Overuse Injuries in Youth Baseball

Repetitive injuries: These are the concerns of mature athletes approaching retirement -- or so we might wish. However, recent decades have seen an increasing number of overuse injuries in youth. The American Sports Medicine Institute cites a dramatic rise in UCL (elbow) surgery among youth baseball pitchers (http://www.asmi.org/research.php?).

One reason is the increase in competitive sports. Even preteens may specialize by playing the same sport year-round. Some youngsters play for multiple teams at the same time, for example, a local recreational league and a travel team.

Repetitive injuries don't happen suddenly, even when they appear to. Fortunately there are ways these can be headed off. Prevention can include everything from having a comprehensive physical to doing stretches and watching for signs of fatigue.

A big part of the solution, though, appears to be less baseball! That’s why major organizations are recommending limits on pitching.

Overuse Injuries: Pitchers

Pitching, with its elaborate windup, is more demanding than simply throwing. Injuries are often seen in the elbow. Injuries may take the form of microscopic tears that simply need rest to recover. However, they can progress. Medial Apophysitis is sometimes termed Little Leaguer's Elbow. When ligaments and tendons tear away from the bone, they can actually disrupt bone growth.

The shoulder is another frequent site of injury. One longitudinal study found that 5% of young pitchers eventually had a shoulder or elbow injury that was serious enough to require surgery or force them to quit the sport (http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3435945).

The most significant risk factor is overuse. Some research points to increased risk for youth who play more than 100 innings a year (http://www.sciencedaily.com/releases/2011/02/110201083343.htm).

The USA Baseball Medical & Safety Advisory Committee recommends pitch count limits by player age (http://web.usabaseball.com/news/article.jsp?ymd=20090813&content_id=6409508). A 10-year-old is advised to have no more than 50 pitches per game, 1,000 per season, and 2,000 per year. At eleven, the per-game limit goes up to 75 and the per-year limit to 3,000. Eleven-year-olds, though, are still expected to accrue no more than 1,000 pitches per season.

Some organizations are in a position to enforce pitch counts. The United States Specialty Sports Association (USSSA) has set limits on the number of innings a youth can pitch during competitive play (http://www.gamedayusssa.com/pitching-rules). The daily limits are tighter if the child will be playing again the following day. Youth fourteen and under can only play three consecutive days, regardless of the number of innings pitched.

Other organizations, like Little League, have set their own pitching limits. However, since youngsters sometimes play for more than one team, it's important that an adult monitors the total amount of pitching. The coach may well be counting pitches or innings. He may simply not know how much baseball children play “on the side”.

It’s a good idea to take some lengthy rest periods. The American Sports Medicine Institute recommends taking four months off from competitive pitching each year -- and at least two to three months from all overhead throwing.

Overuse Injuries: Catchers

Pitchers are at the greatest risk, but catchers also have some risk of throwing- and catching-related injuries. One area of vulnerability: the knees. Tucson Physical Therapy Clinics notes that it can be a good idea for catchers to cool down with cold compresses on their knees (http://www.prlog.org/12153937-tucson-physical-therapy-clinics-partner-with-youth-baseball-league-to-teach-injury-prevention.html).

It may be that go-to players who play more than one key position are at heightened risk. Some research suggests that when the same youth plays both catcher and pitcher, injury is more likely to occur.

Overuse Injuries: Batters and Infield

Even those in the outfield can succumb to repetitive throwing injuries. And, while pitching and throwing are the activities we most associate with youth baseball overuse injury, a variety of issues are possible. Tucson Physical Therapy Clinics even cites hamstring strains among the potential results of too much intense ball play.

The American Medical Society for Sports Medicine notes in a position statement that while there hasn't been a lot of research into the effects of poorly fitted equipment, such equipment could affect biomechanics and contribute to injury. Care should be taken that bats are the proper size and weight, and that they are adjusted as players grow (www.amssm.org/Content/pdf%20files/2014_OverUse_Injuries-Burnout.pdf).

Other Risk Factors

There are many things that can predispose a young player to overuse injury (http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3445152/). One is improper biomechanics. The child with the high velocity pitch may also have a heightened risk of injury. Even nutrition and hydration play roles.

The coaching team must consider at what age and development level players are ready for manoeuvers like curveballs and sliders.

More Solutions

It’s important to limit play, but this is not the whole solution.

One simple fix is watching for signs of fatigue before a true injury develops. The American Sports Medicine Institute notes that it is important to be aware of changes in performance, for example, decreased velocity and accuracy (http://www.asmi.org/research.php?page=research).

One should keep in mind the psyche of the young ball player. A youth may come down on himself for costing his team the game. It’s up to adults to recognize when there may be a physical issue and to make sure that that the player gets some rest.

This means talking to children beforehand. They should be taught to let someone know when they are in pain (http://www.sciencedaily.com/releases/2013/03/130329161137.htm).

Pain that doesn’t resolve within a few days should be brought to the attention of a medical professional.

The American Academy of Orthopedic Surgeons notes the importance of the pre-season physical examination. Medical professionals may also suggest preseason conditioning.