Overuse injuries can affect athletes of all ages and sizes, and youth softball and baseball competitors are no exception, a CHOC Children’s pediatrician says. Two of the most common injuries that affect softball and baseball are commonly referred to as “Little League Shoulder” and “Little League Elbow,” says Dr. John Mersch, a CHOC pediatrician.
These injuries fit into three broad categories of injuries which can affect a young athlete’s musculoskeletal system (muscles, ligaments and tendons, or bones). They can happen:
- Suddenly: The most common is a sudden and often traumatic event. For example, a sudden loss of balance resulting in a fracture of one or both bones of the forearm.
- Over time: Overuse injuries are another type of sports injury. In this situation the pain gradually becomes worse over time in the affected area. Ultimately the pain and/or deterioration of skills necessary to compete in their sport will require the athlete to stop participation and seek medical care. “Pitcher’s Shoulder” and “Pitcher’s Elbow” are common examples of such overuse injuries.
- A combination: The final, and fortunately the least common, experience,) is a combination of the above two scenarios. In this case, an overuse injury is suddenly worsened, making it impossible for the athlete to participate. A common situation would be a baseball player developing “Little League Elbow” and attempting to play through the pain. A sudden bone fracture at the site of attachment of the involved tendon takes an already bad situation and makes it worse.
The area of bone growth in children is called the growth plate. Growth plates are not fully matured and is often the area most susceptive to an acute injury or overuse injury.
What is Little League Shoulder?
- “Little League Shoulder”’ is a fracture of the growth plate in the shoulder.
- A warning sign is often pain that comes with throwing without any preexisting injury.
What is Little League Elbow?
- “Little League Elbow” is a growth plate injury on the inside the elbow.
- If inner elbow pain and loss of control when throwing is ignored, many players may eventually hear or feel a ‘pop’ on the inside of the elbow. This means a small piece of bone has been pulled away from the elbow.
- This injury is considered a fracture and the player should seek an urgent medical evaluation.
Warning signs of Little League Shoulder, Warning signs of Little League Elbow
With either injury, pain tends to be gradual and progressive. Initially the shoulder or elbow may feel sore after games for players in heavy throwing positions such as pitchers, catchers or outfielders. However, often after one to two weeks of continued throwing, the athlete may experience pain both during the game as well as following the event. Loss of control is a common consequence of shoulder or elbow pain.
How to prevent Little League Shoulder, How to prevent Little League Elbow
“Proper form is essential to preventing injuries. Although forty percent of the speed of the ball comes from the arm and shoulder, the majority comes from the core, legs and hips,” says Mersch. “This also means that having strong lower body and core muscles, not just a strong upper body, is imperative. Working with a throwing mechanics coach can be very helpful at utilizing each of these different muscle groups.”
Other tips for how to prevent Little League Shoulder and how to prevent Little League Elbow include adhering to the sporting organization’s rules for pitch counts and rest requirements between pitching appearances. Athletes should not be allowed to switch from one heavy throwing position to another during the game. An example would be converting a pitcher into a catcher after several innings of pitching. Remind your child to do a proper warm-up and cool down before and after practices and games. Consider loosening up arm muscles with a heating pad prior to practice, as tight muscles are more prone to injury.
Athletes at this age are developing their skills as well as their sense of competitiveness, but that doesn’t mean they should be playing through the pain, Mersch says.
Never play through the pain
Sports leagues encourage players to recognize when and where their pain occurs. The young athlete should be encouraged to notify their coach and parents should shoulder or elbow pain (or any other pain) develop. Coaches and parents should reinforce that playing through pain is not an option. Evaluation by a physical therapist or athletic trainer is necessary if basic treatments like rest, ice, and basic medication such as ibuprofen are not helpful. Further evaluation by your child’s pediatrician or a sports medicine specialist may be needed. Recommendations for treatment are made on a case-by-case basis, but may include rest, X-rays or other imaging, or changing positions in the game to a position less provocative to their injury.
Since a major contributing factor to these all-too-common injuries include throwing mechanics, athletes may benefit from working with a physical therapy program that has experience with athletes in their chosen sport in order to work on proper form.
Since these pains are often gradual, they may get more severe as the season progresses. As playoffs commence, athletes may fear that speaking up about an injury could prevent them from participating or result in other consequences. Encourage your young athlete to be honest about how they’re feeling, since identifying an injury and seeking treatment sooner rather than later, can allow them to return to competition earlier.