Strengthening Elbow (13yo)

I am not a doctor but I do know that at 13 years of age the growth plates are not complete in growth

Dr. Hit
I could actually see this in the xrays

cball

I said I was not a doctor---

Glad you can read X rays that well but nowhere is it mentioned regarding the growth plates---

Exercises aimed at the shoulder are pretty common. The doctors/therapist want the shoulder stronger to take stress away from the elbow. When the shoulder tires, it puts far more stress on the elbow. I would stick with what they are telling you.

I can only read them when a Doc is standing there pointing out whats what.

Tx-Husker, that's the problem. Doc is not recommemding any exercises, he's just saying we need to get the elbow stronger. How to?

A good source for exercises is the American Sports Medicine Institute (ASMI). They are affiliated with (Dr. James) Andrews Sports Medicine and Orthopaedic Center.

ASMI puts out two publications that have exercises for both the shoulder and elbow. Both can be found on the ASMI web site www.asmi.org

CONDITIONING PROGRAM FOR BASEBALL PITCHERS, 2nd Edition.
Loftice JW, Fleisig GS, Wilk KE, Reinold MM, Chmielewski T, Escamilla RF, Andrews JR
With this top-conditioning plan you can train like the pros or enhance your program. This book has been specifically designed for the pitcher but the concepts apply to all baseball players. The second edition of this book contains a completely updated and revised program based on recent advances in the understanding and care of baseball pitchers. Included are explanations, illustrations, and charts for a year-round program.

PREVENTIVE & REHABILITATIVE EXERCISES FOR THE SHOULDER & ELBOW, 6th Edition
Wilk KE (ed)
This book provides information on preventive and rehabilitative exercise routines for athletes, coaches, andeven parents. Learn from descriptions and illustrations on how to properly utilize various stretching,strengthening, and plyometric exercises. Detailed information is also provided for the interval-throwing program (adults and youth) including golf, tennis, and racquetball.

This is what ASMI suggests with their "throwers 10" it is mostly targeted at the shoulder but develops the arm and "elbow" area also. Frankly the only cure for tendonitis is NO throwing at all, so I am not sure about your Dr's experience with baseball players. I am also not sure what strengthening “the elbow” means.

I am not a Dr but my experiences suggests you not throw AT ALL for 2 weeks and do the throwers 10 daily and he should be OK.


http://www.asmi.org/SportsMed/throwing/thrower10.html

1st & 3rd
BOF

Thanks

cball,

Your doc should have given you a protocol to follow or at least referred you to a Physical Therapist.

If he just said "go strengthen the elbow" (which is a VERY braod term and really has no meaning) I highly suggest you go elsewhere and find someone who will work with you through the entire process.

This isn't something you should be searching around for. It should be provided to you by medical and health professionals.

cball...there are lots of PTs that focus on throwing related injuries/recovery. What part of Texas are you in? If you're in the Dallas/Ft. Worth area, you could call either John Conway or Keith Meister's office and ask them for a PT recommendation near you. They only work with solid PTs. They could probably also get you a recommendation elsewhere as well.

There are plenty of exercises focused on strengthening the shoulder and elbow. My son's going through them now. His PT showed him what/how to do them and gave him photo copies of the ones he wanted done at home. Don't do it on your own...get some direction.

Let me back up a little. Our last visit was to review his MRI and that's were the "we need to strengthen the elbow" discussion began. Previous to that we did have a cortisone shot and PT. WE are in the Houston area and the Doc we are seeing is fairly well regarded but his specialty is knees. We tried to get an appointment with the Astros Doc (name escapes me) but he doesn't accept our insurance. Right now we are on a precription anti inflamatory, have a neoprene commpression sleeve and are icing after practice and games and also taking Advil. I might get with his coach to see if we can just EH for a while and shut down his throwing for a few weeks.

13 and on anti-inflammatory AND Advil?

this was the diagnosis:

Medial Epicondylitis (Golfer's and Baseball Elbow)
What is medial epicondylitis?
Medial epicondylitis, also known as golfer's elbow, baseball elbow, suitcase elbow, or forehand tennis elbow, is characterized by pain from the elbow to the wrist on the palm side of the forearm. The pain is caused by damage to the tendons that bend the wrist toward the palm. A tendon is a tough cord of tissue that connects muscles to bones.

