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My son is 13 and is in the midst of an 8 week shut down due to little league elbow (medial epicondyle growth plate).  This is the third time he has had to be shut down from throwing.  The most recent shut down was about 2 years ago.  We thought we had fully recovered from this the second time but apparently not.  Who out here has dealt with this multiple times and when did it finally end and were there any lingering affects?

Last edited by mysonsacatcher
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Son had it 7th grade off season and freshman year during season. First time shut down for two weeks second for one week. It wasn't as bad the second time but he was more conscious of it and noticed it sooner. Doctor said it could come back anytime until the growth plate closes. He's a junior now and hasn't had a problem since. 

Scotty83 posted:

Son had it 7th grade off season and freshman year during season. First time shut down for two weeks second for one week. It wasn't as bad the second time but he was more conscious of it and noticed it sooner. Doctor said it could come back anytime until the growth plate closes. He's a junior now and hasn't had a problem since. 

Were the shorter shut down periods, as he got older, per the direction of the dr?

Last edited by mysonsacatcher
mysonsacatcher posted:
Scotty83 posted:

Son had it 7th grade off season and freshman year during season. First time shut down for two weeks second for one week. It wasn't as bad the second time but he was more conscious of it and noticed it sooner. Doctor said it could come back anytime until the growth plate closes. He's a junior now and hasn't had a problem since. 

Were the shorter shut down periods, as he got older, per the direction of the dr?

Same instruction both times. Son felt pain when he turned his hand so the instructions were to shut down till no pain. Then light throwing. If pain came back shut down 2 days and try again. If no pain work up to full throwing over a week. At anytime if pain shut back down. Both times after pain went away from being examined he threw without pain and worked up to full speed without incident. 

The second time was shorter because at the very first twinge of pain in that area my son recognized is and called the coach out to the mound then left the field. 

Also keep in mind sons return was quicker than I'd advise most. I know how to examine him and was able to constantly check. For most situations I'd wait for a return to the doctor. 

Nither time was there any injury. Just noticeable pain in the growth plate. Both cases would have lead to injury had son not stopped throwing when he felt it. First time he finished the drill (which caused a longer recovery) second time he stopped immediately. 

Oh I also put him in a wrist brace both times to help with the recovery. 

My son dealt with this at 12. We shut him down for a year and then limited him to 25-30 pitches for a year.  He was fine for 2 years but last spring his coach had him throwing 80-90 pitches a week every week.  Towards the end of tge season, elbow pain again.  We shut down for 4 weeks. We now have a doctor's note for no more than 65 pitches a week.  He also upped band work and hasn't had any trouble for the last  6-8 months.

Last edited by baseballhs
baseballhs posted:

My son dealt with this at 12. We shut him down for a year and then limited home to 25-30 pitches for a year.  He was fine for 2 years but last spring his coach had him throwing 80-90 pitches a week every week.  Towards the end of tge season, elbow pain again.  We shut down for 4 weeks. We now have a doctor's note for no more than 65 pitches a week.  He also upped band work and hasn't had any trouble for the last  6-8 months.

"shut him down for a year"  that sounds like a long time.  Was that the dr.'s recommendation or a conservative plan on your part?

mysonsacatcher posted:
baseballhs posted:

My son dealt with this at 12. We shut him down for a year and then limited home to 25-30 pitches for a year.  He was fine for 2 years but last spring his coach had him throwing 80-90 pitches a week every week.  Towards the end of tge season, elbow pain again.  We shut down for 4 weeks. We now have a doctor's note for no more than 65 pitches a week.  He also upped band work and hasn't had any trouble for the last  6-8 months.

"shut him down for a year"  that sounds like a long time.  Was that the dr.'s recommendation or a conservative plan on your part?

He said if it was his son he wouldn't have him pitch until his growth plates closed,  But he is 16 now and they are still open.  He advised if we did let him, to be very conservative.  It hasn't hurt him, he throws  hard and like our doctor said...would you rather throw at 13-14 or in hs and college. Don't get me wrong, my son was devastated at the time.  

My son (now a HS sophomore, 16 yrs old) had the same elbow issue as a 12 yr old.  We were told to shut him down at least 6-8 weeks, then start a throwing program when he could throw ~20 feet w/o pain (which was at 8 weeks, as I recall).  He did some pitching that year after the throwing program, then had similar growth plate-related issues in his shoulder.  That was near the end of the summer season, and he stopped baseball and didn't play at all that fall.

