by Dr. Alonzo Sexton, Athens Orthopedic Center
Youth Baseball has never been more popular. The increased popularity of traveling teams, along with Little League and school teams, now means the opportunity for year-round play exists. With the increases in playing time, a dramatic increase in injury rates has also been experienced.
As a sports medicine specialist, I am seeing more and more shoulder and elbow problems in young baseball players; in fact, they are some of the most common injuries I treat. Research has shown that repetitive overhead throwing places extraordinary stress on both the shoulder and elbow in both adult and youth athletes. But youth athletes in particular may be at increased risk due to the extremely vulnerable growth plates that are susceptible in young athletes. The vast majority of these injuries can be tied to overuse in the athlete in some shape or fashion. Athletes may experience overuse in a game, during a showcase or throughout a season, and this overuse can lead to serious, career-ending injuries requiring surgery. In fact, athletes pitching greater than 100 innings per year are 3.5 times more likely to suffer a career-ending injury or require surgery on the shoulder or elbow.
My first question to athletes participating in youth baseball is, “What position do you play?” Pitchers by far have a greater incidence of injuries compared to other positions due to the increased volume and speed with which they throw the ball. My second question is, “Do you use a pitch count?” In 2002, an article came out that detailed the problems with overuse in youth baseball. They found a higher incidence of shoulder and elbow injuries in pitchers that threw more innings. This article was instrumental in the development of guidelines by the USA Baseball Medical & Safety Advisory Committee and Little League Baseball limiting the number of pitches in a game.
What appears to be clear is that the best treatment is prevention. In order to protect and prevent injuries, healthcare providers recommend the ARM approach:
Adherence to pitch count
Rehabilitation exercises (strengthening and stretching) … Rest (2 months of rest per year)
Mechanics (utilizing proper pitching mechanics)
Figures 1 and 2 below show the recommended pitches per outing for various age groups, and the recommended days of rest required between outings for Little League Baseball. There are specific exercises that all throwing athletes should perform in order to lower the chances of developing problems. These exercises focus on rotator cuff strengthening and stretching.
It has also been recommended that throwers avoid year-round pitching by having at least two months off per year. Improper mechanics can put tremendous stress on and ultimately overload structures in the shoulder and elbow.
While the problem of shoulder and elbow injuries in youth baseball has been growing, it can be avoidable. While the treatment and surgical techniques have advanced over the last decade, protecting our children with prevention is preferable.
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