Coordinated Health

The dangers of throwing year-round

The dangers of throwing year-round

By: Mike Price, MPT   May 20, 2016
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Learn more about Mike and schedule an appointment with him here: https://coordinatedhealth.com/team/michael-price-pt/

Nationally we have seen a recent uptick in coverage on Tommy John injuries.  Sports Illustrated and ESPN The Magazine have written numerous articles over the past 2 years and Jeff Passan has just released a book called The Arm.  The injuries covered in these writings are happening locally too.  In the past 3 years I have personally treated 25-35 kids a year between the ages of 9-21 years old with throwing related injuries.  Some of the injuries you hear about are apophysitis (growth plate injury) to the shoulder or elbow, SLAP or rotator cuff injuries to the shoulder and Tommy John Injuries.  Many will note that 20-30 years ago you didn’t hear much about these injuries in baseball but 20-30 years ago no one played year round baseball unless they were professionals.  It is important to note that until we reach skeletal maturity, the forces and stresses of playing sports are mainly absorbed by our bones and after we reach skeletal maturity our muscles, tendons and ligaments absorb more of that force.  So the growth plate injuries we hear about in our youth very much equate to the tendon and ligament injuries we hear about in adults.  Here are some facts about throwing injuries from youth to the major leagues. 

  • More pitchers in major league baseball had surgery in 2014 than the entire decade of the 1990s
  • Just 67% of MLB pitchers undergoing Tommy John surgery return to even pitch another 10 games in their careers
  • In between 2007-2011, the age of 15-19 years old make up for 56.7 of the Tommy John Surgeries performed in the United States and the rate is increasing 9.12% a year in that age cohort

So you can see that only 1/3 of Major League Pitchers ever pitch more than 10 games in their careers after they have Tommy John surgery and unfortunately more than half of Tommy John surgeries are being done on kids between the age of 15 and 19 years old.  The risk factors for why you sustain these injuries does vary some by age but the important thing in youth sports to realize is most of these injuries are occurring when kids are overused.  No youth baseball player should ever throw through pain.  No youth baseball player should throw year round.  Their bodies need time to rest and reset from the stresses of throwing and if you never stop throwing you never get to heal from the stress of throwing a baseball.  The forces and stresses involved in throwing a baseball are awesome.  The force through the inside of the elbow (where Tommy John ligament is located) is equivalent to 67 pounds at ball release and the force going through the front of the shoulder is 1-1.5x a person’s body weight.  All humans need a break from activities as stressful as that, especially youth athletes.  Here are the facts when it comes to youth baseball injuries.

  • Averaging more than 80 pitches a start = 4x more likely to get hurt
  • Averaging more than 8 months a year pitching = 5x more likely to get hurt
  • Pitching more than 100 innings a year = 3x more likely to get hurt
  • Injured players requiring elbow or shoulder surgery played in 4x as many showcases as kids not requiring surgery
  • Kids pitching despite having arm pain = 35x more likely to injure themselves
  • Elbow pain between 9-14 years old increased 35% when kids throw 75-99 pitches per game and exceed 600 total pitches per season
  • 75-99 pitches a game also faced 52% higher risk of shoulder pain

Most leagues have a pitch count rule and if they don’t then they should.  Pitch counts are rest periods need to be followed strictly to prevent our young throwers from ever getting hurt.  Someone on every team should be counting the pitches and following the rules to ensure our youth aren’t increasing their odds of getting hurt.  It is true that pitch counts and rest periods are an inexact science but they are important because they protect the majority of our young throwing athletes.    

 Here are some tips on preventing throwing injuries in our youth baseball players.

  • Student athletes need to feel it is okay to be removed from the game
  • Open communication from player/coach/parent needs to be encouraged
  • Parents and Coaches need to be alert for signs of arm fatigue/pain (rubbing, massaging, shaking, wincing)
  • Parents question coaches on knowledge of rules
  • Parents count pitches themselves and make sure rules are followed if no one else is paying attention to pitch counts
  • Follow pitch count rules
  • Don’t let same kid play pitcher and catcher
  • Don’t play for more than 1 team, minimize showcases
  • Wait till mature to throw breaking balls
  • Get good coaching

As you see here even at the major league level when it is the athlete’s job to rehabilitate after their injury, 2/3 of the guys only pitch 10 more games in their career.  This is far from an optimal outcome.  The best way to combat these injuries is not to have surgery and rehab, it is to stop the injuries from ever happening.

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