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Little League Shoulder and Elbow Injuries

Last month’s article was specifically directed at the high school aged throwing arm. This month I will target the little league aged throwing arm. Little league baseball is in full swing and because of the fickle central New York weather so are the make up games. This article will focus on some simple observations that players, parents and coaches can use to help prevent a minor arm injury from becoming a catastrophic injury.

 

Every year, in every league, there seems to be one player that is just physically more advanced than the other players. While they are physically bigger and stronger this size difference may hide and mask their faults and weaknesses. Because this player is big and strong they usually throw very hard. They also accumulate a bunch of strikeouts making everyone gasp in amazement. Lets look inside that statistic for a moment. Why is it that this player, that is so much better, commonly reaches their maximum pitch count in less than 6-innings? How many of these strikeouts occur swinging or looking? How many are swinging on pitches out of the strike zone in “self defense”?

 

This is the first observation and earliest observation that tips us off that something is starting to go wrong.  Poor control is evidenced by high pitch counts in a small number of innings.  First of all 75 pitches in 6 innings is an incredibly large number of pitches in a very short time. So if they are reaching their limit before the 6th inning, something is wrong with their mechanics and it needs to be addressed. So keep an eye out for this scenario; poor control is the first sign of breakdown.

 

The second observation is a gradual decrease in velocity. A player that previously threw very hard is now struggling with the fastball. Back in “our day” catchers were not only educated on how to call a game, but also on how to watch their pitcher and assess any fall off in control and/or velocity. It would not be uncommon for the manager to ask the catcher their opinion and for the catcher to tell the manager if the pitcher was throwing “creampuffs” meaning there had been a reduction in pitch velocity. With coaches and managers call pitches from the dugout catchers are not being taught the finer points of the position at an early age. This is a hidden potential contributing factor in pitching related arm injuries.

 

The third and last observation is the onset of pain. Unfortunately this is the terminal sign. If a player gets to the third observation that means the first two were missed. This means the road to recovery will be much longer than it could have been had someone said something at observation one or two. What is also amazing is that parents and coaches will suggest that this player continue to play medicated with an anti-inflammatory. There is a simple rule in youth sports; if you need to play medicated, you should not be playing especially at 12 years old! The other aspect to throwing related arm pain, is that while the pain will resolve with rest and discontinuance of throwing, the pain will most likely return as soon as throwing resumes if the biomechanical faults such as pitching mechanics, rotator cuff weakness, hip weakness, etc. are not corrected prior to resumption of throwing.

 

The x-factor if you will, with Little League aged throwers is the presence of “growth spaces” in the shoulder and elbow. So while our physically advanced athlete looks larger than life exteriorly, on the inside they still possess the weak link they cannot see, the open or immature growth space. In the common condition known as Little League shoulder or Little League Elbow the growth space has actually fractured and is classified as a Salter Harris 1 growth space fracture also referred to as widening of the growth space. This injury does not resolve fast and the athlete should not attempt to “play through it”. For the record the growth space typically closes in girls between 14 to 17 years of age and 16 to 18 years of age in boys. Fortunately in patients that are still growing, Youth Thrower’s Elbow typically resolves with proper treatment but may progress to chronic elbow pain as an adult if not properly addressed.

 

Players, parents, and coaches have incredible resources available to them to help prevent throwing related injuries. Sometimes those resources are in their backyard. They usually have missed several signs along the path to the athlete experiencing pain and injury. We all know the simple rules of a young throwing arm. They should not throw any type of breaking pitch (curveball, slider, etc.). Develop a fastball and learn how to control it. It really is that simple.