Overuse Injuries Common In Little League Pitchers

MIAMI — For serious young baseball players, adherence to recommended pitching limitations and proper management of overuse injuries can help ensure continued healthy pitching, Dr. Andrew Gregory explained at a meeting on pediatric sports medicine sponsored by the American Academy of Pediatrics.

The highly repetitive action of pitching can result in overuse injuries of two joints, generally referred to as Little League elbow or Little League shoulder.

Young pitchers are often serious in their sport, sometimes playing on multiple teams at once in hopes of earning a college scholarship or playing professionally. Such intense participation at an early age, however, can have long-term consequences. About one-third of Little League pitchers never play in high school because of overuse in their younger years, according to Dr. Gregory of the departments of orthopedics and pediatrics at Vanderbilt University in Nashville, Tenn.

This number may seem high, but pain is a common occurrence in pitching. According to a review of 476 pitchers aged 9–14 years, 7% of youth pitching results in pain, and 28% of pitchers report elbow pain at least once in a season. As Dr. Gregory explained, “They're subjecting themselves to this maximal force over and over again, by trying to throw as hard as they can every time.”

Most young pitchers with Little League elbow will present with medial elbow pain that occurs only with throwing; they also may not be able to fully straighten the arm. “It is a constellation of problems, the first being stress injury to the medial epicondyle apophysis,” Dr. Gregory said in an interview. He explained that continuing to pitch through the pain can lead to a loss of blood supply to the joint and irritation of the ulnar nerve.

The main treatment should be rest from all throwing. Treatment also should include ice, NSAIDs for pain, scapular and core stabilization, and a gradual return to throwing after 6–12 weeks, when throwing no longer hurts. Pitching should be resumed only when the athlete can throw without any pain.

Dr. Gregory said that patients should be referred in the following cases: an acute injury with a “pop,” significant widening of the apophysis visible on x-ray, opening with valgus stress, or persistent pain with throwing despite following treatment measures.

Little League elbow is seen in players aged 9–14 years. After the medial epicondylar apophysis closes at age 15–17 years in boys (age 14 in girls), these symptoms are likely caused by injury to the ligament instead.

Dr. Gregory reviewed pitching restrictions that were designed to minimize the likelihood of developing an overuse injury. (See box.) He recommended that physicians have handouts with safety tips to give to parents.

A fragmented medial epicondyle apophysis is common in pitchers. Courtesy Dr. Andrew Gregory

'They're subjecting themselves to this maximal force over and over again,' by pitching as hard as they can. DR. GREGORY

Preventing Pitching Injuries

▸ Observe the following pitch count limits:

• 9− to 10-year-olds: 50 pitches/game, 75/week, 1,000/season, 2,000/year

• 11− to 12-year-olds: 75 pitches/game, 100/week, 1,000/season, 3,000/year

• 13− to 14-year-olds: 75 pitches/game, 125/week, 1,000/season, 3,000/year

▸ Do not throw curveballs before age 14 or sliders before age 16.

▸ Avoid pitching “showcases.”

▸ Pitch for only one team at a time.

▸ Do not pitch and catch for the same team.

MIAMI — For serious young baseball players, adherence to recommended pitching limitations and proper management of overuse injuries can help ensure continued healthy pitching, Dr. Andrew Gregory explained at a meeting on pediatric sports medicine sponsored by the American Academy of Pediatrics.

The highly repetitive action of pitching can result in overuse injuries of two joints, generally referred to as Little League elbow or Little League shoulder.

Young pitchers are often serious in their sport, sometimes playing on multiple teams at once in hopes of earning a college scholarship or playing professionally. Such intense participation at an early age, however, can have long-term consequences. About one-third of Little League pitchers never play in high school because of overuse in their younger years, according to Dr. Gregory of the departments of orthopedics and pediatrics at Vanderbilt University in Nashville, Tenn.

This number may seem high, but pain is a common occurrence in pitching. According to a review of 476 pitchers aged 9–14 years, 7% of youth pitching results in pain, and 28% of pitchers report elbow pain at least once in a season. As Dr. Gregory explained, “They're subjecting themselves to this maximal force over and over again, by trying to throw as hard as they can every time.”

Most young pitchers with Little League elbow will present with medial elbow pain that occurs only with throwing; they also may not be able to fully straighten the arm. “It is a constellation of problems, the first being stress injury to the medial epicondyle apophysis,” Dr. Gregory said in an interview. He explained that continuing to pitch through the pain can lead to a loss of blood supply to the joint and irritation of the ulnar nerve.

