Kid's Sports Health

Ways to avoid "Little League elbow"

A local kids' sports injury expert says the new national Little League "pitch count" limits are a step in the right direction. But, Dr. Jay Noffsinger says the limits don't tell the whole story.

Dr. Jay Noffsinger

Dr. Noffsinger is the director of pediatric sports medicine at Cardinal Glennon Children's Hospital in St. Louis.

He said the new national Little League rules set limits on the number of pitches kids can throw per day in actual games. The rules have daily pitch-count limits for kids 10 and under, 11-12, 13-16 and 17-18.

They also dictate the number of rest days between games after pitch limits are reached.

"But, they don't take into account the throwing kids may do at other times, including playing catch with Dad in the back yard," he said.

He said "pitch count" rules are recognition by Little League officials of the danger of shoulder and elbow injuries that can occur from overthrowing.

Kid sports fans living in the St. Louis metro area certainly hear plenty about pitchers' injury woes. For instance, ace pitcher Chris Carpenter of the St. Louis Cardinals went on the disabled list after pitching in only the opening day game.

The diagnosis was that Carpenter had "moderate arthritis" and an "impingement" in his pitching elbow. So far, the doctors have recommended rest as the treatment.

Dr. Noffsinger said kid pitchers usually don't have the same sort of injuries that adults do. Kids' problems are associated with injuries to bones that are still growing, he said.

At early ages, the kids have soft "growth plates" at the ends of their bones. "At those ages, the muscles, tendons and ligaments are stronger than bones," Dr. Noffsinger said.

Too much pitching can damage those "growth plates," he said. In extreme cases, long pitching sessions can cause a ligament or tendon to tear away a piece of the soft bone.

These injuries go by names such as "Little League elbow" or "Little League shoulder."

In a recent article in the New York Times, Dr. Walter Lowe of Baylor University said, "When young kids are pushed to throw at a very high level, they don't have the hormonal ability to build a lot of strength."

Dr. Noffsinger said kids usually stop growing at puberty and "growth plates" disappear as bones harden. He said puberty come at varying ages. "It may as early as 9 or as late as 15," he said.

Too much hard throwing before puberty can do permanent damage, Dr. Noffsinger said.

The national "pitch count" rules vary by age. For instance, pitchers 10 and under have a daily maximum of 75 pitches. Anything over 60 requires three days rest.

At ages 13-16, pitchers have a daily maximum of 95 pitches. But, again, anything over 60 requires three days rest.

But, Dr. Noffsinger urges young pitchers to use these pitch-count limits to include "non-game" throwing as well.

He said kid athletes of all kinds should focus on developing correct form and technique.

"If he can, a kid ought to get a pitching coach to teach proper pitching technique," he said.

One of the first things a pitching coach will focus on is developing a pitching motion that uses the whole body. He said kids should work on developing "core strength" and strength in their legs.

He said, "Good pitching starts at the bottom. 'Arm pitchers' often have trouble later."

In developing strength in the torso and legs, Dr. Noffsinger warned against lifting heavy weights. "Weight lifting at early ages should involve repetitions with light weights and using proper lifting techniques," he said.

He said kid athletes in other summer sports also should be aware of the "growth plates" in their bones. For instance, kid tennis players can develop "tennis elbow" in much the same way as pitchers get "Little League elbow."

He said the popularity of the two-hand backhand has been a good development. That's because the backhand swing exposes a weaker set of muscles and tendons in kids.

He said kid swimmers usually have fewer problems because the water takes a lot of the weight-bearing strain off the body. However, he said swimmers could get sore shoulders because of free-style and butterfly strokes.

"Young shoulders can be pretty "loosely, goosey," he said.