Here are twelve ways to reduce the chance of injury to a baseball pitcher's elbow or shoulder:
This risk factor should not only be the easiest to understand, but it's also one of the biggest reasons for injury.
Because fatigue, like pain (another early warning sign of overuse injury [1]), is subjective, and most pitchers won't tell you they are tired, it is usually up to the coach to use his observational skills and judgment to detect signs of fatigue, usng pitch counts, ball velocity, ball location, pitching mechanics, and strength to detect whether a pitcher is tired.
For the warning signs of fatigue, click here. [2]
Research1 [3]shows that youth baseball pitchers who pitch competitively more than 8 months a year are 5 times more likely to require surgery than those who take at least a four month break from throwing. This is particularly true for pitchers in warm-weather climates, who tend to play more months of the year than those in cold-weather climates.
For more on what studies show are the risks from playing baseball all-year round and what the experts recommend in terms of time off, click here. [4]Making sure kids don't exceed pitch limits is particularly difficult when they pitch for more than one team because the coaches may not communicate with each other. It thus may up to parents [8] of youth baseball pitchers on independent travel and all-star teams competing in independently-operated tournaments to monitor pitch counts because of such lack of communication and because they may have NO rules at all on pitch limits and rest.
For a study by Little League critical of such programs,3 click here [9].
For pitch limits recommended by the the National Athletic Trainers' Association,4 click here [10].
More and more youth baseball players play on multiple teams at the same time. While doing so may give him/her more opportunities to develop his skills, and while the amount of pitching may be limited by league rule or the judgment of the coaches, playing on multiple teams with overlapping seasons increases the risk that he/she may end up exceeding pitch limits (or the 100 inning limit [11] recommended by ASMI.2
If you do let your child play on more than one team at once, it may be up to you, as his parent [8], to keep track your child's pitch counts and days off and to insist that the coaches not exceed those overall limits.
The American Academy of Pediatrics' 2012 revised Policy Statement5 says "Young pitchers should avoid pitching on multiple teams with overlapping seasons," and calls for the enforcement of rest requirements across all teams.
The 2011 Little League pitching injury study [9]3 emphasizes the importance of explaining to "coaches, parents and players the high risk and limited reward of travel ball and showcases."
Poor pitching mechanics [12] can put additional stress on a young arm and increase the risk of injury, experts say.
It will come as no surprise to anyone who watches youth and high school baseball with any regularity that pitchers in their teens have better throwing mechanics than younger pitchers.
For what studies have found about the role pitching mechanics plays in injury risk and teaching proper mechanics, click here [13].Most pitching injuries are caused by overuse, which may be the result of insufficient conditioning of certain muscles. All pitchers should incorporate conditioning and stretching exercises for the shoulder [14] into an overall conditioning program. The muscles in the front of the arm are naturally stronger.
Because many shoulder injuries result from weaker muscles in the back of the arm that are used to stop the pitching motion, the conditioning program should emphasize building up those muscles.
The AAP5 says a preseason conditioning program that includes strengthening the core, the rotator cuff and the shoulder-stabilizing muscles [15] (scapular stabilizers) may help reduce throwing injuries.
For an article on shoulder stretching and conditioning exercises, click here [14].
Research shows that cold muscles are more injury prone. While a proper warm-up is important for all youth athletes, it is particularly critical during a growth spurt, when your child's muscles and tendons are tight. Experts, including the American Academy of Orthopedic Surgeons , recommend that your child warm up by:
The stories about youth baseball pitchers pitching in pain to the point of injury abound.
Pitchers should never try and get through an inning when they feel any soreness or tiredness in their pitching arm.
The key is to be able to distinguish between normal stiffness/soreness from throwing (which needs to be worked out by playing catch the day after) from pain which is the result of overuse, muscle or ligament strain, or serious injury, says youth baseball coach, author and MomsTeam contributor, Dan Clemens."It's tough for kids to know the difference until they've been though it several times (maybe even into high school), " he says. "Coaches have a tough time knowing the difference because it's not their arm and they aren't feeling it. Part of what we need to teach the kids is to know their own bodies," Clemens says.
