Common Little League and Softball Injuries in Children

Overuse injuries can plague athletes of all ages and sizes, and youth softball and baseball competitors are no exception, a CHOC Children’s sports medicine specialist says. Two of the most common injuries that affect youth competing in either of these sports are commonly referred to as ‘Little League Shoulder’ and ‘Little League Elbow,’ says Dr. Jonathan Minor, a CHOC pediatrician who specializes in sports injuries, injury prevention, and concussion management.

Dr. Jonathon Minor

‘Little League shoulder’ is a fracture of the growth plate in the shoulder. A warning sign is often pain that comes with throwing, without any preexisting injury. ‘Little League elbow’ is a small growth plate injury on the inside part of the elbow. Many will eventually hear or feel a ‘pop’ on the inside of the elbow, which often is a small piece of bone being pulled away from the elbow, at which time you should seek medical evaluation urgently, says Minor.

With either injury, pain tends to be gradual. Initially the shoulder or elbow may feel sore after games for players in heavy throwing positions such as pitchers, catchers or outfielders. For example, for pitchers, the shoulder or elbow may feel sore after pitching, but often after one to two weeks of continued throwing, they may experience pain during the game as well.

“Forty percent of the speed of the ball comes from the arm and shoulder, and the rest comes from the core, legs and hips,” says Minor. “Proper form is essential to preventing injuries. This also means that having strong lower body and core muscles, not just a strong upper body, is imperative. Working with a throwing mechanics coach can be very helpful at utilizing each of these different muscle groups.”

Other preventative measures include adhering to the sporting organization’s rules for pitch counts and rest requirements between pitching appearances. Athletes also should not be allowed to switch from one heavy-throwing position to another during the game, such as playing catcher after pitching for several innings. Remind your child to do a proper warm-up and cool down before and after practices and games. Consider loosening up arm muscles with a heating pad prior to practice, as tight muscles are more prone to injury.

Athletes at this age are developing their skills as well as their sense of competitiveness, but that doesn’t mean they should be playing through the pain, he adds.

Leagues often encourage players to recognize when and where their pain occurs. Consult a physical therapist or athletic trainer initially, and if basic treatments like rest, ice, and basic medication such as ibuprofen, are not helping, ask your pediatrician about a referral to a sports medicine specialist.

Since a major contributing factor to these all-too-common injuries include throwing mechanics, Minor often recommends athletes work with a physical therapy program that has experience with athletes in their chosen sport, in order to work on proper form.

Recommendations for treatment are made on a case-by-case basis says Minor, but may include rest, X-rays or other imaging, or changing positions in the game to a position less strenuous to their injury.

Since these pains are often gradual, they may get more severe as the season progresses. As playoffs commence, athletes may fear that speaking up about an injury could prevent them from participating, or result in other consequences. Encourage your young athlete to be honest about how they’re feeling, since identifying an injury and seeking treatment sooner rather than later, can allow them to return to competition earlier.

“Southern California is such a great place to live- the weather is very conducive to playing baseball and softball for twelve months out of the year. But every athlete, especially ones who throw often, should have a few months off per year to prevent overuse injuries. Try playing another sport that doesn’t involve throwing, or focus on conditioning work, particularly hips, legs and core that all too often get neglected during the season,” says Minor.

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Concussion Program Prescribes At-Home Exercises

Athletes and other adolescents with mild to severe concussions who experience symptoms such as dizziness, feeling unbalanced on their feet, blurred vision or trouble focusing on objects, may be good candidates for at-home visual and vestibular exercises recently designed by experts of the CHOC Children’s concussion program.

“Concussions are like puzzles, and every one is a little bit different,” says Dr. Jonathan Minor, a CHOC sports medicine specialist. “As many as fifty percent of concussed athletes may experience these symptoms and could benefit from these exercises that may get them back on the field or back in the classroom sooner.”

concussion exercises
Dr. Jonathan Minor models one of several at-home exercises recently designed by experts of the CHOC Children’s concussion program.

The convenient and self-explanatory exercises are ones that athletes and students can perform at home, but should only be started under the guidance of a concussion specialist, after an appropriate evaluation, and as part of an overall post-concussion treatment plan. These exercises are intended to enhance and improve a patient’s recovery from a concussion.

“Patients should be aware that beginning these exercises may stimulate some symptoms for a short period of time, such as trouble focusing, dizziness, nausea or headaches. But after just a few days of daily exercises, they may find that they can tolerate each exercise for a longer period of time,” says Minor, who is a lifetime athlete himself.

“We encourage our patients to only perform these exercises for the duration tolerated, rather than endure and push through worsening symptoms initially. Seeing a difference quickly with improved tolerance resonates especially with athletes, who are used to training and then seeing improved results.”

