Overuse injuries of the youth baseball pitcher

Typical injuries that are seen at the youth level usually affect the growth plates which are the weakest link in the chain. Rather than soft tissue ‘s like ligaments and tendons which are usually seen in older – more mature athletes, growth plate injuries usually heal without a problem as long as they are recognized early and are given time to heal.

The parents and coaches are usually the ones pushing the athlete to play without recognizing the child’s perception of pain. Prevention of these types of injury is to realize that there shouldn’t be any pain when throwing. Simply thinking that the problem is tendonitis and taking over the counter medication isn’t the proper approach to arm pain. Having a formal examination and arriving at a proper diagnosis is important. If the parent, child or coach have any aspiration of playing at higher levels then its very important to recognize an injury and be ready to sit out as long as it takes. They need to be mentally ready to sit out, even if the most important game is on the line.

 Secondly, we do see many soft tissue injuries of the shoulder and elbow. We can point to either overuse being the cause or improper throwing mechanics. Counting pitches has become very popular and can be helpful in avoiding injuries. However, I have heard numerous stories where a child pitches one day and practices the next. I would suggest that following a game, that the arm has several days without any activity to ensure the arm has had an adequate amount of time to recover.

Proper Throwing Mechanics:
1. Start with hips leading toward home plate and generating strength from the legs
2. When the hands start to come apart, we want the hand to be on top of the ball. Gripping ball with the palm facing down. This helps with positioning of the arm and shoulder throughout the pitch.
3. Get arm quickly up into the throwing position before the lead leg comes down
4. Lead leg needs to be pointing toward home plate
 This helps the shoulder stay in the closed position where the arm isn’t “flown” behind them (which puts a lot of stress on the arm).  

Stretching: With shoulder injuries, I have found that the posterior (back) shoulder muscles become tight. Which can reach all the way to the upper spine. So learning posterior shoulder stretches is helpful. Oppositely, the front of the shoulder tends to become overly stretched. So, we would like to avoid any activities that will stretch the front.

Outside of the actual mechanics of throwing, the most important thing to recognize is the need to strengthen the legs, core muscles and improve balance. When talking to any higher level pitcher, you will discover that their leg and core development is the most important. At the professional level, pitchers are usually the ones who work on their leg strength more than any other position player.

 The pitcher’s mound should be used more for pushing off than to just stand on. Having a strong core and leg strength will enable an athlete to propel forward toward the plate which transfers to a higher velocity. Using the legs to create speed, rather than the arm is the way youth athlete should be taught.  

Balance: I encourage balance protocols in youth pitcher development. Youth athletes tend to have inadequate balancing ability. When a pitcher is in the middle of their motion, they may have a balance issue which will most likely require the arm to make up for it and will increase the stress on the joints. There are many easy ways to improve balance and should be a part of any program.  

Pitching coaches: There are a wide variety of coaches any many of they may not be exposed to proper techniques that will decrease arm stress. Some coaches may not recognize the cause of arm pain so I would suggest that the parents encourage their coaches to tape the throwing motion and lok for the mechanics that I have outlined. The child can also see what you are talking about which makes them take part in their improvements.  

Down time: Baseball has evolved to a year round sport which is a large reason why I see so many elbow and shoulder injuries in my clinic. When speaking to a prominent shoulder surgeon, he remarked that kids should have several months off between seasons to allow the arm to rest and grow. It’s important to remember that when a child is throwing on a daily/weekly/monthly basis, that the arm is still growing. The arm will in turn grow in response to the stresses that are placed on it. This can lead to an early onset of scar tissue from injuries which will lead to abnormal joint and muscle function. Some athletes participate in multiple sports. I would highly suggest if your child is a pitcher that they don’t participate in another “overhand” sport. An example would be a pitcher who is also a quarterback of their football team. I recently had a case like this in my clinic where a young man played year-round baseball as a pitcher who excelled at the national level and he was also a quarterback. He would also go to a quarterback coach in the weekends. While getting ready for his ninth grade baseball season, we found a tear in his ulnar collateral ligament which required surgery. He missed this season and could miss the next football season as well. This was an unfortunate situation for this young man who has a promising career as a college athlete. The problem is that this scenario is become more common. I would encourage anyone who has a child that has developed an injury to their arm, to have it properly evaluated and treated. I would also stress that to become a better pitcher, you need to concentrate on becoming a better athlete by improving your core, balance and leg strength.

 Best of Luck

David Sommer, DC
Sommer Sports Chiropractic
Sports Concussion Clinic

I would like to acknowledge the work performed by Karen Mohr PT, Research Director at Kerlan-Jobe Foundation and Orr Limpisvasti MD, Kerlan-Jobe