rest between appearances.
In between the games the player pitches, he should continue to watch how much and how strenuously he throws. One common problem, Congeni said, is that pitchers, because of their strong arms, also play third base, shortstop and outfield, position in which throws can put added strain on the arm. Consider playing first or second base between starts.
Coaches should educate players to the importance of and techniques for stretching and strengthening the arms and shoulders, the AAOS says. Always take time to warm up and stretch.
Research studies have shown that cold muscles are more prone to injury.
The AAOS suggests warming up with jumping jacks, stationary cycling, running or walking in place for three to five minutes, followed by slow, gentle stretching, holding each stretch for 30 seconds.
Poor throwing motions put too much stress on the elbow. Discourage sidearm throwing because it is three times more likely to cause injury, according to the AAOS.
Between the ages of 8 and 14, Congeni suggests working on three phases -- gaining control, increasing velocity and developing a command of the strike zone, throwing only fast balls.
"If you can do that, that's excellent," Congeni said. "If you can do that, you've done a lot for a young pitcher."
Pitchers can begin throwing change-ups at 10, but no breaking pitches (curves, sliders, etc.) until at least 14.
- Recognize injuries when they occur
Any persistent pain, loss of motion (especially extension) or X-ray abnormalities should keep a player on the sidelines until the symptoms disappear or a doctor clears the players.
Little League elbow is known medically as medial apophysitis, because it's always on the inner side, or medial side, of the elbow. So, not all elbow pain is Little League elbow.
As for David Redovian, he won't take any chances on injuring his elbow again.
"I know now to say something right away, to get checked right away," the Copley freshman said. "I don't want to have to go through that again. It was hard to hear I was going to have to sit and watch."
Tracy Wheeler can be reached at 330-996-3721 or tawheeler@thebeaconjournal.com.
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Copyright (c) 2006, The Akron Beacon Journal, Ohio
Distributed by Knight Ridder/Tribune Business News.
Submitted by: Tracy Wheeler, Akron Beacon Journal
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