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Keeping young pitchers out of medical trouble

Mar. 12, 2013 @ 12:00 AM

If you pay attention to Major League Baseball then you probably have heard of pitchers like Steven Strasburg, Daisuke Matsuzaka, Kerry Wood and many others who have undergone "Tommy John" surgery. "Tommy John" surgery is a repair of the ulnar collateral ligament on the inside of the elbow. A pitcher who requires this surgery is usually sidelined for a minimum of six months and too often is unable to return to sport at his previous level. Recently, the Andrews medical clinic (Birmingham, Ala.) anecdotally reported that they are seeing an increase in adolescent elbow pain. In my local practice we are also seeing a greater frequency of pitchers with elbow pain and unfortunately it tends to be the higher caliber players that are more frequently affected. The reason for this will be discussed and possibly argued but nevertheless we are noticing an alarming trend. In this article I will discuss reasons for the apparent increase in elbow pain and some of the possible methods or techniques that can be implemented to safeguard against this problem.

A recent study on the topic reported that 29 percent of adolescent pitchers experienced elbow pain in a given season. Multiple risk factors for elbow pain have been identified in youth baseball pitchers. One of the newest identified predictors of elbow pain is high pitch velocity (PV). Higher PV is one of the greatest indicators of talent in young pitchers which is of greater concern now considering these athletes may be at the highest risk for elbow injury. That is not to say that parents and coaches should encourage their child to throw with less velocity but velocity should be taken into account when determining a safe pitch count. Throwing a fastball 85 mph or higher resulted in a 2.58 times higher rate of arm injury. Therefore setting a lower pitch count for these athletes as compared to their teammates that throw at a lower velocity should be considered.

High pitch count has been highly publicized as a risk for adolescent arm injury. It has been addressed in Little League baseball with the implementation of rules regarding number of pitches, innings limitations and days of rest between outings. The question remains, are we really taking these measures far enough? Many adolescents are involved in travel ball, showcases, and high school baseball where such regulation on innings and pitch count doesn't exist.

Here are a couple of frightening statistics:

Averaging 80 pitches per game increased the chance of elbow/shoulder surgery by almost 4 fold.

Pitching competitively for more than 8 months per year increased surgery risk 5 fold.

Regularly pitching with arm fatigue increased the surgery risk by 36 times. The take home message from these statistics is that parents and coaches should be paying attention to innings and pitch counts at all levels of baseball not just little league.

There are multiple aspects of baseball and pitching that have recently been evaluated to try and identify increased risk for elbow injury. Many people have talked for a long time about children throwing "curveballs" before they reach skeletal maturity and how that may lead to arm injury. This has been investigated and determined to be false. Researchers have found no evidence to link adolescents throwing curve balls to the incidence of adolescent elbow injury. They have, however, found that kids playing pitcher and catcher are 2.7 times more likely to have a serious elbow injury. This statistic speaks to the repeated microtrauma and lack of time allowed for healing when a young athlete is always throwing the ball as in the case of pitching and catching.

Although elbow injuries in youth pitchers are on the rise, I am certainly not advocating children stop playing baseball. However, we need to be paying close attention to the stresses of the sport. There are some easy things that can be done by parents and coaches to mitigate the risk of injury in youth baseball. Pay attention to your child's pitch count in games, practices, and throughout the year. Encourage children to play multiple sports. Playing different sports allows children to develop a more rounded skill set, decreases muscular imbalances, and minimizes overuse pains associated with focusing on one sport year round. Finally, don't forget the importance of injury prevention programs for your high level athlete to keep them strong, flexible, and healthy.

John Oxley, PT, DPT, Cert. MDT, CSCS is a physical therapist at HPT Physical Therapy Specialists. Email: joxley@hptservices.com.

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