Certified Athletic Trainers (ATC’s) are allied health care providers trained in the prevention, evaluation and rehabilitation of sports injuries. They work under the direction of a physician and they are board certified nationally and licensed in CT. Visit www.NATA.org for more information. Certified athletic trainers at Enfield High School and Enrico Fermi High School are provided by Eastern Rehabilitation Network (www.easternrehab.net ), a department of Hartford Hospital (www.harthosp.org).

Eastern Rehabilitation Network (ERN) and The Sports Department have partnered to bring readers a monthly column on sports medicine topics. Readers may submit questions related to injuries, training advice, rehabilitation or any other sports medicine topic. Submit questions to:

Ben Stralka, ATC (Enrico Fermi High School) – bstralka@harthosp.org; Kyle Hicks, ATC (Enfield High School) – khicks@harthosp.org; Wendy Nichols, Physical Therapist (ERN Enfield) – wnichols@harthosp.org

Dear Kyle: My son plays baseball for our local high school and was diagnosed with “little league elbow.” What is “little league elbow” and what can we do to help get him back on the field as quickly as possible?

With baseball season in full swing many people have probably heard the term “little league elbow” and wonder what it is. Little league elbow occurs in 10 to 25 percent of young pitchers, typically younger than 16 years of age. It is from the repetitive throwing motion which causes increased stress at the medial (inside) elbow joint. In the younger athlete the growth areas are still active and if excessively stressed pain, inflammation, and in some cases an avulsion fracture at the growth plate can occur. In addition to excessive throwing there are other factors that can contribute to this disorder, such as: accelerated growth, a delay in maturation (growth) at the medial growth plate of the elbow, and stress fractures.

This injury will present gradually over time. The athlete may complain of soreness and point tenderness over the medial side of the elbow, a decrease in range of motion at both the wrist and elbow, or even complain of a locking or catching sensation at the elbow.

The initial way to manage this condition is RICE - rest, ice, compression and elevation. A word of caution when applying ice to the medial elbow: you should always cover the skin to protect it, not compress ice over the medial elbow, and closely monitor the hand and wrist while ice is on this area. The ulnar nerve is very superficial and is at risk of being damaged by ice. If the athlete reports any sensation/function changes remove the ice immediately. Anti-inflammatory medication may be used, but this should always be done under the direction of a physician. The athlete should start a gradual stretching program for the wrist, forearm and triceps, and once full range of motion and flexibility are regained, begin a supervised strengthening program. If the symptoms worsen or last more than a week you should consult your physician for further evaluation and testing.

The throwing motion is very complicated. Throwing with good form and technique always helps prevent overuse injuries. A pitching biomechanics video analysis may be beneficial. This analysis dissects the athlete’s throwing motion so that modifications and/or corrections can be made. Also, following the USA Baseball Guidelines or the Little League International Guidelines for the maximum number of pitches that should be thrown in any particular age group can also help prevent an overuse injury.