Summer is almost here which means high school playoffs are around the corner and the travel and summer league baseball seasons are heating up! Exciting times for sure, but also a time to be sure your young pitcher’s long term health is at the front of your mind. You don’t have to look hard to find an article detailing the increase in Ulnar Collateral Ligament (UCL) tears among pitchers both at the professional and youth levels resulting in Tommy John surgery. In fact, it’s also not that hard to find youth and high school pitchers that have dealt with or are currently dealing with elbow soreness or pain as a result of pitching, which in and of itself is a risk factor for a more serious injury down the road. There are also many experts in the Orthopedic Surgery field that believe the rise in UCL tears seen in collegiate and professional pitchers is less a result of anything they are currently doing and more a result of the damage they started doing as a youth baseball player.
Fortunately, there is research available that has identified certain risk factors (in youth ages 9-20yrs old) that increase the risk of future elbow or shoulder injuries. A few of those risk factors are:
- averaging greater than 80 pitches per game=3x greater injury risk
- fastball velocity greater than 85mph=2.5x more injury risk,
- pitching competitively more than 8 months a yr=5x greater injury risk ,
- pitching more than 100 inning per calender=3.5x greater injury risk,
- pitching for more than one team at same time=5.3x injury risk.
Depending on the study, “injury” was either defined as surgery, ending playing career because of an injury or elbow pain. Regardless, all those statistics are a result of overuse which is very preventable with awareness from both coaches and parents.
Another issue that happens far too often in travel ball, especially at younger levels is pitching on back to back days at weekend tournaments. For example, a young kid may throw 30-40 pitches one day, then come back and throw 20 pitches the next day. That may not seem like a big deal when taken as a whole (50-60 pitchers) over course of the weekend, but pitching is a high stress activity. You’re asking a young kid that still has open growth plates and is not fully, physically mature, to put his arm through back to back stressful days along with the fact he likely is playing in the field during other games the same weekend, meaning his arm is not fully recovered for the 2nd game and that adds up to a lot of accumulated stress over the summer/fall. Why does that matter? The single biggest risk factor for injury, at a whopping 36x greater risk, is regularly pitching with a fatigued arm.
Finally, many young kids (even high school kids) simply don’t understand or realize the need for proper recovery, maintenance, and strengthening of their arm and overall body throughout the year, nor do they participate in any type of specific physical development program. I honestly believe this is a larger problem than people realize. Imagine putting a 405 horsepower engine in a car with bald tires, poor steering, rusted bolts and brakes that need to be replaced. That’s just asking for trouble. Yet we think nothing of having young kids place repeated stress on their shoulder and elbow without the physical or mental tools in place to manage that stress.
Proper tools to manage joint and soft tissue stress may be:
- how much sleep to get
- what foods to eat
- soft tissue massage
- specific individual assessment of shoulder/elbow strength, stability and range of motion
- individualized arm care programs
- proper lifting for their sport
- proper throwing program
- a better way to warm up and recover prior to and after, pitching
Combining high workloads of tissue and joint stress (pitching) at a young age with lack of necessary tools to manage that repeated stress is often what leads to tissue and joint injuries down the road. The damage kids start doing to their arm at age 12 may not reach a threshold point until high school or college. Just because a kid doesn’t get hurt or show signs of injury after 8 months of playing baseball at age 12 (for example) doesn’t mean no damage occurred.
However, the opposite is also true. A well managed youth baseball travel season (with long term health, rather than short term success in mind) combined with proper recovery and development in and out of season, may also lead to a long and successful, injury free, baseball career.
There is a great study/reveiw of literature by Dr. Glenn Fleisig and Dr. James Andrews that goes into even greater detail about how to prevent elbow injuries in youth baseball pitchers and identifies several risk factors. Check it out here:
Youth injury rate literature review: Fleisig and Andrews
Dun et al. American Journal of Sports Medicine 2008: 36
Fleisig et al. American Journal of Sports Medicine 2011: 39
Fleisig et al. American Journal of Sports Medicine 2006: 34
Nissen et al. American Journal of Sports Medicine 2009: 37
Olsen et. al. Amercian Journal of Sports Medicine 2006:34