Young Athlete Elbow Injury Prevention
Baseball and other overhead throwing athletes are often associated with a plethora of shoulder elbow pathologies, with UCL tears and Tommy John surgy running amok through high-level baseball athletes. All overhead throwing athletes are at risk of serious injury to the shoulder girdle, rotator cuff, elbow joint, or even wrist dependent upon the demands of the sport. Baseball players are at increased risk of UCL tears and medial epicondylitis, tennis players are at increased risk of lateral epicondylitis, volleyball players are at risk of injuries due to shoulder instability, and even swimmers are at risk of subacromial impingement syndrome.
That being said, there is a risk with everything in life, especially in competitive sports as athletes attempt to be their best to help their team and achieve championship and/or scholarship goals. It is crucial for young athletes to recognize the signs of injury and how to prevent injury. Injury prevention will be the most important aspect of training in a young athlete’s sporting career. Unfortunately, the how and why of injury prevention is somewhat overlooked, with the elbow joint being overlooked seemingly most of all.
Elbow Mechanics
In order to be able to prevent injury, one needs to have an understanding of just what is occurring at the elbow joint during the overhead throwing motion. Intense forces act on the elbow at the fullest extent of its range of motion as well as stressing the ulnar collateral ligament (UCL) tremendously. This ligament is one of the primary passive stabilizers of the elbow joint that is challenged from valgus, or outward, forces acting on the elbow.
Baseball, javelin, and other overhead throwing athletes place significant valgus stress upon the UCL that can cause microtears in the ligament. This then could lead to bigger tears and eventually a complete tear, requiring the infamous Tommy John surgery.
Tennis, golf, and other similar racket or club athletes place significant force on the elbow joint with their sport’s demands as well, but on the outside of the elbow (for tennis players especially, ever heard of tennis elbow?), and the inside of the elbow similar to baseball players (this would give rise to the golfer’s elbow denomination).
Signs and Symptoms
The tears in the inside of the elbow could lead to the diagnosis of medial epicondylitis associated with the medial (inside of the elbow) epicondyle (bone projection where many forearm muscles attach). An athlete may complain of pain in the inside of the elbow that may run from the elbow to the wrist on the inside of the forearm, pain when flexing their hand downward, numbness and tingling in the fingers, or even when grasping objects.
Tennis elbow (medical diagnosis of lateral epicondylitis) can present similarly, but with pain stemming from the lateral epicondyle (outside of the elbow. Similar to medial epicondylitis, both are repetitive strain issues that occur due to frequent use causing small tears and inflammation in the compact elbow joint.
The compact elbow joint only has so much capacity for muscles, ligaments, bones, nerves, blood vessels, etc., that any sort of excess fluid can lead to potential issues such as medial and lateral epicondylitis. Fortunately, regardless of the sport, whether a racket or club is used, all can be treated for with simple training and exercises.
Elbow Stabilization and Strengthening
Two primary focuses should dictate a training program for these overhead athletes: elbow and shoulder stretching/strengthening and global core stabilization/strengthening. Much of the power for these athletes will actually stem from the legs and core with the shoulder and arms directing the forces at play. Thus, not only should shoulder and elbow stretching/strengthening be targeted, but also global core stabilization/strengthening should be sought after.
Elbow and shoulder stretching/strengthening will aid in overall stabilization at both joints. The elbow and shoulder work closely with each other, with the shoulder directing the arm, and the elbow directing the forearm and wrist (to some extent). Some muscles even cross the shoulder and elbow joint aiding in overall arm movements such as the long heads of the biceps and triceps.
Global core stabilization/strengthening, for this training regimen, will home in on developing the abdominals, obliques, back, glutes, quads, and hamstrings as the kinetic chain will be enhanced and strengthened from developing these muscle groups. All of these muscle groups contribute to the kinetic chain to aid in preventing elbow and shoulder injury as well as increasing power in throwing.
Essential for Throwing Athletes
In fact, proper form for all of the overhead arm athletes will benefit from utilizing the kinetic chain and lower extremities. Take pitchers, for instance, they are learning that the beefier they become, the harder they can throw because they have more muscle mass and can generate more force from their legs into their arms. Golfers, tennis players, baseball players, and others with twisting motions essential to the game will be able to turn faster when swinging their club, racket, bat, or other piece of equipment after developing the torso twisting muscles, the abdominals and obliques.
Template for Training
Now that an understanding of how the elbow joint works during throwing/overhead arm movement in general, how to recognize some signs and symptoms of two common elbow pathologies, and why training will be beneficial, young athletes now need to understand what a training program could present for them.