The following spring, when my son was 13, his middle school coach planned to use him as a closer to keep his inning count low.  In the second game of the season, his elbow started bothering him again.  Another 8-week shutdown.  This time he did physical therapy (which had not been recommended when he was 12).  That summer and fall he played 1B and closer--didn't have any problems (though his coaches were pretty careful with him).

Since that time, my son has been a starter throwing a moderate number of innings for school ball in spring, then summer and fall travel teams.  No problems for 2 years now (fingers crossed).  He seems to be done or very nearly done growing.

The problem years are during major growth spurts.  (My son did his fastest growing at 12 and 13.)  My advice is to find a physical therapist who has experience working with young pitchers.  Have the therapist evaluate and treat any imbalance or flexibility issues, and also get your boy in the habit of doing regular PT at home for maintenance.  Buy some 3 lb. dumb bells, therabands or whatever equipment your therapist recommends, put the gear where the boy can see it, and do a little nagging until PT becomes a habit. 

It's frustrating, but the initial pain at the inside elbow is his body warning him to stop--make sure he knows he should pay attention.  I saw a kid on my son's team play through elbow pain at 3B until his UCL pulled the growth plate away from the bone.  That required surgery and full year to recover.  

A couple of sports medicine docs told us that the issue most commonly shows up in kids who throw hard / are strong for their age--which made my son feel a little better.  Missing most of two years of pitching didn't seem to hold my son back much--he should be pitching on varsity as a soph this spring. 

I know it can be hard to keep a kid from getting frustrated and either quitting baseball or trying to throw too soon.  I told my son many times that if he wanted to stop pitching, I'd support that; but that if wanted to keep trying I would drive him to PT, see any doctors he needed, etc. as long as I could afford it and he was willing to work at it (but only if he put in the work).  There were days I thought he was going to give up, but he stuck it out.

Good luck to you and your son.  (And sorry this is so long.)

Last edited by Chico Escuela

2 other things that might help:  My son's physical therapist (who has worked with a lot of pro and college pitchers, as well as young ones) told us that my son might just need to plan on being a closer until he finished growing quickly.  That turned out to be good advice.  He also told us that growth goes in fits and starts--a kid might grow an inch in a month and then not at all for a couple of months after that.  So he actually recommended that I measure my son monthly and if he was in a period of fast growth, limit his innings.  By the time we tried this, the boy wasn't growing all that fast any more, so I don't know if it would have helped. 

 

Chico Escuela posted:

2 other things that might help:  My son's physical therapist (who has worked with a lot of pro and college pitchers, as well as young ones) told us that my son might just need to plan on being a closer until he finished growing quickly.  That turned out to be good advice.  He also told us that growth goes in fits and starts--a kid might grow an inch in a month and then not at all for a couple of months after that.  So he actually recommended that I measure my son monthly and if he was in a period of fast growth, limit his innings.  By the time we tried this, the boy wasn't growing all that fast any more, so I don't know if it would have helped. 

 

This is basically what we did with my son.  He was a closer (usually no more than an inning and a half) until last year when the HS coach had him start every week and issues returned.  He hadn't trained to throw 80-90 pitches and his body told him.

mysonsacatcher posted:

My son is 13 and is in the midst of an 8 week shut down due to little league elbow (medial epicondyle growth plate).  This is the third time he has had to be shut down from throwing.  The most recent shut down was about 2 years ago.  We thought we had fully recovered from this the second time but apparently not.  Who out here has dealt with this multiple times and when did it finally end and were there any lingering affects?

He may very well have fully recovered until it happened again. 

Make sure he is seeing a sports ortho, they are generally better than a genetic ortho.  They have seen this more and therefor have more experience.    I saw the most arm issues in 12u-13u.  It seemed like a kid a week was unable to pitch.  I also saw several go down with growth plate issues because of how they were throwing compounded with how they were growing.  Have you had his mechanics evaluated? 

Also, some kids are just stretchier than others. I've heard of not one, not two, but THREE cases where the hip growth plate caused the kids to be on crutches for more than a month, and that was just from running.  One kid refused to listen to his body and the hip growth plate actually fractured.  He was out for 3 months. 

There isn't really a great amount you can do to stop this from happening, but your son recognizing the pain and stopping will go a long way in keeping him healthy.

