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Growth Plate Injuries in Young
Throwing Athletes |
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by: William Reilly, MSPT
New Brunswick Staff Therapist |
Children tend to injure themselves frequently, especially those
participating in sports. Luckily, children's bones and bodies are
resilient and most injuries heal quickly and without long-term effects. Unfortunately, there is one type of injury seen in young throwing
athletes (i.e. little league pitchers) that is extremely dangerous to a
child's development. An injury to the growth plate of
their bone can translate into serious problems in proper bone growth and
formation.
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What is the growth
plate? |
The growth plate is the center of growth and development in each
individual bone. They are primarily located at the ends of bones and in
adolescents, there is a space between growing bone and the growth plate
itself. As the child gets older, this space will get smaller and
smaller until it is no longer present and only solid bone exists.
This is when the plate is sealed and growth stops.
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What
happens if the growth plate is injured? |
The injured bone can develop abnormally,
causing possible long-term disability to the athlete..
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How is a growth plate injured in a young
throwing athlete? |
Most growth plate injuries are due to broken
bones during a fall or acute injury. However, young throwing athletes incur these injuries
through overuse of their arm. The medial (inside) aspect of the elbow is
most common area
growth plate injuries happen because of the tremendous amount of force placed
upon it during the throwing motion (especially pitching). This force
can cause stress fractures of the growth plate, as well as full fractures.
An avulsion may also result, which is the actual tearing away of bone. Because the bone is
immature and weaker than in adults, tension applied to soft tissue structures
such as muscle or ligament is more likely to cause a portion of bone to
pull away from its
attachment site. In the older and more skeletally mature throwing
athlete, injury will more often occur to the soft tissue structure
itself and leave the bon intact.
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Growth Plate Injury vs. Medial Epicondylitis |
It is easy to mistake a growth plate fracture for medial epicondylitis,
which is the inflammation of the forearm tendons (of the flexor muscles) on the
inside aspect of the elbow. The signs and symptoms of medial epicondylitis can closely mimic a growth plate injury in the elbow. Pain with throwing and tenderness to touch on the inside part of the
elbow are often present with both. However, if the pain persists long
after the athlete stops throwing, this could signal a growth plate
fracture. In any case, medical attention
should be sought to get the proper treatment for any injury.
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How is a growth plate injury treated? |
Conservative treatment can include rest, immobilization, therapeutic
exercise, and the gradual return to throwing as condition allows.
Physical Therapy is often recommended to get the athlete back to full
strength without incurring further injury. Surgical intervention may be necessary if growth plate fracture is large
enough, usually 3 mm separation of the growth plate as shown on an x-ray.
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Can growth plate injuries be prevented?
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Yes. Proper diet that includes calcium and regular exercise has been
shown to improve the strength of the bone itself, making it less
susceptible to injury. However, the best
preventative measure is monitoring the amount of throwing a young
individual is doing since the injury is the result of this repetitive
motion. It is important to keep track of the number
of pitches an athlete is throwing over the course of a game and week.
The athlete should also have an appropriate amount of rest between games.
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What are the pitch count and
recovery time guidelines? |
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According To
the American Sports Medicine Institute
Maximum
Pitch Counts per Game and Games per Week
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Age (years) |
Max Pitches
per Game |
Max Games
per Week |
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8-10 |
52 |
2 |
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11-12 |
68 |
2 |
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13-14 |
76 |
2 |
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15-16 |
91 |
2 |
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17-18 |
106 |
2 |
Pitch Count
Ranges to Require Specified Rest
| Age
(years) |
1 day
rest |
2 days
rest |
3 days
rest |
4 days
rest |
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8-10 |
21-33 |
34-42 |
43-50 |
51+ |
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11-12 |
27-34 |
35-54 |
55-57 |
58+ |
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13-14 |
30-35 |
36-55 |
56-69 |
70+ |
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15-16 |
25-37 |
38-61 |
62-76 |
77+ |
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17-18 |
27-44 |
45-61 |
62-88 |
89+ |
www.asmi.org/SportsMed/youth
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