Chronic Pain Starting Young

It is always a parent’s dream to have their child be successful at whatever they do. This is especially true when it comes to sports. However, some parents take it too far and put immense pressure of the child to succeed. This can be potentially damaging to the child’s psyche as well as physical trauma it may cause. Chronic pain in a child's future usually isn't the first thing on the parent's mind, when sadly it should be. This is extremely prevalent in Little League Baseball. Despite common recommendations not to throw anything but a Fastball and Changeup until at least High School age, parents and coaches are still putting children at risk for injury by teaching them to throw Sliders and Curveballs.



The developing pitching elbow contains the Ulnar Collateral Ligament (UCL) which can become stretched, frayed, or torn through the repetitive stress of the throwing motion. The risk of injury to the throwing athlete's UCL of the elbow is thought to be extremely high as the amount of stress through this structure approaches its ultimate tensile strength during a hard throw.



While many authorities suggest that an individual's style of throwing or the type of pitches they throw are the most important determinant of their likelihood to sustain an injury, the results of a 2002 study suggest that the total number of pitches thrown is the greatest determinant. The 2002 study followed 426 pitchers aged 9 to 14 for one year, and studied their throwing volume, pitch type, and throwing mechanics. Compared to pitchers who threw 200 or fewer pitches in a season, players who threw 201–400, 401–600, 601–800, and 800+ pitches faced an increased risk of 63%, 181%, 234%, and 161% respectively.



The types of pitches thrown showed a smaller effect; throwing a Slider was associated with an 86% increased chance of elbow injury, while throwing a Curveball was associated with an increase in shoulder pain. There was only a weak correlation between throwing mechanics perceived as bad and injury. Thus, although there is a large body of other evidence that suggests mistakes in throwing mechanics increases the likelihood of injury that the greater risk lies in the volume of throwing in total. Research into the area of throwing injuries in young athletes has led to age-based recommendations for pitch limits for young athletes. In younger athletes, for whom the growth plate (the medial epicondylar physis) is still open, the force on the inside of the elbow during throwing is more likely to cause the elbow to fail at this point than at the Ulnar Collateral Ligament. This injury is often termed "Little League Elbow" and can be serious but does not require reconstructing the Ulnar Collateral Ligament.



Tommy John was a pitcher for the Los Angeles Dodgers baseball team. In 1974 he was unable to pitch because of injury to his elbow. Until that time, this particular injury ended the career of baseball pitchers. The surgical procedure hasn't changed much since it was pioneered by Frank Jobe for John in 1974. A tendon is removed from the patient's wrist or hamstring and grafted into the elbow. It is woven in a figure-eight pattern through tunnels drilled in the humerus and ulna bones. Doctors typically complete the operation in about an hour which is about one-third of the time it first took. The procedure is not unlike that done for reconstructive surgery of the anterior cruciate knee ligament (ACL) that has revived the careers of many pro football players.



With an 85% success rate, there is some concern that young players will continue to throw the Slider and Curveball early in life as they can simply use the surgery as a crutch. What people don’t realize is that the injury itself is incredibly painful. Additionally, a year of rehabilitation with a pain management center is often required to get back to form. Based on the research above it is evident that young players should hold off on the “breaking stuff” and stick with the “heater”.