CaCO3Girl posted:
mysonsacatcher posted:

My son is 13 and is in the midst of an 8 week shut down due to little league elbow (medial epicondyle growth plate).  This is the third time he has had to be shut down from throwing.  The most recent shut down was about 2 years ago.  We thought we had fully recovered from this the second time but apparently not.  Who out here has dealt with this multiple times and when did it finally end and were there any lingering affects?

He may very well have fully recovered until it happened again. 

Make sure he is seeing a sports ortho, they are generally better than a genetic ortho.  They have seen this more and therefor have more experience.    I saw the most arm issues in 12u-13u.  It seemed like a kid a week was unable to pitch.  I also saw several go down with growth plate issues because of how they were throwing compounded with how they were growing.  Have you had his mechanics evaluated? 

Also, some kids are just stretchier than others. I've heard of not one, not two, but THREE cases where the hip growth plate caused the kids to be on crutches for more than a month, and that was just from running.  One kid refused to listen to his body and the hip growth plate actually fractured.  He was out for 3 months. 

There isn't really a great amount you can do to stop this from happening, but your son recognizing the pain and stopping will go a long way in keeping him healthy.

I don't think his throwing mechanics are flawed but I am no throwing expert.  Not saying his mechanics can't be improved.  In our baseball circle of friends/coaches, we are around a former high school coach, several former high level D1 players and a former minor league player.  None of them have said anything to me about his throwing mechanics being flawed so I am assuming no issues there.

CaCO3Girl posted:
mysonsacatcher posted:

My son is 13 and is in the midst of an 8 week shut down due to little league elbow (medial epicondyle growth plate).  This is the third time he has had to be shut down from throwing.  The most recent shut down was about 2 years ago.  We thought we had fully recovered from this the second time but apparently not.  Who out here has dealt with this multiple times and when did it finally end and were there any lingering affects?

He may very well have fully recovered until it happened again. 

Make sure he is seeing a sports ortho, they are generally better than a genetic ortho.  They have seen this more and therefor have more experience.    I saw the most arm issues in 12u-13u.  It seemed like a kid a week was unable to pitch.  I also saw several go down with growth plate issues because of how they were throwing compounded with how they were growing.  Have you had his mechanics evaluated? 

Also, some kids are just stretchier than others. I've heard of not one, not two, but THREE cases where the hip growth plate caused the kids to be on crutches for more than a month, and that was just from running.  One kid refused to listen to his body and the hip growth plate actually fractured.  He was out for 3 months. 

There isn't really a great amount you can do to stop this from happening, but your son recognizing the pain and stopping will go a long way in keeping him healthy.

"I saw the most arm issues in 12u-13u"  are you in the medical field....dr./PT?

mysonsacatcher posted:
CaCO3Girl posted:
mysonsacatcher posted:

My son is 13 and is in the midst of an 8 week shut down due to little league elbow (medial epicondyle growth plate).  This is the third time he has had to be shut down from throwing.  The most recent shut down was about 2 years ago.  We thought we had fully recovered from this the second time but apparently not.  Who out here has dealt with this multiple times and when did it finally end and were there any lingering affects?

He may very well have fully recovered until it happened again. 

Make sure he is seeing a sports ortho, they are generally better than a genetic ortho.  They have seen this more and therefor have more experience.    I saw the most arm issues in 12u-13u.  It seemed like a kid a week was unable to pitch.  I also saw several go down with growth plate issues because of how they were throwing compounded with how they were growing.  Have you had his mechanics evaluated? 

Also, some kids are just stretchier than others. I've heard of not one, not two, but THREE cases where the hip growth plate caused the kids to be on crutches for more than a month, and that was just from running.  One kid refused to listen to his body and the hip growth plate actually fractured.  He was out for 3 months. 

There isn't really a great amount you can do to stop this from happening, but your son recognizing the pain and stopping will go a long way in keeping him healthy.

I don't think his throwing mechanics are flawed but I am no throwing expert.  Not saying his mechanics can't be improved.  In our baseball circle of friends/coaches, we are around a former high school coach, several former high level D1 players and a former minor league player.  None of them have said anything to me about his throwing mechanics being flawed so I am assuming no issues there.

