LL/travel ball pitcher & competitive swimmer diagnosed with little league elbow


#1

Please forgive the long post. I stumbled upon this forum while reading/researching after my son was recently diagnosed with medial epicondyle apophysitis (aka little league elbow) and there seems to be knowledgeable members here that may be able to answer my questions/concerns. My son will be 10 next month and plays on a 10U travel team. He has also swam competitively year-round for the last 3 years and plays flag football in the winter. Baseball, pitching to be specific, is his number 1 passion and we want to make sure we do what’s in his best interest. First, is anyone familiar with apophysitis being an acute injury? A week ago, during a casual fly ball practice session with his dad he got mad and “whipped the ball as hard as he could and let out a yell”. He said he got a sharp pain to medial elbow area and felt a pop at that time. After a few days of rest and attempting just some soft toss throws he got pain again and stopped. X-rays (completely normal) and pediatric ortho appt. yielded a diagnosis of medial epicondyle apophysitis. Everything I’ve read seems to imply this is a chronic injury with gradual onset. Upon questioning at the Dr.'s office he admitted that he felt soreness only once for only a few hours after pitching an entire game in May–denies feeling anything since. He does throw very hard, and did throw a lot last season due to that team’s lack of pitchers and over dependence on him to win games, but had never complained of soreness or pain at all. That season ended June 30th and he only had minimal pitching practice with dad over summer. He has since recently changed to a different (better) team where this overpitching should no longer be an issue, as everyone on this team pitches. Seemed more like an acute injury to me since there was no pain prior and he’s been practicing with his new team for a few weeks now.
The big question now is what to do about his other sports. We always thought that the year-round swimming was great strength and conditioning for him and was probably the reason he was as great and strong of a pitcher/baseball player that he is. Now I’m reading conflicting information that swimming may be bad for a pitcher and contribute to overuse injuries? He’s been swimming 5 days/week, sometimes going straight from swim practice to baseball practice. He desires to play baseball for a long time and yes, like many young players even has dreams of becoming an MLB pitcher. Does anyone have any thoughts or experience with baseball players, pitchers particularly swimming as well? When he comes out of the “rest period” of his injury recovery in a few weeks, we’re not sure if swimming should continue. We’re contemplating taking him out of swimming to protect his shoulder & elbow from additional wear & tear. Thoughts on playing baseball/pitching and swimming?


#2

I am not qualified to address this, however, others will chime in and offer their experiences and advice as a matter of being helpful.
I just want to point out that the responses that follow will be honestly helpful - NOT MEDICAL ADVICE. There are so many variables with the physical condition that keyboard approach to this, or any other physical impairment, is not the way to go.
So take away whatever good intentions may follow, just be advised of the limitations with those good intentions and advice.


#3

Coach baker is right in that this is not medical advice, merely just our observations and opinions. We haven’t seen anything of your son, for example videos and such so what i say might not apply to your son. Now with me swimming hurt me when it came to pitching. Multiple sources advise against swimming saying it causes glaring scapular instability, big internal rotation deficits, and insufficient dynamic stability. (Eric Cressey) and Swimming actually is counter productive and lowers your velocity (Brent Pourciau). For me my scapular instability actually came back to bite me, putting stress on my UCL. I’d advise against swimming and pitching at the same time, or at least not doing it during the same season. ~an Ex swimmer who swam competitively for 5 years.


#4

Thank you very much. I was not looking for medical advice but information/educated opinions about whether playing baseball and swimming 5 days/week was a good idea, or could potentially lead to increased shoulder and/or elbow issues. Your thoughts and information is exactly what I was searching for. We had always assumed he would do both for a long time to come and had actually thought the swimming helped and made him a better conditioned, stronger baseball player. It is only after this sudden injury and reading that it occurred to us that these might not be 2 sports that should be done together. We are all about being multi-sport, even though baseball is his 1st choice if he had to choose. Now considering breaking from swimming, but allowing flag football (no QB or throwing) this winter during his team’s baseball break. He needs to stay fit and be active, but not stress the arm so he’ll be good for spring season. I guess after that may be good time to try out soccer or basketball? He loves all sports and would honestly play everything if there was enough time.


#5

I’m a big fan of playing multiple sports – baseball in the spring and summer, maybe soccer or football in the fall, basketball, swimming or weightlifting in the winter.

There are just so many benefits to playing different sports, plus it’s a lot of fun.

While baseball (specifically, pitching) and competitive swimming during the same season is usually not recommended, I see no issue with participating in them in different seasons. As a parent myself, if my son loved both and wanted to do both, we’d do both.

Good luck with your decision!


#6

Take a look at this article. Pay close attention to the time allotted for each technique during pool work. Hope this helps. http://www.thecompletepitcher.com/pitching_swimming.htm


#7

Quick update and question:
After 4 wks off, no throwing (and no more swimming for now) my son started throwing again. Pretty light at 1st, soft toss, long toss. 1st session went ok, felt only a small “twinge” at the end in the inner forearm area. Went to team practice and threw with the team in practice drills for the 1st time, no pain, no problems. A couple days later, went out to the fields for some more short toss, long toss and about 20 pitches at about 60%. Felt a couple “twinges” again last few pitches at the end–again in the forearm. The original injury was acute pain in the elbow at the medial epicondyle. He has never had any forearm discomfort at all while throwing until now. He has rated these “twinges” 1/10 on pain scale, and we had thought may just tightness from not throwing at all for a while??. Practiced with the team again a couple days later with no pain, no issues throwing. Still no pitching in team practice or games. Played in a tournament this past weekend, 5 games between Sat & Sun. Put him in the outfield to minimize throwing, but he made 1 long hard throw to home from the outfield fence on a ball that got by him and felt it. He again reported feeling discomfort in the inner forearm during that throw, but this time a little more than previous, rated 3/10. He continues to deny any pain at all in the elbow, during or after throwing. No other problems or pain throughout the weekend–during warm ups or games. He’s probably made a couple hundred throws pain -free now in the past 2 weeks between soft/toss long toss sessions, practices and the tournament this weekend. “Twinges” felt in less than 10 total.

So what do you all think this new forearm discomfort is, that seems to be intermittently arising, seemingly on the hardest throws? He’s been doing forearm muscle building exercises included in his therapy/rehab exercises. Our first thought was muscle tightness from not throwing for 4 weeks and maybe needs more stretching, but not really sure what it is since he’s never had it before. We are just glad that there is no more elbow pain. He (and his coach) really wants to get back to pitching and is aiming to try to pitch in a tournament next month. His next follow-up appt. with the ortho is in 1 week, but thought I’d ask if anyone here could possibly shed some light on this.
Thanks!


#8

First off let me say I am not a doctor and I am not offering medical advice.

With that said, when the forearm muscles are tight the elbow compensates for poor range of motion. The elbow tendons can become inflamed causing pain in the forearm. A myriad of reasons can cause the tendons to become inflamed, such as poor throwing mechanics, tight forearm muscles, overuse, etc …

Excessive force on wrist snap can be a culprit of medial epicondylitis (degeneration of the forearm tendon). If the pain is on the inside of the forearm; see if it extends to his little finger, if so, it may be the flexor tendon.

Another culprit can be an irritated ulnar nerve or ulnar neuritis that causes pain in the forearm and a tingling sensation in the little finger.

Mention these to your doctor just in case he or she may overlook these issues.

Hope this helps,
From a former college pitcher and current pitching coach.

Keep us informed.