What causes medial epicondylitis?
Medial epicondylitis is caused by the excessive force used to bend the wrist toward the palm, such as swinging a golf club or pitching a baseball. Other possible causes of medial epicondylitis include the following:

serving with great force in tennis or using a spin serve
weak shoulder and wrist muscles
using a too tightly strung, too short, and/or too heavy tennis racket
throwing a javelin
carrying a heavy suitcase
chopping wood with an ax
operating a chain saw
frequent use of other hand tools on a continuous basis
What are the symptoms of medial epicondylitis?
The following are the most common symptoms of medial epicondylitis. However, each individual may experience symptoms differently.

The most common symptom of medial epicondylitis is pain along the palm side of the forearm, from the elbow to the wrist, on the same side as the thumb. The pain can be felt when bending the wrist toward the palm against resistance, or when squeezing a rubber ball.

The symptoms of medial epicondylitis may resemble other medical problems or conditions. Always consult your physician for a diagnosis.

How is medial epicondylitis diagnosed?
The diagnosis of medial epicondylitis usually can be made based on a physical examination. The physician may rest the arm on a table, palm side up, and ask the patient to raise the hand by bending the wrist against resistance. If a person has medial epicondylitis, pain usually is felt in the elbow.

Treatment for medial epicondylitis:
Specific treatment for medial epicondylitis will be determined by your physician based on:

your age, overall health, and medical history
extent of the condition
your tolerance for specific medications, procedures, and therapies
expectation for the course of the condition
your opinion or preference
Treatment for medial epicondylitis includes stopping the activity that produces the symptoms. Treatment may include:

ice pack application (to reduce inflammation)
strengthening exercises
anti-inflammatory medications
surgery

quote:

Originally posted by Jon Doyle:
13 and on anti-inflammatory AND Advil?

maybe once a week on the advil-when he complains about pain. daily on the anti-inflamatory until it's gone. about two more weeks.
Sometimes his complaint isn't nessesarliy pain but what he descrides as a dead arm feeling, like he has to put extra effort to make a throw.

I should also point out this kids coach (me) always counted pitches from 9U on and did not allow breaking pitches until 13. Very sparingingly then.
He has not thrown/pitched too much.
I think what may be causing a problem is we did not throw enough last fall and frankly didn't have a true well planned long toss regimen.

After this that's going to change.

quote:

THE KIDS TODAY DO NOT THROW ENOUGH !!!!!

I agree with that statement.

The treatment for medial epicondylitis is complete rest for a long time followed by an extremely gradual return to throwing. It is very common for players to try to return to throwing too quickly and cause chronic problems.

He needs to be shut down from throwing for 7 to 8 weeks and then needs to return to throwing very gradually, almost as gradually as one would return from TJ rehab. It is very possible that returning to throwing too quickly after not throwing for a while caused the problem. However, the solution is shutting down, letting the injury heal and then returning very carefully to throwing. Once it has healed then throwing on a regular basis is a good thing and resting for a few weeks each year is also a good thing as long as you are careful about the return to throwing.

The fact that he is icing after games and practices means that you haven't shut him down and are trying to play through the problem. That's a big mistake.

After it has fully healed and you start the gradual return to throwing program then rice bucket exercises and stretching are good for this type of condition.

quote:

The fact that he is icing after games and practices means that you haven't shut him down and are trying to play through the problem. That's a big mistake.

CADad
Thanks for the advice, but that's what his doctor said to do.
We're quickly approaching a decision point as the pre-high teams try out on May 17 and a summer program run by area high schools coaches are putting teams together now. He's already been offered a spot there.
I'm relying on a board certified orthopdedic surgeon who has seen him several times, done X-rays and an MRI.
Maybe time for a second opinion.

quote:

Treatment for medial epicondylitis includes stopping the activity that produces the symptoms.

There's what you posted. Advice you get on a board like this is enough to provoke thought and perhaps question your doctor's advice, but you should never put advice you get online ahead of what the doctor tells you.

I can certainly believe he's being told to ice after games, etc. but I have to wonder if that advice was given because you insisted he was going to play and he just wanted to minimize the damage.

My recommendation is that you go onto asmi.org and relate your son's treatment for medial epicondylitis on their forum. If nothing else they can refer you to a doctor who is intimately familiar with throwing related injuries in your area just in case you want to get a second opinion.

quote:

Originally posted by CADad:

quote:

Treatment for medial epicondylitis includes stopping the activity that produces the symptoms.

There's what you posted. Advice you get on a board like this is enough to provoke thought and perhaps question your doctor's advice, but you should never put advice you get online ahead of what the doctor tells you.

