With the spring sports season well under way, besides an increase of sunshine, there is usually an increase in injuries as well and baseball players in little leagues are no exception. Overuse injuries from constant repetitive motions are a common injury, but does that mean less play time is the answer? Not necessarily. According to Dr. R. Scott Cook, a sports medicine physician at Commonwealth Orthopaedic Associates in Exeter, Pa., these injuries are preventable with better education and throwing skills.

Cook recently spoke at the American Osteopathic Academy of Sports Medicine annual conference held here in Philadelphia on "Scholastic Baseball Overuse Injuries". He discussed the different types of overuse throwing injuries like lateral epicondylitis, extensor tendonitis, radiocapitellar osteochondritis and "Golfers' Elbow" also known as "Little Leaguer's Elbow" and how to diagnose and treat them, but his big message was the importance of teaching young athletes the right way to throw so that they are less susceptible to getting injured.

"Young athletes need to realize that they should throw the same way on the mound that they do when playing catch with their dad," Cook said during his presentation.

He talked about the benefits of a pitching analysis and of learning proper exercises to help prevent overuse injuries. He recommended to his audience of sports medicine physicians that when seeing a young athlete for an overuse throwing injury, that it is important to teach them stretches to do ongoing to prevent future problems not just for during the current injury.

Cook believes that the biggest battle sports medicine physicians face when treating these patients is that once they rest a little and feel better, they think they can go right back out on the field. But once they are out there again, the pain quickly comes back.

Good communication

Kids face peer pressure from their teammates and they are afraid of letting their coach down. Another challenge is that many kids play on multiple leagues, and often the coaches are not aware of how much play time a kid is getting. Parents also have difficulty giving clear answers on when their child started to feel pain.

Cook said to his audience, "Communication is where the breakdown is, but we continue to hope that it gets better. Communication and documentation between you, the parent and the coach is important."

"We need to teach kids that there are things they can do to build strength and prevent injuries," he said.

Proper technique and conditioning

Dr. Michael Ciccotti, director of the sports medicine team at the Rothman Institute, professor of orthopaedic surgery, chief of sports medicine and director of the Sports Medicine Fellowship at Thomas Jefferson University, also spoke at the conference. His presentation was specifically about elbow injuries. As head team physician for the Philadelphia Phillies for the past 23 years, he has seen an epidemic of elbow injuries in professional baseball.

"This has prompted us to look at collegiate, high school and youth levels as well and what we are finding is that overuse is one of the primary risk factors. Young athletes play because they love the sport and want to be great. They just want to be on the field throwing the ball, and parents want their kids to be successful, so they think that more is better," he explained in a phone interview.

"But what we are realizing is the 'more' puts more stress on the musculoskeletal structure and can create overuse injuries."

Ciccotti also explained that the other main factors in these types of injuries are technique (the way they throw the ball or swing the bat) and conditioning of the musculoskeletal structure for strength and flexibility, which is important because these young athletes are still growing.

"There has been an effort among medical and health providers in sports medicine to prevent these types of injuries, and not just in baseball, but in all sports medicine."

The American Orthopaedic Society for Sports Medicine sponsors a website STOP Sports Injuries to give guidelines on preventing injuries. On it, they offer resources on risk factors, proper technique and conditioning exercises.

For youth baseball players, Major League Baseball's Pitch Smart website is another good resource. They have found pitch counts to be an effective way to set workload limits for pitchers. For example, for players ages 7-8, the recommended daily maximum pitch count is 50.

Ciccotti said that at the Rothman Institute they are developing injury prevention techniques for all sports. He is also a part of a Major League Baseball prospective study which is beginning to look at risk factors of baseball player injuries. "The goal is to prevent injuries. We want to keep these players on the field playing as long as they want."

"The majority of injuries in baseball are in the upper extremities like the shoulder and elbow, so it is really important for throwing athletes to have good flexibility."

"When you throw a ball, the core muscles are incredibly important so sit ups and crunches are good for the abdominal muscles and general cardio conditioning like running, biking and cardio machines are effective as well."

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