I definitely agree re: seeing a sports orthopedist.  My son and my daughter (soccer player, knee injury) each initially saw a pediatric orthopedic specialist.  He is well-regarded; but for both my kids, being subsequently seen by an orthopod who specializes in athletic injuries was far more helpful.

Mechanical flaws may not be apparent to someone watching your son throw.  A good physical therapist will check the flexibility and strength of various muscles and joints for imbalances.  I have no medical training, but have spent many, many hours dealing with doctors and therapists on orthopedic issues.  IMO a good physical therapist (with sports-related experience) is just as valuable as a good physician (and the therapist likely will spend a *lot* more time with your son).

From your screen name, I take it your son is primarily a catcher?  It's possible he will need to move to another position for a year or two.  My son was focused on pitching, but he moved from 3B to 1B (reluctantly) because the long throws aggravated his elbow.  The fast-growth years can be tough re: injuries, but they pass.  

Not to set off alarm bells, because I know "little league elbow" is not the end of the world.  Back in the day, as an RHP, I threw with a sore elbow as a youngster and in HS all the time and then was 100% pain free all through college.  But, these are different times.  I would get an MRI ASAP.  My RHP son (now a sophomore at a D1) had soreness in his inner elbow on and off from about 8th grade on.  We rested it, would shut him down as needed and he then felt fine.  I know at times he threw through some pain and even had to be shut down in HS for a couple of weeks (in a strange twist of fortune, it rained for 10 days straight and he only missed 1 start!!).  In any case, he is is now coming back from Tommy John Surgery (15 months out).  He tore his UCL two weeks after starting college, but the doctor who did his surgery said that he had a separate tear that had been there for a long time and had scar tissue around it.  I would get ahead of it.

Scott Munroe posted:

You may want to call Randy Sullivan at the Florida Baseball Ranch. He is good at eliminating arm pain.

This reminds me:  As the parent of a young player with arm pain, you will find a LOT of differing advice.  There just isn't much of a consensus out there about this stuff (even among MLB clubs and players who have millions of dollars at stake).  It can be frustrating.  Which is another reason I wish the OP all the best in deciding what to do about your son.

(No opinion intended about the comment I'm replying to here.  It just made me think about how many sources I consulted about my son, and how many different takes I got.)

mysonsacatcher posted:
CaCO3Girl posted:
mysonsacatcher posted:

My son is 13 and is in the midst of an 8 week shut down due to little league elbow (medial epicondyle growth plate).  This is the third time he has had to be shut down from throwing.  The most recent shut down was about 2 years ago.  We thought we had fully recovered from this the second time but apparently not.  Who out here has dealt with this multiple times and when did it finally end and were there any lingering affects?

He may very well have fully recovered until it happened again. 

Make sure he is seeing a sports ortho, they are generally better than a genetic ortho.  They have seen this more and therefor have more experience.    I saw the most arm issues in 12u-13u.  It seemed like a kid a week was unable to pitch.  I also saw several go down with growth plate issues because of how they were throwing compounded with how they were growing.  Have you had his mechanics evaluated? 

Also, some kids are just stretchier than others. I've heard of not one, not two, but THREE cases where the hip growth plate caused the kids to be on crutches for more than a month, and that was just from running.  One kid refused to listen to his body and the hip growth plate actually fractured.  He was out for 3 months. 

There isn't really a great amount you can do to stop this from happening, but your son recognizing the pain and stopping will go a long way in keeping him healthy.

"I saw the most arm issues in 12u-13u"  are you in the medical field....dr./PT?

Nope, just a mom who was hyper conscious of arm issues.  My son was a prime candidate.  At 12u he was already 5'7 and throwing 70mph.  He's big and throws hard are the kiss of death for arm issues.

As to the no one has told you he has issues with his throwing....have you asked?  Our society as a whole is apathetic at times.  If I saw a near high schooler throwing wonky I would think "that kid throws weird, I assume someone has told him and that's just a weird natural arm slot or something"....isn't that what you would think? Or would you think that no one had told the kid for the 6+ years and you should say something?

 At age 12 my son didn't look like he was throwing weird but he thankfully told me about his elbow pain.  Being hyper conscious I took him to a pitching instructor who isolated in two minutes that after he released the ball he was doing something weird with his arm.  Minor adjustment and poof, no more pain. Growth plate issues occur due to stress.  What's causing the stress is the issue.  Is it normal stress or is there something minor that can be changed to reduce that stress?

