Abdominal Oblique Injuries in Rotational Sports

Abdominal oblique injuries, also known as side strains, are common in rotational sports such as baseball, tennis, golf, and track and field.  These injuries are characterized by a sudden, sharp onset of pain near or on the side of the rib cage.  The injury usually occurs during some type of rotational sports movement such as swinging a bat, club or racket; or throwing a ball.

Trunk rotation plays an important role in generating and transferring power during sport.  It is through the trunk or core, that forces are transferred from the lower body to the shoulder and arms. Activities such as throwing and swinging require the core muscles to both stabilize the trunk and create force in order to transfer power to the upper body.

Anatomy of the Abdominal Oblique Muscles

The core includes the thoracolumbar, abdominal, pelvic, and hip musculature.  These muscle groups provide trunk stability to allow integrated limb movements, such as throwing and swinging, to occur. The abdominal core muscles include the rectus abdominis, transversus abdominis, internal oblique and external oblique.  Most abdominal injuries occur in the internal and external oblique muscles.  Less commonly, injuries can occur to the intercostal muscles between the ribs themselves.

The Role of the Oblique Muscles in Sport

The internal and external oblique muscles are responsible for flexion and rotation of the trunk, as well as providing trunk stabilization during complex sports movements.    Poor mobility of the hips or thoracic spine can contribute to excessive stress and compensation through the trunk musculature during swinging or throwing.  Rehabilitation often addresses hip mobility with manual therapy techniques performed by the physical therapist.  An imbalance between right and left side oblique muscles are also common is in sports such as golf and baseball.  This may place excessive forces through the lead side oblique musculature.  Finally, the large forces generated by lower body muscles (quadriceps and hamstrings) may overpower the weaker core musculature leading to injury during explosive sports movements.

The incidence of Abdominal Oblique Injuries in Baseball

A 2010 study in the American Journal of Sports Medicine investigated the incidence and trends of abdominal injuries in professional baseball players.  From 1991 through 2010, abdominal strains accounted for approximately 5% of all injuries in Major League Baseball.   Nearly half of these injuries occurred in pitchers.   These injuries occurred most often during the early part of the season.

In both pitchers and position players, the majority of injuries occurred on the side opposite to their throwing arm.  Pitchers missed, on average 35 days on the disabled list, while position players missed 26 days on average.  Players who receive steroid or PRP injections have been shown to miss more time from injury.   More than 1 out of every 10 sustained a re-injury during their career.  Most of these re-injuries occurred during the same or the following season.   As a result of these injury trends, many MLB teams have increased their focus on preemptive core and trunk strengthening exercises for all players.

Closing Thoughts

The incidence of abdominal oblique injuries is on the rise in rotational sports such as baseball and golf.   These injuries can result in substantial loss of playing time.  Proper training can prevent abdominal oblique injuries from occurring.  In a few weeks, I will post an article describing exercises which can help reduce the risk of sustaining an injury.  These exercises can also be part of a comprehensive rehabilitation program to safely return an injured athlete back to sport.

References

  1. Camp CL, Conte S, Cohen SB, et al. Epidemiology and impact of abdominal oblique injuries in major and minor league baseball. Orthop J Sport Med. 2015;5(3):1-8. doi:10.1177/2325967117694025.
  2. Conte SA, Thompson MM, Marks MA, Dines JS. Abdominal muscle strains in professional baseball. Am J Sports Med. 2010;40(3):650-656. doi:10.1177/0363546511433030.
  3. Nealon AR, Kountouris A, Cook JL. Side strain in sport: A narrative review of pathomechanics, diagnosis, imaging and management for the clinician. J Sci Med Sport. 2017;20:261-266.

Early Sport Specialization and Long-Term Athletic Success

Sport specialization is defined as year-round (≥8 months per year) intensive training in a single sport at the exclusion of other sports.   Early sport specialization refers to those who focus on a single sport before entering high school.  Advocates for early specialization propose that athletic performance in that sport will be better than the performance of those who play multiple sports.  These beliefs became popularized after several recently published best-selling books proposed a “10,000 hour rule” of practice for developing expertise in any given skill or sport.

