The Young Athlete
The elbow area is the last epiphyseal center to close so injuries can occur. “Young bones” and soft tissues can be particularly vulnerable to repetitive overload and injury.
Over the past few decades, the number of organized sports for children has grown significantly, with millions of children participating in organized athletics each year. The level of competition has also increased, along with the lure of “big bucks” funded by a media circus. It is not uncommon for young athletes to have year- round training with higher intensities at ever- younger ages.
An estimated 4.8 million children aged 5-14 years participate in baseball and softball. The incidence of all baseball-related overuse injuries is 2%-8% per year. The incidence of overuse injuries in the 9- to 12-year-old range for baseball is 20%-40%, and in the adolescent age group is 30-50%. The most common injury is Little Leaguer’s Elbow (LLE), but this group also includes traction Apophysitis of the Medial Epicondyle, Panner disease, and Osteochondritis Dissecans.
Little League Elbow (LLE)
LLE is an overload syndrome resulting from the repetitive action of softball/baseball and results in elbow pain. LLE occurs more frequently in pitchers and can result in various fractures or bone growths.
During the throwing motion, inwards (valgus) stress is placed on the elbow. This valgus stress results in tension on the medial structures (i.e., medial epicondyle, medial epicondylar apophysis, medial collateral ligament complex) and compression of the lateral structures (i.e., radial head and capitullum). Overuse occurs when the level of tissue breakdown is larger than repair. Recurrent micro-trauma of the elbow joint will often lead to Little League Elbow, a syndrome that includes:
(1) delayed or accelerated growth of the medial epicondyle (medial epicondylar apophysitis)
(2) traction apophysitis (medial epicondylar fragmentation)
(3) medial epicondylitis.
Trigger Point Therapy
There are a number of widely used treatment protocols (mostly developed in college athletics treatment rooms) which include trigger point therapy combined with specific stretching and strengthening programs. In particular, trigger point therapy applied to the wrist flexors is non-invasive and can be uniquely effective in both providing pain relief and helping to accelerate the healing process.
Remember, when treating children, you should always obtain parental consent and offer the option of a chaperone.
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