Little League Elbow
The long winter is over. The warm spring has arrived and what do we think of as summer approaches? The boys of summer are back to play baseball. We dig out our gloves, bats and balls and head to the park to play. In Canada baseball is one of the fastest growing organized sport. As the sport becomes more structured there are always increased demands on the players. The pressures to win pushes us to play our children harder and longer. The most common problem we see in our young ball players especially the pitchers is Little League Elbow.
The elbow is place under extreme stress in the throwing motion. The body will begin to break down when we do not allow the body sufficient time to recover between throwing or if we throw for too long a time. I tend to see elbow problems at the beginning of the season and at the end of the season. At the beginning we do not allow the arm to adapt to the increased throwing after a long rest from throwing over the winter. I then see more elbows near the end of the season when the pitchers are being asked to throw harder and more frequently to peak for the play offs. In the throwing motion the arm leads with the elbow. The hand then rotates over the elbow to propel the ball towards the plate. Therefore the most stress is on the inside of the elbow. In the mature athlete the stress on the tendon.
In the young growing athlete the stress is mostly on the growth plate on the end of the humerus(the upper large bone of the arm). The growth plate becomes inflamed with this increased stress. The athlete will complain of pain and swelling. Gradually the pain will be such that they will not be able to throw. The key is to treat this injury early before there is any permanent damage to the elbow. The inflammation is initially reduced by ice, rest and therapy. Once the pain is diminished the arm is strengthened to help tolerate the stress that it will be placed under.
The key is proper mechanics. You are much more prone to elbow problems with a sidearm motion as opposed to a pure overhead motion. It is important that the young athlete is shown the proper way to use his total body in the throwing motion as opposed to using only the arm. The key is to this problem early and monitor it closely over the years. Elbows that are not treated properly will go on to have future problems not only in throwing but may suffer chronic problems in the elbow later in life. It is not uncommon to notice changes in the elbow of young pitchers on x-rays.
This is a warning that something must be done. While most of the problems occur on the inside of the elbow where there is the most stress, there can also be problems on the outside of the elbow. In the throwing motion the elbow is ""opened up"" on the inside of the elbow as you accelerate the arm forward in the throwing motion. This means there will be a compressive force on the outside of the elbow. The pressure on the joint surfaces there can cause a disruption in blood flow to the joint surface. A syndrome called osteochondritis desicans(more common in the knee) develops where there is disruption to the joint surface and loose pieces of bone in the joint.
This is obviously a serious problem and must be dealt with appropriately. Little League Elbow while usually not serious can turn into a disaster for the young athlete. The key is to ensure that our young athletes are throwing properly and for limited amounts of time. Pitchers under 13 should limit the innings thrown a week and gradually increase over the years. Curve balls should be discouraged until the athlete matures. Start slowly each spring to allow the arm time to adapt to the increased stress. If pain develops seek proper advice early. With this in mind we can hopefully decrease the sore elbows and preserve our developing ball players.
As the snow melts and the weather becomes warmer we turn our attention to the spring and summer sports. One of the most popular of these is tennis. People flock to the courts to aggressively pound that little ball over the net and land it onto the opponents side of the court. A relatively simple sport when you think about it. The traditional spring French Open with its brown courts further simulate our interests. Unfortunately the spring is the time when I see the most people with the affliction we call tennis elbow. This is the most common ""overuse"" injury I see from tennis. Classically this develops insidiously over time but there will be some people who actually feel their elbow ""go"" while hitting a particularly difficult or hard shot. The pain will be felt on taking a backhand shot and with a hard overhand serve or smash.
As the pain gets worse as we initially ignore the pain as it will of course ""get better on it's own."" It then starts to affect you in your daily activities. You will find yourself avoiding lifting things, have pain lifting your coffee cup and certainly avoid shaking hands at any cost to avoid the pain. The cause of the pain is a tendinitis in the tendon of the muscles which extend the wrist. It is actually a poor design where all the muscles which extend the wrist insert into one small localized spot. If treated early and you follow a simple and comprehensive plan the problem is easily resolved. It is the people I see one or two years later who have ignored the pain who although not impossible to treat are certainly harder to get better and get back to playing pain free. The treatment is as follows:
1/MODIFY The injury must be somewhat rested. This means playing less often and avoiding the strokes such as the hard serve and backhand which cause the pain. A two handed backhand is easier on the elbow. Daily activities which put stress on the elbow like carrying a briefcase should be avoided as well.
2/ICE Ice should be applied for 10-15 minutes 2-3 times a day and after activity.
3/MEDICATION Your doctor may prescribe anti-inflammatory pills.
4/PHYSIOTHERAPY This is the main component of the treatment. The therapist will initially reduce the inflammation in the elbow and the give you a flexibility and specific strengthening program to prevent the problem from recurring.
5/STRETCH The therapist will teach you a specific stretch which you should do all day long as well as prior to and after you play.
6/BRACE Special braces are used to alleviate the stress to the area of inflammation. I find the air braces to be most effective. When the pain is initially severe and present during the day I advise you to wear the brace all day long as well as when you play. As you get better you should wear the brace only during tennis or when you are doing other activities which can cause pain. ie. home repairs.
7/RACQUET This might be the most important factor. A lot of the newer racquets are lighter and are designed to produce less vibration and force through the racquet and up the arm. You might have to increase your grip size if it is too small. Having your racquet restrung at a lower tension will be easier on your arm.
8/MECHANICS If we would hit the ball perfectly every time we would never get injured. This is obviously impossible but lessons from a good pro can not only improve your game but put less stress on your arm as you learn to hit the ball more efficiently.
9/COURT Playing on slower courts such as clay allow you to hit the ball more cleanly as you have more time to prepare to hit the ball.
10/CORTISONE Although not used very much your doctor might recommend an injection once your pain is very localized, unresponsive to the above, and used in conjunction to the above.
11/SURGERY Rarely needed and only in very resistant cases. So if you do develop tennis elbow see your physician and treat it sooner than later. Once it has healed go back to your sport slowly. Initially rally only for short periods of time and avoiding the problem shots. Slowly, increase the frequency and intensity of your play. Avoid playing at a competitive level until your elbow is well healed. Paying attention to a minor problem now will save you from months or years of aggravation and pain.