The effectiveness of increasing the amount of early exposure to a single sport on athletic performance is questionable.  In fact recent research suggests those youth athletes who participate in multiple sports and delay specialization are at an advantage over those who specialize.  The long-term athletic development (LTAD) model provides a structured framework where youth athletes participate in multiple sports in order to maximize their full athletic potential over the lifespan.  Emerging research supports multiple sports participation and the LTAD model as methods to reduce injury risk and maximize athletic potential through high school, college, and beyond.

Early Sport Specialization & High School Athletics

Present day athletes are specializing in a single sport earlier than previous generations.  One recent study showed current high school athletes specialize at an average age of 13 years old.  Current collegiate athletes specialized at an average age of 15 years old.  High school athletes who specialize in one sport for more than 8 months of the year are 2 to 3 times more likely to suffer a lower body overuse injury.  Athletes who engage in baseball for more than 8 months per year are more likely to develop overuse arm injuries.  The repetitive nature of engaging in a single sport predisposes youth athletes to chronic injuries which will likely impact their career beyond high school.  Also, there is currently no evidence which suggests athletes who specialize in a single high school sport are more successful performers than multisport athletes.

Early Sport Specialization & Collegiate Athletics

A survey of Division I college athletes showed 16% specialized in 9th grade and 41% specialized in 12th grade.  This suggests the majority of NCAA Division I athletes were late to specialize in their chosen sport.  Therefore, early specialization does not appear to be necessary in order to succeed at the collegiate level.   Other research found college basketball players who specialized late in their playing career developed their skills and performance to a greater level than those who specialized early.    Several Division I college coaches have gone on record to state their preference for recruiting multisport college athletes.  Athletes who participate in multiple sports possess superior fundamental movement skills and are generally more “coachable” than single sport athletes.

Early Sport Specialization & Professional Sports

Professional athletes are now advocating for multiple sport participation in today’s youth.  Sixty-three percent of surveyed professional baseball players believe early sport specialization is not required to play professionally.  Only twenty-two percent of professional athletes from multiple sports would want their own child to specialize in 1 sport during childhood

NBA players who played multiple sports in high school participate in more professional basketball games throughout their career compared to those who specialized early.  These same NBA players who played in more games were less likely to suffer an injury compared to those who specialized early.  Also, those NBA players who specialize late demonstrate greater longevity in the league.

Approximately half of present day MLB players specialized prior to high school.  Those who specialized early sustain more serious injuries during their professional career compared to those who specialize late.   Youth baseball players should be encouraged not to participate in a single sport given the increased incidence of serious injuries later in their careers. To date no research suggests that early specialization is needed to reach the professional level of any team sport.

Closing Thoughts

Parents and coaches should encourage youth athletes to delay sport specialization as late as possible.  Athletes who specialize late are at least as likely to compete at high levels (college and professionally) as those who specialize early.  Also, those  who delay specialization are less likely to sustain injuries and more likely to achieve long-term success at the professional level.   Most importantly, encouraging multiple sports participation promotes long-term enjoyment of sport which will build health and fitness habits for a lifetime.

References

  1. Bell DR, Post EG, Trigsted SM, Hetzel S, Mcguine TA, Brooks MA. Prevalence of sport specialization in high school athletics: A 1-year observational study. Am J Sports Med. 2016;44(6):1469-1474. doi:10.1177/0363546516629943.
  2. Buckley PS, Bishop M, Kane P, et al. Early single-sport specialization and professional athletes. Orthop J Sport Med. 2017;5(7):1-7. doi:10.1177/2325967117703944.
  3. Post EG, Thein-Nissenbaum JM, Stiffler MR, Brooks MA, Bell DR. High school sport specialization patterns of current division I athletes. Sport Heal A Multidiscip Approach. 2016;XX(x):1-6. doi:10.1177/1941738116675455.
  4. Santos S, Mateus N, Sampaio J, et al. Do previous sports experiences influence the effect of an enrichment programme in basketball skills? J Sports Sci. 2017;35(17):1759-1767. doi:10.1080/02640414.2016.1236206.
  5. Wilhelm A, Choi C, Deitch J. Early sport specialization effectiveness and risk of injury in professional baseball players. Orthop J Sport Med. 2017;9:1-5. doi:10.1177/2325967117728922.

