Injuries Can Bench the Kids of Summer

'Little League shoulder' and 'Little League elbow' deserve special attention

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HealthDay Reporter

SATURDAY, May 1, 2004 (HealthDayNews) -- Three million boys and girls will flock to Little League baseball diamonds this spring to enjoy another season of America's national pastime.

And more than 90,000 will get hurt.

Yet many of those injuries -- from broken bones and split lips to aching shoulders and elbows -- can be avoided with proper equipment and adult guidance, experts say.

The most common injuries are shoulder and elbow problems -- called Little League shoulder and Little League elbow.

"These are overuse injuries that are related to throwing too hard and too much," said Dr. Edward McFarland, an associate professor of sports medicine at Johns Hopkins University.

The majority of these injuries occur to pitchers and position players who also pitch. "It usually happens to the kids who throw the best, and the hardest, because they usually pitch more. Of course, you can get problems with your shoulder or elbow in any position," he added.

McFarland estimated that more than one-third of Little League pitchers develop shoulder or elbow injuries.

In children, growth plates in the shoulder and elbow don't fully close until early adulthood. "If you throw too much, you can damage the growth plates," which are made of cartilage, McFarland explained.

Damage to the shoulder shows up as pain, which is usually relieved with four to six weeks of rest. Kids shouldn't throw again until they can do so without pain, he said.

Children and their parents should also be concerned about elbow pain, McFarland said. "We tell parents that any elbow pain is not normal. Elbow injury can be serious and damage the elbow for life," he added.

If the elbow injury is serious enough, it can cause arthritis in the joint when the child becomes a young adult, McFarland said. This can significantly restrict the use of the joint and the quality of life, he noted.

With either injury, parents should avoid encouraging their children to play through the pain or giving them medication to mask the pain, McFarland said.

Children need to be encouraged to tell adults if they're in pain, and if they are they should be taken out of the lineup. If a child is having trouble throwing or has persistent pain after a game, he or she should see a doctor, McFarland advised.

"Kids should not be taking anti-inflammatory medications or icing their shoulder all the time. It's really best that they listen to their bodies, and if they get soreness or pain, they should rest," he said.

Surgery is seldom needed, McFarland said. He recommends resting the affected shoulder and elbow for several weeks until the growth plates heal.

Dr. Stephen Silver, an orthopedic surgeon at Beth Israel Medical Center in New York City, said that to avoid injury, children need to warm up with stretching exercises before playing.

Silver added that sliding into a base and other collisions can cause shoulder dislocation or separation, and throwing can cause injuries to the rotator cuff in the shoulder.

And catchers are susceptible to back and knee pain from squatting, Silver said. These children need a stretching program for the knee and back before each game.

However, "if soreness lasts over four to six weeks and doesn't get better with rest or stretching, it's time to see an orthopedist," Silver said.

Silver said stretching exercises before each game help maintain flexibility in the shoulders, back and legs throughout the baseball season.

However, if an injury occurs and the soreness lasts more than four to six weeks and does not get better with rest or stretching, the child should see an orthopedist, Silver said.

Emory Healthcare, part of Emory University School of Medicine in Atlanta, offers the following suggestions to avoid elbow and shoulder injures:

  • Always stretch your muscles slowly and gently before pitching. Recommended routines include light aerobic exercise, such as jogging or jumping jacks.
  • Always follow the pitching rules of your baseball league and don't play in two leagues at the same time.
  • Limit your pitching to four to 10 innings a week.
  • Learn and practice the mechanics of good pitching technique.
  • Don't throw curve balls and sliders until high school when the growth plate in your elbow is fused with the bone.

Silver said all players should wear safety gear such as batting helmets with face guards. Coaches and parents should be sure first aid is available at all games and practices, and coaches must instruct children how to slide safely. Above all, keep the game fun. Too much pressure invites injuries, he said.

More information

To learn more about child sports injuries, visit the National Institute of Arthritis and Musculoskeletal and Skin Diseases.

SOURCES: Edward McFarland, M.D., associate professor, sports medicine, Johns Hopkins University, Baltimore; Stephen Silver, M.D., sports medicine orthopedic surgeon, Beth Israel Medical Center, New York City

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