If you are a parent or grandparent of someone competing in youth baseball, you will be involved in the preseason preparation ritual that is now occurring. How do you get your future MLB star ready to play without overdoing it? What physical complaints are serious enough to require down time or medical evaluation, and which ones can be worked through while continuing to play?
The two anatomical areas of primary concern in a throwing athlete are the dominant shoulder and elbow. In youth baseball, these injuries are almost always overuse injuries due to a training regimen that exceeds the physiologic capacity of the individual to recover from the training stress. While as sports medicine “experts” we, as orthopaedic surgeons, try to establish rules to guide training and promote healthy play, there is no one size fits all approach to throwing which is universally applicable. Children mature at different rates, have different inherent levels of flexibility and strength, and varying genetic capabilities of physically responding to the stress of throwing. A 50 pitch count limit per game may work for your 10 year-old, but exceed the capabilities of his brothers. Nolan Ryan could throw over 100 pitches a game easily on 2 days rest repetitively, but that’s not a good plan for the other 99.99% of the world. Thus, the routine should be tailored to the individual in terms of their physical strengths and weaknesses, understanding that the initial sign of overuse is almost always pain with throwing.
The most common serious injuries of the shoulder and elbow involve cartilage, bone, and ligament injuries. In the shoulder, stress fractures of the proximal humerus (arm bone near shoulder), labral tears (shoulder cartilage/ligament tears), and rotator cuff strain/tendonitis from shoulder instability are the main concerns. In the elbow, ulnar collateral ligament injuries or stress injuries to the medial epicondyle (inside part of elbow) and cartilage injuries to the capitellum (outside part of elbow) are the primary injuries seen. Time constraints limit in-depth discussion of all thes injuries here. However, they are all usually related to a throwing regimen whose intensity exceeds the player’s ability to absorb physical stress, leading either directly to anatomical damage (fracture/ligament tears) or indirectly through the sacrifice of good biomechanical form to achieve the throwing goal. Bad form leads to excess stress in the above structures and eventual anatomical failure if the stress is not dialed down. Symptoms of concern are pain in the joint aggravated by throwing, especially if associated with “mechanical symptoms” -i.e. locking/catching/grinding in the joint. Pain in the muscle belly, on the other hand, is usually not medically-serious and a healthy response to productive training intensity.
If symptoms of concern arise, the treatment is to decrease the stress until the pain resolves, then undergo a staged return to full activity. This is common sense – continuing to abuse an injured joint will worsen the damage and prolong recovery. Supplementation with anti-inflammatory medicine and a rehab exercise program to strengthen and stretch supporting musculature is standard. For baseball players, the standard protocol for an injured throwing arm is rest until pain-free (about 2 weeks), then progression through an interval throwing program as long as there is no pain with throwing. I have included a copy of our ITP instructions with this article. If pain persists or severity of symptoms does not improve rapidly, seek the advice of an orthopaedic surgeon who treats shoulder and elbow injuries. When preparing for the season, it is a great idea to progress through an interval throwing program before throwing full strength, even if injury has never been an issue. Luckily, the great majority of players have resolution of their symptoms without long term issues with this regimen.
Good luck and God bless!
Click here to see info about the best interval training methods. Chapter 1
Click here to see the top 10 throwing exercises. Throwers Ten AOC