The Pitching Academy

“My son/daughter has a sore (elbow or shoulder).
What’s the best way to handle this?”

          More games are being played, due, at least in part, to the expansion of travel ball and fall leagues, arm problems for young ball players are becoming more prevalent. According to Dr. Glenn Fleisig of the American Sports Medicine Institute there are two major “thresholds” where he sees more arm problems:

• With pitchers who play for 8 months per year, or more 
• With pitchers throwing 85 mph or faster

Major League Baseball starts in mid-February (pitchers and catchers report first), and, aside for teams that make it to the playoffs, ends by October.  A total of roughly 6 months. A LOT of games in those months, but a lot of downtime after the season.          

Are the number of games your kids playing approaching that of highly skilled, physically mature adults?

As for throwing 85+ mph, well, of course, we want pitchers to throw this hard; even harder. At this level of velocity, however, the structures of the arm undergo greater forces and stress. If not properly cared for, problems are inevitable.

  Tendinosis –  a more serious condition characterized by degeneration (not inflammation) of the collagen fibers in the tendon due to excessive wear and tear. More common, and more difficult to treat, than tendonitis.

  =Healthy vs. Broken Down Tendons

  Impingement Syndrome - the diagnosis given for shoulder pain that is the result of tissues that get "pinched" or "impinged." This pinching occurs when the shoulder joint no longer stays centered in the socket as the arm is raised, as in the overhead throwing motion of a baseball or softball player. Can be caused by imbalances of strength and flexibility between various muscles in the shoulder.
                                      

    Medial epicondylitis – also known as pitcher’s elbow, golfer's elbow, and tennis elbow.  Caused by damage to the tendons that bend the wrist toward the palm (flexion). The most common symptom of ME is pain along the palm side of the forearm, from the elbow to the wrist, on the same side as the little finger.

  Can be caused by inflammation from too much repetitive activity, like throwing, or from a breakdown of tendon fibers known as tendonosis (see above).

  Pain vs. Soreness

            When is pain serious? When you can no longer perform your normal activity - like throwing - and/or the pain causes you to adjust from your normal mechanics to compensate for the pain.

          Post-activity pain, which is ordinarily felt after training or competition, should dissipate within 24-48 hours. Pain persisting beyond this time should be referred to appropriate medical authority.  At this point, trying to "tough it out" can lead to more serious injury.

  Basic Recovery Regimen

          When arm problems occur, this is the course that will likely have to be followed:

1) Stop any activity causing pain. Recovery time will vary; can take weeks even months.

2) When pain is gone, begin appropriate strength and conditioning work to re-hab the structures involved.

3) After a minimum of 6-8 weeks of S & C work, begin throwing again.

          There are NO shortcuts through this process. It is better to lean on the side of extra recovery time rather than rushing back prematurely and risking re-injury. The good news is that appropriate strength and conditioning can help ball players to both prevent as well as recover from most throwing injuries.

 Baseball Fit

1.  Khan KM, Cook JL, Taunton JE, Bonar F. Overuse tendinosis, not tendonitis. The Physician & Sports Medicine 2000;28(5):38-48.