Elbow Pitching Injuries (Continued)

He noted, “The changes were in direct proportion to the amount and type of throwing.” Torg and associates made similar observations, noting 70 percent of a group of 13 year old pitchers had symptoms about the elbow or shoulder during a season. Why are all of these elbows getting injured? Are athletes throwing too much? Should the athlete just stop throwing?

The answers to these questions come when you consider the main stabilizing forces about the joints. Because these tissues are constantly injured during pitching, they ultimately cause the condition called Little League Elbow, which encompasses a myriad of symptoms.

The medial side of the elbow takes the brunt of the force during the late cocking and the acceleration phase of the throwing motion. This can apply to any throwing motion of the elbow, including the baseball pitch, javelin throw, or tennis serve. Stability of the elbow is provided by a combination of the bony congruity provided by the articular geometry, and the capsuloligamentous structures. The main ligament supporting the medial side of the elbow is the ulnar collateral ligament (UCL). The relative contribution to elbow stability by the bony and ligamentous structures is range-of-motion dependent. With the elbow in complete extension, the UCL and bony articulation of the ulnohumeral joint each contribute 31 percent of the restraining force to resist valgus stress.

With the elbow in a flexed position, similar to the position of the elbow during peak valgus stress during the acceleration phase of the throwing motion, the bony articulation accounts for 33 percent of the restraining force to valgus stress, with 54 percent coming from the UCL.

Because of the excessive and repetitive loads imparted to the UCL in the throwing athlete, this structure requires strengthening to not only prevent medial elbow throwing injuries, but to cure them when they have already occurred.

You may be saying to yourself that other factors play a part in these injuries. We agree! Poor mechanics, lack of flexibility and conditioning, and muscular fatigue from overuse may have a cumulative effect leading to a decrease in active muscular protection of the medial elbow and, hence, greater stress is imparted to the UCL. Limiting pitching hours, physiotherapy, and good coaching will help all of the above and should be done. The fact remains that the main structure requiring strengthening is the UCL, if medial elbow pain is to be completely eliminated.

Their are various methods that you may want to explore with your health care professional. The author practices a technique known as Prolotherapy for strengthening ligaments.

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