Every year when spring sports season rolls around, doctors see an increase in certain sports-related injuries in young athletes.
"Young athletes are skeletally immature," says Peter Kriz, MD, a sports medicine physician at The Center For Sports Medicine."Their growth plates have not yet closed. This unique quality makes them susceptible to a variety of elbow injuries that are not encountered in older throwing athletes."
The Center For Sports Medicine is collaborating with Rhode Island
Hospital/Hasbro Rehabilitation Services to provide dedicated throwing
programs for young athletes recovering from throwing-related injuries.
The programs focus on improving throwing mechanics, flexibility, core
strength, while teaching how the entire kinetic chain — from the toes to
the fingertips and transmits energy from the lower body to the upper
body (including arm, hand, and fingers), and eventually to the ball.
In an era of year-round single sport participation, multi-league seasons and showcases for the adolescent athlete, the sheer volume of throwing the developing athlete may perform is staggering. Strong evidence suggests that programs which limit pitch counts among young throwers are effective in reducing overuse syndromes. The table below provides a program endorsed by USA Baseball’s Medical and Safety Advisory Committee; it also addresses commonly-asked questions by parents of young throwers.
|9-10 years old||50||75||1000||2000|
|11 - 12 years old||75||100||1000||3000|
|13 - 14 years old||75||125||1000||3000|
|Pitch Type||Youth pitchers should avoid throwing breaking pitches (curves, sliders) until they reach physical maturity.|
|Multiple Appearances||Once a pitcher has been removed from a game, do NOT return him/her to the mound.|
|Showcases||Participation typically occurs at end/after season, increasing risk of serious arm injury due to fatigue/deconditioning. This should be discouraged unless proper rest/recovery can be provided.|
|Multiple Leagues||Pitching in multiple leagues is discouraged given the likelihood of exceeding pitch counts.|
|Year-Round Baseball (leagues, training)||Pitchers need a period of “active rest” after their season ends and before the next preseason begins. For at least 3 months per year, baseball pitchers should NOT play any baseball, participate in throwing drills, or other stressful overhead activities (football quarterback, competitive swimming, javelin throwing).|
|Technique/Conditioning||Proper mechanics should be taught as early as possible. Year-round physical conditioning (including core strengthening) can be started as the young athlete’s body develops.|
Medial epicondylar apophysitis, commonly referred to as Little League Elbow (LLE), is a condition that frequently presents in young throwers, usually 9 to 14 years old.
LLE is often encountered in pitchers. Many athletes suffering from LLE typically pitch in addition to playing shortstop or other infield positions such as catcher or third base. This injury results from repetitive stresses on the medial epicondyle (inner elbow) encountered with throwing activities. Ultimately, the weak link — the growth plate — becomes inflamed, resulting in a spectrum of injuries, ranging from irritation to stress fracture and separation of the medial epicondyle from the rest of the upper arm. X-rays may demonstrate a subtle widening of the growth plate.
Medial epicondyle avulsion fractures are seen in children and adolescent throwers. These injuries occur suddenly. X-rays typically reveal the fracture and subtle widening of the growth plate.
Osteochondritis dissecans (OCD) of the capitellum, a bone and cartilage-containing part of the developing elbow, is a cause of lateral (outside) elbow pain in throwing athletes typically between 11 and 16 years old. This injury results from repetitive forces to the radiocapitellar joint during certain phases of throwing. These forces are believed to affect the blood supply to the capitellum.