Sharing a couple of paragraphs from article by Mike Reinold:

"We are starting to see the results of what these kids did 10 years ago.  The excessive pitching from youth and high school baseball is catching up.  There is a lifespan on your ligament.  Many kids are injuring themselves as kids and may not even know it.  Remember that week your elbow was soreness in High School?  Yup, that may have been the beginning.

In addition to avoiding overuse, which has repetitively been proved to be the #1 factor in youth pitching injuries, youth pitchers need to proactively manage their soreness and injuries.  Don’t ignore your symptoms, get them worked on by a physical therapist."

If it were my son, I would have him see the best sports PT available (preferably one that works with a lot of overhead athletes). A good sports PT is going to test and diagnose. If there is concern, the PT will refer out to good sports ortho. If the issue can be handled in house, then PT will treat with appropriate corrective exercises and provide a prehab program to minimize further problems. Highly recommend, as others have, that you avoid pediatric/family doctors.

I would also echo CaCO3Girl's comments regarding mechanics. Just because no one has said anything does not mean there is not an issue and as you stated, you are not an expert. My son and I have personally experienced the lack of knowledge in regards to pitching mechanics by coaches/players with varying experience levels including former pro pitchers. Not one of them identified and/or provided drills that improved my son's performance or arm health as a pitcher throughout youth ball and well into his HS experience. Fortunately, we have an awesome sports PT and eventually met a pitching coach that really understands mechanics and the importance of timing. My son is now in a much better place in terms of command, velo, and arm health...and looking forward to his final HS spring season and college baseball.

Goosegg posted:

"[A]fter he released the ball he was doing something weird with his arm."

Was it the "backward C?"

The instructor told my kid what he did wrong, worked with him for 30 minutes.  Instructor and kid said they understood the problem. I paid the man and the pain went away. That's the extent of my knowledge. :- )

You all will not believe this.  My son went through with the rehab process like a champ return to play two weekends ago and looked great.  Well...this past week at the football spring game he severely dislocated the elbow of his throwing arm.  It was a horrible thing to even look at.  He had surgery yesterday morning to insert a screw to reattach the medial epicondyle.  The ortho says the way his arm (medial epicondyle) broke, probably saved the ligaments/tendons on the inner part of his elbow.  The Dr. says the ligaments on the outer part of the elbow will scar up and heal on their own.  The boy can't catch a break.  Needless to say we are faced with a much longer rehab now.  I am not sure how long and what all it will be.  We will find that part out next week when go back for a follow up.  The kid is devastated. 

I am so sorry for your son and for you.

I have been there as a parent--it is really hard.  All I can suggest is to tell your son it's ok to be upset about the injury and to encourage him through treatment and rehab.  My oldest eventually gave up competitive sports after a long string of painful freak accidents and injuries.  The "what-ifs" and "if-onlys" can be tough for an injured athlete or their parents.

I think he will be fine.  I've known several kids that suffered fractured medial epicondyle (from throwing, not from an impact injury such as yours).  In each case (with and without surgical repair) the athletes experienced full recovery and had excellent throwing velocity as they matured.  Neither of these kids pitched but I'm not sure that would have mattered.  My recollection is that recovery was on the order of 4 months to begin throwing program and 6-8 months before game ready.  PT was essential and really needs to be done diligently to restore full range of motion.

Smitty28 posted:

I think he will be fine.  I've known several kids that suffered fractured medial epicondyle (from throwing, not from an impact injury such as yours).  In each case (with and without surgical repair) the athletes experienced full recovery and had excellent throwing velocity as they matured.  Neither of these kids pitched but I'm not sure that would have mattered.  My recollection is that recovery was on the order of 4 months to begin throwing program and 6-8 months before game ready.  PT was essential and really needs to be done diligently to restore full range of motion.

We will do what ever is needed and will stay the course.  I am just hoping my son will not lose faith and will work through the pain of therapy.  He just needs to know that the outcome can be a positive situation.  If he knows that, then I believe that he will be able to motivate himself.  This will be a massive test of his patience, desire and toughness.  He and I came up with a new saying: "There isn't but one way to eat an elephant.......one bite at a time"

mysonsacatcher posted:
Smitty28 posted:

I think he will be fine.  I've known several kids that suffered fractured medial epicondyle (from throwing, not from an impact injury such as yours).  In each case (with and without surgical repair) the athletes experienced full recovery and had excellent throwing velocity as they matured.  Neither of these kids pitched but I'm not sure that would have mattered.  My recollection is that recovery was on the order of 4 months to begin throwing program and 6-8 months before game ready.  PT was essential and really needs to be done diligently to restore full range of motion.

