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Meet
Joseph Norris, MD
Orthopedic Surgeon Sports Medicine

ports Talk with Dr. Joseph Norris – Elbow Pain In The Throwing Athlete

p>Now that baseball season is in full swing, my office becomes flooded with tons of young baseball players aspiring to be the next Stephen Strasburg, Mike Trout, or Yasiel Puig. While some of these young flame-throwers might think they are ready to tackle the Big Leagues now, their arms are not and these Little Leaguers end up in my office with Big League elbow pain.

Since the advent of traveling baseball programs, elbow injuries have increased dramatically in the last 15 plus years. Baseball used to be a seasonal sport that was played in the summer only, but now it is not unusual for some to play year round. With this year round play, kids do not get the adequate rest and time away from throwing that they need, thus putting them at risk for elbow injuries.

It is important for parents, coaches, and players to understand all the factors that play into elbow injuries, and it starts with lower body strength. This is commonly referred to as a kinetic chain, and the energy and strength from the lower body is transferred to the upper body as a player goes through his throwing motion. If there is a "glitch" anywhere along the chain, the elbow will feel it. If you look at any Big League pitcher, they all have one thing in common, they have a strong base. All those guys have huge calf and gluteal muscles and that’s because that is where all the drive and force comes from. The stronger the base, the less force there is going to have across the shoulder and elbow. Most young athletes do not possess this strength yet, and they make up for it by throwing with all arm, and this leads to elbow pain.

Like I mentioned earlier, if there is a "glitch" anywhere in the chain, the elbow will feel it. It is very important to look at shoulder and scapula function when assessing elbow pain. The scapula (shoulder blade) and the shoulder have to work together like a finally tuned orchestra, and if one of them is out of tune, the elbow is going to notice. A condition known as scapular dyskinesis (literally means bad scapular movement) can lead to shoulder and elbow pain. There is usually a noticeable "winging" of the scapula indicating scapular dysfunction. Pain is also usually noted between the shoulder blades.

With proper instruction on mechanics and appropriate rest elbow injuries can be avoided. If elbow pain does present, there are steps that can be taken to reduce the chances of having surgery later on. This usually involves shutting down the athlete from throwing for about 4-6 weeks and having them start physical therapy. In therapy, pitching mechanics will be addressed, as well as shoulder function. Also, a lot of focus will be put on strengthening the core and lower extremities. Once the athlete is pain free and kinetic chain deficits have been addressed they can begin a formal return to throwing program, which is guided by a therapist or throwing instructor to insure the athlete remains pain free before attempting any return to play.

Due to this epidemic of elbow pain in the young throwing athlete, the USA Baseball Medical/Safety Advisory Committee has put together guidelines and recommendations for youth pitchers which include:

  • No breaking pitches (curveball, sliders) until puberty, approximately age 13.
  • Proper pitching mechanics and conditioning should be stressed
  • Discourage youth from pitching for more than one team in a season
  • Three-month rest period per year from overhead throwing activities
  • No pitching in a game or practice after being removed from pitching in a game

Age

Pitches Per Game

Pitches Per Week

Pitches Per Season

Pitches Per Year

9-10

50

75

1,000

2,000

11-12

75

100

1,000

3,000

13-14

75

125

1,000

3,000

15-16

90

2 games/week

N/A

N/A

17-18

105

2 games/week

N/A

N/A

 

Age

1 Day Rest

2 Days Rest

3 Days Rest

4 Days Rest

9-10

21-33 pitches

34-42 pitches

43-50 pitches

51+ pitches

11-12

27-34 pitches

35-54 pitches

55-57 pitches

58+ pitches

13-14

30-35 pitches

36-55 pitches

56-69 pitches

70+ pitches

15-16

30-39 pitches

40-59 pitches

60-79 pitches

80+ pitches

17-18

30-39 pitches

40-59 pitches

60-89 pitches

90+ pitches

 

 

I hope the information here helps your Little Leaguers stay healthy and have a great season. But if elbow pain does occur, come see me and my staff at Mclean County Orthopedics and we will help get you back in the game!

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