The below offseason template can be used by young athletes, coaches, and/parents as a launching point of how young athletes (or any overhead athlete, really) can train for increasing elbow strength and stability and prevent injury:
Off Season Training Template for Overhead Youth Athletes
Weeks 1-3 and 5-7:
Day 1:
Warm Up: Dynamic Warm Up
1. Medicine Ball Rotational Throws: 3 sets of 10 throws per side
2. Lunge with a Twist: 3 sets of 8 lunges per leg
3. Single Leg Romanian Deadlift: 3 sets of 8 reps per leg
4. Overhead Medicine Ball Slams: 3 sets of 10 slams
5. Cable Woodchops: 3 sets of 10 reps per side
6: Suitcase Carries: 3 sets of 20 yards per side
Stretching:
1. Triceps Stretch: 3 sets of 30 seconds per side
2. Forearm Flexor Stretch: 2 sets of 30 seconds per arm
3. Cross Body Shoulder Stretch: 2 sets of 30 seconds per side
Day 2:
Warm Up: Dynamic Warm Up
Exercises:
1. Pallof Press: 3 sets of 10 reps per side
2. Single Leg Romanian Deadlift: 3 sets of 8 reps per leg
3. Scapular Retractions: 3 sets of 10 reps
4. Standing Cable Push-Pull: 3 sets of 8 reps per arm
5. Bicep Curls: 3 sets of 10 reps
6. Bulgarian Split Squats: 3 sets of 10 reps per leg
Stretching:
1. Triceps Stretch: 2 sets of 30 seconds per arm
2. Forearm Extensor Stretch: 2 sets of 30 seconds per arm
3. Cross Body Shoulder Stretch: 2 sets of 30 seconds per side
Day 3:
Warm Up: Dynamic Warm Up
Exercises:
1. Medicine Ball Rotational Throws: 3 sets of 10 throws per side
2. Half Knee Reverse Throws: 3 sets of 10 slams
3. Regular/Reverse Wrist Curls: 3 sets of 12 reps
4. Pronation and Supination with Resistance Band: 3 sets of 10 rotations per arm
5. Single Kettlebell Overhead Carries: 3 sets of 20 yards per side
6. Goblet Squats: 3 sets of 12 reps
Stretching:
1. Triceps Stretch: 3 sets of 30 seconds per side
2. Forearm Flexor Stretch: 2 sets of 30 seconds per arm
3. Cross Body Shoulder Stretch: 2 sets of 30 seconds per arm
Weeks 4 & 8: Active Recovery
Low-impact activities such as walking, swimming, or light cycling
Avoid lifting or intense training; enjoy the week “off”; you’ve earned it!
The full-body aspect of the training program may not be for every athlete. Encourage the young athlete to experiment with this template as it is generalized rather than individualized. All athletes hoping to perform their best would benefit from an individualized training program for their body and their sport.
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Young Athlete Elbow Injury Prevention
Baseball and other overhead throwing athletes are often associated with a plethora of shoulder elbow pathologies, with UCL tears and Tommy John surgy running amok through high-level baseball athletes. All overhead throwing athletes are at risk of serious injury to the shoulder girdle, rotator cuff, elbow joint, or even wrist dependent upon the demands of the sport. Baseball players are at increased risk of UCL tears and medial epicondylitis, tennis players are at increased risk of lateral epicondylitis, volleyball players are at risk of injuries due to shoulder instability, and even swimmers are at risk of subacromial impingement syndrome.
That being said, there is a risk with everything in life, especially in competitive sports as athletes attempt to be their best to help their team and achieve championship and/or scholarship goals. It is crucial for young athletes to recognize the signs of injury and how to prevent injury. Injury prevention will be the most important aspect of training in a young athlete’s sporting career. Unfortunately, the how and why of injury prevention is somewhat overlooked, with the elbow joint being overlooked seemingly most of all.
Elbow Mechanics
In order to be able to prevent injury, one needs to have an understanding of just what is occurring at the elbow joint during the overhead throwing motion. Intense forces act on the elbow at the fullest extent of its range of motion as well as stressing the ulnar collateral ligament (UCL) tremendously. This ligament is one of the primary passive stabilizers of the elbow joint that is challenged from valgus, or outward, forces acting on the elbow.
Baseball, javelin, and other overhead throwing athletes place significant valgus stress upon the UCL that can cause microtears in the ligament. This then could lead to bigger tears and eventually a complete tear, requiring the infamous Tommy John surgery.
Tennis, golf, and other similar racket or club athletes place significant force on the elbow joint with their sport’s demands as well, but on the outside of the elbow (for tennis players especially, ever heard of tennis elbow?), and the inside of the elbow similar to baseball players (this would give rise to the golfer’s elbow denomination).
Signs and Symptoms
The tears in the inside of the elbow could lead to the diagnosis of medial epicondylitis associated with the medial (inside of the elbow) epicondyle (bone projection where many forearm muscles attach). An athlete may complain of pain in the inside of the elbow that may run from the elbow to the wrist on the inside of the forearm, pain when flexing their hand downward, numbness and tingling in the fingers, or even when grasping objects.
Tennis elbow (medical diagnosis of lateral epicondylitis) can present similarly, but with pain stemming from the lateral epicondyle (outside of the elbow. Similar to medial epicondylitis, both are repetitive strain issues that occur due to frequent use causing small tears and inflammation in the compact elbow joint.