We will do what ever is needed and will stay the course.  I am just hoping my son will not lose faith and will work through the pain of therapy.  He just needs to know that the outcome can be a positive situation.  If he knows that, then I believe that he will be able to motivate himself.  This will be a massive test of his patience, desire and toughness.  He and I came up with a new saying: "There isn't but one way to eat an elephant.......one bite at a time"

He's still very young in the scheme of things, and even though it's a bad time of year and he'll miss this season, the good news is that it's bone (which heals 100%) and the ortho said good things about his ligaments.  When he's 15/16 and playing all this will be ancient history, and the break at 13 may have the effect of re-energizing his hunger.

My son has above average ability.  He is very athletic, not only in baseball but also in other sports.  As a dad, you think there may be some baseball for him after high school.....maybe junior college.....maybe 4 year. Now you are just hoping he can play the game again at all and if he can't, how do you deal with this?  Baseball is his love and to think it could possibly be over is a very tough pill to swallow. 

mysonsacatcher posted:

My son has above average ability.  He is very athletic, not only in baseball but also in other sports.  As a dad, you think there may be some baseball for him after high school.....maybe junior college.....maybe 4 year. Now you are just hoping he can play the game again at all and if he can't, how do you deal with this?  Baseball is his love and to think it could possibly be over is a very tough pill to swallow. 

It's not the end of the world.  You tell him baseball ends for everyone at some point in time.  You get him to try other activities....chess, graphic design, go kart racing....whatever.  Lots of stuff to do in life.  I live baseball, whether my kid is playing or not, it's just an amazing game.  But if it ended tomorrow we would find other things to do.  It's not healthy to obsess over one thing, not even a girl, and not even a sport you/he love.  If it's over it's over.  

I will add, that this is your sons arm for the rest of his life.  Be very careful and do NOT push it, even if he wants to push it.  Having a 30 year old unable to play catch with his son because he messed up his arm at age 13 is ridiculous.  Keep that in mind.

mysonsacatcher posted:

My son has above average ability.  He is very athletic, not only in baseball but also in other sports.  As a dad, you think there may be some baseball for him after high school.....maybe junior college.....maybe 4 year. Now you are just hoping he can play the game again at all and if he can't, how do you deal with this?  Baseball is his love and to think it could possibly be over is a very tough pill to swallow. 

Try to keep everything in context.  He is young.  I know it feels like missing 6 months or a year or whatever they recommend will set him back, but it is short in the scheme of things.  You also need to make sure you are reinforcing the fact that he is more than an athlete, more than a baseball player.  Kids do have to give it up all the time, and they need to realize they are valuable for a multitude of reasons that have zero to do with sports.

mysonsacatcher posted:

Went to DR this morning for follow up and things are looking good  got him out of the cast and into a lockable brace (locked at 90 degrees).  Will start therapy this week or next.  Will go to therapy 2-3 days a week for 4 weeks.  Screw looks good and the scar was HUGE.

There are lotions/creams to reduce the scars appearance.  Visit your local pharmacy and ask for a recommendation.  I have an 8 inch scar at my ankle. but am finally comfortable wearing flip flops and shorts.

mysonsacatcher posted:

Went to DR this morning for follow up and things are looking good  got him out of the cast and into a lockable brace (locked at 90 degrees).  Will start therapy this week or next.  Will go to therapy 2-3 days a week for 4 weeks.  Screw looks good and the scar was HUGE.

Sorry to hear about your son's injury. If he needs a little extra motivation at some point, and you're so inclined, the promise of a nice tattoo for that scar might help.

MidAtlanticDad posted:
mysonsacatcher posted:

Went to DR this morning for follow up and things are looking good  got him out of the cast and into a lockable brace (locked at 90 degrees).  Will start therapy this week or next.  Will go to therapy 2-3 days a week for 4 weeks.  Screw looks good and the scar was HUGE.

Sorry to hear about your son's injury. If he needs a little extra motivation at some point, and you're so inclined, the promise of a nice tattoo for that scar might help.

we have already looked at options.

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