Little
League Overuse Throwing Injuries
As youth participation in baseball
continues to remain popular, the occurrence of upper extremity overuse injuries
continues to increase. Further, there is
an increasing trend for youngsters to specialize in and train year round for a
single sport at an early age. Such a
high level of intensity and demand for advanced athletic skills throughout the
years of skeletal growth have raised concerns about risk and severity of injury
in young athletes.
Young athletes are risk for unique
types of overuse injuries due to the presence of multiple growth plates
throughout the entire skeleton. These
growth plates are composed of cartilage, which is softer and more vulnerable to
injury than more mature bones. In the
upper extremity, both the upper arm bone called the humerus and the bones of
the forearm called the radius and ulna have multiple growth plates close to the
shoulder and elbow joints that are prone to overuse injuries in overhead
athletes, such as baseball players. Repetitive activities, such as throwing
baseballs, can overload the susceptible growth plates of the immature upper
extremity and result in growth plate irritation, inflammation, and pain. If improperly treated, growth plate disturbance
as a result of overuse injury may lead to irreversible alterations in normal
bone growth patterns, which can lead to altered joint mechanics. This can ultimately lead to significant
long-term pain and disability.
Young baseball players participating
in repetitive overhead throwing, such as pitchers, are at risk for growth plate
injuries around the shoulder and elbow.
The overuse condition called “Little League Shoulder”, also know as
proximal humeral epiphysitis, results in pain in the upper arm or
shoulder. While the overuse condition
call “Little League Elbow” results in pain in the elbow. Children with these injuries will have
shoulder or elbow pain when throwing.
These athletes may also be sore for a few days after participation and
may notice loss of throwing velocity or control. Further, swelling and tenderness around the
shoulder or elbow may be present. Such
injuries may be a source of discomfort and time lost from training or
competition.
Severe pain around a joint may be a
symptom of growth plate injury, which may require prompt evaluation and
treatment by a physician. Orthopedic
physicians diagnose these injuries by listening to the history and performing a
physical examination. Further, x-rays
may be helpful to demonstrate widening or a break in the growth plate. The most effective treatment for “Little
League Shoulder” and “Little League Elbow” is rest from throwing so the growth
plate can heal. The addition of physical
therapy may also help improve the strength of the shoulder and elbow and
prevent re-injury. A young athlete should never be expected to or allowed to
“throw through the pain,” as such mistreatment may lead to a limited throwing
career and chronic pain as an adult. An
athlete typically can return throwing again once they have full strength and
full range of motion of the shoulder or elbow.
Often times, many coaches of youth
sports are enthusiastic and well meaning volunteers, yet they are also
typically uninformed about the growth and development of children and
appropriate injury preventative strategies.
Therefore, it is critical for the caregivers of youth participating in
athletics to educate themselves and the athlete about potential growth plate
injury and precautionary tactics.
Ultimately, the best way to prevent “Little League Shoulder” and “Little
League Elbow” is to follow recommended guidelines for appropriate pitch count
limits and proper rest between pitching appearances. Please refer below for further preventative
tips and pitch count recommendations.
Tips for Parents:
-emphasize the
benefits of year-round physical fitness, while also emphasizing the importance
of appropriate rest and training variety
-allow your child
to pitch in only one league in a single season and play baseball only two seasons
of the year
-do not allow your
child to play through pain
-consult an
orthopedic physician if your child’s throwing injuries are not relieved by four
days of rest and ice
Tips for Pitchers:
-appropriately
warm up before all athletic participation and throwing
-remain physically
fit all year and incorporate a supervised resistance training program that
focuses on total body fitness, including leg and core strengthening
-do not practice
pitching after the game
-rest your arm for
at least 24 hours after pitching
Pitch Count Recommendations:
9- to 10-Year Old
Pitcher:
50 pitches a game
75 pitches a week
1,000 pitches a
season
2,000 pitches a
year
11- to 12-Year Old
Pitcher:
75 pitches a game
100 pitches a week
1,000 pitches a season
3,000 pitches a year
13- to 15-Year Old
Pitcher:
75 pitches a game
125 pitches a week
1,000 pitches a season
3,000 pitches a year
16-Year Old or
Older Pitcher:
Needs an
individualized program based on skill level and input from trainers, coaches,
and an orthopaedic physician
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