 

Baseball Stretching Drill to Restore Range of Motion between Innings

Baseball players will lose range of motion in their throwing shoulder and elbow following a pitching session.  This loss of range of motion becomes cumulative over the course of a season.   Range of motion deficits have been shown to increase the risk of arm injury in baseball players.  Baseball stretching routines performed over the course of a season can help reduce this risk.  Also, stretching drills during baseball games, or between innings, is another method to combat muscle tightness and loss of range of motion in baseball pitchers.

The two-out drill has been developed by researchers from the California State University in Sacramento, and world-renowned orthopaedic surgeon Dr. James Andrews.   These seven baseball stretching exercises can be performed in approximately one minute between innings.  During game situations, the drill is initiated after two outs have been recorded and prior to the pitcher taking the mound each inning.   Performing this drill has been shown to restore professional baseball pitchers shoulder range of motion back to pre-pitching levels.   The seven baseball stretching exercises are described below with a video to follow.

Baseball Stretching: The Two-Out Drill

  1. Internal rotation stretch. Place the non-throwing hand on top of the throwing elbow with the non- throwing forearm resting on top of the throwing forearm. The non-throwing arm is then used to produce an internal rotation stretch in the throwing shoulder by rotating the forearms down towards the ground. This stretch is held for 3 seconds and is repeated twice with approximately 1 to 2 seconds of rest between stretches.  Be sure to stay tall during the stretch and avoid holding your breath.
  2. Elbow extension stretch. Extend the throwing elbow with the forearm tuned up. With the opposite hand, pull the throwing hand so that the wrist is extended back. This stretch is held for 3 seconds and is repeated twice with approximately 1 to 2 seconds of rest between stretches.  Be sure to stay tall during the stretch and avoid holding your breath.
  3. Big arm circles. Perform big arm circles clockwise and counterclockwise for 5 repetitions each way.  Make the circles as big and fast but comfortable, with an emphasis on increasing range of motion.  Be sure to stay tall during the exercise.
  4. Small arm circles. Perform small, tight arm circles clockwise and counterclockwise. Movement is fast but at a comfortable pace.  Perform 5 circles forward, and 5 circles in reverse.
  5. Forearm touch. With the arms up out to the side and elbows bent, move the elbows in so the elbows and forearms touch.  Next, move the arms in the opposite direction until a mild stretch is felt in the front of the shoulders or chest.  Repeat 5 times continuously.
  6. 90/90 IR and ER. Begin with the arms up out to the side and elbows bent. Internally and externally rotate the shoulders as far as possible at a fast but comfortable pace. Repeat 5 times continuously.  Be sure to stay tall and breathe during the exercise.
  7. Trunk Rotation. Begin with the arms fully extended and out to the side.  Rotate your arms and trunk from side to side, through a full range of motion, to the left and then back to the right. Movement is fast but at a comfortable pace.  Repeat 5 times continuously.

Closing Thoughts

Performing the two-out drill with two outs will allow adequate time to prepare the throwing shoulder for the subsequent inning.  This may be a practical and effective means to preserve shoulder range of motion throughout the course of a baseball game.  Rest and avoiding excessive throwing is undoubtedly the most important factor related to reducing risk for arm injuries in baseball players.  However, the two-out drill may help maintain shoulder flexibility during a game, and perhaps over the course of a season.  Maintaining shoulder range of motion is just one small piece to minimizing risk for injury in baseball players.

