Jock Doc

Treating overuse injuries in pitchers

Q. My son is a 14-year-old baseball player and pitcher who has had pain in his right shoulder for the last month. It bothered him the more he threw the ball and he has had to stop playing for the last three weeks. When he went back to play this week, after one inning he again experienced pain in his right shoulder. Did we not rest him long enough for this to get better or should we have him see a doctor?

Overuse problems in throwing athletes are very common particularly in South Florida.

Many of our young aspiring athletes will play in two leagues simultaneously and there is not always a limit to the number of pitches that they can make in a game and how many times a week they can throw.

In the young throwing athletes, the growth plate “epiphysis” can become inflamed and a stress fracture can result. It gets worse the more the athlete throws. Although problems with the rotator cuff and other shoulder muscles are possible, in the athlete who is still growing an overuse stress reaction should be suspected.

I recommend your son see an orthopedic surgeon who likely will perform a physical examination and take X-rays of your son’s shoulder. Sometimes a comparison X-ray of the opposite shoulder can help reveal a difference on the injured side that can be consistent with widening of the growth plate and a stress reaction.

Many of these injuries can require one to two months of rest followed by a rehabilitation program to heal. Only after the athlete has healed completely and has been through rehab and a strengthening and conditioning program, can he return gradually to the throwing activity. Proper warm-upand conditioning as well as an emphasis on proper throwing techniques can decrease the risks of re-injury.


Dr. Harlan Selesnick is team physician of the Miami Heat and director of Miami Sports Medicine Fellowship, Doctors Hospital. Send your questions to

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