I can certainly believe he's being told to ice after games, etc. but I have to wonder if that advice was given because you insisted he was going to play and he just wanted to minimize the damage.

My recommendation is that you go onto asmi.org and relate your son's treatment for medial epicondylitis on their forum. If nothing else they can refer you to a doctor who is intimately familiar with throwing related injuries in your area just in case you want to get a second opinion.

CADad,
Thanks again I am going to try to find another opinion and have asked a high school coach for a recommendation.
I never insisted to the doc that we had to keep playing. As hard as it will be to shut down we will do it if we're told to by the doc.
I would rather miss this summer's baseball than to risk a more serious setback later. He's just a 13YO 8th grader now with a lot of baseball ahead. Hopefully. Thanks.


edit: CADad I went to the ASMI site you mentioned. Thanks for the headsup

cball,

I am sorry to hear of your son's injury, as I know too well how hard it is for them when this happens.

When my son was a few months shy of 12YO and just prior to a growth spurt, he fractured the growth plate and partially tore the MCL in his throwing elbow while pitching his first inning in an April scrimmage game.

He was first put in a removable cast by ortho for 3 weeks. She then said he could start light throwing at that point. My wife and I thought that was a bit aggressive, but we deferred to her expertise. Well, after missing the first 3 games, he came back for a game, but injured it again - on a swing, not a throw.

He was told to rest it for 3 more weeks, which we extended to 5. After that, he came back and finished the rest of the season, playoffs and All-Stars. Obviously, no pitching, and only at 2B the rest. By the time All-Stars ended, we were just playing catch in the yard and he said it still hurt. So he DH'ed only during Fall Ball and we found a new ortho.

He recommended that my son shut down completely from all throwing (incl. football, gym class, etc.) for 3 months - which he did (and he became pretty adept at throwing lefty in gym class ). Then he did some light physical therapy for 3 weeks and was sent home and told to continue the stretching, tubing and light dumbbells every day through the winter. He faithfully complied and maybe missed a day or 2 per week.

So I wholeheartedly agree w/ the advice to shut him down completely for some period of time, then do some physical therapy to learn the proper form to do the tubing stretches, then continue from there.

Good luck.

Just to update.
We followed a conservative approach where we did not pitch at all and limited throwing by amount and distance. We caught a few breaks where he was in between teams and had some total shutdown time.
We have done the band work and the throwers 10 and it seems to be working.
Just completed a tryout for pre-high team where they did a lot of throwing and he said he had no pain at all.
I hope we have turned the corner and it's behind us because a total shutdown was looming if he continued to have pain.

cball,
I'm sorry for the delayed response, but I wanted to add a couple things for you to think about as your son continues his baseball career. Some of the best exercises for the elbow (atleast in my experience)will be done in a Rice Bucket. Most of these exercises are great for getting blood flow to the area around the elbow. When he gets older and gets on a lifting program there are 2 exercises that I would recomend. I like to superset Standing Wrist Curls (a Forearm exercise) with Reverse Pressdowns (a Tricep exercise). This combination does a great job strengthening this area. I hope this helps & Good Kuck in the future - Kerry

Thanks
We did see another doc and got another opinion. Pronator tendonitis. Same therapy including ultra sound. Plan is no throwing from July 15 until after Thansgiving. He's now playing football and fall baseball as an EH only.
Hope this much rest will do the trick.

When you go back into throwing , make sure you ease into it. I would maybe even just throw a tennis ball the first day. Give at least 1 day rest between throws maybe 2-3 days inthe first week. No throw hard or long toss until 4-6 throwing sessions. imo

LAball
You can bet on it. Don't want thos lingering around right when he needs to be ready for HS ball.

Best doctor for elbows/shoulders in Houston,TX is David Lintner. I went to 3 differents sport medicine orthos for my son until I found Lintner, big difference!

Texan01
Yeah we called Dr. Lintner's office and unfortunatly he doesn't take our insurance. We found a good one though. Tendonitis is a strange deal and can be much more serious than I previously thought.

The elbow pain means:
1 there is/are flaws in his delivery
2 he is over used - pitching or throwing too much
3 he is not conditioned well enough

We strongly suggest he get a biomechanical analysis on his pitching/throwing. It is the only scientific way to detect flaws.

Want to know Mariano Rivera's training approach... click here and watch https://3psports.com/videos/mangold-on-rivera/