A Painful League of Their Own

If a kid throws more than 75 pitches in a ball game, he's headed for elbow and shoulder woes, says study

FRIDAY, Dec. 14, 2001 (HealthDayNews) -- When young baseball pitchers regularly throw more than 75 pitches in one game, they'll probably have some pain and they'll possibly do serious damage to their elbows or shoulders, a new study says.

Stephen Lyman, an epidemiological consultant to the American Sports Medicine Institute and the chief author of the study, believes those are good reasons for coaches and parents to keep close count on how often a young player goes to the mound and how many times he throws.

Lyman says, "The elbow, in particular, is very vulnerable in 9- to 12-year-olds because it is still growing. If a child complains of pain in the elbow, it's something to be concerned about because it could signal damage to growth plates of the bones."

The study, published in the December issue of the journal Medicine and Science in Sports and Exercise, was conducted at the request of concerned parents, Lyman says.

It tracked arm pain in 298 players in the Dixie Youth and other independent leagues active in the Birmingham, Ala., area, where the American Sports Medicine Institute is located.

The pitchers were contacted by phone after every game for two seasons and asked to rate the severity of any pain they felt.

Forty-seven percent of them reported elbow or shoulder pain at some point during the study. At least 70 percent of the complaints were mild, and the kids continued to play.

But for those who threw more than 75 pitches per game, the odds of elbow pain increased more than 50 percent. Likewise, their risk of shoulder pain was 3.2 times higher than it was for those who pitched at the lowest level -- no more than 25 pitches.

Thirteen arm-related doctor visits were reported. The most serious were three pitchers who were diagnosed with medial epicondylitis, a form of the syndrome labeled "Little League elbow." In this form, small tears in the muscle begin to heal but are re-injured by continued use, becoming scarred and painful. One pitcher who complained of shoulder pain was diagnosed with an inflamed rotator cuff; another had a muscle strain.

The researchers also asked coaches to count pitches and report, among other things, the style in which they were thrown. The study found that split-finger pitches, like sinkers, for instance, tended to be associated with a 70 percent higher risk of elbow pain. Among 11- and 12-year olds, change-ups had a 73 percent lower risk of elbow pain.

The study concludes that young pitchers should be encouraged to learn to throw more change-ups. The study also urged exercising control over out-of-league play, pointing out that even if kids observe limits set by school or league coaches, sandlot play can make things worse.

Officials at Little League Baseball, the largest national youth baseball organization in the world, expressed some doubt over the need to add further rules to league play.

Communications director Lance Van Auken said Little League has long had strict rules limiting pitchers to six innings -- one full Little League game -- in a calendar week.

"We think that limit has worked well for 60 years, because our injury statistics show that treatment for arm injuries are close to nonexistent in the 9-12 age group," he says.

Van Auken is doubly dubious about a rule that would limit out-of-league play: "Little League can't control what kids do with their buddies after school."

That's a job for parents, adds Dr. Jordan D. Metzl, medical director of the Sports Medicine Institute for Young Athletes at Cornell Medical College in New York.

Metzl believes overuse injuries like Little League Elbow are becoming increasingly common as kids play more competitive sports at younger ages.

Parents need to step up to the plate and exert some control, he says.

"There is such a thing as too much. Sports should be fun and build a lifestyle that encourages healthy behaviors, but it is important to know when enough is enough," Metzl adds.

What To Do

Little League Baseball has a monthly newsletter devoted to safe practices called ASAP (A Safety Awareness Program). You can check out current and back issues.

Here's what the Centers for Disease Control and Prevention has to say about baseball safety.

KidsSourceOnline also has a thorough discussion and lots of links on its baseball safety page.

SOURCES: Interviews with Stephen Lyman, Ph.D., epidemiology consultant for the American Sports Medicine Institute; Jordan D. Metzl, M.D., medical director, Sports Medicine Institute for Young Athletes, Hospital for Special Surgery, Cornell Medical College, New York; Lance Van Auken, spokesman, Little League Baseball Inc.; December 2001 Medicine and Science in Sports and Exercise
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