Ah, the wonders of baseball. I love it. I know how it feels to hit a hanging curve for a home run, execute a suicide squeeze or hit and run, stretch a double into a triple, rob someone of a base hit, turn two and take one for the team.
Unfortunately, as an orthopedic surgeon specializing in elbow injuries, on a weekly basis, I also know what it feels like to tell young athletes they must shut it down for the season, that they need season-ending elbow surgery or that they should give up baseball entirely due to the effects of overuse and baseball.
Elbow injuries are commonplace in baseball. The most devastating and increasingly common injury is the dreaded ulnar collateral ligament (UCL) tear. The UCL tear leads to Tommy John surgery, where the ulnar collateral ligament is reconstructed.
There are also variants of an ulnar collateral ligament tear in different age groups, which can be every bit as dreadful. These injuries are caused by overuse and stress to the UCL and include stress fractures, acute fractures, bone spurs, loose bodies, ulnar nerve compression, and osteochondral injuries.
Fortunately, elbow problems do not need to be season- or career-ending injuries, and most are preventable. Here are some suggestions for preventing elbow injuries in your little slugger:
Because improper warm-up is a risk factor for UCL rupture, major leaguers follow a very specific warm-up routine prior to throwing. The Major League Baseball PitchSmart Program recommends properly warming up before pitching.
In my experience, I found I needed to stretch my legs and back, my shoulder, chest, upper arm, and forearm followed by 15-20 minutes of playing catch until my arm and body were warm. Following this routine, my arm felt great each day throughout the season.
In a study looking at high school baseball players who required Tommy John surgery, it was noted that 23 percent of these boys admitted to improper warm-ups prior to playing.
Concentrate on mechanics and accuracy
In my field of expertise, we know that poor pitching mechanics lead to increased stress on forearm musculature, which places greater stress on elbow ligaments, specifically the ulnar collateral ligament.
For example, a January 2015 report published by the United States National Library of Medicine National Institutes of Health concluded “despite much debate in the baseball community about the curveball's safety in youth pitchers, limited biomechanical and most epidemiologic data do not indicate an increased risk of injury when compared with the fastball.”
In fact, a fastball produced the greatest load on both the shoulder and elbow, followed by the curveball and then a change-up. Young pitchers should concentrate on mechanics and control before worrying about velocity and pitches other than fastballs.
Keep a pitch count
Collegiate and major league baseball players and coaches follow pitch counts very closely, and with good reason. The risk factor with the strongest correlation to elbow injury is the number of pitches thrown. The more pitches a baseball player throws, the more stress he places on the elbow and shoulder.
In a study presented at the annual meeting of the American Academy of Orthopedic Surgeons, 54 percent of parents or caregivers did not actively participate in monitoring their child’s pitch count. If pitch counts are not feasible or are being taken advantage of by opposing coaches, the number of batters faced per game might be a better option. According to USA baseball, 9-to-12-year-old pitchers average five pitches per batter.
If you wanted to keep a youth pitcher around 75 pitches per game, you might restrict him to facing 15 batters per game instead. Keeping a pitch count will keep young arms fresh and less injury-prone, allow more boys the chance to pitch, and allow pitchers to play and learn more positions.
Take a break
In a 2006 study published in The American Journal of Sports Medicine, the authors found a 500-percent increase in the need for reconstructive elbow surgery in adolescents who pitched greater than eight months per year. According to USA baseball and MLB Pitch Smart programs, pitchers are encouraged to take a four-month break yearly from throwing, with two to three of these months being consecutive.
An interesting study comparing baseball-related elbow injuries in Southern states and baseball-related injuries in Northern states is quite compelling. Southeastern Conference baseball players, who play in Southern states and warmer climates, sustained more UCL injuries than did Big 10 Conference baseball players playing baseball in the Northern states and colder climates. The study found that not only did SEC pitchers sustain more UCL ruptures than Big 10 pitchers, but high school pitchers growing up in Southern states also had a greater likelihood of UCL injuries than did high school players growing up in Northern states, regardless of where they played their college baseball.
This study suggests the need for a yearly break in order to allow the elbow to rest from throwing sports. This break will allow ligaments and tendons to heal and strengthen as well as over-used muscles to rest. It also will prevent your youth from experiencing mental and physical burnout while allowing them the chance to experience other sports or activities.
Don’t be a one-sport wonder
In today’s world, most kids pick one sport and play it year-round, but it doesn’t have to be that way. In his Hall of Fame speech, John Smoltz said, “I want to encourage the families and parents that are out there to understand that this is not normal to have surgery at 14 and 15 years old. That you have time, that baseball is not a year-round sport. That you have an opportunity to be athletic and play other sports.”
Playing one sport year-round strengthens certain muscles excessively but neglects others. The same holds true for tendons and ligaments. Playing multiple sports throughout the year is similar to cross training, which decreases the chance of stress fractures and overuse syndrome while allowing joints time to rest during the off-season.
In a 2014 ESPN article that surveyed 128 (NFL) quarterbacks, 73 active and 55 retired, 122 played at least two sports in high school (95 percent), and nearly 70 percent played three or more. Some of those who participated in the survey (and played at least two sports in high school) include Peyton and Eli Manning, Joe Namath, Joe Flacco, Russell Wilson, Matthew Stafford, Bob Griese, and Steve Young.
This survey supports the idea that if you have what it takes to play collegiately or professionally, you can diversify and lessen the chance of injury by playing more than one sport.
Remember, it’s just a game
Sports are a great way for young men and women to stay active and healthy, experience success, meet new people, and develop skills that will benefit them for a lifetime. The reality, however, according to a study published by the NCAA, is that a high school baseball player has a 6.8 percent chance to play NCAA baseball, and that same high school baseball player has a 0.5 percent chance to be drafted by an MLB team.
To put this in perspective, in a study of 481 youth pitchers age 9-to-14-years-old, the incidence of serious elbow or shoulder injuries which required either surgery or retirement from baseball was 5 percent. By contrast, your son has a 6.8 percent chance of playing college baseball but has a 5 percent chance of having a season or career-ending shoulder or elbow injury.
Encourage your children to do their best, get the best equipment, work with the best coaches, and put them on the best teams, but be realistic. It is only a game that will probably end after high school.
As much as I love baseball, there is no reason to see the current elbow injury trend continue. Parents, coaches and baseball players can reverse this trend by following these guidelines and recommendations. By properly warming up, concentrating on mechanics, keeping a pitch count, taking breaks from baseball throughout the year, and enjoying other sports, our boys will be playing baseball -- my favorite sport, and America's pastime -- for many years to come.