Chronic elbow soreness advice

How are you sure he is mechanically sound?

There are two things that cause the vast majority of arm pain - either throwing too much, or not throwing properly.

It doesn't appear he is throwing what would be considered "too much", so I would go with - he's not throwing properly.

For anyone in the South, I always suggest they reach out to Randy at the Florida Baseball Ranch when they have throwing pain issues.  Very knowledgeable with the diagnosis and correction of mechanical flaws. 

Rob T posted:

How are you sure he is mechanically sound?

There are two things that cause the vast majority of arm pain - either throwing too much, or not throwing properly.

It doesn't appear he is throwing what would be considered "too much", so I would go with - he's not throwing properly.

For anyone in the South, I always suggest they reach out to Randy at the Florida Baseball Ranch when they have throwing pain issues.  Very knowledgeable with the diagnosis and correction of mechanical flaws. 

 

Several knowledgeable baseball people have told me that he's mechanically but that doesn't mean he is.  I am looking for answers so am open to more evaluation. 

I coached a player about that same age (12/13) a few years ago that was a big kid for his age and threw hard. He also had elbow growth plate issues that caused him arm pain that wouldn't subside.

If I remember correctly, the dr. told him that what was causing it was the muscles used to decelerate his arm were not as developed as those that were accelerating the arm (the ones used to throw so hard). This lack of decelerating ability was putting too much stress on the growth plate area of his elbow and causing the pain.

He was shut down for the entire season from all throwing, and was only able to hit for us. He found first base and fell in love with that, and really never had any desire to get back on the mound once he physically matured/recovered.

Seek out a sports physical therapist-kinesiologist type in your area.  We've been working with one for years and it really makes a difference to check if your hips are aligned (growth, poor posture, previous injury).  We'd find this created a lot of tension up through his shoulders, which would restrict his throwing capability.

Because of growth there's a lot of push pull going on with ligaments & tendons, and muscle development to provide joint stability. (Independent of growth plates)  My son is 16 and a SS/RHP, we dealt with this two years ago.

This sports therapist taught my son how to do apply acupressure in his forearm and bicep to "activate" the area prior to throwing; he was also taught some basic band work that does the same type of activation prior to throwing.  It was also a time to check his throwing mechanics.  

It has made a world of difference to his physical health year around, especially during the season. I get my son into see this guys once or twice a month simply as a preventative measure.

Thanks Buzzard - Just the opposite here - hates playing first base baseball because he's always played there and has now fallen in love with playing the outfield. 

@Gov - Thanks for the info! Ironically, he is dealing with a growth plate issue in his hips (iliac apophysitis) right now as well, so that may be the issue. I think I am going to seek out a sports therapist as you suggested. He has been and continues to grow so I am sure that things in his kenitic chain are out of whack. 

hshuler posted: 

Several knowledgeable baseball people have told me that he's mechanically but that doesn't mean he is.  I am looking for answers so am open to more evaluation. 

My son was in the same boat at that age.  He had worked with a few different pitching coaches - guys from local bucket sitters to former MLB pitchers.  They all said he had "good" mechanics, and I didn't know any better really. Then he started having elbow issues, and eventually missed his freshman spring season due to tendonitis. 

It was recommended to me by a poster here that I should speak to the guys at the Armory, and have them take a look at my son's mechanics.  Our first time there, they showed us how many of the things my son was doing were contributing to his pain.  Most of things wouldn't be evident unless you looked at high speed video with an experienced eye.

After following their advice and making changes, my son has never had any further elbow pain.

The point being, if the experts you have worked with in the past didn't notice a problem - but it is pretty evident that there is something going on, well...  you probably need to find different experts.  

When he pitched for the first time again (the Sunday outing), how many innings, how many total pitches, did he warm up properly, and how many pitches per inning were thrown.  Having not pitched or done any pitch specific conditioning, can be an issue when coming back to the mound.  Maybe too much too soon.  When my youngest, took the winter off to Swim & Dive, and pitched this Spring,  he talked to his coaches about his arm and shoulder soreness (happens to him every year with any kind of layoff from throwing).  He is able to work his way through it by continued throwing, but no bull pens or pitching until the pain goes away.  For my son anyway, he is able to work his way back over several weeks to a point where he can pitch again and typically has no other discomfort.  I also agree with the deceleration muscles need to be worked heavily - seated rows, shrugs, and deadlifts - the brakes need to be in top shape.