References

  1. Escamilla RF, Yamashiro K, Mikla T, Collins J, Lieppman K, Andrews JR. Effects of a short-duration stretching drill after pitching on elbow and shoulder range of motion in professional baseball pitchers. Am J Sports Med. 2016;45(3):692-700. doi:10.1177/0363546516671943.
  2. Reinold MM, Wilk KE, Macrina LC, et al. Changes in shoulder and elbow passive range of motion after pitching in professional baseball players. Am J Sports Med. 2008;36(3):523-527. doi:10.1177/0363546507308935.
  3. Wilk KE, Macrina LC, Fleisig GS, et al. Correlation of glenohumeral internal rotation deficit and total rotational motion to shoulder injuries in professional baseball pitchers. Am J Sports Med. 2011;39(2):329-335. doi:10.1177/0363546510384223.
  4. Wilk KE, Macrina LC, Fleisig GS, et al. Deficits in glenohumeral passive range of motion increase risk of elbow injury in professional baseball pitchers: A prospective study. Am J Sports Med. 2014;42(9):2075-2081. doi:10.1177/0363546514538

 

 

5 Arm Care Stretching Exercises for Baseball Players

The unique demand of throwing a baseball places a great deal of stress on the bones, muscles, and soft tissues of the arm.  Therefore, shoulder and elbow injuries are common amongst baseball players of all ages.  Repetitive throwing leads to adaptations in the bony structure and muscles around the shoulder.  Some of these adaptations are believed to be necessary in order to perform at a high level.  Other changes, specifically those related to muscle tightness, can increase the risk of sustaining an elbow or shoulder injury.   Therefore, it is important for baseball players, coaches, and parents to understand the rationale and best methods for stretching the muscles of the arm in overhead athletes.

Range of Motion in the Baseball Pitcher

The amount of shoulder external and internal rotation range of motion receives a great deal of attention in overhead athletes.  Repetitive throwing during a youth athlete’s period of peak growth induces adaptive changes to the structure of the upper arm bone.  The middle portion of the arm bone actually rotates backward in relation to the upper end of the bone or head of the humerus.  This is termed retroversion and it is believed to be a necessary and beneficial adaptation.  Retroversion of the humerus allows the baseball player to achieve greater amounts of shoulder external rotation, or layback, during the arm cocking phase of throwing.

Retroversion of the humerus will cause an increase in the amount of shoulder external rotation but a decrease in the amount of available internal rotation.  Again, this is believed to be a necessary adaption to improve performance.  Research suggests that the total arc of internal and external rotation range of motion is what becomes important.  The total arc of motion between the throwing and non-throwing shoulder should be within 5 degrees of each other (shown in the illustration below).  When greater discrepancies in the total arc of motion are present, stretching exercises should be performed to improve symmetry between sides.

Image result for total arc motion

The Basics of Stretching for Baseball Players

Baseball players have been shown to lose range of motion throughout the course of a single game and over the course of a season.  This loss of range of motion and flexibility typically occurs in the shoulder and elbow musculature.  Common muscles prone to tightness in baseball players include the rotator cuff, lattisimus dorsi, pectoralis major and minor, biceps, and triceps.  A regular stretching routine, performed 3-5 times per week, can help restore lost range of motion.  Also, a basic 10-minute stretching routine may potentially improve performance and decrease risk for an arm injury.  The stretching exercises presented here are a few baseball players should be familiar with.

Five Arm Stretching Exercises for Baseball Players

  1.  Cross-Body Stretch: This stretch addresses the posterior shoulder muscles which are prone tightness in overhead athletes.  The infraspinatus, teres major, and teres minor muscles can become shortened from repetitive throwing.  This stretch is performed lying on the involved side with hips and knees bent.  The involved shoulder and elbow are positioned in 90 degrees of flexion.  The hand of the uninvolved arm grasps the elbow of the involved arm and gently pulls it across the body.  Once a mild stretch is felt on the outside or back of the shoulder, this position is held for approximately 30 seconds.  The stretch is typically performed 2-3 times each session.

