Minimizing the Risk of Injury in Little League Players

It’s that special time of the summer again when young players flock to Williamsport, Pennsylvania in search of the Little League World Series Championship. Watching the games on television, you can’t help but notice the young pitchers and pay attention to how many pitches they throw and the types of pitches they throw. At the youth level, it seems that the pitchers who excel are the ones who are able to learn to throw a breaking ball. At that age, it is difficult for the hitter to recognize and hit that pitch. So, often the pitcher uses the curveball or slider frequently. Recently, in the media, there has been a lot of discussion regarding overuse injuries of the youth pitcher. The conventional wisdom was that throwing the curveball at too early an age would lead to injury in the young pitcher. However, research done by several authors in the past couple of years contradicts that idea.

A couple of studies done by The American Sports Medicine Institute (Birmingham, AL) and Connecticut Children’s Medical Center (Farmington, CT) were done to evaluate and compare the biomechanical differences between the fastball, curveball, and change-up pitches. Both studies demonstrated that the stresses to the shoulder and elbow joint were greatest when throwing a fastball as compared to the other types of pitches. The authors concluded that throwing the curveball may not be responsible for the rising injury toll in young pitchers.

So, if it’s not the type of pitch, then what is responsible for what seems like an epidemic of shoulder and elbow injuries in the young baseball athlete? The answer, yet again, may come from research done at ASMI in Birmingham, Alabama. Three main risk factors seem to be more responsible for contributing to a young pitcher’s development of pain and injury: Improper Mechanics, Fatigue, and Overuse.

Improper Mechanics

I’ve wrote about this area in many of my articles and blogs, but it bears repeating again. The overhead pitching motion is a fine-tuned sequence of movements in body segments originating from the lower extremities and pelvis, progressing through the trunk, and culminating in the smaller, less powerful upper extremity structures. The better and more efficient the thrower’s mechanics, the better the chances of reducing stresses on the shoulder and elbow. Mechanical faults that alter the timing of the sequencing of events or place the body in an improper position can result in increased upper extremity forces and torques. These increases in joint stresses can lead to an increase in subsequent risk of injury. Even though the curveball, by evidence of research, is less stress full on the elbow and shoulder than the fastball, the pitch should still be taught by a qualified pitching instructor. Too often, a volunteer coach or parent attempts to introduce the breaking ball to a young pitcher. Without proper knowledge of the pitching motion and the specific grips and key teaching points, the athlete may learn incorrect technique which may surely elevate his risk of potential problems.

Fatigue

The ASMI study notes that young athletes who pitch with arm fatigue or throw more than 85 pitches per game are more likely to require elbow surgery. Younger, less experienced pitchers are unable to maintain their accuracy or level of performance as they become fatigued. The fine-tuned chain of events necessary to execute the throwing motion is altered and creates timing delays and compensations in movement and muscle activation patterns which may ultimately result in an increased risk of injury. Fortunately, many youth baseball programs have adopted limits on pitch counts per outing and mandated specific lengths of rest prior to returning to the mound.

Overuse

Along with the number of pitches per outing, the length of a young player’s “season” also impacts his risk of potential shoulder or elbow injury. Adolescents who pitch more than 8 months out of the year are also several more times likely to require arm surgery. 8 months out of the year?! This seems absurd to me. The Major League Regular Season is only 7 months long and these are mature, seasoned, developed, and conditioned pitchers. If you enjoy playing baseball, that is fantastic! It is a great game. But as a youngster, go out and play other sports too. Learn how to move, run, cut, jump. Develop your overall athleticism. As you get older, then you can begin to focus on a sport that best suits your talents. If it’s baseball and pitching, then having a better foundation of athleticism can only help you.

The moral of the story is that if your son is going to throw the curveball, he should learn how to throw it correctly. It is important to learn how to identify when he is beginning to tire and be sure to allow for adequate rest and recovery between outings. Finally, avoid overuse by allowing your young player to become a multi-sport athlete. This will allow the body physically and mentally rest from the repetitive stresses of baseball and help to develop a better physical foundation for athletic performance.

David Yeager, ATC, CSCS
Co-Founder
BaseballStrengthCoaching.com

Statistically Speaking...

I am going to go out on a limb and say that there is something wrong with your shoulder. You probably throw a baseball more than 100 times a day for 9 or 10 months out of the year. You have probably been throwing a baseball since you were 5 or six years old.

Check these out if you get a chance – just read the abstracts:

Wright, RW, Steger-May, K, Klein, SE. Radiographic findings in the shoulder and elbow of Major League Baseball pitchers. American Journal of Sports Medicine. 2007 Nov; 35(11):1893-43.

Fredericson M, Ho C, Waite B, Jennings F, Peterson J, Williams C, Mathesonn GO. Magnetic resonance imaging abnormalities in the shoulder and wrist joints of asymptomatic elite athletes. PM R 2009 Feb;1(2): 107-16.

Miniaci A, Mascia AT, Salonen DC, Becker EJ. Magnetic resonance imaging of the shoulder in asymptomatic professional baseball pitchers. American Journal of Sports Medicine. 2002 Jan-Feb;30(1):66-73

The same thing can be said about the knees and backs. It would probably take about one google medical search that takes .000005 seconds to find articles saying the same thing about the knee and back.

I say this because the majority of you have had shoulder trouble at some point in time. If it persists, you need to go talk to an educated individual. When it comes to an overhead athlete – you need to talk to the right kind of physician. Your family physician is really smart – don’t get me wrong. However, he might panic when he sees damage to the rotator cuff and some fraying of the labrum. I would highly recommend talking to a physician that has some experience with the overhead athlete - an orthopeadic/sports medicine physician.

Chris Ham, MSA, ATC, CES
Athletic Trainer
Vanderbilt University Baseball