The compact elbow joint only has so much capacity for muscles, ligaments, bones, nerves, blood vessels, etc., that any sort of excess fluid can lead to potential issues such as medial and lateral epicondylitis. Fortunately, regardless of the sport, whether a racket or club is used, all can be treated for with simple training and exercises.
Elbow Stabilization and Strengthening
Two primary focuses should dictate a training program for these overhead athletes: elbow and shoulder stretching/strengthening and global core stabilization/strengthening. Much of the power for these athletes will actually stem from the legs and core with the shoulder and arms directing the forces at play. Thus, not only should shoulder and elbow stretching/strengthening be targeted, but also global core stabilization/strengthening should be sought after.
Elbow and shoulder stretching/strengthening will aid in overall stabilization at both joints. The elbow and shoulder work closely with each other, with the shoulder directing the arm, and the elbow directing the forearm and wrist (to some extent). Some muscles even cross the shoulder and elbow joint aiding in overall arm movements such as the long heads of the biceps and triceps.
Global core stabilization/strengthening, for this training regimen, will home in on developing the abdominals, obliques, back, glutes, quads, and hamstrings as the kinetic chain will be enhanced and strengthened from developing these muscle groups. All of these muscle groups contribute to the kinetic chain to aid in preventing elbow and shoulder injury as well as increasing power in throwing.
Essential for Throwing Athletes
In fact, proper form for all of the overhead arm athletes will benefit from utilizing the kinetic chain and lower extremities. Take pitchers, for instance, they are learning that the beefier they become, the harder they can throw because they have more muscle mass and can generate more force from their legs into their arms. Golfers, tennis players, baseball players, and others with twisting motions essential to the game will be able to turn faster when swinging their club, racket, bat, or other piece of equipment after developing the torso twisting muscles, the abdominals and obliques.
Template for Training
Now that an understanding of how the elbow joint works during throwing/overhead arm movement in general, how to recognize some signs and symptoms of two common elbow pathologies, and why training will be beneficial, young athletes now need to understand what a training program could present for them.
The below offseason template can be used by young athletes, coaches, and/parents as a launching point of how young athletes (or any overhead athlete, really) can train for increasing elbow strength and stability and prevent injury:
Off Season Training Template for Overhead Youth Athletes
Weeks 1-3 and 5-7:
Day 1:
Warm Up: Dynamic Warm Up
1. Medicine Ball Rotational Throws: 3 sets of 10 throws per side
2. Lunge with a Twist: 3 sets of 8 lunges per leg
3. Single Leg Romanian Deadlift: 3 sets of 8 reps per leg
4. Overhead Medicine Ball Slams: 3 sets of 10 slams
5. Cable Woodchops: 3 sets of 10 reps per side
6: Suitcase Carries: 3 sets of 20 yards per side
Stretching:
1. Triceps Stretch: 3 sets of 30 seconds per side
2. Forearm Flexor Stretch: 2 sets of 30 seconds per arm
3. Cross Body Shoulder Stretch: 2 sets of 30 seconds per side
Day 2:
Warm Up: Dynamic Warm Up
Exercises:
1. Pallof Press: 3 sets of 10 reps per side
2. Single Leg Romanian Deadlift: 3 sets of 8 reps per leg
3. Scapular Retractions: 3 sets of 10 reps
4. Standing Cable Push-Pull: 3 sets of 8 reps per arm
5. Bicep Curls: 3 sets of 10 reps
6. Bulgarian Split Squats: 3 sets of 10 reps per leg
Stretching:
1. Triceps Stretch: 2 sets of 30 seconds per arm
2. Forearm Extensor Stretch: 2 sets of 30 seconds per arm
3. Cross Body Shoulder Stretch: 2 sets of 30 seconds per side
Day 3:
Warm Up: Dynamic Warm Up
Exercises:
1. Medicine Ball Rotational Throws: 3 sets of 10 throws per side
2. Half Knee Reverse Throws: 3 sets of 10 slams
3. Regular/Reverse Wrist Curls: 3 sets of 12 reps
4. Pronation and Supination with Resistance Band: 3 sets of 10 rotations per arm
5. Single Kettlebell Overhead Carries: 3 sets of 20 yards per side
6. Goblet Squats: 3 sets of 12 reps
Stretching:
1. Triceps Stretch: 3 sets of 30 seconds per side
2. Forearm Flexor Stretch: 2 sets of 30 seconds per arm
3. Cross Body Shoulder Stretch: 2 sets of 30 seconds per arm
Weeks 4 & 8: Active Recovery
Low-impact activities such as walking, swimming, or light cycling
Avoid lifting or intense training; enjoy the week “off”; you’ve earned it!
The full-body aspect of the training program may not be for every athlete. Encourage the young athlete to experiment with this template as it is generalized rather than individualized. All athletes hoping to perform their best would benefit from an individualized training program for their body and their sport.