  1. Sleeper Stretch: The cross-body stretch has been shown to be superior to the sleeper stretch for improving shoulder range of motion in young baseball players.  However, the sleeper stretch is probably the more popular of the two stretches.  For this stretch, the same starting position as the cross body stretch is assumed.  However, with the sleeper stretch, the wrist and forearm of the involved arm are gently moved down towards the table.  Once a mild stretch is felt on the outside or back of the shoulder, this position is held for approximately 30 seconds.  The stretch is typically performed 2-3 times each session.   For most athletes, both the sleeper and cross-body stretch do not need to be performed.  My personal experience, and the best available evidence, suggests the cross-body stretch is the most beneficial for improving range of motion.

  1. Bench T-Spine Mobilization: Extension of the upper back is necessary to achieve the arm cocking position needed for throwing.  Without adequate extension of the spine, unnecessary stress will be placed on the shoulder or elbow.  This stretch also provides a nice stretch to the lattisimus dorsi and triceps muscles which can also limit overhead mobility. The exercise begins by assuming a kneeling position facing a bench.  Place your elbows on the bench in front of you holding a PVC pipe or dowel with the palms facing up.  Sit back, pushing your buttocks towards your heels, keeping your spine relaxed, until you feel a stretch in your upper back.  Be sure to engage your abdominal muscles to prevent excessive arching of the low back.  (I could have done a better job of this in the video below).  For an added stretch you can bend your elbows further past your head.  Hold this position briefly, and exhale fully.  Reverse the motion to return to the start and repeat 6-8 repetitins.

  1. Thoracic Spine Windmill: This is a great dynamic mobility drill to restore thoracic spine rotation and improve the flexibility of the lattisimus and pectoral muscles.  Begin on your side with both arms outstretched in front of you.  Place a foam roll under your top leg with the knee and hip bent to 90 degrees.  The bottom knee and hip remain extended throughout the exercise.   Reach forward with your top hand and then complete a large circular windmill motion as you rotate your entire upper body.  Keep reaching as if you were attempting to lengthen your entire arm.  Follow your hand with your eyes to ensure proper thoracic spine and rib cage movement.  The top knee and leg should remain in contact with the foam roll throughout the exercise.  We generally perform 6-8 repetitions on each side.

  1. Side-Lying IR/ER: This is a more advanced dynamic mobility exercise targeting the thoracic spine, rib cage, lattisimus dorsi, and pectoral muscles.  Start in a side-lying position with the arm to be stretched on top.  Place a foam roll under your top leg with the knee and hip bent to 90 degrees.  The bottom knee and hip remain extended throughout the exercise.  Initiate the movement by reaching with the lower arm up towards the sky.  Hold this position, reaching upwards, throughout the drill.  The arm to be stretched is then placed overhead with the thumb pointing down towards the floor.  Exhale fully at the top and then reverse the movement by bringing the arm down to the side.  As the arm is lowered the thumb position changes so it is pointing down towards the back pocket.  It is important that both elbows remain fully straight during the drill.  We generally perform 6-8 repetitions on each side.

Closing Thoughts

These five stretching and mobility drills address typical muscle flexibility problems baseball players present with.  As always, an individualized approach is always superior to ready-made one-size fits all programs.  Building arm strength through resistance training is also important for improved performance and resiliency in the baseball player.   Before engaging in any exercise program, those with a history of arm problems or those currently experiencing pain should first be evaluated by a physician, physical therapist, or athletic trainer.  Some players may require additional arm care strategies such as passive stretching and soft tissue mobilization techniques.