"As coaches we need to err on the side of caution. But I know that if kids only throw on the days they feel great, they'll only be doing it once or twice a week - and that's a "weekend warrior" strategy that's a surefire recipe for injury," he says.
He recommends that kids throw 4 to 6 times a week (throw, not pitch) in order to build arm strength, which is what prevents a lot of injuries. To do this, they'll have stiffness they have to work through. Just as the only way for runners to work out the pain and stiffness from the previous day's run is to go lace up the shoes, Clemens observes. "I've tried this excuse and it only makes the run later in the week worse!"
According to a 2006 study,6 pitchers throwing harder than 85 mph are two-and-one-half more times likely to suffer a serious arm injury.
A 2012 study7 [19] by researchers at the Mayo Clinic and the Kerlan-Jobe Orthopedic Clinic in Los Angeles suggests the reason: the harder a pitcher throws, the greater the stress on the elbow and risk of injury, particularly to the ulnar collateral ligament (the ligament repaired in Tommy John surgery [20]).
The researchers called the link "alarming," especially since "increasing velocity is the goal of many pitchers." Since "a high PV is considered a hallmark of talented young pitchers," says the study, it is the best pitchers who may be the "most vulnerable to injury,"
Dr. Andrews, for one, thinks one of the culprits is the radar gun, which he argues, should be outlawed. "Young pitchers, coaches, scouts and parents put so much emphasis now on throwing hard that these kids are hurting their elbows and their shoulders because they are trying to throw 90 mph," he told ESPN.com in February 2012.
Some experts [21], including Ron Wolforth of Texas Baseball Ranch and Pitching Central,8 recommend continued use of radar guns, not out of an obsession with velocity, but because of their value to measure pitcher fatigue [2] (see #1 above)(in other words, a drop off in velocity is a tell-tale sign that a pitcher is tired, regardless of competitive level, from youth baseball up to Major League Baseball).
The 2012 Mayo Clinic study implies a continued role for radar guns, if only to identify pitchers at greatest risk of elbow injury and in determining the appropriate pitch count.
Showcases (multiday, high-level events in which athletes may play in multiple games in a short period of time) provide young players the opportunity to show off their skills to scouts at higher levels of baseball.
As USA Baseball notes,2 "Unfortunately, showcases often occur near the end of the player's season, when players are often fatigued and require rest and recovery. In other instances, players participate in a showcase after a prolonged period since the league ended and without adequate preparation for throwing hard again. It is without a doubt that young throwers will try to overthrow at these events in an effort to impress the scouts, which further increases the risk of serious arm injury."
The 2011 Little League pitching injury study3 [22] reported that pitching in showcase events was associated with an increased risk of elbow and shoulder injury for those who also pitched in Little League Baseball and in high school pitchers.
That showcases are not safe is a view shared by Dr. Andrews: "A lot of the times they go to these events not in shape or tired because they may have pitched the night before. They throw them off the mound as hard as they can and damage their arm by doing so," he told ESPN.com.
The pitcher-catcher combination results in too many throws and may increase the risk of injury. Little League Baseball instituted a new rule for 2010 [5] banning any pitcher who delivers 41 or more pitches in a game from going behind the plate to play catcher for the remainder of the day.
The results of a 2010 ASMI study9 [11] appear to support such a ban. While it found that playing catcher appeared to double or triple a pitcher's risk of injury, the small number of injured players in the study prevented a finding that the risk was statistically significant. Neverthless, the authors concluded that playing both pitcher and catcher in the same game or on the same day be "discouraged."
For its part, the National Athletic Trainers' Association 2011 position statement on overuse injuries4 [10] advises "caution when combining pitching with other demanding throwing positions (e.g. pitch 1 day and catch the next day) to ensure adequate time for recovery."
