Kerlan-Jobe Orthopaedic Clinic Physician Discusses Little League Injuries

March 2006

Dr. Neal ElAttrache is a Member of the Centinela Freeman Medical Staff

Daily Breeze

Pitcher Perfect

Year-round baseball in Southern California is causing more injuries in Little League players

By Lee Peterson

DAILY BREEZE

Spring is here, which means Little League is well under way. But for the youngest athletes, it's always baseball season.

Thanks to Southern California's weather, young baseball players are throwing, catching and batting year round.

And consequently, many are wearing out their young arms and shoulders.

When it comes to young pitchers, overuse injuries are happening at a particularly alarming rate, said Dr. Neal ElAttrache, director of sports medicine at the Westchester-based Kerlan-Jobe Orthopaedic Clinic. It's happening despite rules in Little League, other youth leagues and schools that limit the number of innings individual players can pitch each week.

"In the warmer parts of the country, there is a specific trend toward year-round participation, more than one league and more than one team at a time," ElAttrache said.

Players will attend baseball clinics and try out for traveling teams at special "showcase" tryouts, compounding the overuse, he said. Then they will go out back with dad and practice their curve ball.

Often the players aren't aware of any problem until they notice a feeling in the arm or shoulder that just won't go away. Then their parents take them to the doctor, who may find a torn rotator cuff in the shoulder or a torn elbow ligament.

It's not all about the quantity of the pitches. It's also about the quality of the pitching motion.

To throw hard, time after time, a pitcher has to learn to use his legs. The force from the big muscles of the legs, ElAttrache explains, must be properly transferred during the pitching motion to the arm and shoulder. The little muscles of the arm on their own can't throw hard repeatedly without getting injured.

It takes awhile for young athletes to achieve proper mechanics, as they develop mass, timing and coordination, ElAttrache said. Some achieve it earlier, some later.

To create guidelines for proper pitching mechanics that can be used by every coach in every dugout, the orthopedic surgeon is working on a study closely examining the pitching motion of young players. The study is being conducted at the Kerlan-Jobe Biomechanics Lab at the Centinela campus of the Centinela Hospital Medical Center in Inglewood.

Max Berger, a 15-year-old sophomore on Mira Costa High School's junior varsity baseball team, has been playing baseball since he was 5.

Although he plays catcher now, he did pitch in Little League. He said there were occasions when he was younger when he played on more than one team at a time, but luckily, he's never been hurt.

Berger is one of the volunteer subjects in the Kerlan-Jobe study.

Before stepping up on the fiberglass mound in the biomechanics lab, Berger is outfitted with about three dozen reflective markers jutting from his body, from cap to sneaker.

Berger hurls the ball into a net down a hallway, surrounded by a battery of infrared cameras that fill the room with crimson light.

The video cameras make a computerized record of Berger's pitching motion, gathering details that observers can use to check the efficiency of his movements.

"The computer is able to calculate the position of the shoulder, trunk and knees, and the forces across the joints," said Karen Mohr, a research therapist at Kerlan-Jobe.

Although the current study is not yet complete, Mohr said research in the biomechanics lab has shown that anyone who knows what to look for can use a regular video camera to check a pitcher's biomechanics to maximize power while minimizing the chance of injury.

"We can see the same errors with a video as you can with our big fancy system," Mohr said.

Breakthrough treatments, such as the so-called Tommy John surgery developed by Kerlan-Jobe clinic co-founder Dr. Frank Jobe, have saved many a professional athlete's career. But children have been seeking the same kind of surgeries, ElAttrache said.

An alarming number of children are developing torn rotator cuffs, damaged cartilage in the shoulder and torn ligaments in the elbow, ElAttrache said. Equally alarming is the "I can just get the surgery" attitude he encounters in some young ballplayers.

Young players should focus on avoiding these injuries, not counting on surgery to fix them up if they overdo it, ElAttrache said.

There's an overestimation of what can be accomplished with the surgery, he said, so researchers at Kerlan-Jobe hope to nurture a philosophy of prevention among young players, their coaches and parents.

Send comments to lee.peterson@dailybreeze.com or to Medical Notebook, Daily Breeze, 5215 Torrance Blvd., Torrance, CA 90503-4077