Dr. John R. Mishock, PT, DPT, DC
Approximately 40 million children and adolescents between the ages of 4 and 17 begin participating in organized baseball worldwide. Many young athletes develop elbow and shoulder injuries commonly seen in physical therapy clinics and orthopedic surgeons’ offices. Despite pitch count rules and guidelines, youth injuries and surgeries are rising. The fastest growing segment of elbow surgeries (Tommy John) is in 15-19 year-olds at 57%, followed by 20 to 24-year-olds at 22% (American Journal of Sports Medicine, 2016). One study showed a 193% increase in the volume of elbow surgery from 2002 to 2011. (American Journal of Sports Medicine, 2017). Many adult throwing injuries seen in the MLB today are attributed to overuse and injuries suffered as a youth player.
The most significant predictor of arm injury is throwing through fatigue. There is an astounding 36 times increase in arm injury when a pitcher throws while the arm and body are fatigued. (Pitch Smart, MLB 2015). The coaches’ inability to recognize fatigue, playing on multiple teams simultaneously, and not adhering to stringent pitch counts is the most common reason pitchers throw through fatigue.
There is a long-held belief that breaking pitches lead to an arm injury. Three studies have shown approximately 10% less stress on the elbow with breaking pitches. (Orthopedic Journal of Sports Medicine, 2013, American Journal of Sports Medicine, 2009, American Journal of Sports Medicine, 2008). It has been shown that those who throw the fastball more often increase their risk of arm injuries. MLB pitchers who threw more than 48% of fastballs during practice and games had a significantly increased risk of an elbow injury, which required surgery (Journal of Shoulder and Elbow Surgery, 2016). Another study showed that the risk of needing elbow surgery in MLB pitchers increased as the fastball velocity increased (American Journal of Sports Medicine, 44, 2016). The changeup is the safest pitch, producing 5-10% less stress than the breaking pitches. The bottom line should always be to learn to throw strikes first, with less concentration on velocity. At the same time, there needs to be more emphasis on the proper development of pitch mechanics and arm control across various speeds, which reduces stress on the arm. Once there is a strong command of the strike zone with the fastball and the changeup, breaking pitches can be added.
If a pitcher throws more than eight months per year, arm injury increases five times. If the pitcher throws on consecutive days, they have more than 2.5 times greater risk of experiencing arm pain. (Pitch Smart, MLB 2015). Even the amount of warm-up pitches can impact youth arm injuries. Pitchers who threw over 34 warm-ups before pitching showed an increased risk of arm injuries. Showcase tournaments are a popular recruiting tool; however, throwing in four or greater showcase tournaments increases the risk of arm injuries. (American Journal of Sports Medicine, 2016).
In protecting the youth and adolescent baseball player from an arm injury, the coach and parent must use a comprehensive approach of; appropriate pitch counts, recognizing pitcher fatigue, understanding proper pitch mechanics, knowing the athlete’s physical conditioning and previous injury status, and understanding the player’s overall throwing volume. This comprehensive understanding will give athletes the best chance to keep their shoulder and elbow healthy throughout their baseball career. The parents must be vigilant in protecting their child from pitching “abuse,” which is commonly seen in youth baseball. Playing baseball is much more than “winning” a baseball game; it’s about the young athlete’s health and safety. It is this overuse at the youth level which has led to the near epidemic of elbow and shoulder injuries in MLB. The future MLB draft pick will need durability as much as he will need ability.
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Dr. Mishock is one of only a few clinicians with doctorate-level degrees in both physical therapy and chiropractic in the state of Pennsylvania. He has authored two books; “Fundamental Training Principles: Essential Knowledge for Building the Elite Athlete”, and “The Rubber Arm; Using Science to Increase Pitch Control, Improve Velocity, and Prevent Elbow and Shoulder Injury” both can be bought on Amazon and train2playsports.com.