Pitch Count, Mechanics Can Keep Elbow Healthy
By Dr. Eric W. Edmonds
As far back as the 1960s, physicians recognized youth leaguer’s elbow, which occurs only in the growing child and is considered an overuse sports injury. It results in pain on the inside of the elbow and has the potential to cripple a throwing athlete.
Q: What exactly is youth leaguer’s elbow?
A: This term has evolved to indicate a childhood elbow injury related to throwing. It can represent a broken bone or a ligament injury, but traditionally indicates a stress fracture of the growth plate on the inner side of the elbow.
Q: Why did my kid get this problem?
A: Stress fractures are caused by overuse. We see it in kids who are pitching too much, kids who are growing stronger and throwing harder without sufficient practice, or those with poor throwing mechanics. The force of throwing a ball places significant stress at the inner portion of the elbow. This overload results in the injury that can be immediate or worsen with time.
Q: How do I prevent this from happening?
A: Limit the amount of throwing (especially pitching). Take time off from baseball. Consider cross-training to become a better all-around athlete. When in season, remember to monitor the pitch count (and add up all pitches if your child is in multiple leagues). Pitch count recommendations, based on age, can be found at www.asmi.org/asmiweb/usabaseball.htm. Young pitchers should stick with fastballs and change-ups and not throw curves, screwballs or other specialized pitches until high school. Even subtle poor throwing mechanics will increase the force across the elbow with these types of pitches. Teach good throwing mechanics at an early age. Do not let them rely on arm strength to throw, teach them to use their core muscles to throw.
Q: But, what if my son already has elbow pain?
A: If your young athlete is experiencing pain, then have them stop the painful activity. Rest is always a wise course. For mild discomfort, the player can be moved to first base (which demands less throwing). More severe cases may require casting to help rest the injury. You can consider ice and anti-inflammatory medications, but not before play because they might mask pain. A legitimate amount of rest is often four to six weeks. Remember, if a stress fracture turns into either a torn ligament or a broken bone, then your child might require surgery and could be out of all sports for more than a season.
You should contact, or see, your doctor if there is an obvious deformity of the elbow, there is joint swelling, the pain is not improving after two weeks of rest, or the pain is associated with a fever.
Eric W. Edmonds, M.D., is a pediatric and adolescent orthopedic sports medicine specialist at Rady Children’s Hospital-San Diego and an assistant professor of orthopedics at UC San Diego. He can be reached at email@example.com.