Keeping Young Players in the Game This Season …. and the Next

Pitch Count Guidelines and Little League Recommendations

Last month we discussed the increase in injuries among Little Leaguers – particularly the prevalence of “Little Leaguer’s Elbow.”  We continue this discussion in this month’s blog with some of the things that the American Sports Medicine Institute (ASMI) and the USA Baseball, Little League Baseball and Major League Baseball organizations have done to ensure the safe play of our young athletes today….and tomorrow.

Avoiding little league injuries.

Pitch count regulations developed to reduce risk of injury in young players.

 New Recommendations

While curve balls are implicated in throwing injuries of the young athlete, because of inadequate physical development and neuromuscular control, scientific data does not yet support this.  Nonetheless, reducing the use of curve balls in Little League pitching is highly recommended.

Other recommendations include: 

  • Watching and responding to fatigue (decreased ball velocity/accuracy, upright trunk during pitching, dropped elbow during pitching, or increased time between pitches). If a youth pitcher complains of fatigue or looks fatigued, let him rest from pitching and other throwing.
  • No overhead throwing for at least two to three months per year (four months is preferred). No competitive baseball pitching for at least four months per year.
  • No pitching more than 100 innings in games – in any calendar year.
  • Follow limits for pitch counts and days of rest.
  • Avoid pitching on multiple teams with overlapping seasons.
  • Learn good throwing mechanics. First steps should be, in order: 1) basic throwing, 2) fastball pitching, 3) change-up pitching.
  • Avoid using radar guns.
  • A pitcher should not also be a catcher. The pitcher-catcher combination results in many throws and may increase the risk of injury.
  • If a pitcher complains of elbow or shoulder pain, discontinue pitching until evaluated by a sports medicine physician.

Pitch Count

The pitch count restrictions for Little League Baseball were established to reduce the number of overuse throwing injuries among these young players and vary by age.  While the complete pitch count restrictions/recommendations can be reviewed on the ASMI website (www.asmi.org ), below is a listing of the latest Little League “daily” limits.

Daily Limits
17-18 N/A 105/day
15-16 N/A 95/day
13-14 75/game 95/day
11-12 75/game 85/day
9-10 50/game 75/day
7-8 N/A 50/day

(Resources – recommendations and pitch count: American Sports Medicine Institute, Position Statement for Youth Baseball Pitchers http://www.asmi.org/research.php?page=research&section=positionStatement

 

Platelet Rich Plasma Procedure, Among the Latest in Less Invasive Hand & Upper Extremity Treatment Options

While research efforts continue to assess the benefits of platelet-rich plasma (PRP) in the treatment of some orthopedic injuries and conditions, the clinical results for many, including some high-profile athletes such as Tiger Woods and Pittsburgh Steelers, Troy Polamalu and Hines Ward, are proving favorable.

PRP therapy is thought to accelerate healing by using the patient’s own “platelet rich plasma” and growth factors.  A small amount of a patient’s blood is taken and rotated in a centrifuge to separate red blood cells from platelets.  The concentrated platelets are then re-injected into the affected area – releasing growth factors that are believed to help the tissue recover more quickly.  The procedure is performed on elbows, shoulders, knees, hips and feet.

Initially PRP therapy was used to help athletes recover more quickly from an injury, accelerating recovery of arthroscopic cartilage and ligament repair.  Today, PRP injection therapy is used for some chronic tennis elbow and golfer’s elbow cases, as well as other cases of tendinitis.  The growth factors and stem cells that concentrated levels of the patient’s platelets activate not only promote more rapid healing but are also found to reduce pain and osteoarthritic symptoms and inflammation.

Tennis Elbow and Golfer’s Elbow

“Overuse conditions” affecting the muscles and tendons of the forearm where they attach at the outside of the elbow, tennis elbow (also known as lateral epicondylitis), or inside of the elbow and forearm as in golfer’s elbow (medial epicondylitis), are generally first addressed with conservative treatment – rest/activity modification, bracing, non steroidal anti inflammatory medication (NSAIDs).  Traditionally, patients continuing to suffer from chronic tennis elbow despite conservative treatment are recommended for surgery to address the affected tendons.  While arthroscopy has made surgical intervention less invasive, PRP therapy offers a non surgical option for chronic tennis elbow sufferers – providing relief for the pain and tenderness associated with the condition.

The Procedure

PRP therapy is a simple in office procedure and does not require a separate visit.  Patients opting for the therapy simply request it during their examination.  Results are usually evident within just a few days.

 

 

Unexpected… Pregnancy Related Hand & Wrist Problems, Part 2

Last month we discussed several unexpected hand and wrist conditions associated with pregnancy – the first in a series of blogs on this subject.

We focused first on one of the most common pregnancy related hand and wrist conditions, Carpal Tunnel Syndrome – discussing the symptoms and common treatment options available to expectant moms.Pregnancy related hand conditions

This month we’re discussing another common hand and wrist condition women may experience during pregnancy and following childbirth, deQuervain’s Tendonitis.  Like Carpal Tunnel Syndrome, deQuervain’s can develop as a result of the musculoskeletal changes, hormonal fluctuations, pregnancy related fluid retention and nursing – all of which can place stresses on the tendons.

DeQuervain’s Tendonitis affects the tendons around the base of the thumb and results when these tendons become irritated – causing the lining around the tendon, known as synovium, to become inflamed.  Tendonitis actually means “swelling of the tendons.”  Tendons are responsible for attaching muscle to bone.

The main symptom of deQuervain’s Tendonitis is pain and tenderness along the thumb side of the wrist, which may radiate down the thumb or up the forearm when rotating the wrist, grasping things or gripping.  The swelling may also place pressure on nearby nerves, causing numbness in the thumb and index finger.  The pain may be gradual or arise suddenly.

DeQuervain’s Tendonitis is generally easily diagnosed in the physicians office after a physical examination and discussion of patient history.  Patients are then asked to perform a series of hand movements and discuss the level of discomfort and area of pain and tenderness.Parts of the hand and wrist affected by deQuervain's Tendonitis

Treating deQuervain’s Tendonitis
Treatment for deQuervain’s Tendonitis is generally nonsurgical and may include:

  • Resting the thumb and wrist with the support of a splint
  • Anti-inflammatory medication 
  • A steroid injection into the tendon compartment
Look for the final part of this series on Unexpected Pregnancy Related Hand & Wrist problems next month when we talk about Trigger Finger.