Rob T posted:

hshuler posted: 

Several knowledgeable baseball people have told me that he's mechanically but that doesn't mean he is.  I am looking for answers so am open to more evaluation. 

My son was in the same boat at that age.  He had worked with a few different pitching coaches - guys from local bucket sitters to former MLB pitchers.  They all said he had "good" mechanics, and I didn't know any better really. Then he started having elbow issues, and eventually missed his freshman spring season due to tendonitis. 

It was recommended to me by a poster here that I should speak to the guys at the Armory, and have them take a look at my son's mechanics.  Our first time there, they showed us how many of the things my son was doing were contributing to his pain.  Most of things wouldn't be evident unless you looked at high speed video with an experienced eye.

After following their advice and making changes, my son has never had any further elbow pain.

The point being, if the experts you have worked with in the past didn't notice a problem - but it is pretty evident that there is something going on, well...  you probably need to find different experts.  

Point taken...and I did say knowledgeable, not experts. :-) 

The folks from the Armory came up to work with our team in the fall but he was playing football at the time and missed it. 

Thanks for the info!

2forU posted:

When he pitched for the first time again (the Sunday outing), how many innings, how many total pitches, did he warm up properly, and how many pitches per inning were thrown.  Having not pitched or done any pitch specific conditioning, can be an issue when coming back to the mound.  Maybe too much too soon.  When my youngest, took the winter off to Swim & Dive, and pitched this Spring,  he talked to his coaches about his arm and shoulder soreness (happens to him every year with any kind of layoff from throwing).  He is able to work his way through it by continued throwing, but no bull pens or pitching until the pain goes away.  For my son anyway, he is able to work his way back over several weeks to a point where he can pitch again and typically has no other discomfort.  I also agree with the deceleration muscles need to be worked heavily - seated rows, shrugs, and deadlifts - the brakes need to be in top shape.

38 pitches total...

So, if I am reading correctly, no one who's responded thinks that he could just be throwing harder than his arm can physically handle as his ortho suggests?

I think that could be one of the possibilities.  I've seen kids arms come apart and always thought they were able to throw harder than their body can handle.   I've posted this in other threads.  Four kids in a winter pitching clinic, three were throwing much harder than a typical above average pitcher (according to the instructor who is well known, called them genetic freaks of nature).  The fourth kid, my youngest, throws about average, the others can't pitch any longer - all had surgery to correct elbow issues.   Just an observation and when I was a kid, I could throw hard enough to feel my elbow separate and go back together.  Fingers and forearm would tingle.  I was aware enough to stop throwing that hard, but just barely.

If the 38 pitches was in one inning, that is too much.

hshuler posted:

38 pitches total...

So, if I am reading correctly, no one who's responded thinks that he could just be throwing harder than his arm can physically handle as his ortho suggests?

I think that in a way can be partly to blame.  My son's doctor said that rapid muscle gain may have been a contributing factor to his issues.  The connective tissues just hadn't caught up yet.

The PT we were working with put it this way - it wasn't that my son was throwing too hard, it's that he's throwing too hard for the way he's throwing, with the equipment he has.

Rob T posted:

hshuler posted:

38 pitches total...

So, if I am reading correctly, no one who's responded thinks that he could just be throwing harder than his arm can physically handle as his ortho suggests?

I think that in a way can be partly to blame.  My son's doctor said that rapid muscle gain may have been a contributing factor to his issues.  The connective tissues just hadn't caught up yet.

The PT we were working with put it this way - it wasn't that my son was throwing too hard, it's that he's throwing too hard for the way he's throwing, with the equipment he has.

Got it, thanks...and I've already placed a call to a therapist.

As others have said, find a physical therapist.  He need to strengthen everything around the elbow and shoulder.  They'll put him thru the throwers ten type exercises.  It should help.  Good luck. 

Golfman25 posted:

As others have said, find a physical therapist.  He need to strengthen everything around the elbow and shoulder.  They'll put him thru the throwers ten type exercises.  It should help.  Good luck. 

Thanks!

