There are many hurdles young throwers may have to face. The very act of throwing is fairly aggressive requiring a unique combination of flexibility and strength. The epitome of this combination is expressed in elite pitchers, who some say, are born, not made.

One of the important structural elements of throwers is at the elbow. The ‘carrying angle’ is a measurement of the slight angle at the elbow. This is best seen when the elbow is fully straight. Normally the carrying angle is about 11 degrees valgus (forearm turned outward in relation to upper arm) in adult males and 13 degrees in adult females.

An increase in carrying angle puts more stress to the medial elbow structures (ulnar collateral ligament, flexor-pronator muscles, medial epicondyle and ulnar nerve) and makes them more susceptible to traction injuries. The increase in carrying angle can be due to trauma, developmental abnormalities or adaptive changes to repetitive stress.

During the overhead throwing cycle, large medial tensile force generated on the elbow stresses the medial structures in the late cocking and acceleration phases. Therefore, it is not uncommon for overhead throwers to develop an increase in carrying angle due to the repetitive stress. As a result of the combination, these athletes are prone to injuries such as medial epicondylitis, ulnar collateral ligament insufficiency, ulnar neuritis, etc. Most of them experience pain during acceleration phase of throwing.

In most cases, the increased carrying angle is due to the inefficient alignment/ hypomobility of the 3 bones (humerus, radius and ulna) that formed the elbow joint and/ or soft tissue tightness and Physical Therapy can help this condition!

Recently, a 14-year old baseball player with medial epicondyle microtrauma has been treated at Ando & Aston Physical Wellness Therapy. The patient had an increased carrying angle of 20 degree and pain with throwing when he first came in. After 6 weeks of treatment (joint/ soft tissue mobilization and exercise program) he is able to throw and play continuously for more than 20 innings without pain and his carrying angle has decreased to 12 degrees!
Comments are welcome.
Gary Aston PT