Sports Physical Therapy Institute

Children tend to injure themselves frequently, especially those participating in sports. Luckily, children's bones and bodies are resilient and most injuries heal quickly and without long-term effects. Unfortunately, there is one type of injury seen in young throwing athletes (i.e. little league pitchers) that is extremely dangerous to a child's development. An injury to the growth plate of their bone can translate into serious problems in proper bone growth and formation.  

What is the growth plate?

The growth plate is the center of growth and development in each individual bone. They are primarily located at the ends of bones and in adolescents; there is a space between growing bone and the growth plate itself.  As the child gets older, this space will get smaller and smaller until it is no longer present and only solid bone exists.  This is when the plate is sealed and growth stops. 

What happens if the growth plate is injured?

The injured bone can develop abnormally, causing possible long-term disability to the athlete.

How is a growth plate injured in a young throwing athlete?

Most growth plate injuries are due to broken bones during a fall or acute injury. However, young throwing athletes incur these injuries through overuse of their arm. The medial (inside) aspect of the elbow is most common area growth plate injuries happen because of the tremendous amount of force placed upon it during the throwing motion (especially pitching). This force can cause stress fractures of the growth plate, as well as full fractures. An avulsion may also result, which is the actual tearing away of bone. Because the bone is immature and weaker than in adults, tension applied to soft tissue structures such as muscle or ligament is more likely to cause a portion of bone to pull away from its attachment site. In the older and more skeletally mature throwing athlete, injury will  more often occur to the soft tissue structure itself and leave the bon intact. 

Growth Plate Injury vs. Medial Epicondylitis

It is easy to mistake a growth plate fracture for medial epicondylitis, which is the inflammation of the forearm tendons (of the flexor muscles) on the inside aspect of the elbow.  The signs and symptoms of medial epicondylitis can closely mimic a growth plate injury in the elbow. Pain with throwing and tenderness to touch on the inside part of the elbow are often present with both. However, if the pain persists long after the athlete stops throwing, this could signal a growth plate fracture. In any case, medical attention should be sought to get the proper treatment for any injury. 

How is a growth plate injury treated?

Conservative treatment can include rest, immobilization, therapeutic exercise, and the gradual return to throwing as condition allows.  Physical Therapy is often recommended to get the athlete back to full strength without incurring further injury. Surgical intervention may be necessary if growth plate fracture is large enough, usually 3 mm separation of the growth plate as shown on an x-ray. 

Can growth plate injuries be prevented?

Yes. Proper diet that includes calcium and regular exercise has been shown to improve the strength of the bone itself, making it less susceptible to injury. However, the best preventative measure is monitoring the amount of throwing a young individual is doing since the injury is the result of this repetitive motion. It is important to keep track of the number of pitches an athlete is throwing over the course of a game and week. The athlete should also have an appropriate amount of rest between games.

What are the pitch count and recovery time guidelines?

According To the American Sports Medicine Institute

Maximum Pitch Counts per Game and Games per Week

Pitch Count Ranges to Require Specified Rest