Spring is in the air, and with this comes the crack of bats, and the sound of baseballs slapping into gloves. As many of your sons or daughters begin the 2015 baseball season, Russell Kowalinski, a Sports Physical Therapist would like to share some words of wisdom to help make this season a successful one.
As you may know, baseball is considered to be a relatively safe sport compared to many contact sports. Nevertheless, almost 50% of pitchers ages 9-14 experience elbow or shoulder pain at some point during the season. Sadly, approximately one-third of Little League pitchers never even play in high school due to their overuse injuries as a younger player.
The most common complaints are either medial (the side nearest to the body) elbow pain, or anterior (front) shoulder pain. Until the player has stopped growing, this almost always infers an injury to the growth plate in that region. With this type of pain, a prompt evaluation by your pediatrician would be advised. At that visit, a complete exam of the extremity would be performed, and an x-ray may be ordered to exclude a stress or avulsion (chip) fracture. Treatment may include anti-inflammatory medications, physical therapy and rest from throwing.
When the physical therapy begins, the first thing to be accomplished is education. The player and parent need to know the very controllable factors which lead to this injury and might lead to another in the future if not changed. With respect to pitch type, Little League age pitchers who throw sliders have an 86% higher risk of elbow pain. Those who throw curve balls have a 52% increase in shoulder pain. We recommend you save these pitches for later. Little Leaguers should work their fastball up and down and in and out of the strike zone. For an off-speed pitch learn a change up. This is a pitch proven to be safe.
From a physical stand point, the most common dysfunctions we see are poor balance and lack of muscular stability about the pelvis, shoulder blade and lead leg. Dysfunction of these types lead to mechanical flaws in the delivery and follow-through which negatively affect performance and abnormally stress tissues, especially those in the throwing arm. When tissues are re¬peatedly exposed to these types of forces they start to break down. With good technique large forces are controlled by large muscles of the legs and trunk or "core." With poor technique these large forces translate up the kinetic chain to the smaller muscles of the rotator cuff and forearm. Because they're smaller they break down faster and that's why we see them more often in the clinic. More serious injuries to growth plates, ligaments and nerve tissue are common as well.
Whether a pitcher comes in for performance enhancement training or for rehabilitation of an injury, the needs are the same. Good balance on each leg, good stable pelvis and shoulder blade so rotary power can be generated, imparted onto the ball and then the pitch completed with a clean balanced finish with endurance to do it again and again pain-free. Remember pain is a sign that something is wrong. If the pitcher has elbow or shoulder pain it isn't necessarily a catastrophe but it is a sign and shouldn't be ignored. The sooner you address it the quicker the recovery.
This year for the first time, Little League is following the pitch count rule. The pitch counts provided by Little League will be higher than those we provide. Ours are based on studies performed by the American Sports Medicine Institute and have been the industry standard for several years. They are provided below.
Please follow the pitch counts but remember they are maximums not minimums.
As prevention is always preferred over treatment, here is a summary of ways you can help your son avoid pitching overuse injuries:
Finally, since an estimated one out of four pitchers will experience elbow or shoulder injuries every season, always remember that there are eight other positions on the field that are much less likely to subject a child to repeated motion at high forces. We don't see many injured field players in our clinics!
May all your baseball players have an injury-free season this year.