Sore inner elbow

Question
QUESTION: I have a son who is 11 yrs old. He has been playing little league baseball for 4 yrs now and has occasionally pitched the last 3. We also play 3 or 4 tournament games on average each year after little league season, and rest or play other sports for 3 or 4 months. This year he has been pitching great, but two weeks ago (4th game this season)while warming up before a game he complained his inner elbow was a little sore, but not that sore where he couldn't pitch. He went on to pitch 3 innings and the next day the pain had increased. I iced his elbow once a day for 20 minutes for a week and he stated his elbow felt better. After pitching last Saturday (Big Mistake) his elbow is back sore. He does not throw curveballs or any other type of breaking balls and his pitch count is usually 60 or so pitches. I'm also told his mechanics are strong (elbow above the shoulder, etc.). Please Help. Signed- A dad who does not know what to do. Thanks
ANSWER: Keith,

Thanks for the question and I can help.  This is an area where I do have expertise.  The key at this point is to stop throwing and rest.  He most likely has a simple flexor muscle and tendon sprain/strain which will respond to ice, rest and some physical therapy if necessary.  For such an injury, electric muscle stimulation and ultrasound will go a long way.  Ice is also key.  10 minutes on/3-5 times per day right now.  He should also ice after throwing, when he returns to playing.

At age 11, 3 innings is about max and 60 pitches would be the absolute max if the pitcher has good mechanics.  I would worry a little bit about his mechanics as far as not getting the arm all the way back to to a proper launch position where he is mainly using the large muscles of the torso to throw.  He may be short arming it a little bit thus using really snapping the wrist and putting stress on the elbow.  This can be easily corrected.

MORE SERIOUS a problem would be what is rampant around little league parks and that is a stress fracture at the growth plate in the elbow.  This is why it is very important that you take time off for about 2 weeks with ice and rest and the therapy if possible.  At that point, he should be able to throw without any difficulty or pain.  Then you check his mechanics.  A lot of kids are thought to have great mechanics because they have great control at that age, when in reality they throw from their ear, which is not proper mechanics.  If they bring the ball to the ear, they will usually snap hard at the wrist to get extra velocity.  This will irritate the flexor tendons and muscles and lead to inner elbow pain.

I recommend what I outlined above and if the pain persists, get an xray, or you could get the xray now and rule out any type of fracture.

From now on, (you now know this), if there is any soreness that does not go away with warmup, then he does not pitch. PERIOD.  

Like I told a dad yesterday, there has never been an 11 year old that was signed to a contract or scholarship, but there have been a lot of 11 year olds that lost a chance at one because of blowing their arms out in little league.  Strict pitch counts and innings.  You have to protect your son.

I have an agreement with my son's coaches, 85 pitches.  We have gone over that a couple of times, once for a NO-Hitter and once for a state championship tournament game, but those were extreme circumstances.  At 11, there really aren't any extreme circumstances.  Plus, I know the training, preparation and workouts that my son does.

Please let me know how your son recovers.  I hope this helps.

Coach Boss

---------- FOLLOW-UP ----------

QUESTION: This is great information. Thank You. Where can he get the electric muscle stimulation and ultra sound performed? Is this something that our Health Care provider needs to perform?

Answer
Yes, you will have to see a healthcare provider.  Most MD's will refer you to a physical therapist for this type of treatment.  The MD does not actually do the treatment in their office, but he will write a referral to the PT.  A chiropractor is a doctor who can perform these types of treatments in office and is normally well educated in sports related injuries such as this.  The chiropractor is often more convenient as you get everything done at one office and most insurances cover the charges.

Good luck and let me know how he does.