Your Emails, Answered by Dr. Bush-Joseph
Welcome to the 2007 season! Dr. Bush Joseph will be answering your questions, so email them to us (with the subject of "Ask the Doctor" please).
Q: I am almost eleven years old and was recently diagnosed with tendinitis in both of my elbows. The positions I play most frequently are pitcher and catcher. I have played on the Hinsdale house league and All Stars and also a full time travel team. The Doctor I saw recommended frequent icing and ibuprofen for swelling. This injury has been causing me a lot of discomfort. I was wondering if you have any suggestions as to the general cause of this injury, what I could do to treat this injury and what I could do (if anything) to prevent it in the future.
A: Assuming there is no structural or bone damage. The best way to minimize arm and elbow soreness is to improve leg and chest wall strength. Kids your age get sore because they tend to "overthrow" using the small muscles of your arm as opposed to the big muscles of your chest and hips. Throwing technique is very important.
Q: My son pitches for the 10 year old Phillies team, and he has a couple of pitches. An overhand fastball and a submarine pitch. Maybe an off speed overhand pitch too. I've been told by trainers and coaches that the submarine pitch that he throws is a natural motion of the arm, so it shouldn't damage his arm. Some others question this advice and said I should Ask the Doctor.So, I'm wondering what your opinion is? I appreciate any advice you can provide, and thanks for your support. Last, is there a warm up routine for pitchers that you may recommend on and off the field on the day they are pitching?
A: In general, a submarine delivery is easier on the arm as with the girl's fast soft ball the safest of hard throwing deliveries. I would caution coaches though that any significant change in the throwing motion for a child or adolescent takes time to developed control and consistency.
As for warming up, we use the same routine for all with only minor variation. A quick jog or aerobic routine followed by a good stretch. Next we use a graduated throwing warm-up of short toss followed by long toss (15-20 throws). Finally, have the pitcher warm-up off the mound throwing 15-25 pitches working on 1. delivery form, 2. location, and 3. velocity. Don't warm up too early and don't over throw.
Q: My son is a 12 year old little leaguer who has been an active pitcher ever since he was 8 years old. I have always been very protective of his arm, making sure that he was not "over pitched" and that he was taught the right mechanics.
He has been suffering from some pain in his right shoulder since Feb/March whenever he throws. He had an x-ray and there were no breaks. He then underwent physical therapy for something the doctor called "baseball shoulder". This didn't help. He recently had an MRI to determine if he had a tear in the shoulder area but that came back negative. Instead they found deep bruising to the front of the shoulder bone where the tendons meet the bone and the tendons showed some signs of inflammation. They thought it was caused by some kind of trauma that he may not have even been aware of. He gets no pain when he hits so the doctor suggested that he just hits and plays first base. He is throwing underhanded in warm ups and feels no pain.
The MRI was a week ago and now he claims that the pain has receded when he raises his arm above his head.
What long do you suggest we wait before doing some soft toss? We do not want to re-ignite the problem and would rather wait until we are sure the swelling has gone down and the healing has begun. Would you suggest any exercises or do you think rest is the best medicine?
A: As children grow into the preteen and adolescent years, they will spurt off and on with growth. During phases of rapid growth they are more vulnerable to overuse injuries without any apparent trauma. The MRI and x-rays rule out any structural damage. I have treated several young players like your son who are forced to take the season off from pitching. If his pain has subsided, it is safe to allow him to play the field and bat, but he should not pitch again this season. Once he is pain free, start the soft toss progression gradually stretching him out over the course of 2-3 weeks. I doubt this will have any long term impact on his baseball and or pitching career.
Q: I have had a number of my 13 year old players complaining of sore arms during practice. One while pitching and the others while either warming up or just normal throwing. What do you suggest?
A: Pain while warming up is usually due to either stiffness or overuse. For our professional players, warm-ups are gradual and players will throw for up to 10 minutes. They start with short toss (10-20 feet) moving up in 10 ft. increments up to a 10 throws with a long toss program. Emphasis needs to placed on form, leg drive, and arm angles. Many kids at this age have immature muscle development and poor technique, both of which lead to shoulder pain. Certainly if their pain is progressive or severe, a short period of rest is needed with a gradual ramp up to throwing once their pain subsides. Icing and ibuprofen can be used occasionally but should not be used on a regular basis at this age.
Q: My eight-year-old son was recently diagnosed with having collapsed arches in his feet as a result of walking/running on the inside of his feet for so long (as perhaps aggravated more recently by the fact that he has grown from 50 to 70 pounds over the last year). He had always run somewhat flat-footed, but my wife and I foolishly never thought enough of it to do something about it until yesterday. It had become so painful for him to run that he just really couldn't do it. He is being fitted today for "orthodic" (I think that's what they called it) inserts for his shoes. We have been told by a physical therapist that, if these inserts are fitted correctly, we should see an immediate and significant improvement in Sean's ability to run and that he could be at full speed very shortly. Do you agree with that assessment? He is very excited about this baseball season and very disappointed in the way his inability to run has suddenly made it difficult to do some things he is used to doing (whether on the baseball field or in the backyard). I just want to make sure that he and I have realistic expectations so that we don't create a bigger problem.
A: Flat feet in the growing child are very common and occasionally can be symptomatic. Most flat feet are hereditary and due to lax ligaments in the arch of the foot. The use of orthotics can be helpful in allowing the child to return to running and sports. Improvement is seen over the course of 2-6 weeks. The orthotics will help the symptoms but not change the ultimate shape of the foot. Surgery is rarely if ever indicated in the treatment of flat feet in children.
Q: I am a little league coach for a team of 8 years olds. League
rules prohibit a pitcher from pitching more than 2 innings, but there
are no limits on total pitches thrown. We frequently ask the pitchers whether they are experiencing any pain or soreness, but wonder how the average 8 year old would express that there is. Do you have any
experience with this?
A: You are right that pitch count is more important that innings, especially at the Little League level. Unfortunately, at this level it is not always practical to count pitches as the coach may have his hands full just keepings kids in position, on the bench, or in proper order. Each child may have a different upper limit of pitch count based on experience, arm strength, and technique. At this time, Hinsdale Little League is doing at it can to educate coaches and maintaining constant contact with the child is important. Children, even 7-10 years old, will let you know if they are having pain or problems as long as the coach has fostered an honest approach. All children want to please so if they feel the coach will give them a "suck it up and pitch" response, they will. Little League International has established an optional pitch count guide that many communities adhere to. Under the age of 10, the maximum pitch count for any outing is 75 pitches per day followed by 4 calendar days of rest. Check out this for more information.
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