Pitching Injury Series Part One: Pitch Count, It’s Not Just for the Pro’s

By Jim Fanara, CSCS

 If you had a fifty-fifty chance of experiencing joint pain at some point by participating in your favorite recreational activity, would you continue?  What if I told you that continuing the activity on a regular basis for more than eight months per year would make you five times as likely to need surgery to repair that painful joint?

Maybe you’d still take the risk; but would you let your son face the same odds? These are the odds facing youth baseball league pitchers.  Studies published by the American Sports Medicine Institute and the American Journal of Sports Medicine linked pitching related injuries to both volume and fatigue. One study found that youth or high school pitchers who pitch competitively for more than eight months per year are five times as likely to have Tommy John surgery.  Also, youth or high-school pitchers who threw more than 100 innings in a calendar year were over three times as likely to require elbow surgery as those who threw fewer than 100 innings.

A study comparing two groups of adolescent pitchers found that players who regularly pitched with a tired arm were 36 times more likely to have had elbow or shoulder surgery. The study states that “The factors with the strongest associations with injury were overuse and fatigue.”  The study also indicated that players in the injured group “…pitched in more showcases, pitched with higher velocity, and pitched more often with arm pain and fatigue.”

Parents and coaches need to not only monitor the volume of pitches thrown by their young athletes but also look for signs of fatigue. Players should also be regularly questioned about the existence of any shoulder or elbow pain. Players need to take joint pain seriously and refrain from lying about symptoms just to stay on the field.

Teaching proper throwing mechanics is essential to maintaining healthy shoulders and elbows.  Sound pitching mechanics, adequate rest and an appropriate conditioning program can reduce the likelihood of shoulder and elbow problems. At a minimum, conditioning programs for pitchers should address scapula and thoracic spine function along with the shoulder and elbow.

Part Two: Youth Pitching Injuries on the Rise

Pitching Injury Series: Youth Pitching Injuries on the Rise

By Jim Fanara, CSCS

If you are a parent of a baseball player or even just a baseball fan, it’s hard to miss the number of shoulder and elbow injuries that shut down pitchers.  While championships are won and lost based on pitchers’ availability, parents have more personal concerns.

 Youth pitching injuries have been on the rise for two decades. Dr. James Andrews, the renowned orthopedic surgeon, has seen surgeries to high school age pitchers rise from almost none in the early 1990’s to 18% of the surgeries he performed by 1999. By 2003, the number rose to 26% and remained between 20% and 30% thru the decade.

 We know youth injuries have risen and MLB statistics also indicate a rising trend in professional pitching injuries. So is there a connection between youth and MLB pitching injuries? Dr. Andrew’s experience indicates that there may be a link.

 The experience of Dr. Andrew’s indicates that a major contributor to Tommy John surgeries for pitchers in their 20’s is previous injury. He has found that it is common to see areas of calcification on the elbow ligaments of older pitchers undergoing elbow surgery.  This calcification points to damage caused by previous trauma at young ages. As pitchers get bigger and stronger, the compromised tissue eventually ruptures.       

 Unfortunately, pitching is not good for you and studies indicate that pitching volume is a primary cause of shoulder and elbow injuries. The younger you start pitching and the longer you last in the game it seems the more chance you have of ending up hurt.

 However, there are ways to reduce injury risk. Monitoring and limiting pitching volume of youth pitchers is a good place to start.

Pitching Injury Series Part Three:  Pitching Volume Causes Injury

Pitching Injury Series Part Three: Pitching Volume Causes Injury

By Jim Fanara, CSCS

Pitchers at every age group are getting hurt more often.  The reasons for pitching injuries are well known. Years of research and clinical observations have demonstrated the link between pitching injuries and several key risk factors.  The most important of these risk factors is pitching volume.

 Numerous studies have shown that injured players pitch more months, games, innings and pitches per year.  Multiple studies come to similar conclusions:

• Pitch more than 100 innings per year there is a3 times greater chance of injures (Fleisig AJSM’11
• Pitch more than 8 months per year there is a 5 times greater chance of injuries (Olsen AJSM ’06)
• Average more than 80 pitches per game there is a 4    times greater chance of injuries (Olsen AJSM ’06)

Pitching in showcases and travel leagues significantly correlates to increased injuries. (Olsen AJSM ’06; Register, Mahlick; Athletic Training ’12)

Pitchers that also catch have a 2.7 times greater chance of injuries. (Fleisig AJSM ’11)

Major league coaches and trainers understand that the number one injury risk to a pitcher is too much volume.  That’s why pitch counts and limiting innings pitched has become such an important part of managing a pitching staff.

Youth and high school baseball league administrators have also realized that limiting pitching volume is important.  Youth leagues now provide coaches with rules regarding pitching volume.  Yet, injury rates are still high.

Pitch counts rules are great. However, the rules need to be followed by coaches. In a study published by Sports Health (Fazalare, Sports Health ’12):

• 27% of coaches admitted to not following rules
• 19% of coaches admitted pitching a child with a sore or fatigued arm.

Even if every coach followed pitch counts rules, playing in overlapping leagues and showcases adds volume. A particular coach may not be aware of all the innings that a player has logged.  Also, every throw adds volume. That means that activities such as bullpen, warm-up throws and long toss programs all count towards accumulated volume. 

Why is limiting pitching volume such an important factor in reducing injury risk? Pitching is not good for your arm and shoulder in the best of circumstances. Fatigue only makes things worse.

Fatigue alters neuromuscular control. Altering neuromuscular control changes the way the shoulder and elbow move thereby inhibiting normal joint mechanics. Given the high velocity and force achieved when pitching, maintaining proper joint mechanics is essential to reducing injury risk.

Take pitch counts and volume guidelines seriously.  Limit overlapping leagues and showcases. Don’t pitch and catch.