Throwers Clinic

Whether they are seeking a competitive edge or returning from injury, the Throwers Clinic at Boston Children’s Hospital helps pediatric, adolescent, and college-age athletes perform to their potential while reducing their risk of injury.

Success in throwing sports like baseball, softball, and javelin requires sound mechanics and strength. Each time an athlete throws or pitches, they put significant force on their throwing shoulder and elbow. Over time, these repeated forces can lead to pain, strains, sprains, and in some cases, career-threatening injuries.

Many of the injuries we treat, such as Little League shoulder or osteochondritis dissecans (OCD) of the elbow, occur during periods of rapid growth, when an athlete’s bones, ligaments, and muscles are especially vulnerable. Young athletes may have the same symptoms as an adult, but for completely different reasons and therefore require different treatment.

As they near physical maturity in mid- to late-adolescence, throwing athletes are at risk for some of the same injuries as young-adult athletes, including ulnar collateral ligament injuries, rotator cuff injuries, and labral injuries of the shoulder.

As part of Boston Children’s Sports Medicine Division, we treat hundreds of middle school, high school, and collegiate athletes every year. We apply our clinical experience and research to provide each athlete care tailored to their injury and stage of physical development.

Whenever possible, we address injuries with non-operative care such as physical therapy, shockwave therapy, ultrasound-guided injections (PRP injections), and other forms of regenerative medicine.

When a serious injury requires surgery, we use the most advanced, evidence-based methods that offer the best outcomes and, in many cases, the shortest recovery times possible.

Our patients have access to the extensive services available at Boston Children’s Hospital and The Micheli Center for Sports Injury Prevention, part of the Sports Medicine Division. Your child’s care team may include:

• Sports medicine doctors and surgeons
• Physical therapists
• Athletic trainers
• Strength and conditioning specialists
• Biomechanical experts
• Behavioral health experts
• Sports dietitians

We’ll work together to coordinate care around your child’s individual goals and needs.

Very often, evaluating an athlete’s throwing biomechanics (movement patterns) can reduce their injury risk while also supporting improved performance. In many cases, athletes get injured when they try to throw at higher velocities than their foundation of strength can support.

When treating a throwing injury, once an athlete is pain-free and has restored range of motion and strength, we use advanced technologies to provide insights into the athlete’s movement patterns, muscular strength, range of motion, and flexibility imbalances. These technologies include:

• 2D (video) throwing analysis
• 3D (motion capture) throwing analysis
• Force-plate technology 
• Functional movement screening (FMS)
• ForceFrame strength testing
   

At the Throwers Clinic, athletes have access to sports medicine experts who are advancing the field of injury prevention and treatment. Our research includes:

Improved surgical treatment for osteochondritis dissecans

Osteochondral grafting is a surgical procedure that replaces the bone and cartilage damaged by osteochondritis dissecans (OCD) with healthy tissue from another part of the body. Osteochondral grafting is well established as a treatment for osteochondritis dissecans of the knee. For more than 10 years, surgeons in our Orthopedics and Sports Medicine Department have tested the method to repair the condition in elbows as well.

We’ve also founded a multicenter prospective registry of young throwers with elbow osteochondritis dissecans (OCD). Through careful study of hundreds of throwers with elbow OCD, our surgeons and researchers hope to improve prevention, diagnosis, and treatment of athletes with this condition.

Developing strength and mobility benchmarks for high school pitchers

Velocity programs have gained popularity as focus on younger athletes pitching at higher velocities has grown. In many cases, athletes are trying to achieve high velocities without an appropriate foundation of strength to minimize injury. We are currently recruiting athletes to participate in a study that will help us develop standards on the strength and mobility required to safely throw at high velocity.

Effectiveness of pitching restriction policies

Pitch counts and days of rest, formally known as pitching restriction policies, have been in effect since the late 1990s at numerous levels of organized baseball, including Little League, high school (NFHS), college (NCAA), and professional baseball. We are actively conducting research to determine whether these pitching restriction policies reduce shoulder and elbow injuries in high school baseball players.