The relationship between pitch types (particularly curve-balls) and injuries in youth baseball pitchers is controversial, and the evidence, and the views of experts, go both ways. For a detailed discussion of the curve ball debate, click here [22].
1. Kaplan KM, Jobe FW, Morrey BF, Kaufman KR, Hurd WJ. Comparison of Shoulder Range of Motion, Strength, and Playing Time in Uninjured High School Baseball Pitchers Who Reside in Warm- and Cold-Weather Climates. Am. J Sports Med. 2011; 39(2): 320-328.
2. ASMI Position Statement for Youth Baseball Pitchers, August 2009 [23].
3. The Learning Curve: Little League Seeks to Address Concerns, Answer Questions about Curveballs and Overuse (Little League International 2011).
4. Valovich McLeod TC, Decoster LC, Loud KJ, Micheli LJ, Parker JT, SandreyMA, White C. National Athletic Trainers' Association Position Statement: Prevention of Pediatric Overuse Injuries. J Ath. Tr. 2011;46(2):206-220.
5. American Academy of Pediatrics Council on Sports Medicine and Fitness, Baseball and Softball Policy Statement (doi 10.1542/peds 2011-3593)(www.pediatrics.org/cgi/doi/10.1542/peds2011-3593 [24] (accessed February 27, 2012).
6. Olsen SJ 2nd, Fleisig GS, Dun S, Loftice J, Andrews JR. Risk factors forshoulder and elbow injuries in adolescent baseball pitchers. Am. J Sports Med. 2006;34(6):905-912.
7. Hurd W, Jazayeri R, Mohr K, Limpisvasti O, ElAttrache N, Kaufman K. Pitch Velocity Is A Predictor of Medial Elbow Distraction Forces in the Uninjured High-School Aged Baseball Pitcher. Sports Health: A Multidisciplinary Approach. 2012; DOI:10.1177/1941738112439695 (accessed March 22, 2012)(published online ahead of print).
8. Wolforth, Ron, Observational Fatigue & New Guidelines [21] (accessed May 27, 2010)
9. Fleisig G, Andrews J, Cutter G, Weber A, Loftice J, McMichael C, Hassel N, Lyman S. Risk of Serious Injury for Young Baseball Pitchers: A 10-Year Prospective Study. Am. J. Sports Med. 2010;20(10): 1-5.
Most recently revised May 2, 2013
Links:
[1] https://www.momsteam.com/node/3344
[2] https://www.momsteam.com/node/3346
[3] https://www.momsteam.com/node/3306
[4] https://www.momsteam.com/node/3355
[5] https://www.momsteam.com/node/816
[6] https://www.momsteam.com/node/2936
[7] https://www.momsteam.com/node/4414
[8] https://www.momsteam.com/node/2941
[9] https://www.momsteam.com/node/3715
[10] https://www.momsteam.com/node/3343
[11] https://www.momsteam.com/node/3239
[12] https://www.momsteam.com/node/2938
[13] https://www.momsteam.com/node/3367
[14] https://www.momsteam.com/node/2988
[15] https://www.momsteam.com/node/2977
[16] https://www.momsteam.com/node/2606
[17] https://www.momsteam.com/node/291
[18] https://www.momsteam.com/alpha/features/health_safety/physical_therapy.shtml
[19] https://www.momsteam.com/node/4622
[20] https://www.momsteam.com/node/3305
[21] http://www.webball.com/cms/page7199.cfm
[22] https://www.momsteam.com/node/3348
[23] http://www.asmi.org/asmiweb/position_statement.htm
[24] http://www.pediatrics.org/cgi/doi/10.1542/peds2011-3593
[25] https://www.momsteam.com/health-safety/pitching-injuries-risk-factors
[26] https://www.momsteam.com/sports/baseball/safety/preventing-pitching-injuries-in-youth-baseball
[27] https://www.momsteam.com/breaking-pitches/preventing-pitching-injuries-curve-ball-debate-continues