Sufficient Duration of Off-Season Decreases Elbow Disorders in Elementary School–Aged Baseball Players

Otoshi K, Kikuchi S, Kato K, Kaneko Y, Mashiko R, Sato R, Igari T, Kaga T, Konno S. Am J Sports Med. 2019 [Epub ahead of print]

Take Home Message: Pediatric baseball athletes that reported taking at least 1 month off for an off-season were less likely to report elbow pain or have morphological abnormalities of the medial elbow joint compared to those who reported no off-season.

Among young athletes, repetitive stress from overhead throwing may be a main cause of elbow injuries, such as medial epicondyle apophysitis. Several guidelines recommend that an athlete take time off from throwing each year; however, how much time and if time away from throwing prevents elbow injury and pain is unclear. Therefore, the authors investigated the relationship between amount of time off per year and elbow pain and morphological abnormalities of the elbow joint among 680 pediatric baseball players (ages 10-12 years). Baseball athletes completed a demographic questionnaire (age, practices per week, hours per week, duration of off-season, elbow pain history), physical examination, and ultrasonic assessment of the elbow joint. The ultrasound assessment was performed by several trained and blinded researchers at the completion of their 2016 and 2017 seasons. The 12-year-old athletes (34%) reported more elbow pain in the previous season compared to the 10- (~16%) and 11- (~20%) year olds. Additionally, medial epicondyle apophysitis was more common in 12-year-old athletes (~53%) compared to the 10- and 11-year olds (27%, 42%, respectively). Two or more years of experience was also related to a greater chance of elbow pain and medial epicondyle apophysitis. An athlete who participated in more days or hours at practice was more likely to have medial epicondyle apophysitis. Finally, an athlete with a longer off-season was less likely to have elbow pain or medial epicondyle apophysitis (see table).

Duration of off-season Elbow pain Medial epicondyle apophysitis
No off-season ~29% ~55%
< 1 month off ~28% ~47%
1 to 2 months off ~13% ~31%
> 2 months off ~21% ~31%

The authors provide support for recommendations that an athlete may benefit from an adequate off-season away from overhead throwing. The authors are the first to provide evidence that 1 month may be the minimum time that is enough for an off-season duration to reduce the risk of elbow pain or medial epicondyle apophysitis. However, a prospective cohort could provide more compelling evidence or even better a randomized control trial could demonstrate the potential cause-and-effect relationship between off-season duration and risk of elbow pain or injury. Currently, medical professionals, coaches, and parents should be aware of the guidelines and supportive evidence that aim to prevent injury and keep athletes in the game.

Questions for Discussion: How can we promote other sports to children to better support time away from overhead practices and competitions?

Written by: Jane McDevitt
Reviewed by: Jeffrey Driban

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