late season velocity loss

I think it's very common.

It's hard to find a pitching/rest/conditioning routine that works for any one individual pitcher. It's harder to maintain and adapt that routine through a high school season with fairly predictable usage patterns. And it's even harder to do so though the irregular schedules summer tournament play. If he plays a position, it's harder still.

Overuse might also be an issue. Your son has thrown 94 innings this year. It's only late July, and he must be very close to the rule of thumb that a pitcher should throw no more than 100 pitches times his age in any calendar year.

Also, 60 innings from the end of high school (late May?) thru the end of July is a lot of work in a short time. From looking at college summer league stats, it appears that very few college guys (older, stronger, better conditioned, more aware of their bodies) have thrown more than 40 or 45 innings over the same time period.

Best wishes,

I have to agree with Swampboy on some points made.

Your son has pitched (IMO) an awful lot since the beginning of the year for his age.

Loss of velocity, I feel is a signal that something is not right. While not necessarily an injury, his body has to be telling him to slow down.

Perhaps at this time depending on what is planned for fall, you might shut him down.

Has he lost weight over the Spring/Summer season?

Sultan...Yes, he has lost weight...about 5 lbs

Thanks for the input everyone. Forgot to mention that he also participated in a week-long camp and several showcases this summer. The IPs do add up...

Think we'll shut it down this fall and pass the time in the weight room...

Injuries can manifest themselves through lost velocity or a control loss before the pain shows up.

Loss of internal rotation of the shoulder and the dropping of the scap will cause loss of velocity and control. Is he doing sleeper stretches and blackburn type exercises?

Thanks to all who responded.

We decided to take the cautious route and visit an elbow specialist who came recommended by friends and teammates.

Seems that a bone spur has developed on the anterior side of the elbow, and had irritated something known as a "fat pad" nearby.

Doc said bone spurs are very common in pitchers. Prescribed anti-inflammatory medication and scheduled a cortisone injection. All things considered, a fortunate outcome.

quote:

Originally posted by Tribe:
Doc said bone spurs are very common in pitchers. Prescribed anti-inflammatory medication and scheduled a cortisone injection .

I am no expert at all ... but I would be careful doing this in a pitching elbow, without more information. Ask around about drawbacks of potentially weakening tendons and such.

Tribe,
Has he lost some ability to extend his arm more than the usual for pitchers? An anterior bone spur can get tied into the elbow capsule and result in lost extension and velocity. Bone spurs are very common in pitchers however anterior bone spurs are far less common than posterior bone spurs.

Interestingly, the loss of velocity I was referring to in my previous post was the result of lost extension due to a rather large anterior bone spur and there was no pain.

quote:

Originally posted by SultanofSwat:

quote:

Originally posted by Tribe:
Doc said bone spurs are very common in pitchers. Prescribed anti-inflammatory medication and scheduled a cortisone injection .

I am no expert at all ... but I would be careful doing this in a pitching elbow, without more information. Ask around about drawbacks of potentially weakening tendons and such.

I asked my son's Dr. about him getting a cortisone shot during the season last spring. He said he didn't want to do it because he would have to shut down for 8-10 days. Gave the reason that the cortisone shot actually weakens the tendons for a period of time and you really shouldn't throw durning that time. He prescribed oral cotisone instead.

I think if you have a couple of weeks to shut down after the shot, you should be OK. Don't take it if you are going to continue playing. Could be asking for trouble.

The above poster summarizes what I've heard. You shouldn't throw immediately following cortisone, and it shouldn't really be a frequent event. One time with some time off post-administration should not be a problem.

I'd be careful with oral cortisone also. You generally want to wait for at least a few days after the medicine has been completed to make sure you aren't simply masking the pain and allowing further damage to occur. I realize that professional athletes will return sooner in many cases.

Thanks everyone...I was not aware of the risks associated with cortisone injections.

We'll likely cancel the injection appointment. Seems that rest and recuperation is a better course.

Having said that, does anyone have any first or second-hand experience with elbow cortisone treatments?

Tribe,
I recommend talking to the doctor and expressing your concerns rather than summarily cancelling the injection. Local injection is often the most effective approach especially when the location and cause of the inflammation can be clearly identified.

The other options are something like a Medrol dose pack (oral cortisone equivalent) or high levels of NSAIDs over an extended period. Rest and ice are an option of course but sometimes the inflammation can feed on itself and it takes some sort of medication to knock it down in any reasonable amount of time.

sounds like a tired arm to me---rest should cure the sitution

Still wondering about the bone spur. Is it expected to dissolve or will it need to be dealt with sooner or later?

Bone spurs don't just go away. It takes surgery. Removing anterior bone spurs tends to be trickier than removing posterior bone spurs and the bone spur isn't necessarily a problem in and of itself so generally one wants to try not to have surgery. In this case, it is probably irritating something else. Anti-inflammatories may do the trick or the problem may still be there and the pain could return once the medication wears off. If that's the case then a decision will have to be made relative to surgery.

CADad:

Apparently, the spur had irritated something called a "fat pad" in the elbow.
The latest info is that anti-inflammatory meds have helped out. He's thrown a couple of pain-free pens and is scheduled to get a start this weekend. He's only thrown 4 innings (plus a few pens) since the original post, so he's getting some rest.
By the way, the ortho says that everything else seems fine with the elbow.
Regarding how we address the bone spur...I really don't know what we're going to do yet. There's never a good time for surgery, but fall of the junior year is a pretty active time for a ball player.
This forum has provided some excellent questions that I will be asking the ortho during our next visit. We did cancel the cortisone shot because 1) the anti inflammatory meds were effective and 2) there was not enough time available between the shot and a camp that he's attending.
Anyone have any experience with bone spur removal? Are they usually scoped? Recovery time?
Thanks again everybody...

When my son had his ulnar nerve moved, he had a few bone spurs cleaned out. These are very common.

I do beleive that it was not the ulnar nerve surgery but the other stuff that slowed down his rehab and progress.

Never open up anything unless you have to. Surgery is surgery.

Did he have an MRI?

First of all if the bone spur isn't causing a problem they aren't likely to remove it. There are a lot of pitchers out there who are pitching with asymptomatic bone spurs. You will certainly want to keep an eye on it in this case given that it has caused irritation as that could continue to occur.

Posterior bone spurs are more common and are relatively easy to remove by scope. Any surgery has it's risks though.

Anterior bone spurs depending on the location can be much more difficult and risky to remove, especially if the capsule is involved. Only the specialist can tell you what the risks and the recovery time are likely to be. My son, when given the option of surgery to release the capsule and remove the bone spur with a significant recovery time and no guarantee of success opted to run track.