 References

  1. Bailey LB, Thigpen CA, Hawkins RJ, Beattie PF, Shanley E. Effectiveness of manual therapy and stretching for baseball players with shoulder range of motion deficits. Sport Heal A Multidiscip Approach. 2017;9(3):230-237. doi:10.1177/1941738117702835.
  2. Hibberd EE, Oyama S, Myers JB. Increase in humeral retrotorsion accounts for age-related increase in glenohumeral internal rotation deficit in youth and adolescent baseball players. Am J Sports Med. 2014;42(4):851-858. doi:10.1177/0363546513519325.
  3. Keller RA, De Giacomo AF, Neumann JA, Limpisvasti O, Tibone JE. Glenohumeral internal rotation deficit and risk of upper extremity injury in overhead athletes: A meta-analysis and systematic review. Sport Heal A Multidiscip Approach. 2018;Online:1-8. doi:10.1177/1941738118756577.
  4. Mine K, Nakayama T, Milanese S, Grimmer K. Effectiveness of stretching on posterior shoulder tightness and glenohumeral internal-rotation deficit: A systematic review of randomized controlled trials. J Sport Rehabil. 2017;26:294-305.

Lower Trapezius: Exercises to Improve Overhead Shoulder Mobility

The lower trapezius muscle plays an important role in moving and positioning the shoulder blade (scapula) during overhead sports.  The lower trapezius spans from the lower 6 thoracic spine vertebrae to the upper portion of the scapula.   Along with the middle and upper portions, the lower fibers comprise the large trapezius muscle of the upper back.   The lower trapezius, upper trapezius, and serratus anterior muscles work together to upwardly rotate the scapula.  This function is important to optimally position the arm during overhead function such as the cocking phase of throwing a baseball.  This muscle is often ignored when it comes to developing resistance training programs for athletes or fitness enthusiasts.

Role of the Lower Trapezius in Sport

Poor thoracic spine posture or loss of thoracic spine extension places the lower trapezius at a disadvantage to fulfill its role as a scapular stabilizer.  Therefore, exercises which restore thoracic extension are often included in programs which train the lower trapezius.  Delayed lower trapezius activation has been demonstrated in overhead athletes with shoulder pain.  Weakness of this muscle has been implicated with upper extremity injuries in baseball, swimming, and tennis.

Exercises performed with the arms below shoulder level elicit very little lower trapezius activity.  In order to optimally activate the lower fibers of the trapezius, movements which facilitate scapular upward rotation with depression should be performed.  The lower fibers are aligned at an approximate 135-degree angle from the spine.  This corresponds to the 10:00 and 2:00 positions on a clock.  Exercises such as the wall slide, prone trapezius raise, and shoulder external rotation in 90 degrees of abduction position the scapula for optimal lower trapezius activation.

Prone 1-Arm Lower Trapezius Raise

This exercise is performed lying face down with one arm over the side of the table or bench.  Be sure to keep the neck in a relaxed neutral position resting on your other forearm.  With the thumb up, arm straight, elbow slightly bent, lift toward the ceiling at a 45-degree angle from your head (the 10:00 and 2:00 positions of a clock).  This position is aligned with the muscle fibers of the lower trapezius.  Be careful to avoid shrugging the entire shoulder as you raise the arm.  Instead, think about tilting the shoulder blade backward as you raise the arm.  Pause at the top of the movement before returning to the start position in a controlled manner.

Prone External Rotation in 90 Degrees of Abduction      

Lie face down with one arm over the side of the table or bench supported on a small towel roll.  Be sure to keep the neck in a relaxed neutral position resting on your other forearm.  Rotate the hand up towards the sky in a slow and controlled manner.  Be careful to avoid shrugging the entire shoulder as you perform the exercise.  Pause at the top of the movement before returning to the start position.

Wall Slides at 135 Degrees with Lift Off

Stand to face a wall with one foot slightly ahead of the other.  Place both forearms against the wall starting just below shoulder level.   Initiate the movement by sliding the forearms toward the ceiling at a 45-degree angle from your head (the 10:00 and 2:00 positions of a clock).  This aligns with the muscle fibers of the lower trapezius.  Once the elbows are fully extended, slightly lift the hands and arms away from the wall.  Be sure to avoid arching the low back as you lift away.  Instead, think about tilting the shoulder blades backward as you lift away.   Pause at the top of the movement before returning to the start position in a controlled manner.

