Little Leaguer’s Elbow
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Here in Southern California there is never a shortage of young baseball players coming in for various shoulder and elbow issues. With Little League, Pony and travel ball, there are literally millions of athletes between the ages 10-18 participating in baseball in the U.S. throughout the year. Overuse injuries are common occurrences, and studies that include surveys of orthopedic surgeons, coaches and athletes indicate that injuries such as those to the ulnar collateral ligament (UCL), are increasing in incidence. The UCL is the ligament that, when ruptured, requires surgery made famous by Dr. Jobe and Tommy John. Although the surgical technique has improved tremendously and players are returning to pitch after the surgery, it’s obviously better if it can be avoided. Even though there has been an increase in UCL injuries, the more common malady seen at CATZ Physical Therapy is a condition termed “Little Leaguer’s Elbow”. This term has become somewhat synonymous with any pain around the elbow; however, the specific condition that is Little Leaguer’s Elbow is medial epicondyl apophysitis. It is an actual stress fracture or separation of the growth plate of the distal humerus. A serious condition that needs professional care but quite different from the UCL injuries that get all the press.
What’s the Difference? The main difference is age. Let me explain, 10-14 yr. olds have an immature skeleton and the growth plates are still cartilage (which is relatively soft compared to ossified bone). When the young pitcher throws, the forces on the medial aspect of the elbow are the same as for an older pitcher, however, the tendons and ligaments of the young pitcher are stronger than their growth plate. Instead of the ligament giving way under the stress, it’s the growth plate that gets pulled apart. At 18 yrs. old, this growth plate has begun to ossify and is now stronger than the ligaments and tendons. Abnormal stress in the same area now goes to the ligament, and over time, the ligament will fray and eventually rupture. You can have two different injuries with the exact same mechanism of injury.
Can we Prevent It? If we look at all the risk factors involved –immature skeleton, poor throwing mechanics, range of motion and strength deficits, too many pitches (or continuing to pitch while fatigued), pitch type and velocity—we could never be 100% guarded against injury. However, in my opinion and experience, the two biggest factors are poor mechanics and range of motion/strength deficits. Both of which can be addressed as part of a thorough evaluation by a sports Physical Therapist. The journal, Sports Health, published a list of seven safeguards recommended for preventing youth throwing injuries in 2009. Number 2 on the list: “Young pitchers should develop proper mechanics and participate in year-round physical conditioning programs.” If you’ve got a young baseball player that is getting a chance to pitch (kids pitching usually starts around 7 yrs. old), it’s never too early to think about their mechanics and an exercise program geared towards throwers. One little hint about choosing a good program: throwing is a full-body activity and kids need to learn to throw from the ground up. Strength, mobility and coordination of the legs, torso and shoulder need to be addressed using full body movement patterns that mimic this ground up approach. If a coach, trainer or health/fitness professional is teaching isolated exercises for the arms, they probably don’t know that much about pitching.