Download your copy of the vestibular/balance exercises and the visual concussion home exercises.

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Cheerleading Safety Tips

Cheerleading is a physically demanding sport, much like ballet or gymnastics. Sports medicine specialists at CHOC Children’s regularly treat common sports injuries like ankle sprains and tendinitis, but say athletes may be overlooking some of the more serious injuries, and ways to avoid them, according to Dr. Jonathan Minor.

Dr. Jonathon Minor

Stress fractures in the feet, shins and back, herniated discs, spinal cord and vertebral injuries, elbow and shoulder dislocations, concussions and major fractures, are some of the other potential injuries athletes, parents and  coaches should be aware of and monitor for, says Minor.

Since each member of a cheer squad plays a unique role, they’re exposed to different potentials for injury. Flyers, bases and spotters rely on one another in teamwork to safely perform stunts and poses. One slip up could mean foot coming into contact with a teammate’s head leading to a concussion, or a fall to the ground with a major injury.

Like many other sports, youth cheerleaders spend many hours each week working together and developing teamwork that depends on a sense of trust and communication in order to perform with perfection. But this can often lead to overuse injuries, says Minor. Overuse injuries are becoming more common in youth sports because increasing pressure to compete at a higher level leads athletes to specialize in one sport at a younger age, as opposed to trying other activities in their off season. Learn how to prevent overuse injuries.

Much like gymnastics, running, diving, figure skating and dance, among other sports, there is an aesthetic look that the sport cultivates, such as low body weight and a slim build. The pressure of appearance and the rewards of recognition, says Minor, can promote unhealthy eating behaviors and disorders. This can lead to broken bones, stress fractures and muscle strains because bones and muscles don’t properly recover from stress and demands. Learn more about the warning signs of eating disorders.

Although cheerleaders can suffer serious sports injuries due to the physical demands they meet that are unparalleled in other sports, safety and proper education when performing stunts, as well as communication with teammates, is paramount to preventing these injuries.

Learn more about CHOC’s sports medicine program.

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CHOC Children’s Expands Orthopaedic Services

Young athletes in Orange County now have greater access to specialized sports medicine care as a non-surgical sports medicine specialist joins the CHOC Children’s Orthopaedic Institute. Dr. Jonathan Minor specializes in ultrasound-guided injections and procedures, as well as diagnostic ultrasound evaluations, which provide improved visualization of the body tissues. The enhanced view, so to speak, along with dynamic tissue evaluation and use of selective injections can confirm the location of pain and assist with surgical decision-making.  Ultrasound-guided injections can offer a quicker recovery and may be used to avoid surgery altogether in some patients.

Dr. Jonathon Minor

Dr. Minor’s commitment to helping young athletes return to the field stems from his own lifetime experience as an athlete. As an adult, he has completed multiple marathons and Ironman triathlons, including three Long Course World Championship races with Team USA.

His passion for sports medicine was inspired by his father, an accomplished orthopaedic surgeon.

“I was moved by my dad being able to take an injury, and just like a carpenter, put it back together,” Dr. Minor said. “As a non-surgeon, I consider myself more like an architect, laying out a floor plan, and bringing together a team of providers to treat and safely return our athletes back to the sports arena.”

After medical school and residency training, he completed a non-surgical sports medicine fellowship and an additional musculoskeletal ultrasound fellowship at Boston Children’s Hospital. During his training in Boston, he served as team physician for several collegiate and high school teams, and worked closely with the Boston Ballet.

A chance to work with the expert team at CHOC and help expand the sports medicine program led Dr. Minor back to his native California. He treats everything from ankle and knee ligament sprains to overuse injuries and concussions.  Dr. Minor is working with the experts at the Orthopaedic Institute to expand the footprint of its sports medicine program with the addition of physical therapists, new regional physical therapy locations and a new orthopaedic surgeon, Dr. Jessica McMichael.

“Given the number and caliber of athletes coming out of Orange County, I am honored to be part of a growing and highly respected sports medicine program at the CHOC Children’s Orthopaedic Institute,” says Minor.

As an avid athlete, Dr. Minor is dedicated to injury prevention, particularly overuse injuries. He offers athletes of all ages the following tips to prevent sports injuries:

  • Stay committed to a progressive training program
  • In preparation for a new sport or season, make sure your body is conditioned aerobically before training with your team
  • Consistently stretch after a warm-up and again after exercise
  • With the exception of gymnasts and ice skaters, athletes should not specialize in a single sport until they are well into high school
  • While California offers a perfect climate for year-round single sport specialization, every athlete should spend 2-4 months every year outside of their primary sport; this could involve playing a sport that uses different muscle groups, or spending the time working with a personal trainer to optimize fitness and neglected muscle groups

Learn more about CHOC’s sports medicine program.