Overuse injuries are becoming increasingly common in youth athletics. Participation in organized sports provides many physical and social benefits. However, poor training and overuse can result in serious and lasting damage. Athletic injuries range from simple abrasions and contusions to serious head and back injuries. Most often such injuries involve damage to the muscles and joints of the arms and legs.
Thrower’s elbow is damage to the elbow due to overuse. It occurs when forceful overhand/overhead throwing motions are routine. This condition is most frequently seen in baseball, specifically in pitchers. It also occurs in other sports such as volleyball and tennis. This type of injury has always been a problem for professional athletes. In professional sports, competitive demands may require continued play without adequate rest or even with a moderate injury. With increased participation and competitiveness in youth athletics, similar injuries are occurring more often there as well. Due to the age groups involved and the distinct type of joint damage, “youth thrower’s elbow” is currently being recognized.
Bone Development in Children
As the body matures, growth continues at the ends of long bones, until the full adult length is reached. These growing regions, known as growth plates, are composed of cartilage. They provide a physical template where new bone is added. Growth plate cartilage is less flexible. This makes it less resistant to torsion and impact injury than the ligaments and tendons at the joint. Therefore, damage by overuse can seriously affect this region.
In the case of youth thrower’s elbow, the primary site of damage is the growth plate on the little finger side of the humerus. A short hiatus from throwing can help in repairing mild injuries in this location. More severe harm to this area may require several months to completely heal. As overuse continues, the growth plate can fracture and may require surgery to repair. In some cases, the damage is so extensive that even surgical intervention can only restore partial range of motion. This can result in a significant limitation on further participation in the sport. Following such a severe injury, chronic pain may persist even into adulthood.
As with all overuse injuries, pushing the body beyond its ability to repair itself presents the most risk for damage. Unfortunately, many young players participate in more than one sport. This potentially leads to them greatly exceeding the level of activity that can result in injury. Additional risk can result from poor training and conditioning or engaging in athletic activities that are not age-appropriate.
The USA Baseball’s Medical and Safety Advisory Committee has released a set of guidelines to prevent injury. They advocate for “pitch counts” per game, week, season and year. Plus, they provide recommendations on days of rest per pitch cycle for players in different age groups. In addition, young “throwers” should avoid curve balls or other breaking pitches. Finally, it is advised that children avoid year round participation in a single sport. The latter recommendation also encourages a yearly three month rest period between sports.
There are a number of recommendations to prevent further damage and improve recovery if an overuse injury is present. These include suspending the likely activity to provide rest and recovery time. And, if necessary, seek medical evaluation. Most importantly, avoiding activities that produce joint pain or numbness.
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