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“My boy didn’t make the pitching roster for his fifth baseball travel team‘cause of shoulder pain, a 38 year old Mets player won the Cy Young award, and Kevin Youkilis is a friggin Yankee?… Those darn Mayans were right about that calendar…”
By Matthew Stiebel, MD, FRCSC –
Shoulder pain in the overhead throwing athlete is a constant source of frustration and disability. Not only are we occasionally annoyed (or even injured) by the overbearing familiarity of the “little league father,” but now we must face a new enemy, “the little league shoulder.”
Why is it that child athletes from the ages of 10 to about 14 complain of shoulder pain so often?
The easiest answer is overuse injuries. Adolescents that torque and stress their shoulders by whipping fastballs often fail to have adequate recovery time. Middle school aged baseball players still have open growth plates in their shoulders that can be stressed to the point where they act like fractures. Fortunately, the easiest way for these injuries to heal is simple to hear (but often strangely hard to achieve compliance)… stop playing ball until things feel better. Keeping pitch counts to reasonable levels and limiting the number of travel teams children join help prevent these kinds of injuries. Here in Florida, where every child is either the next Walter Johnson or Sandy Koufax, parents need to understand that overuse of the developing pitcher can lead to problems even more severe than little league shoulder. Unfortunately shoulder biceps/ labral tears and elbow ligament ruptures that necessitate arthroscopic shoulder surgeries and Tommy John elbow ligament operations are fast becoming the norm—even in 12 year olds!
What can the “educated” little league parent do to best help their child avoid injury?
The simple answer is to carefully monitor pitch counts, prohibit the use of breaking balls in the juvenile elbow, and to encourage the proper strengthening and stretching of the throwing shoulder. While proper pitching coaches can help perfect form on the mound, it is the “homework” part of pitching that is often most important. One series of exercises that I encourage all of my baseball and softball players to utilize is called the “Thrower’s Ten.” Developed and perfected in Alabama by the therapist Kevin Wilk, the Thrower’s Ten program addresses scapular muscle balance and strives to stretch the posterior capsule of the throwing shoulder.
Repetitive overhead activities such as pitching, hitting a volleyball, throwing a football, or even serving a tennis ball can lead to thickening of the posterior shoulder capsule. This means that the arm gradually begins to lose its normal ability to internally rotate. Because you lose this rotatory motion from the shoulder, the body tries to compensate by increasing the motion between the scapula and the ribcage and by increasing the torque on the inside of the elbow at the end of the pitching follow-through. This abnormal change in biomechanics overloads structures on the inside of the shoulder and on the inside of the elbow. If these pains are ignored, they can lead to tears of the shoulder labrum or of the ulnar collateral ligament in the elbow. Amazingly, much of the abnormal biomechanics in a pitcher’s shoulder can be prevented or reversed with the use of the Thrower’s Ten exercise protocol and appropriate capsular “sleeper stretches” coupled with occasional breaks from the offending activity.
In a world where even the great Strasburg’s of the elite pitching world require elbow ligament reconstruction—you have to wonder just how terrific they would have been if only they had done their homework and committed to a shoulder stretching and strengthening protocol when they were middle school aged– before the damage was too far gone. Maybe their careers would continue into the fabled Roger Clemens years? (even without those groovy steroids) But hey, heroes like R.A. Dickey lets us know that there’s always the knuckle ball for us crippled old guys with those preventable little league battle injuries.
Matthew Stiebel, M.D. FRCSC
Board Certified, Fellowship Trained Orthopaedic Surgeon
Matthew Stiebel, MD FRCSC, is the newest partner at Palm Beach Sportsmedicine. After un-
dergraduate and medical school degrees at Yale University, he completed an orthopaedic surgery residency at McGill University and a subspecialty fellowship in sports medicine at Boston University. His specialties include complex shoulder and knee injuries. Dr Stiebel has published papers and book chapters on specialty surgeries of the knee and shoulder. He is an associate master instructor for the Arthroscopy Asscociation of North America, where he instructs both arthrocopic shoulder and patellofemoral knee courses for surgeons in the US and internationally. He has lectured to the International Patellofemoral Reseach Group in London and New York City, and has worked with patellofemoral implant design companies. His other current interest involves the repair of pectoralis major muscle tears and their subsequent outcomes. While in Montreal, Dr Stiebel worked with the Montreal Canadians Hockey team and Expos Baseball team. During his fellowship time in Boston he was able to serve as team physician for the NCAA championship BU men’s hockey team, UMASS Boston Hockey, as well as work with the World Wrestling Entertainment Summer Slam Series. Locally, Dr Stiebel stays active in the community by currently serving as team physician for some of the local high school football and gymnastics programs.
Certificates/Memberships:
– Board Certification: American Board of Orthopaedic Surgery, July 2012
– American Academy of Orthopaedic Surgeons
– Fellow, Royal College of Physicians and Surgeons of Canada American Arthroscopy Association of North America
– International Society of Arthrosocopy, Knee Surgery & Orthopaedic Sports Medicine
– International Patellofemoral Reseach Group
Palm Beach Sports Medicine
(561) 845-6000
www.pbsportsmed.com
