There seems to be an epidemic of sorts in my practice. I have had several boys undergo the “Tommy John” surgery to repair a torn ligament in the elbow over the last few years. All of these athletes are great pitchers and all now in high school. All of them had to undergo a long rehab process after the surgery and although they all returned to their high school teams, only one was able to match his pre-injury pitching prowess.
I also have had several high school athletes with shoulder overuse injuries including rotator cuff strains and repeated dislocations and some of these athletes have gone on to require surgery as well.
As baseball season is approaching, I want to review some important information to help parents and coaches keep these young athletes healthy and not get sidelined with an overuse injury.
-Follow pitch counts and rest days closely. Pitch counts and number of rest days vary by age so be informed. Even if the athlete is feeling great after his or her pitch count has been met for a given game or practice, pull the player out of pitching.
-If the athlete’s arm is feeling fatigued or if they seem to be having more trouble controlling their pitches (a sign of fatigue in younger players who may not be able to tell you what muscle fatigue feels like), the athlete should stop pitching. The shoulder in particular is susceptible to injury when muscular fatigue is present because the shoulder joint has fewer ligaments holding it together and is more greatly supported by the rotator cuff muscle group.
The shoulder is a complex joint that attaches the humerus (arm bone) to the clavicle (collar bone) to the scapula (shoulder blade) and the acromion (the bone that is the bump at the top of the shoulder). Because all of these bones have to work to allow for circular rotation, upward, downward, inward, outward and twisting motions, it is very vulnerable to injury when the muscles surrounding and supporting the joint are strained. When the muscles are tired, injuries occur.
Instruct your children and their teammates to listen to the messages their shoulder muscles are sending and stop throwing when they get tired.
-Gradually work up to the pitch count guidelines. If you aren’t pitching in the off season, going from a few pitches to many or going from easy throwing to hard, fast pitching is a strain. You wouldn’t get off your couch and run a 10K without working up to it and neither should a young athlete’s arm! By going too fast you will promote fatigue and increase the risk of injury.
-Pitchers shouldn’t be catchers too. Catchers throw even more than pitchers and although the intensity of the throws is less, it is an additional stress. When a pitcher is not on the mound, he or she should not be a catcher.
-Avoid playing for more than one team in the same season or overlapping. Each coach is keeping track of your pitch counts and rest days but if you are playing for more than one team you are likely to exceed the guidelines and frankly won’t be playing as well for either team as a result.
-Don’t throw curve balls or sliders until you’re shaving (for boys) or year or more beyond your first period (for girls). Although the research on this is mixed, the recommendation from the AAP and the Little League is that athletes who are still growing are at greater risk of injury to their growth plates with these two pitches since the mechanics of the arm movement creates different stresses on the arm and these pitches shouldn’t be part of the repertoire until the child is skeletally mature.
-Consider having your child continue to play a number of different sports until high school to remain active and develop a variety of skill sets but to minimize overuse. Playing anything nearly year round will increase the risk of overuse injury.
It used to be that most kids played different sports at different times of the year and in doing so rested the sport-specific muscles for any given sport for several months at a time. Now there is a strong trend toward kids as young as kindergarten age focusing on a single sport and playing it year round. The risk not only of injury but of burnout is huge. Encourage your children to play a variety of sports and winnow it down as they near the end of middle school. You’ll find that they will have fewer injuries and enjoy playing more.
Baseball and softball are two of the safest sports around and both can be played for a lifetime if you avoid overuse injuries and burnout. Enjoy the season and protect your child’s shoulder and elbow by insisting they rest when needed.