Closing Thoughts

The lower trapezius muscle is often ignored by athletes and exercise enthusiasts who regularly engage in strength training.  Poor timing or weakness of this muscle results in compensatory movement patterns during overhead activity.  Specific exercise targeting the lower trapezius should be included as part of a warm-up routine or regular strength and conditioning program for athletes looking to optimize shoulder health.

 

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Youth Baseball Pitching Injuries on The Rise

Youth baseball pitching injuries are on the rise. The world-renowned Dr. James Andrews describes the increase in injury rates as an epidemic (ESPN interview).  His research shows 5% of youth pitchers will sustain at least one serious elbow or shoulder injury which will require surgery or end their career. Historically, throwing breaking pitches at a young age was cited as the major risk factor for these types of injuries. However, the latest research shows arm fatigue, not breaking pitches, is the primary reason for the sharp rise in youth pitching injuries.

Should Youth Pitchers Throw Curveballs?

Dr. Andrews and his team at the American Sports Medicine Institute (ASMI) in Birmingham, Alabama tracked 481 youth baseball pitchers (ages 9 to 14) for ten years. Pitchers were interviewed annually to determine the incidence of serious injury and to track pitching volume and pitch type. Serious injury was defined as those requiring surgery or ended an athlete’s career. Pitching more than 100 innings in a year significantly increased the risk of a serious elbow or shoulder injury by 3.5 times. Throwing curveballs before the age of 13 did not significantly increase the risk of injury.

Throwing with Arm Fatigue

Another 2006 study at ASMI identified the following risk factors for shoulder or elbow surgery in youth baseball pitchers:

  • Pitching 8 or more months per calendar year (5 times more likely to sustain a serious injury)
  • Throwing 80 or more pitches per appearance (3.8 times more likely)
  • Throwing velocities greater than 85 mph (2.5 times more likely)
  • Regularly pitching with arm fatigue (36 times more likely)

Research from the Journal of Strength and Conditioning Research found throwing accuracy and arm soreness to be closely associated with arm fatigue. Throwing velocity is more closely associated with generalized fatigue. Therefore, youth athletes should be closely monitored by coaches and training staff to gauge arm fatigue and throwing-induced injury risk. Throwing accuracy, and not velocity, is probably the more important variable to monitor in order to reduce injury risk. Also, regularly communicating with athletes about arm soreness is crucual  to reduce the risk of youth baseball pitching injuries.

Conclusion: Youth Baseball Pitching Injuries

Parents and coaches should closely monitor youth pitchers for signs of arm fatigue and soreness and discourage throwing year round. A minimum of 2-3 months without throwing is recommended (more from Dr. Andrews). During this active recovery period, athletes should work on other baseball skills along with aspects of strength and conditioning to improve their long-term athletic development. The off-season is the ideal time for an athlete to work with a strength coach to develop strength and power.  Contrary to popular belief, throwing breaking pitches is not associated with youth baseball injuries. The Stop Sports Injuries website has posted some other valuable youth baseball pitching injury prevention tips here.

References

  1. Fleisig, G. S., Andrews, J. R., Cutter, G. R., Weber, A., Loftice, J., Mcmichael, C., … Lyman, S. (2011). Risk of serious injury for young baseball pitchers: A 10-year prospective study. The American Journal of Sports Medicine, 39(2), 253–257. http://doi.org/10.1177/0363546510384224
  2. Olsen, S. J., Fleisig, G. S., Dun, S., Loftice, J., & Andrews, J. R. (2006). Risk factors for shoulder and elbow injuries in adolescent baseball pitchers. The American Journal of Sports Medicine, 34(6), 905–12. http://doi.org/10.1177/0363546505284188
  3. Freeston, J., Adams, R., Ferdinands, R., & Rooney, K. (2014). Indicators of throwing arm fatigue in elite adolescent male baseball players: A randomized crossover trial. Journal of Strength & Conditioning Research, 28(8), 2115–2120.