Authored by: David C. Buck, M.D. - Orthopedic Surgeon and Sports Medicine Specialist at MD West ONE (Omaha and Fremont, Nebraska)
The sights, sounds, and smells of spring are the signs that baseball and softball seasons are just around the corner. The crack of the bat. The smell of fresh cut grass. The chalklines showing up on freshly manicured infields.
Along with those signs unfortunately also come the increased rates of injuries that coincide with the preseason and early season months of spring. Even at the Major League level, we see the highest rates of injuries in April and May. In my practice where I see a range from t-ball up through college players this also holds true.
Today’s blog will focus on the little league and high school athlete in particular.
We have seen a rise over the years of youth baseball and softball injuries. The "why" of this increase is up for speculation and debate and includes: pitching mechanics, pitch types, pitch counts, early sport specialization, and overuse injuries. Opinions differ on how to prevent injuries, but it’s clear that the greatest factor for increased injury risk is continued throwing while an arm is fatigued. Pitching with a sore, tired, fatigued arm has been shown to increase the likelihood of injury by a factor of greater than 30 times. Early season conditioning, throwing mechanics, and athlete recovery habits all can help play a role in reducing the risk of injury in the younger athlete.
It is also important to remember that the age of our athlete plays a role in how we manage their pitching load. Younger children with open growth plates are at higher risk for injury to these weaker areas than the older high school or college athlete who is skeletally mature. The younger athlete is at risk for little league elbow and shoulder (growth plate fractures) as well as muscle strain and overuse. The older high school and college athlete is at risk for rotator cuff and shoulder labrum or biceps tendon injuries as well as UCL injuries to the elbow (Tommy John injuries) and forearm muscle strain. All ages are also at risk for traumatic injuries in addition to the overuse injuries described above.
If your son or daughter is experiencing increased pain, swelling, stiffness or loss of motion, numbness/tingling into the arm, pain at rest or pain at night, those are the red flags in my opinion that require appropriate evaluation by an orthopedic sports medicine specialist. Contact our office at (402) 721-0090 and request an appointment for an orthopedic evaluation.
So the big question, how can we reduce the rate of injury?
Early Season Conditioning
As I said above, the majority of baseball related injuries occur early in the spring (April and May). This is likely due to athletes not being physically prepared to start their season. Baseball and softball are explosive sports which take an athlete from a ready position to an explosive athletic move (hitting, throwing, fielding, and running) where the athlete goes from being relatively still to maximal effort over a short time period.
Offseason conditioning to prepare for the season should start well before the games begin and should include sprints, plyometrics, band work, and sport-specific drills to mimic in-season activities. We also want to build up our throwing and hitting volume gradually to help reduce the risk for injury. Often, especially in Nebraska given our recent March snowstorm, it is difficult to get outside early to begin practices. Once the fields are ready athletes will tend to jump in at full speed to get ready for their season. Ideally, athletes should start 6-8 weeks prior to their practice season and build up volume 10% per week (throwing and hitting) in an indoor setting to prepare for the outdoor season once the weather warms up and the fields become playable.
Adequate Warm-Up and Recovery
As a youth baseball coach myself, I will dedicate 15-20 minutes of a 90-120 minute practice to proper and systematic warm-ups. This includes activities to get a sweat going (sprints, lead-off sprints, high knees, carioca, superman lunges, and burpees), arm stretches (cross body stretch, forearm stretch, towel stretches), and arm band work (shoulder rotation, lawn mower pulls, shoulder pull backs and forward rolls with the arm at 90-90, T-pulls, and shoulder flys). Throwing will begin with short to medium toss and advancing to power throws and finally shuffle power throws at long toss. I am definitely watching our athletes to insure proper mechanics during this time.
I will have our players (especially the pitchers and catchers) ice their elbow and shoulders for 15-20 minutes after throwing following practice and games. Ice is an excellent pain reliever and helps reduce inflammation and swelling. During their rest days off of pitching I will have them do some light band work and stretching to restore range of motion and improve overall muscle function in the shoulder. Finally, proper hydration, nutrition, and sleep habits are needed for a successful season and to reduce the risk of injury in the young athlete.
My final recommendation comes at the end of the season. I strongly recommend 2 months away from throwing activities at the conclusion of the baseball season. The major league level pitchers take 2-3 months of rest to allow their arms to recover so I believe our youth athletes should do the same. I also strongly recommend playing multiple sports, especially at a younger age, to help our young athletes develop and succeed.
Proper Mechanics
As a youth baseball coach for 12 years I can share from both the medical and coaching viewpoint that proper mechanics are crucial for any baseball player. They are even more important for young players who may be still working on developing their skills. These mechanics include a proper grip on the ball, foot position, body mechanics, arm position, and the delivery of the throw and follow-through. Working with your coach or another experienced player to fine-tune these mechanics can greatly improve a player’s throwing ability and reduce the risk of injury.
Pitch Count Considerations
The pitch count guidelines are now widely used and accepted in youth baseball and are being implemented at the high school level as well. These guidelines can be helpful to reduce the likelihood of an overuse throwing injury. Parents, please be careful if your young athlete is playing on multiple teams. If they do, make sure both coaches know what the athelte is doing that so they can monitor their overall arm health. Athletes need to also monitor their throwing totals on their arm health while playing other positions other than pitcher. Catchers also have a lot of throws which can lead to arm fatigue and players who pitch should NOT then immediately switch to catcher in the same game after they reach their pitch count limit.
Not all pitches are equal: Pressure-pitches put more strain on the throwing arm. It is common sense that we will put more "mustard" on a pitch with two outs and bases loaded over the first pitch of an inning. Having baserunners on base consistently rather than a series of smooth 1-2-3 innings will also put more strain on the pitching arm. Watch for signs of fatigue including decreased velocity, loss of control, or leaving the ball up in the strike zone. We often will see emotional frustration in the younger athlete as they recognize their arm is beginning to fatigue. In addition, we find that those younger athletes who tend to naturally throw harder may put more stress on their arm. Be sure to follow pitch count guidelines but also watch for signs of fatigue as outlined above and do not feel they have to reach their maximum before their arm is fatigued.
Participation in College or All-Star Showcase Events: A recent study out of Brown University showed that athletes participating in College Showcase or All-Star events had a statistically significant increased risk of injury. Pitch counts (cumulative) may not be closely monitored and athletes are often throwing at a maximum level in front of radar guns and college scouts which will put added stress on the arm. In addition, many of these events occur in the fall after a season is completed and the athlete may already have arm fatigue or in the winter when an athlete may not be prepared for the stress of maximal effort throws. These are important events for the higher level athlete, just may sure you prepare and adjust your workload accordingly.
Other Resources: A partnership between USA Baseball and MLB Baseball, the PitchSmart Program provides an excellent overview of recommendations for pitch limits and days of rest between pitching broken down by age. Their website with additional information can be found here.
Personal Note from Dr. Buck: Best wishes to all of our area baseball and softball athletes as they begin their spring seasons! I wish you a safe, healthy, and fun season on the diamond.
About Dr. Buck:
Dr. David Buck is a Board Certified Orthopedic Surgeon with a Certificate of Added Qualification as a Sports Medicine Specialist with MD West ONE.
Dr. Buck serves as the Team Physician for Midland University and also is a part of the Sports Medicine team providing coverage for the NCAA College World Series in Omaha. He works closely with several local area high schools and their sports medicine programs. Dr. Buck is a former Certified Athletic Trainer as well as an athlete and coach. He can be reached at (402) 721-0090 to schedule an appointment at either our Elkhorn (192nd & Dodge) or Fremont locations.