Comeback Kid

Even though his first word was "ba'kketball," 14-year-old Eric Olveira began his sports career as a baseball pitcher at age 5. When a chronic over-use injury recently brought his pitching career close to a premature end, the sports medicine clinic at Children's Hospital & Research Center Oakland helped bring him back from the brink.

Eric, now a three-sport high school athlete in football, basketball and baseball in Alameda, got his first baseball overuse injury when he was 12, a "blown-out" deltoid muscle in his right shoulder. Rest and therapy helped.

One year later, pitching gave him elbow problems. Again, rest and physical therapy alleviated the problem. But some coaches drove him too hard.

This year Eric hit the wall, partly because he jumped overnight from one sport to the next without preparation. On a Friday he played basketball, helping high school teammates finish their season. The next day Eric played baseball, pitching a game at the request of his coach even though he hadn't practiced pitching for months. By the second inning Eric's pitching arm was sore. By the end of the game he couldn't throw at all.

A referral from Robert Butts, MD, Eric's primary care physician, brought him to the sports medicine clinic at Children's Hospital. Here, where about 75 percent of the young athletes seen suffer from overuse injuries, Eric began working with physical therapist Robin Bergquist, MPT.

Eric had the classic pitcher's ailment, irritated wrist flexor tendons. These tendons connect forearm wrist flexor muscles to an upper arm bone knob at the elbow, called the medial epicondyle. An x-ray showed the knob had probably broken off and then healed in place after his injury the previous year. The tendons, pulled by tight, sore muscles, were stronger than the still-growing bone, which gave way under the stress of throwing a pitch.

Bergquist prescribed ice, rest, stretching and strengthening exercises over the course of many weeks. She also gave Eric and his father, Andy, an education.

Pitch counts for boys 13 and 14 should be no more than 75 pitches per game, according to USA Baseball, the sport's national amateur governing body. Eric and his pitching teammates had routinely thrown 90 to 100 pitches a game.

Boys at 13 should throw only fastballs and changeups, says USA Baseball. At 14 they can add the curve. But when Eric was about 12, a coach taught him the knuckle curve, said Andy. At 14, after his injury, another coach encouraged him to throw the forkball. USA Baseball says you may add the knuckler to your repertoire at 15 and the fork only when you're 16.

The reason? These more exotic pitches put tremendous strain on developing muscles and bones. Even though Eric at 14 is nearly 5 feet 11 inches tall, weighs 180 pounds and has hands considered large even for a full-grown man, he's still a boy with growing bones. His body couldn't handle the stresses those pitch counts and pitch types threw at him.

"The Eric story for me is about bad information and bad coaching," says Andy. "The (USA Baseball) information did not filter down at the coach/manager level."

Robin agrees that education is critical, that the player, parents and coach need to be a team, working together to ensure kids stay healthy and active. "Parents are very, very proud of what their kids are doing in sports, but our concern here is that pushing them at a young age is not going to do them any good in the future," Robin says.

While Eric's pitching injury is classic, his status as a three-sport athlete is not. Most overuse injuries are occurring because young athletes are playing the same sport all year round. "Now we're seeing overuse because it's the same sport over and over and over," says Robin. "They never get a chance to rest. A long time ago there'd be kids switching sports, so you'd go football, then baseball, then something else."

This trend is seen nationally as kids train harder, start younger and do single sports all year round. "Because training has become more sport-specific and nearly continuous, overuse injuries are now common among young athletes," wrote John P. DiFiori, MD, in the January 1999 issue of The Physician And Sports Medicine.

Eric is on the mend after seven sessions with Robin. He's following her instructions and using the blue elastic resistance band he got at the sports medicine clinic. After tying one end of the band to a door, Eric takes the other and pulls, straightening his arm out and pulling the band taut, away from the door. He's also using ice on his arm after every pitching bout.

After about eight weeks rest, Eric began pitching again in Babe Ruth League games in May, just a couple of innings per game. When he's not pitching, he's fielding at first or third base, or playing catcher, where his knowledge of pitching is a special asset.

"We caught (Eric's injury) early," says Robin. "He's starting up pitching again, he's doing well. As long as he stays with low pitch counts right now, and brings them back up slowly, he's going to be fine."

Now that he knows more about youthful pitching limitations, Eric is philosophical. "I just need to work on my other pitches I guess," says Eric. "I need to get better control. Because sometimes you need that pitch and you can't use it. I have to work with my other ones. It's harder to do, but it's worth it, I guess, if I don't hurt my arm."

Eric's favorite major league pitcher supports his strategy. "When they're in a jam, a lot of pitchers try to throw harder," says Greg Maddux, a 20-year veteran of the Atlanta Braves, in a quote on thebaseballpage.com Web site. "Me, I try to locate better." Maddux, a four-time winner of the Cy Young pitching award, helped the Braves win the 1995 World Series.

Eric's goal is to play as long as he can, maybe at the college level. "The school that I'm going to go to is Oklahoma," says Eric. "For some reason I'm just a big Oklahoma fan of any sport."

For more information
If you're concerned about a young athlete, the Sports Medicine Center for Young Athletes at Children's Hospital is ready to help. The clinic's team approach includes physicians, nurse practitioners and physical therapists, all eager to help young athletes learn how to stay healthy while excelling at their sport. For more information call 510-428-3558.

For a PDF version of USA Baseball's "Guidelines for Youth Baseball Pitchers" go to www.collegesports.com or visit the American Sports Medicine Institute's Web site.