Gameplan Health

    Young athletes once-again are taking to the baseball fields for the start of a new season, signaling a return of spring and invariably to the arm injuries related to throwing. Often these young athletes, despite little or no preparation during the winter months, step onto the field and immediately attempt to emulate their favorite major league player. They may begin throwing without a pre-season program or even without warming-up properly at practice. In contrast, those who play baseball and softball are practically year-round athletes, leaving little time for rest and recovery. Some of these young athletes play on several teams simultaneously. In this situation, injuries often occur for a myriad of reasons. The current "year-round" trend of base/ softball allows no time for shoulder and elbow recovery as there is no "off season." Three months of rest and conditioning is recommended each year. When an athlete plays on several teams at the same time, none of his/her coaches can accurately monitor the workload. These athletes can often pitch for two different teams in the same week without consideration of pitch limitations and days of rest between pitching. The pressure to win at every level may tempt the athlete to attempt pitches that they are not prepared to perform. So what? Is there a problem?
    Yes. We have noted an increase in arm injuries in youth baseball. The growing number of throwing injuries, has prompted Little League Baseball to adopt new rules (based upon the age of the pitcher) limiting the number of pitches a pitcher can throw in a game and mandating days of rest between pitching appearances.
    We first discussed this topic in an earlier issue1 and in this issue we would like to provide some direction in regards to the current thinking in prevention of injury in youth baseball.

So, what is a parent to do?
Here are some items to keep in mind:

• Make sure your child is physically fit to pitch by building up their throwing intensity and pitch volume prior to the season.
• Have your son or daughter warm up before pitching.
• Follow pitch count and recovery guidelines. Monitor your kid's pitch count.
• Monitor your child's well being by asking him/her how he/she is feeling.
• Teach your child that it is okay to stop/rest if pain is occurring.
• Avoid "showcases," multiple simultaneous leagues, and multiple "same game" pitching appearances.
• Do not allow your child to participate in organized baseball for more than 9 months in any year.

The following are risk factors for injury in youth baseball:

• Throwing the breaking ball at an early age.
• Throwing too many pitches per game or innings per week.
• Participation in more than one youth baseball league simultaneously.
• Participation in year-round baseball.
• Poor pitching mechanics.
• Poor practice and conditioning habits due to substandard coaching practices.
• Genetic makeup not optimal for baseball participation.

The following are recommendations regarding youth baseball pitching:

• Age to begin throwing curveball: 14.5 years old
• Age to begin throwing slider: 18 years old
• Age to begin throwing changeup (not considered any more stressful on the arm than the fastball): 11 to 12 years old, or when sufficient velocity and control are developed with the fastball
• Maximum innings per week - Ages 14 and unders: 6 innings/Through Highschool: 10 innings.

If your child develops arm pain that does not seem to be resolving (4 days or longer or pain that returns immediately at the next throwing performance), have them see an orthopaedic doctor specializing in sports medicine, and particularly in baseball and throwing injuries. Prevention is always the best cure.

Co-author Chris Walters is a Physical Therapist and owner of Wake Forest Physical Therapy. Mr. Walters has extensive experience in the evaluation and rehabilitation of throwing injuries for athletes of all ages. Dr. Mark Galland is a Board Certified Orthopaedic Surgeon specializing in sports medicine, practicing in Wake Forest and North Raleigh. He serves as team physician and orthopaedic consultant to the Carolina Mudcats, AA Affiliate of the Cincinnati Reds of Major League Baseball, as well as several area high schools and colleges. Dr. Galland can be reached at (919) 562-9410 or by visiting www.orthonc.com or www.drmarkgalland.com.

Mark Galland, MD, Orthopaedic Surgery and Sports Medicine Shoulder and Elbow Throwing Injuries: What is a Parent to Do? 1Mark Galland, M. (2009, September). Safe Youth Baseball Pitching and Playing Guidelines. VYPE High School Sports Magazine , 2 (9), p. 33. Dr. Galland's September 2009 VYPE article focused on the increasing frequency in the pre-adolescent and adolescent pitcher. The article takes the reader through the different stages associated with the athlete including: How to estimate elbow overuse or misuse, what young pitchers should focus on, and protecting the health of our young athletes. To view a digital version on Dr. Galland's article, please visit www.vype.com/raleighdurham and click on the September 2009 Cover.