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]
https://www.jshoulderelbow.org/article/S1058-2746(19)30113-2/pdf
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
Related Posts:
Predicting Elbow Injuries in Youth Baseball with a Preseason Checklist
Number of Games Over Number of Practices Primary Causal Factor for Elbow Pain
Elbow Stress May Compromise Elbow Health
Very intresting article! I liked that you included the graph to further prove your research. I dont know if there is any correlation between how old they are, yes it would be more wear and tear but that depends on how much rest each of them got. I’ve also read an article that said when they surveyed high school pitchers when they had an “off-season” it was only dec 24-Jan 1st. these youth pitchers had an increase of risk to have UCL reconstruction before entering college. I never experienced high school or any youth baseball but when I did my clinical rotation at a Division 1 college, most of our pitchers came into college with a UCL reconstruction from the summer, not in season. I also didn’t experience Medial epicondyle apophysitis but I did have a lot of pitchers complain of elbow pain.
In regards to the ability to promote another sport is hard. We can’t force people to play another sport they don’t have a love for. especially, pitchers, it’s a unique skill they have, the best we can do is promote playing softball in their offseason. We can also educate them on whats happening with overuse and what happens when you don’t properly rest.
I think it is very interesting to see this statistic in this current time with this new generation. My first thought would be that little league would increase their consistency of practices to games, due to the lower average of inactivity within children now. Being a student in college, it has not been a long time since I was at the age of high school sports, and even travel sports for that matter. I would have practice multiple times a week and still go to the basketball courts after to play pick-up with my friends. I would play hours of sports and go back home at night with mosquito bites and sun tan lines, but never had a serious injury. Now I drive past my local parks and see them empty, because it is not the same with children now. So how can they have a chronic issue in sports? I have four little brothers, and they’re always inside, and it’s not their fault because they’re just following the trend. So I am using my personal experience to form my opinion, and I found it worth sharing. Again, I am surprised on the results from you’re research.
Adriana & Khalif, thank you for your comments. I think you both bring up good points.
Adriana, I think you bring up a good point on education and providing them with options that will still maintain and allow them to play and practice their skill, but maybe allow the necessary time off to allow tissue to heal from the micro tearing they may be suffering. You even stated that in your clinical practice you are seeing a trend in UCL surgeries and elbow pain in this population.
Khalif, I think you brought up a similar point going off of the how can they still enjoy what they are doing and play without increasing their risk of injury. I think you brought up a great point of view in your own anecdote about structured practice versus unstructured play maybe that is the difference. Either way really great research areas to explore to decipher if unstructured play in the same sport would limit risk.