2.17.2013

elbow pain from throwing


"ice. rest. wimpy wrist curl."
If you have sought the attention of a medical doctor, physical therapist, athletic trainer, or personal trainer for the treatment of throwing related elbow pain, you MUST demand more out of them than the old stand-by treatments that even a cave man can advise.

-Take two weeks off. 
-Apply ice.
-Apply electric stimulation and/or ultrasound.
-Do these 12 variations of wimpy wrist curls. 

There is a time and a place for these modalities. They often help control pain and inflammation and promote healing in the first few weeks after an injury. But what do you think is likely to happen when the athlete attempts to return to awesome beast-like throwing?

Medical professionals should at least attempt to track down the source of the elbow injury. There's almost always a clear reason why the tissue is being over loaded. Really, it doesn't require a huge amount of effort or knowledge base to show the world that you're more than a cave man. Your PT, trainer, etc should consider these as a minimal demonstration of non cave man competency:

-Shoulder strength and range of motion.
-Thoracic mobility and scapular stability. 
-Hip strength and range of motion.
-At least ask if the athlete or parent has a video of them throwing, and at some point, take a video if possible. 

Any decent non-cave sports medicine man or women knows that medial elbow pain (near the "funny bone") is generally due to overload of the ligaments and stabilizing muscles during the acceleration phase of throwing, and that lateral elbow pain (thumb side) is due to overload when the arm is decelerating after ball release. They know when and how core and hip strength applies to throwing. They know that throwing with a higher arm slot tends to protect the elbow and strain the shoulder, while a lower arm slot (often referred to as "three quarters") tends to protect the shoulder and strain the elbow.

Over the years of evaluating and treating shoulder and elbow injuries, this grunt has learned to be suspicious of the hips. Lack of hip and/or shoulder external rotation (ER) or internal rotation (IR) often results in more torque at the elbow. The shoulder IR/ER values that are acceptable for an overhead athlete are not what the textbook says.

Years of hard headed trial and error experience as an athlete and working as a small private practice medical professional tends to help my patients/clients survive the modern era.

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