12900 Saratoga Ave., Suite A-1, Saratoga, CA 95070 Phone (408) 973-7700 Fax (408) 973-1600 info@optmsaratoga.com www.optmsaratoga.

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PLAY BALL!
SHOULDER & ELBOW CARE FOR YOUNG THROWERS: TREAT THE WHOLE, NOT THE PART
Given the truth that there are many variables that may lead to injury of a particular body part, the OPTM Physical Therapy of Saratoga team believes it is vital to consider and address all possible factors when working with an individual to rehabilitate an injury, improve functional performance or reduce the chance of getting hurt. When working with young throwers and providing care for their shoulder or elbow, based on what research shows and leading experts say, we believe that a comprehensive approach includes much more than just specific treatment to the upper extremity itself. It is estimated that 2.2 million young Americans between the ages of 4-16 play baseball annually. 50% of little leaguers between the ages of 9-14 will experience shoulder or elbow pain.

Who is at risk for injury?

According to the American Physical Therapy Association and Kevin Wilk, DPT, a leading authority in sports rehabilitation and Director of Rehabilitative Research with the American Sports Medicine Institute, youth baseball players are at risk due to the following factors: - - - Age Elbow joints (bones, ligaments, growth plates) in youth are not fully developed and hence, are susceptible to overuse injuries Pitch Type o Curve balls and breaking pitches appear to put more stress on the growth plate of the elbow compared to other types of pitches Pitch Frequency o Pitching too frequently without adequate rest o Pitching too many games o Individuals that pitch more than 100 innings per year are 3-4 times more likely to sustain a shoulder injury Improper Mechanics o Improper movement through the lower extremity, trunk and/or upper extremity will lead to added force on the elbow and shoulder o

Where does the velocity come from?

Research indicates that 54% of the force required to throw comes from the core (lower extremities and trunk), and 21% is generated from the shoulder. The core is the engine for force generation, and a foundation to minimize loads on the shoulder and maximize performance of the upper extremity. The upper extremity is a downstream segment in the kinetic chain of throwing, which has a major role in force regulation. Mechanical flaws in the core will place added dependency on the upper extremity to become a force producer, which adds stress to the shoulder and elbow, making it susceptible to injury.

A plyometric anterior hop to lunge with rotational reach loads the trunk, lower and upper chain in weight acceptance phase of throwing.

What are the key mechanical issues with throwing and injuries?
In a review of several research studies of injured throwers, a range of 55-100% of the subjects had a combination of the following: 1) weakness and/or abnormal motion of the trunk and a lower extremity, 2) scapular dyskinesis (poor shoulder blade control), 3) Glenohumeral Internal Rotation Deficit (loss of internal rotation of the shoulder). A high percentage of the subjects presented with all three flaws. Therefore, when working with an individual with a shoulder or elbow throwing injury, it is important to perform a comprehensive evaluation of the entire body to screen for and consequently address all potential causes to the problem. Throwing requires efficient and coordinated sequential motion throughout the entire body, which minimizes loads on the individual body segments and maximizes throwing performance. Treatment of just the shoulder or elbow itself may not be sufficient in correcting the cause(s) of the problem. The evaluation should include examination of the strength, flexibility, and motion of the muscles and joints associated with the foot, ankle, knee, hip, pelvis, spine, scapulohumeral and glenohumeral complex. Dysfunction in any one or combination of those areas can result in added compensatory stress to the shoulder and elbow, resulting in pain and injury in the upper extremity with throwing.

Conclusion
There are many causes that are associated with throwing injuries in the young athlete. It is important that athletes, parents, coaches, athletic trainers and physical therapists are aware of and address all the possible variables that can contribute to upper extremity injuries. Awareness of and adherence to professional recommendations and guidelines to avoid injuries should reduce the incidence of injuries and maximize performance. Given the complexity of throwing and the multiple potential causes of injuries, it is imperative that a skilled physical therapist perform a comprehensive evaluation of the entire body, not just the shoulder or elbow, when focusing on injury prevention or screening for causes of throwing injuries. Based on the findings in the research literature, it is recommended that a customized exercise program for each individual incorporate exercises that will improve strength, range of motion, and flexibility of the lower extremities, trunk and upper extremities, which will help keep athletes on the field and performing at their best. The OPTM Saratoga team can help do that with a comprehensive approach!

__________________________________________________________________________ Recommendations for preventing injuries in youth baseball pitchers (according to the American Sports Medicine Institute):
1. Watch and respond to signs of fatigue. If a youth pitcher complains of fatigue or looks fatigued, let him rest from pitching and other throwing. 2. No overhead throwing of any kind for at least 2-3 months per year (4 months is preferred). No competitive baseball pitching for at least 4 months per year. 3. Do not pitch more than 100 innings in games in any calendar year. 4. Follow limits for pitch counts and days rest. 5. Avoid pitching on multiple teams with overlapping seasons. 6. Learn good throwing mechanics as soon as possible. The first steps should be to learn, in order: 1) basic throwing, 2) fastball pitching, 3) change-up pitching. 7. Avoid using radar guns. 8. A pitcher should not also be a catcher for his team. The pitcher-catcher combination results in many throws and may increase the risk of injury. 9. If a pitcher complains of pain in his elbow or shoulder, get an evaluation from a sports medicine physician. 10. Inspire youth pitchers to have fun playing baseball and other sports. Participation and enjoyment of various physical activities will increase the youth's athleticism and interest in sports.

Relevant Resources:
American Sports Medicine Institute: Position Statement for Youth Baseball Pitchers, Pitch Count Recommendations, Rest Schedule - http://www.asmi.org/asmiweb/position_statement.htm Little League Baseball Organization Regular Season Pitching Rules http://www.littleleague.org/assets/forms_pubs/media/pitchingregulationchanges_bb_11-13-09.pdf