Common Shoulder and Elbow Problems in Softball and Baseball

by Terra Blatnik, MD

Pediatric Sports Medicine 

As spring baseball and softball seasons come into full swing, so will shoulder and elbow injuries.  These injuries can range from strains to fractures to overuse injuries.  Kids start playing T-ball as early as 3 and can begin pitching as early as 5 or 6 which can put lots of stress on little arms that may not be ready for it!  I saw an 8 year old in the office that was pitching 7 days per week—3 days of practice but his father was having him practice for an hour in the backyard on his off days.  It is no surprise that he had developed significant shoulder pain! There are two common injuries that we call “overuse” injuries—meaning there wasn’t a fall or some particular incident that caused the injury--just using the arm too much or in the wrong way.  They are both named after the most common sport where they happen, Little League baseball (but they can happen in softball or any other throwing sport).

• ·       “Little League Shoulder”—This is pain at the top of the large upper arm bone, the humerus, that most often happens between the ages of 11-16.  Kids have a growing area here that can become injured with too much throwing or throwing with the wrong technique.  They will complain of pain at the top of the arm, near the shoulder, while throwing or pitching.  Eventually the arm may hurt all the time, even with just lifting it overhead.  Sometimes there can even be a little swelling in the area. 

• ·    “Little League Elbow”—This is pain over the bump on the inner side of the elbow and most commonly happens between the ages of 8-15.  Little league elbow is also pain over another growing area that can cause pain when throwing or pitching.  Kids may notice swelling over the bump or trouble fully bending and straightening the elbow

If a child is having this type of pain during throwing, it is best for them to stop throwing completely and ice the area.  If it is becoming worse or happening every time they go to practice, it is best to stop and see a doctor.  The doctor will likely get x-rays of the area to check on the growth plate.

Treatment for both Little league elbow and shoulder is rest from throwing.  The growth plate needs time to heal before it is stressed again with lots of pitching or throwing.  This can take from a few weeks to a few months depending on how severe the injury may be.  After resting, your doctor may suggest some physical therapy to strengthen the elbow or shoulder and then a SLOW return to throwing.    

As with most “overuse” injuries, prevention is the key!  There are many things that parents, athletes, and coaches can do to lower the risk of Little League shoulder and elbow. 

1.     Set limits--Kids that love baseball or softball would happily throw every day, every game, all year long!  Coaches would also love this!  The reality is that kids arms aren’t meant to take all of that repetition.  Little league baseball has set forth a set of rules in regards to how many pitches, how many games, and how many days of rest a pitcher should be doing.  Visit www.littleleague.org to find these rules.  Talk to coaches about how much your child is throwing.

2.     Develop proper technique—How a child throws or pitches a ball can put unnecessary stress on the shoulder and elbow.  Have a skilled coach take a look and correct if needed.  Start at a young age so they will always have proper technique.

3.     Take time off!—In some areas, baseball is played year round.  Players should take time off between seasons to rest and allow their body to heal.  They can try other sports like soccer, football, or hockey that uses different muscles and don’t involve throwing.

It is always important to take any complaints of shoulder or elbow pain seriously.  Using the above guidelines may help keep your child healthy and on the field. 

If you would like more information on rehabilitation of throwing injuries from a pediatric sports physical therapist, visit http://stlyac.wustl.edu/2015/08/sports-participation-for-pediatric.html.

Should my Child be Lifting Weights?

By: Terra Blatnik, MD
Washington University Orthopedics

In an era where CrossFit has become common place and the pressure continues to mount in youth sports, this is a question that most parents may have on their minds: “Should my child be lifting weights? Is it safe for my child to be lifting weights?”

Strength training is the term that we use in sports medicine for weight lifting and other similar activities. In adults, strength training has been found to have obvious benefits that include improvements in cholesterol and cardiovascular health. Kids may have similar benefits and it may also improve their bone health as well.  It can improve overall strength and appropriate training programs may lead to some benefit in acquiring sports skills.  

The biggest concern is safety in strength training. We don’t want our kids to get injured while participating in weight lifting or to affect their growth in a negative way. In both cases, if done in a supervised setting, these injuries and bone issues can be avoided. Most injuries with strength training occur at home in an unsupervised setting. These are typically muscle strains which could be avoided if done under appropriate supervision. 

Before beginning any type of exercise program, kids should be evaluated by a physician to make sure that it is safe. Once this has been completed, it is important for parents to find a well supervised program with adults that understand strength training in children. They should be well-versed in appropriate lifting techniques and know what limitations kids should have.  

The American Academy of Pediatrics recently made some recommendations regarding strength training in children that provide some good rules to follow. Kids should not begin any type of strength training until they are about 7-8 years old. At this age, they have enough control and balance to handle lifting weights. Programs should focus on light weight and high repetition lifting. Olympic lifting or maximum weight lifting should be avoided until kids are skeletally mature (at least 14-15 years in girls and 16-17 years in boys). Using one’s own body weight is another way that kids can participate in strength training and further minimize the risk of injury. These types of exercises include squats, lunges, burpees, push-ups, and pull-ups. Light weight resistance tubing can also be used in strength training with minimal risk. Every session should include a 10-15 minute warm up and cool down. Strength training should just be one part of an exercise routine for kids—they should also be active in cardiovascular exercise (running, swimming, jogging, etc) and sports specific training.      

Following these basic guidelines should allow safe strength training for kids and ease parental worries about injury.