By Dev K. Mishra, M.D., President, Sideline Sports Doc
Today I think there may have been the wrong kind of record set in my orthopedic practice: I saw a 9-year-old boy with Little League Shoulder. This is a record because prior to this 
the youngest player I had seen was a 10-year-old. This is a disturbing kind of record because we just shouldn’t be seeing pitching injuries in kids that young. The year prior this kid was in t-ball!
This youngster is lucky because his parents recognized very quickly that there was a problem, they shut him down from playing, and when the pain persisted even after three weeks of rest they sought medical care. Unfortunately for them, the reason they had the knowledge is because I took care of the player’s older brother a few years ago with his Little League Shoulder…
The Red Flags: See A Sports Physician Now
There are some things a parent must look out for, which in the medical community would be called “red flags.” If any of these are part of the story you should seek care from a sports medicine physician sooner rather than later.
- Injury started suddenly, often on a single pitch
- The player says he “heard a pop” or “felt something tear”
- Immediate swelling or bruising
- Significant pain at rest
- Inability to fully bend or straighten the shoulder or elbow on his own
Why pay attention to the red flag conditions? They are signs of a possible separation of the growth plate. Growth plate injuries need to be handled with care from the start. They rarely require surgery but elbow injuries almost always need a period of immobilization with a splint or cast, then followed by reconditioning of the arm before return to play. Shoulder growth plate injuries follow a similar pattern. When they are properly treated the young thrower has a very high likelihood of returning to play. If they are not properly treated they can lead to permanent problems and inability to play sports.
Strong words from Mike Reinold of the Boston Red Sox
I started off this post saying that we just shouldn’t be seeing pitching injuries in the very youngest players, but at the same time I don’t think these injuries are going away any time soon. Essentially, the injuries come down to overuse. My friend Mike Reinold, head physical therapist for the Boston Red Sox and former head trainer for the Red Sox wrote an excellent piece in his blog called “The Real Reason Why There Are So Many Youth Pitching Injuries”. Mike references several outstanding sources and closes with a pretty strong statement:
“Not understanding the safety guidelines is irresponsible and intentionally not following them is abuse.”
If you’re a parent or coach of a young thrower pay close attention to what you’re seeing on the field. Be very familiar with total innings pitched per year. Kids will often hide an injury, so a drop in performance should prompt you to ask questions about injuries directly. Take the initiative and take care of problems early.