Sunday, May 23, 2004

Case studies

By John Erardi
The Cincinnati Enquirer

Over-the-top pitching throws off young arms
Case studies
Every player under count
Decision protects son's arm
Coach K's 10 tips
Knuckle curve easier on the wrist
Q&A: Dr. Timothy Kremchek
Q&A: Larry Redwine
Q&A: Ted Power
Fast facts  

Here are some cases that Reds medical director Tim Kremchek has handled over the last three springs and two summers. They are typical of the injuries being suffered by young pitchers.

Josh Ingram, 10

Josh's dad, John, had the best of intentions and for all the right reasons. He reasoned that if Josh, a pitcher, wanted to play 55 games a summer of select baseball with the Tealtown Indians, then he should get his arm in tip-top shape to avoid injury. John knew of the rash of arm injuries afflicting young pitchers nationally.

The problem was that the book the Ingrams were using didn't specify the proper thickness of the resistant rubber tubing to use for Josh's shoulder exercises and didn't make it clear that when lifting 2-pound dumbbells, the shoulder must begin in the proper position so as to avoid injury.

Josh wound up with an inflamed tendon in his elbow and had to be shut down from throwing.

"I knew what a tendon was, because we learned it in science about two weeks before," Josh said after completing a game of long-toss. "I didn't know what an inflamed tendon was, but I knew it didn't sound too good."

He said he's happy the way rehabilitation is going. He exercises six days a week.

"I'm stronger than I was before," he said. "I know what exercises to do now, and I know how to do them right."

Philip Santoro, 15

"For every 20 elbows that I see involving a growth plate situation, I see one shoulder," Kremchek says.

Philip Santoro is that one shoulder - in his case, a fracture of the growth plate. He was a victim of pitching in cold weather, with short sleeves on. The day had begun with sunshine but cooled into the 40s by practice's end.

"As much as I like baseball, I know now that I just can't take my arm for granted," Philip said. "It's just not always going to be there; I have to take care of it."

Lynzi Engel, 14

"I wasn't used to throwing that much," said Lynzi Engel, who plays first base on Loveland's junior-varsity fast-pitch softball team. "I've been playing since I was 7 years old. But last year, we played about 40 games, and my arm wasn't in condition for it. I didn't warm it up enough, didn't stretch it out. I'll never do that again."

Her medical malady is dyskinesia, which is a muscle imbalance in the shoulder. The various parts of the shoulder are not working in sync.

Ian Clark, 13

Parents Brian and Mary Clark say that Ian, a seventh grader, hurt his arm in the late winter/early spring throwing indoors, getting ready for the season. He had some arm problems last season, but when it recurred going into this season - elbow strain and shoulder weakness - he was put on a physical therapy program.

Ethan Furlong, 18

"I started playing baseball since I was 4 or 5, and I've loved it ever since," says Ethan. "Last year, I threw 82 innings during school ball and I don't know how many in the summer. I hurt my arm on Labor Day weekend, in fall ball, during practice. I was on the mound. It was a stress fracture in one of the bones in my elbow and it surprised me. It could have been overuse, or it could have been a freak thing that just happened. I don't know. I had never pitched on less than three days' rest, and I had never pitched in back-to-back games. I had surgery; they had to put a screw and tension wire in there to fix the stress fracture - they've since taken that out. It feels good now. Doc (Kremchek) has me on a throwing program, and I should be able to pitch this summer. I have to follow the program and strengthen my shoulder, because that's what protects the elbow."

Kyle Lonkard, 14

Kyle was called into a recent tournament game to play catcher. He warmed up the pitcher, then threw a warmup throw to second base and fractured his elbow. "It was a freak injury; I don't think it could have been prevented," says father, Steve. "They pinned and screwed the growth plate back onto his elbow. The arm is more vulnerable to injury when you're in a growth spurt. They said he could hit later this summer, and be throwing again (in games) next year.

Devon Rickert, 12

The Sidney resident said, "I broke my arm a while ago, and calcium built up in there, because my arm was trying to heal itself. I had a lot of stuff in there. One thing was a chipped bone. They had to go in and fix that and grind down the calcium. It's feeling pretty good; I'm getting the (range of) motion back. They've got me doing therapy - I go to rehab four times a week - working out my arm and trying to get it back in shape. I think a combination of things is what broke my arm. I pitched quite a bit, and I also played shortstop. I pretty much played everywhere. I don't think I was throwing too many pitches, because they (the coaches) had me on a pitch count."

James Perry
James Perry, 13, suffered a stress-reaction fracture in his elbow. Perry’s father, Michael, said his son now focuses more on mechanics and doesn’t overthrow his pitches.
(Submitted photo)

James Perry, 13

James is a 13-year-old from Milford. His father, Michael, said the stress-reaction fracture in his elbow "wasn't from abuse or over-use. It was just a thing that happened ... I believe it came about because he had pulled a muscle in his leg, and was compensating for it. His arm is still growing ... He's fine and back pitching now. He went to three months of therapy; two months with no throwing ... Because of the injury, he knows now that he isn't invincible anymore. He's really worked to get his mechanics down, and he doesn't overthrow his pitches. He throws much more with the body now, and not just the arm. He's learned a lot from the rehab process. Before, when he struggled, he just struggled; now he has an idea what he needs to correct."

Jimmy Schmidt
After his son (pictured) sustained an injury, Jimmy Schmidt’s father said, “We’ve got to remember that these are fourth-graders … and they aren’t developed to the point where they can be pushed. I think we’ve all learned a lot.”
(Submitted photo)

Jimmy Schmidt, 11

Jimmy is an 11-year-old from Western Hills, who has been pitching since he was 7. Jimmy was on a program to improve his mechanics, and was throwing flawlessly with increased velocity.

"In Jimmy's particular case, his bones weren't capable of handling that, apparently," Jimmy's father, James, said. "The doctor hasn't said it was a blessing in disguise, but he has said, 'When we are done with you, your arm will be stronger and you will be throwing better.' I've learned a lot, too. I told the other coaches, 'We've got to remember that these are fourth-graders ... and they aren't developed to the point where they can be pushed. I think we've all learned a lot."

Noah Buettgen, 12

Noah, a 12-year-old from Middletown, has been pitching competitively since he was 9. He's on a pitch count of 55. He hurt his elbow while throwing, an injury which may have been compounded in part when he fell on his right elbow on concrete at a bus stop.

Over-the-top pitching throws off young arms
Case studies
Every player under count
Decision protects son's arm
Coach K's 10 tips
Knuckle curve easier on the wrist
Q&A: Dr. Timothy Kremchek
Q&A: Larry Redwine
Q&A: Ted Power
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