Sports Corner: Pitching Injuries

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America’s national pastime – BASEBALL – has been a preferred summer sporting event for millions of young athletes since its creation.  The allure and nostalgia of fresh cut grass, playing catch and spring afternoons spent at the ballpark serve as a foundation for many Americans’ childhood memories.  Baseball is not without its challenges, though, one of the primary being the repetitive microtrauma from overhead throwing that can end sporting careers and limit functional usage for life’s later stages. The act of rotating the arm overhead with the purpose of releasing a weighted ball with velocity, places a large amount of stress on both the shoulder and elbow joints.  This movement, repeated over and over again, can far too often lead to injury.  Particularly alarming is the recent and rapid increase in these types of throwing overuse injuries that are occurring at the youth sport and Little League levels. What type of injuries are we talking about? What has caused the increase in these injuries? How can young athletes and their parents appropriately participate in these sports without unnecessarily increasing their injury risk and jeopardizing their future function?  Read on for further information.

Two Main Baseball Injuries:

Rotator Cuff (RTC) Pathology-  The words that no baseball player (especially a pitcher) wants to hear is that they have a rotator cuff tear.  The rotator cuff is made up of 4 individual muscles (Supraspinatus, Infraspinatus, Teres Minor and Subscapularis) that help to move and – more importantly – stabilize the shoulder joint during movement.  The rotational forces and large eccentric load (the work needed for slowing the arm down) produced during throwing place a significant demand on the rotator cuff.  This demand can result in injury – particularly with repetitive stress and/or poor throwing mechanics.  The treatment for rotator cuff injuries ranges from rest and physical therapy to surgical repair.   A variety of factors play into the decision about how to best treat injury.  One of these factors is the amount of damage present in the tissue. (Is the diagnosis of tendonitis? A partial tear?  A full thickness tear?)  It is always a good idea to try rest and physical therapy first.  If surgery is ultimately necessary, it is important to know that most research estimates that there is an approximately 50-50 chance of being able to return to previous levels of athletic performance levels after a surgical rotator cuff repair.

Elbow Ulnar Collateral Ligament (UCL) Tear-  This injury is more commonly known by the operative procedure to repair it: Tommy John Surgery. The Ulnar Collateral Ligament connects the upper arm to the forearm on the inner side of the elbow.  It is stressed by the torque produced when the elbow is twisted during the throwing motion.  Repetitive stress, poor mechanics and high pitch velocity are all risk factors for this injury. In cases where surgical repair is necessary, a full 12 to 18 months of physical therapy is typically required.  Approximately 80% of competitive athletes are able to return to previous levels of performance after such surgery.

Why the rise in youth baseball injuries?

There are numerous factors that contribute to this answer.   Some of the key culprits include:

Year-Round Sports Teams and Early Specialization- The advent of travel/select/showcase teams that play year-round and do not allow for necessary periods of rest and recovery are widely considered to be a key factor in the injury rise in youth sports. Especially in younger athletes, the decreased amount of offseason and the missed opportunity to participate in other sports which help to train different muscle groups results in higher levels of repetitive stress and subsequent injury.

Increased Pitch Velocity and Use of Radar Guns-  There has long been an argument on the effects of throwing breaking balls (curveball and slider) at a younger age.  Many guidelines suggest waiting until physical maturity before throwing these pitches, due to the tendency for improper mechanics and skeletal weakness in younger throwers.  However, most research has been unable to find a specific link between throwing curveballs and injury rates.  What the research has found is that higher velocity pitching and the practice of consistently throwing at maximal effort has a large correlation to injury.  This presents a problem in that velocity is a perceived key marker in pitching ability.  Additionally, with the common usage of radar guns to document throwing velocity, pitchers are encouraged to throw at maximal effort with every pitch.

Poor Understanding of Correct Training and Optimal Mechanics- The value of good coaching and instruction in how best to train the body to hold up to the stress and demands of a given sport can be a vital component in avoiding injury.  Having a good offseason training regimen, understanding how to gradually build intensity leading up to the season, and recognizing early signs of fatigue and breakdown of sound mechanics are all important steps in addressing issues before they result in serious injury.

How Best to Avoid Injuries?

Adhere to guidelines- Most youth sports leagues have adopted pitch count limits and rest requirements. Parents should prioritize following these guidelines, along with participating in leagues that enforce them.  Parents should also recognize and seek out coaches that care more about the long-term health of their players than the results of any given individual game.

Be Informed- There are multiple great resources addressing concerns about baseball injuries and describing strategies for safe participation. Pitchsmart is a great site that is endorsed by Major League Baseball and is recommended reading for any baseball player or baseball parent.  The site offers up excellent strategies for reducing injury risk including:

  • Pitch count and rest requirements on a sliding scale based on age.
  • The recommendation to avoid playing for multiple teams at the same time.
  • The guideline to take at least 3-4 months off from competitive pitching and 1-3 consecutive months from all throwing every year. (Specific rest recommendations are also age dependent.)
  • Encouragement to play other sports in addition to baseball throughout the year.

Prioritize Preventative Care and Early Recognition- Most baseball injuries result from repetitive stress and occur over a period of time as opposed to stemming from a singular event. Setting up an effective preventative training regimen, encouraging an athlete to avoid playing through pain and seeking medical consultation at the onset of discomfort are all excellent strategies to address early symptoms prior to significant injury.

At Symmetry Physical Therapy we are experts in body mechanics, injury prevention, and rehabilitation as they apply to a variety of youth sports – baseball and otherwise. We are also parents of youth athletes, familiar with the challenges and triumphs that youth sports bring.  We enjoy being able to help our patients to resolve their nagging injuries, optimize their performance and be able to excel in their athletic endeavors. Please let us know if we can help to answer any questions that you may have about your young players.

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