Physical Therapy in Pittsburgh for Baseball

There's a simple way to avoid shoulder injuries in Little League pitchers. In this article, sports medicine specialists present a few tips to help in this area. There are known guidelines for injury prevention. The first is: don't overdo it. Second, players, parents, and coaches must work together to keep track of the number of pitches a pitcher throws per practice, per game, per week, and per season.

The maximum number of allowed pitches varies depending on the age of the pitcher. Pitch count (number of pitches per inning) is used rather than the number of innings. A young pitcher can pitch as many as 45 pitches in a single inning. That stresses the arm as much as a 75-pitch game throwing 15 pitches per inning.

The real issue is the number of high-intensity pitches that young players throw. Just as important as the number of pitches is the amount of time the pitching/throwing arm is allowed to rest afterwards. This rest period gives the soft tissues time to recover and repair damage from microtrauma. Players must be encouraged to report (not hide) a sore arm, elbow tenderness, or shoulder pain when it begins.

When young players can throw with speeds of 85 MPH or more, the immature soft tissue structures may not be able to handle the stress. That's why even the length of time needed to rest is predetermined. For example, Little League players 16 years old and younger must rest three days after throwing 61 or more pitches. Even minor injuries need this much time to recover at the cellular level.

Trainers and coaches are encouraged to help young pitchers learn proper technique. Motion analysis studies show that incorrect form when throwing increases the rotational torque and force on the shoulder and elbow. Some pitches are more problematic than others. For example, breaking pitches such as curveballs or sliders (when thrown improperly) increase the risk of arm pain and injury by 50 to 85 per cent.

During the preseason, and between seasons (off-season), a strengthening and conditioning program of exercises is essential. Such a program is the best insurance to reduce the risk of injury to the throwing arm. The authors present a fitness/rehab program that prevents a weight lifting program from further endangering players. This is especially important in the skeletally immature child. They call their approach a functional conditioning program.

The program is presented in a pyramid form. The basic foundation (at the bottom) is the bulk of the program. This begins with physical fitness. Overall fitness provides stability, flexibility, and balanced posture. The athlete doesn't progress to the next level until foundational fitness is demonstrated. This concept is important to prevent joint break down when moving to the next level in the pyramid, which is called joint integrity. At this level, plyometrics (e.g., plyoball training) is used to increase endurance during repetitive movements. Plyometrics refers to a type of exercise training designed to produce fast, powerful movements, and improve the functions of the nervous system.

From there the athlete is progressed to machine work to build up speed and power. Free weights are used to further reinforce speed and power. At the top of the pyramid is the practice of overloading and underloading training work. These activities further enhance speed or velocity.

Throughout the functional conditioning pyramid, there is an effort to train opposing muscle groups equally. The authors stress the idea of muscle balance for young pitchers. The act of throwing training requires the coordination of many muscles working together with perfect timing. Problems can develop if even one muscle is fatigued or overloaded.

Young pitchers who overtrain are at risk for developing a condition called SICK. Overload and fatigue lead to Scapular malposition, Inferior medial border prominence, Coracoid pain and malposition, and scapular dysKinesis. SICK with all its components listed here refers to an altered position and movement of the scapula (shoulder blade). The scapula is an important part of the total shoulder movement complex during the pitch.

A second common injury from poor throwing mechanics is called the dead arm syndrome. The player experiences limited shoulder internal rotation and fatigue. He or she is unable to locate pitches. The posterior shoulder capsule gets tight and cannot protect the shoulder fully.

The authors conclude that young pitchers can stay healthy and return to play quickly after injury by following guidelines set up by the Little League organization. Keeping track of pitch count and pitch type, getting proper rest, and avoiding overparticipation are important. Equally important is a proper conditioning program as described.

Charles F. Preston, MD, et al. Risk Assessment and Prevention of Arm Injuries in Baseball Players. In The Journal of Musculoskeletal Medicine. April 2009. Vol. 26. No. 4. Pp. 149-153.