Contributed to The Globe and Mail
Little Leaguers will soon be taking to baseball diamonds across the country with a little extra enthusiasm thanks to Jose Bautista’s bat flip and Josh Donaldson’s MVP performance last fall.
To prepare for a new season, many young ball players have already been training indoors with their teams for a couple of months. Coaches look to leverage these early reps and hours of practice into reproducible, midseason success.
To keep the kids healthy and having fun, equal consideration must be given to injury prevention and proper progression of training.
The recent trend in increased single-sport athletes, year-round training, longer competitive seasons and higher intensity of training at younger ages, has led to more injuries to throwing arms in young athletes. In my practice, I have seen a significant increase in overuse injuries in children. In most cases, these injuries are associated with sports-related activity. Studies estimate the incidence of overuse sports injuries as 20 per cent to 40 per cent in the nine- to 12-year-old range and 30 per cent to 50 per cent in the adolescent age group.
For the young baseball player, soreness is often felt first in the elbow. This could be a sign of over-throwing, or of improper mechanics, or both. The elbow commonly suffers for the inefficient movement of the shoulder and/or the lower body. Overuse injuries can affect muscles, ligaments, tendons, bones and growth plates. The growth plates represent areas of developing cartilage where bone growth occurs in children. This tissue is sensitive to repetitive stress and deserves extra attention in young athletes.
The “funny-bone” or bony prominence found at the end of the upper arm, along the medial or inside of the elbow is particularly vulnerable to repetitive stress when throwing mechanics are off or the athlete jumps into preseason training too quickly. Conditioning and training errors can also contribute to the risk and frequency of injury. Excessive overhand throwing can irritate and inflame an important growth plate found there, resulting in a condition called Little League Elbow (LLE) Syndrome.
The growth plates at the elbow typically close between 14-16 years of age. Until this point, the player is at risk of this injury.
Coaches and parents should be aware of the more common signs of overuse injury from throwing. These include:
- Pain and tenderness to the touch localized to the medial or inside of the elbow joint.
- Swelling of the elbow
- Sudden changes in throwing mechanics or performance level
Treatment consists of rest, icing, physical therapy and anti-inflammatories. Long-term rest (six to eight weeks) may be necessary in some cases to allow for complete healing. Most cases do resolve with rest and conservative management. In more severe cases of LLE Syndrome, surgical treatment is occasionally necessary to remove loose bone fragments, bone grafting or for reattachment of a ligament to the bone.
Unlike many acute injuries, overuse injuries of this nature are highly preventable if coaches, parents and players commit to educating themselves on prevention. General pitch count guidelines per calendar day are listed as: 70 pitches for nine-to 10-year-olds, 80 pitches for 11- to 12-year-olds, 90 pitches for 13- to 14-year-olds and 100 pitches for those 15 and older. Younger pitchers are usually taught to master the fastball and change-up first before considering breaking-ball pitches, which add additional stress to the elbow.
A proper dynamic warm-up focusing on efficient movement patterns should kick off every practice. Building a solid foundation of strength is highly recommended for all sports and activities. Do not sacrifice overall fitness for sport-specific strength, especially before the body is fully developed. Focus on training the total athlete gradually with adequate resting time. Encouraging kids to play multiple sports is also important. Competing in several sports throughout the year will prevent sport-specific repetitive stress as long as there is adequate rest between seasons. Play smart and good luck this season.
Dr. Dwight Chapin, B.Sc(H)., D.C., is the clinic director of High Point Wellness Centre in Mississauga, team chiropractor for the CFL’s Toronto Argonauts and on-site clinician for employees of The Globe and Mail. Follow him on Twitter @HighPtWellness.