Inevitably, it is mechanical, and there is a flaw somewhere in the movement chain.  Could be as low as the ankle/foot, where the mechanics are off, and is not able to land correctly.  Could be (and most likely is) a glenohumeral internal rotation deficit at the shoulder.  Could be a limitation in the wrist, spine, or hip.  A good therapist can find these things.  Any abnormalities outside the elbow itself, will stress the elbow.  Growing and having soft bones, just makes these things show up more quickly.  However, if it were simply growing and soft bones, all kids would hurt, right?  

Ohio Dad posted:

Inevitably, it is mechanical, and there is a flaw somewhere in the movement chain.  Could be as low as the ankle/foot, where the mechanics are off, and is not able to land correctly.  Could be (and most likely is) a glenohumeral internal rotation deficit at the shoulder.  Could be a limitation in the wrist, spine, or hip.  A good therapist can find these things.  Any abnormalities outside the elbow itself, will stress the elbow.  Growing and having soft bones, just makes these things show up more quickly.  However, if it were simply growing and soft bones, all kids would hurt, right?  

 

Glenohumeral internal rotation deficit at the shoulder? Dude - Now you're just messing with me. :-)

Regarding your "if it were simply growing and soft bones, all kids would hurt, right?" question, my ortho said he tends to see harder throwing kids versus the opposite. It's not just about throwing but throwing hard. It seems to be universally accepted that higher velocity means greater risk, so not sure why it wouldn't apply here?

Please understand that I am here for answers because obviously I am frustrated with the recurring issue. I wanted to see if anyone else has experienced a similar situation with their son and if so, what worked. As I said earlier, I have already called a therapist so I sincerely appreciate the help. 

Having had a son who threw very hard for his size, (he did not truly begin to grow until his junior year in HS) with very good mechanics, we went through 2 periods of growth plate challenges from ages 12 through 15, I would look at this in a risk reward type analysis.

If the ortho has properly captured the diagnosis as being growth plate connected, throwing and throwing hard is one possible contributor to delayed union and a prolongation of that process. It is also a potential contributor to some of the other  elbow conditions which can be secondary the forces connected with pitching when there is  the lack of fusion of the plates.

There is also a further risk of damage to the plates including separation and/or actual fracture and fracture with avulsion. I don't think any parent wants to run a risk of hearing a sports orthopedist talking about a need for surgery, which can happen.

The one known approach to allow the fusion to occur is to not throw/rest.

Luckily, in our family, after we received solid medical advice, my wife insisted on no throwing.  Even then, there was  a recurrence as a HS freshman.  That led to a much longer period of no throwing.  It also resulted in the plates healing, fusing and our son playing through college and Milb with no further elbow issues.

Using our experience and and a risk-reward approach, no throwing would be at the top of the list, when one looks at the longer term upside and the shorter term risks. This includes a consideration of a very talented  peer of our son who ended up with a shortened baseball career when his growth plates did fracture and the avulsion results impacted his healing and throwing.

infielddad posted:

Having had a son who threw very hard for his size, (he did not truly begin to grow until his junior year in HS) with very good mechanics, we went through 2 periods of growth plate challenges from ages 12 through 15, I would look at this in a risk reward type analysis.

If the ortho has properly captured the diagnosis as being growth plate connected, throwing and throwing hard is one possible contributor to delayed union and a prolongation of that process. It is also a potential contributor to some of the other  elbow conditions which can be secondary the forces connected with pitching when there is  the lack of fusion of the plates.

There is also a further risk of damage to the plates including separation and/or actual fracture and fracture with avulsion. I don't think any parent wants to run a risk of hearing a sports orthopedist talking about a need for surgery, which can happen.

The one known approach to allow the fusion to occur is to not throw/rest.

Luckily, in our family, after we received solid medical advice, my wife insisted on no throwing.  Even then, there was  a recurrence as a HS freshman.  That led to a much longer period of no throwing.  It also resulted in the plates healing, fusing and our son playing through college and Milb with no further elbow issues.

Using our experience and and a risk-reward approach, no throwing would be at the top of the list, when one looks at the longer term upside and the shorter term risks. This includes a consideration of a very talented  peer of our son who ended up with a shortened baseball career when his growth plates did fracture and the avulsion results impacted his healing and throwing.

 

Thanks for the insight. It tends to only bother him when he pitches so I will do what we've been doing for the last several years. No pitching...and physical therapy!