“My son/daughter has a sore (elbow or shoulder).
What’s the best way to handle this?”
With more games being played, due, at least in part, to the expansion of travel ball and fall leagues, arm problems for young ball players are becoming more prevalent. According to Dr. Glenn Fleisig of the American Sports Medicine Institute (www.ASMI.org) there are two major “thresholds” where he sees more arm problems:
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With pitchers who play for 8 months per year, or more
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With pitchers throwing 85 mph or harder
Are the number of games your kids are playing approaching that of these highly skilled, physically mature adults?
As for throwing 85+ mph, well, of course, we want pitchers to throw this hard, and harder. At this level of velocity, however, the structures of the arm undergo greater forces and stress. If not properly cared for, problems are inevitable.
1) Overuse – too many practice sessions and games, too many innings pitched. All of which adds up to insufficient recovery time.
Tendinitis – inflammation of a tendon. The white areas on each end of the muscle are its tendons, which connect muscle to bone. Considered to be a rare condition. [1]
Tendinosis – a more serious condition characterized by degeneration (not inflammation) of the collagen fibers in the tendon due to excessive wear and tear. More common, and more difficult to treat, than tendinitis.
Comparing Tendinosis To Tendinitis
| Tendinosis | Tendinitis |
| Takes longer to heal - months/years | Quick to heal - 14 days or less |
| Treated with therapeutic exercise | Aggravated by exercise |
| Irritated by NSAIDs | Helped by NSAIDs |
| Shows up black on a MRI (T1) | Shows up white on an MRI |
| Degenerative | Inflammatory |
| Usually feels better after proper training | Hurts to move at all |
| Responds well to electric stimulation | Irritated by heat |
| Irritated by ice | Responds well to ice |
Impingement Syndrome - the diagnosis given for shoulder pain that is the result of tissues that get "pinched" or "impinged." This pinching occurs when the shoulder joint no longer stays centered in the socket as the arm is raised, as in the overhead throwing motion of a baseball or softball player. Can be caused by imbalances of strength and flexibility between various muscles in the shoulder.
Can be caused by inflammation from too much repetitive activity, like throwing, or from a breakdown of tendon fibers known as tendonosis (see above).
Pain vs. Soreness
Post-activity pain, such as that which is ordinarily felt after training or competition, should dissipate within 24-48 hours. Pain persisting beyond this time should be referred to appropriate medical authority. At this point, trying to "tough it out" can lead to more serious injury.
When arm problems occur, this is the course that will likely have to be followed:
1) Stop any activity causing pain. Recovery time will vary; can take weeks to months.
2) When pain is gone, begin appropriate strength and conditioning work to re-hab the structures involved.
3) After a minimum of 6-8 weeks of S & C work, begin activity (throwing) again.
There are NO shortcuts through this process. It is better to err on the side of extra recovery time rather than rushing back prematurely and risking re-injury. The good news is that appropriate strength and conditioning can help ball players to both prevent as well as recover from
1. Khan KM, Cook JL, Taunton JE, Bonar F. Overuse tendinosis, not tendonitis. The Physician & Sports Medicine 2000;28(5):38-48.
*This report is not intended to diagnose or treat a medical condition. It is presented for informational purposes only. If you are experiencing arm pain/problems, seek the advice of appropriate medical authority.