The main treatment should be rest from all throwing. Treatment also should include ice, NSAIDs for pain, scapular and core stabilization, and a gradual return to throwing after 6–12 weeks, when throwing no longer hurts. Pitching should be resumed only when the athlete can throw without any pain.

Dr. Gregory said that patients should be referred in the following cases: an acute injury with a “pop,” significant widening of the apophysis visible on x-ray, opening with valgus stress, or persistent pain with throwing despite following treatment measures.

Little League elbow is seen in players aged 9–14 years. After the medial epicondylar apophysis closes at age 15–17 years in boys (age 14 in girls), these symptoms are likely caused by injury to the ligament instead.

Dr. Gregory reviewed pitching restrictions that were designed to minimize the likelihood of developing an overuse injury. (See box.) He recommended that physicians have handouts with safety tips to give to parents.

A fragmented medial epicondyle apophysis is common in pitchers. Courtesy Dr. Andrew Gregory

'They're subjecting themselves to this maximal force over and over again,' by pitching as hard as they can. DR. GREGORY

Preventing Pitching Injuries

▸ Observe the following pitch count limits:

• 9− to 10-year-olds: 50 pitches/game, 75/week, 1,000/season, 2,000/year

• 11− to 12-year-olds: 75 pitches/game, 100/week, 1,000/season, 3,000/year

• 13− to 14-year-olds: 75 pitches/game, 125/week, 1,000/season, 3,000/year

▸ Do not throw curveballs before age 14 or sliders before age 16.

▸ Avoid pitching “showcases.”

▸ Pitch for only one team at a time.

▸ Do not pitch and catch for the same team.

MIAMI — For serious young baseball players, adherence to recommended pitching limitations and proper management of overuse injuries can help ensure continued healthy pitching, Dr. Andrew Gregory explained at a meeting on pediatric sports medicine sponsored by the American Academy of Pediatrics.

The highly repetitive action of pitching can result in overuse injuries of two joints, generally referred to as Little League elbow or Little League shoulder.

Young pitchers are often serious in their sport, sometimes playing on multiple teams at once in hopes of earning a college scholarship or playing professionally. Such intense participation at an early age, however, can have long-term consequences. About one-third of Little League pitchers never play in high school because of overuse in their younger years, according to Dr. Gregory of the departments of orthopedics and pediatrics at Vanderbilt University in Nashville, Tenn.

This number may seem high, but pain is a common occurrence in pitching. According to a review of 476 pitchers aged 9–14 years, 7% of youth pitching results in pain, and 28% of pitchers report elbow pain at least once in a season. As Dr. Gregory explained, “They're subjecting themselves to this maximal force over and over again, by trying to throw as hard as they can every time.”

Most young pitchers with Little League elbow will present with medial elbow pain that occurs only with throwing; they also may not be able to fully straighten the arm. “It is a constellation of problems, the first being stress injury to the medial epicondyle apophysis,” Dr. Gregory said in an interview. He explained that continuing to pitch through the pain can lead to a loss of blood supply to the joint and irritation of the ulnar nerve.

The main treatment should be rest from all throwing. Treatment also should include ice, NSAIDs for pain, scapular and core stabilization, and a gradual return to throwing after 6–12 weeks, when throwing no longer hurts. Pitching should be resumed only when the athlete can throw without any pain.

Dr. Gregory said that patients should be referred in the following cases: an acute injury with a “pop,” significant widening of the apophysis visible on x-ray, opening with valgus stress, or persistent pain with throwing despite following treatment measures.

Little League elbow is seen in players aged 9–14 years. After the medial epicondylar apophysis closes at age 15–17 years in boys (age 14 in girls), these symptoms are likely caused by injury to the ligament instead.

Dr. Gregory reviewed pitching restrictions that were designed to minimize the likelihood of developing an overuse injury. (See box.) He recommended that physicians have handouts with safety tips to give to parents.

A fragmented medial epicondyle apophysis is common in pitchers. Courtesy Dr. Andrew Gregory

'They're subjecting themselves to this maximal force over and over again,' by pitching as hard as they can. DR. GREGORY

Preventing Pitching Injuries

▸ Observe the following pitch count limits:

• 9− to 10-year-olds: 50 pitches/game, 75/week, 1,000/season, 2,000/year

• 11− to 12-year-olds: 75 pitches/game, 100/week, 1,000/season, 3,000/year

• 13− to 14-year-olds: 75 pitches/game, 125/week, 1,000/season, 3,000/year

▸ Do not throw curveballs before age 14 or sliders before age 16.

▸ Avoid pitching “showcases.”

▸ Pitch for only one team at a time.

▸ Do not pitch and catch for the same team.