Book Review: The Arm

Another fascinating sports book has reached The New York Times Bestseller List: The Arm by Jeff Passan.  The book evaluates the highly valued pitchers in baseball, the ones that collect more than 1.5 billion dollars each year, far more than competitors in other professional sports. As any parent with a child playing  baseball knows, there is one overarching concern, one huge unsolved problem for any pitcher: the elbow's ulnar collateral ligament (UCL), also know as the medial collateral ligament (MCL).

In this book, Jeff Passan comprehensively evaluates the risk, the science (or lack thereof), and the treatment related to the UCL.  We believe that the basic risk to this ligament is the torque applied to the elbow in the throwing motion, likely made worse with certain pitches like curveballs.  Injuries do not occur in softball pitchers and occur far less commonly in other throwers (outfielders, quarterbacks, etc).  And even more interesting, most of us do not even need this ligament.  That is to say, unless you are a thrower (typically we include baseball players- especially pitchers, quarterbacks, and javelin throwers) or perhaps a participant in another sports such as wrestling, you can participate in all of life's activities without this ligament.  The muscle surrounding the elbow and the bony architecture provide enough stability for most of us.

The book examines the culture behind the epidemic of MCL injuries.  He travels to Japan to better understand their very different pitching culture which often translates into far more innings and pitches than we Americans allow our kids.  He specifically discusses the industry which exists around youth baseball (and all parents should know that these money making entities exist around every youth sports at every level).  Showcases and tournaments are emphasized as a way for any child to gain exposure to potentially allow play at the next level (college or professionally).

I am a parent with highly sports- focused kids, and I have seen first hand this industry in action. Parents like me may feel trapped by a perceived need to participate in these events and tournaments lest their child miss a chance to make their mark and gain attention.  I was also fascinated to read how highly successful pitchers are constantly queried about the status of their arm, during and after each pitching outing (especially games that might not be as successful as expected).

Mr Passan also presents great information on sports medicine and the surgical field surrounding treatment of the MCL. He delves into the science of injury prevention and the real lack of knowledge that exists related to the risk factors and prevention strategies for MCL injuries.   He shares the story of the now famous surgery to treat MCL injury, often considered a rite of passage for pitchers, the 'Tommy John' surgery. We learn about Dr Frank Jobe who 'invented' MCL reconstruction on the willing patient and baseball pitcher, Tommy John.  We learn about many other pitchers who have been treated (both successfully and unsuccessfully) with reconstruction of this ligament.  We follow the surgery and recovery of two pitchers with MCL reconstruction and gain an understanding of their plight- absolutely fascinating.

In short, Mr Passan presents a comprehensive look the MCL and the world surrounding these catastrophic  injuries.  There are no concrete answers to this epidemic which now affects young teens (or even younger) but it is clear that there must be a shift in many aspects of baseball development and pitcher management.

I recommend this book to any physician who cares for athletes, any parent to a youth baseball player, and anyone who loves the game.  As a physician who treats many athletes, I found the book and its stories fascinating and humbling and know now, more than ever, that physicians and medical researchers need to produce better research as a way to understand, hopefully prevent, and treat these injuries.

Charles A. Goldfarb, MD

My Bio at Washington University
congenitalhand@wudosis.wustl.edu

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.

Sports Participation for the Pediatric Thrower

By: David Piskulic, DPT, SCS, ATC/L
St. Louis Children’s Hospital Physical Therapy

It’s summer time! And that means several things…no school, sunshine, and lots of America’s favorite pastime: baseball. Participation in youth baseball leagues and youth sports in general has increased significantly in recent years. Unfortunately, there has also been an increase in sports related injuries. In fact, 3.5 million children under the age of 14 are seen annually for sports related injuries. 

Youth throwing injuries have been a particular area of increased concern. Injuries that were normally seen in professional athletes are being seen in our young athletes. The link to the article below discusses the current environment of youth participation in baseball and its implications towards injury. There is also a free handout with pitch type, pitch count, and rest recommendations for youth baseball players to help prevent some of these injuries.

Click here to continue: http://www.medbridgeeducation.com/blog/2015/12/sports-participation-for-the-pediatric-thrower-how-much-is-too-much/