Baseball injuries can devastate an athlete or team. With one pitch, a baseball team can watch its hopes for a World Series championship evaporate. In the current Spring Training alone, Atlanta Braves pitchers Brandon Beachy and Kris Medlen, A’s opening-day starter Jarrod Parker, Diamondbacks ace Patrick Corbin, Royals reliever Luke Hochevar, and San Diego Padres starter Cory Luebke have all gone down to season-ending Tommy John injuries. For Medlen, Beachy, Parker, and Luebke, these are their second Tommy John surgeries.

Perhaps more worrisome, though, is the trend for younger pitchers to be increasingly shut down by these injuries. Dr. James Andrews has reported increases in the shoulder and elbow surgeries he has performed in recent years. Specifically for elbow surgeries, like the Tommy John operations faced by the pros above, he has seen a four-fold increase in those operations among college pitchers and a six-fold increase for high school pitchers.

What factors increase a pitcher’s risk for injury?

A survey performed at sites across the country aimed to determine the risk factors for shoulder and elbow injuries among youth pitchers. Researchers surveyed pitchers between the ages of nine and 18 and asked questions about their pitching behaviors over the previous 12 months. Specifically they looked at risk factors thought to be associated with injuries, like pitching year round, playing catcher on non-pitching days, and playing only baseball.

The survey, published in the American Journal of Sports Medicine, reveals four worrisome trends among youth pitchers. It is easy to get lost in the statistics, but they all have one underlying theme.

Also read:
7 tips to strike out youth pitching injuries
Pitching too many innings could end your baseball career

Pitching for multiple teams with overlapping seasons

30.4% of the kids pitched for multiple teams in the same season. Not surprisingly, these young throwers were more than three times as likely to develop arm fatigue and almost twice as likely to experience arm pain.

Pitching on consecutive days

Young hurlers that threw on back-to-back days had more than four times greater risk of arm tiredness and 2.5 times greater risk of arm pain. 43.5% of young pitchers threw on consecutive days in the previous 12 months.

Pitching in multiple games in one day

Only 19% of kids pitched multiple games in a day. That’s fortunate given that these pitchers had 89% greater odds of developing arm pain.

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Pitching with arm fatigue or arm pain

This practice is by far the riskiest for a young thrower, and it’s the reason the first three behaviors are problematic. The odds of suffering a pitching injury among young pitchers who often threw with tired arms were almost eight times greater (7.88) than for kids who never pitched with arm fatigue. Likewise, compared to pitchers who never threw with arm pain, the kids who often pitched through pain were 7.50 times more likely to suffer an arm injury.

Despite the risks, 69.2% of kids in the survey said they often or at least sometimes pitched with tired arms. 37.9% did so with arm pain.

The underlying message about youth baseball injuries

The prevailing message in all of these risk factors is overuse. Baseball injuries occur when kids do too much too soon, without enough time to rest and recover. Overuse is especially risky in kids who haven’t hit puberty. Their bones are still growing and are especially weak at the growth plates. They also lack the muscular stability of the shoulder and elbow that older pitchers have. Kids can suffer injuries with repeated stress over time.

The good news is that these are correctable problems. The first three risks – pitching for multiple teams in the same season, pitching on consecutive days, and pitching multiple games in one day – are easily avoided. They just require common sense. Pitch for only one team per season and rest between outings.

The last risk factor could be more challenging because it is rooted within the culture of sports – no pain, no gain. We know kids often deny symptoms in order to play. We know that coaches and parents often push kids to play through pain in order to win or succeed now at the risk of injuries down the road.

Also read:
The misperceptions of Tommy John surgery
Tommy John surgery offers pitchers long-term success
Ask Dr. Geier – Tommy John injuries

How to keep young pitchers healthy

This study is clear. Kids are much more likely to suffer serious baseball injuries pitching with arm pain or with a tired arm. We need to keep the long-term health of the pitcher in mind and stop this practice.

Give young pitchers adequate rest when they’re healthy and enough time to recover when they’re tired or hurting and we can keep kids on the mound and out of the operating room.

Note: A modified version of this post appears as my sports medicine column in the March 27, 2014 issue of The Post and Courier.

References:
Yang J, Mann BJ, Guettler JH, Dugas JR, Irrgang JJ, Fleisig GS, Albright JP. Risk-Prone Pitching Activities and Injuries in Youth Baseball: Findings From a National Sample. Am J Sports Med. Published online March 13, 2014

Olsen SJ II, Fleisig GS, Dun S, Loftice J, Andrews JR. Risk factors for shoulder and elbow injuries in adolescent baseball pitchers. Am J Sports Med. 2006,34:905-912.

Petty DH, Andrews JR, Fleisig GS, Cain EL. Ulnar collateral ligament reconstruction in high school baseball players: clinical results and injury risk factors. Am J Sports Med. 2004;32(5):1158-1164.