According to new research released by the American Orthopaedic Society for Sports Medicine (AOSSM) pitching speed, player’s height, and pitching for multiple teams may correlate with a history of shoulder and elbow injuries.
A couple of quick thoughts from my view, taller athletes tend to be stronger and thus can generate more velocity, and while it's a catch-22 greater arm speed equates to increased stress on the throwing arm. As a result of this increased velocity and probable accompanying high performance these athletes have more opportunity to pitch for multiple teams and more exposure increases the odds of getting injured. And while it's definitely insightful and adds to the current body of knowledge I would hardly describe this information as ground breaking.
That said, three dreaded words for pitchers have again been prominent in the baseball news recently: Tommy John surgery.
The procedure, by its medical name, is ulnar collateral ligament surgery.
The procedure has saved the careers of major leaguers, but the need for it among young pitchers after elbow ligament injury is on the rise. Renowned orthopedic surgeon Dr. James Andrews told Cleveland.com last spring he has seen a sharp increase in youth sports injuries.
"I started seeing a sharp increase in youth sports injuries, particularly baseball, beginning around 2000," Andrews said. “In my practice now, 30 to 40 percent of the ones I'm doing are on high-schoolers, even down to ages 12 or 13. They're already coming in with torn ligaments.”
Dr. Peter Wenger, a Primary Care, Sports Medicine Specialist, said he has seen torn elbow ligaments in players as young as eight years old.
Can young pitchers avoid it? Medical professionals and pitching coaches admit there is no way to completely prevent elbow injuries, but they say there are ways to minimize the risk.
Here are eight tips that could reduce the chances of a young pitcher from needing Tommy John surgery:
1. PRESEASON CONDITIONING FOR YOUR SHOULDER: Your shoulder? Yes. Wenger, said, "Most elbow injuries are caused by weakness in the back of the shoulder.”
Conditioning before the season will increase the endurance of shoulder muscles during the season. Players age eight and older should begin conditioning six to eight weeks before the start of practice. For those playing youth baseball, that means now. If you’re a high school pitcher, these exercises can be done between high school and summer seasons or before the start of fall ball.
The strengthening should focus on shoulder and scapula (shoulder blade) stability. Strengthening the back and core muscles are also essential. More on the types of exercises you can implement into your routine will be provided below.
2. THROW AWAY THE RADAR GUN: “Baseball is a game of numbers, and young players focus on how hard they are throwing,” Wenger said. “It’s more important they focus on form and conditioning. Control and mechanics are far more important than velocity, especially for younger pitchers.”
Mark Leiter, a former big leaguer and pitching coach said the following:
“Overthrowing creates bad habits, which lead to bad mechanics.”
3. PLAY MORE CATCH: Leiter, who had an 11-year major league career, noted players today pitch more but throw less.
“Kids just don’t play catch anymore,” Leiter said. “We used to play pick-up games or throw the ball around in the street. That develops arm strength. Pitching and throwing are two different things.”
4. TAKE THE TIME TO WARM UP: Both Leiter and Wenger noted many players today show up 10 minutes before a game, make 15 throws and then pitch.
You want to get a sweat going before you throw. That means a more general warm-up using exercises that emphasize dynamic and multi-directional movements. Not running poles or sitting on your back doing static stretches!
“You want the muscles warm and moving easily before you pitch,” Wenger said. “Once you begin throwing, it’s a good idea to start at 50 percent velocity and work your way up for a period of 10 to 15 minutes until you feel comfortable.”
5. DITCH THE CURVEBALL: It’s not so much the pitch, but how it’s thrown that can cause injury.
“Most kids aren’t taught to throw the curve the right way,” Leiter said. “For kids eight, nine, 10 years old I believe in throwing a change-up as a deception pitch. If there is an advanced 12-year-old, I might show him how to throw it and then tell him to throw one per inning. I really don’t want a pitcher throwing a curveball until he gets to 60-90 (foot fields).”
“My rule of thumb is, don't throw the curveball until you can shave, until your bone structure has matured and you have the neuromuscular control to be able to throw the pitch properly, Andrews told CLEVELAND.COM. “If you throw it with good mechanics, it doesn't have any greater force on your shoulder than throwing other pitches, but you've got to throw it correctly. It's misleading to say it's OK to throw the curveball with good mechanics because the rub is, most kids don't throw it with good mechanics.”
“When thrown incorrectly the curveball puts stress on the ligaments and the growth plates in the elbow,” Wenger explained.
6. USE A PITCH COUNT: The American Sports Medicine Institute helped developed the pitch counts used by youth baseball organizations.
“Coaches and parents should stick to the guidelines as much as possible,” said Wenger.
According to ASMI, a pitcher between the ages of 15 and 18 years old should have four days of rest after throwing 76 or more pitches. A player 7-8 years old should have four days rest when throwing 66 or more pitches.
7. GET LONG-TERM REST, TOO: Since ulna ligament injuries are from overuse, rest across and between seasons is a key element in prevention.
“Whenever you play a sport season, to season, to season the risk for injury goes up whether its soccer, basketball or tennis. It’s important to give your body time to recover,” Wenger said.
“Specialization leads to playing the sport year-round,” Andrews said. “That means not only an increase in risk factors for traumatic injuries but a sky-high increase in overuse injuries. Almost half of sports injuries in adolescents stem from overuse.”
“I’ve worked with kids who play on three and four teams at a time,” Leiter said. “I would rather see a kid pitch six innings once a week than throw two on Tuesday, three on Friday and two on Sunday.”
How much rest?
“A pitcher should take three or four months off from throwing each year,” Wegner said. “A good rule is for every three months you pitch, take one month off.”
8. DON’T IGNORE THE SIGNS: Wenger said reoccurring pain and lengthy soreness are signs of a problem. “If you wake up the next morning and you are still hurting, that’s not a good thing,” Wenger said. “Pain inside the elbow or shoulder with regularity are signs of a problem. That is not the time to try and gut it out.”
Wenger said signs for coaches to watch for are decreases in velocity, pitch count and control. And, note changes in mechanics.
“If a pitcher starts throwing more sidearm than over the top it is a sign of fatigue or worse,” Wenger said.
Personally I believe overuse injuries could all be virtually eliminated with a long term athletic development plan. In short the younger a child is the more general their movement/sport experiences should be. Master/explore the fundamentals of human movement first and then move on to honing fundamental sports skills and the final step should be specialized sport skills. In America we have it backwards!
That said, we have to deal in reality. Kids are going to pitch and they are want to play well so we can't put the brakes on them but we can equip their bodies with sound training to counteract the demands of throwing a baseball.
On that note...
I have had the pleasure to meet former Boston Red Sox head trainer Mike Reinold at several seminars/conferences over the last 5 years and he has become my go to resource for injury prevention techniques and return from injury protocols as well. I wanted to share a recent post from Reinold:
To prepare before your throwing program, you really need to do two things: 1) Prepare your body and 2) Prepare your throw. In today's baseball stuff should read, Reinold will discuss Part 1: How to Prepare Your Body.