Caution About Year Round Pitching

This week we’d like to highlight a recently published clinical study assessing elbow MRI abnormalities in young baseball players. This well conducted study is a three year follow-up to a previously performed MRI study. In the current study the authors found that 58% of the young players had MRI abnormalities on the most recent MRI scans, up from 35% on the initial preseason MRIs at the start of the study.

There is increasing evidence about the risk to the young player’s elbow from year-round baseball participation. The risk is especially high for year-round pitching. This study along with other available evidence suggests that year-round pitching is not only a risk factor for an abnormal MRI but also a risk factor for injury and loss of performance. Most sports medicine physicians recommend that young pitchers follow guidance from MLB’s PitchSmart. We also recommend multisport participation for athletes up until about age 14.

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Are You Elite? Little League Pitching Speed And Injury Risk

The Little League World Series is well underway now, and it’s interesting to note the peak pitching speed of some of the athletes. This article notes that several pitchers are in the 65mph to 75mph range and one player actually hit 81mph on one of his pitches in this year’s tournament.

But at what cost? There is an interesting database that puts young pitchers into various categories based upon age, pitching speed, and maximum distance on the throw. An observational study published a few years ago suggests that pitchers in the three standard deviation range or higher on the accompanying chart are “elite” and at risk for arm injury.

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Want To Play Pro Baseball? Play Multiple Sports.

Sports medicine specialists and team physicians want to see all of our athletes succeed to the best of each of their abilities. But we’re also in a position to see the many things that unfortunately go wrong for younger athletes, including overuse injuries, burnout, and psychological stress.

It’s believed that two of the main causative factors in the above problems are early sport specialization and high intensity training at a very young age. For the younger athletes it’s believed that sport specialization hampers the opportunity to develop proper neuromuscular skills and general fitness.

A recently published study showed that young athletes interested in a baseball career at the highest professional level can minimize the risk of overuse injuries and have the potential for greater future longevity by participating in multiple sports during high school.

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“Fortnite Shoulder”?

We are now about two weeks away from the start of the 2019 Little League World Series. There will be a lot of baseball, of course, but there’ll also be a lot of Fortnite and other video games being played. With that in mind I thought it would be interesting to take a look at an article published in 2018 showing a strong association between videogame playing and risk of shoulder and elbow injuries in baseball players.

Researchers from the Tohoku University School of Medicine in Japan found that players who spent three or more hours daily on videogames were 5.6 times more likely to have felt elbow or shoulder pain in the prior year than those who played videogames for less than an hour a day.

Could this possibly be real? Do we actually need to add extensive videogame playing to the list of risk factors for shoulder and elbow injuries amongst young baseball players?

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“Tommy John” Surgery Does Not Make You Throw Better Than You Did Before

We now have a solid understanding of the behaviors that place a thrower at risk for elbow injuries, but making inroads in changing that behavior remains a challenge. For example, 40% of youth pitchers report throwing in chronic elbow pain, and 25% of Major League Baseball pitchershad “Tommy John” surgery at some point in their career.

The reality is that surgery to reconstruct a torn ulnar collateral ligament (UCL) does not make the elbow stronger and better than it was before the injury. Many pitchers do successfully compete again after surgery but it’s likely due to extensive rehabilitation to correct underlying functional issues as much as it is to skillful surgery.

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Parents Have A Major Impact On Reducing Kids’ Overuse Injuries

Over the last several years there’s been a growing consensus that some sport behaviors place a young athlete at risk for overuse injury: single sport specialization before age 14, playing that sport in training and competition more hours per week than your age in years, and playing more than eight months out of the year. Sport specific recommendations such as PitchSmart have also emerged.

What was previously unknown was whether following these recommendations actually leads to reduced injury rates. Recently published research indicates that parents who are knowledgeable of the PitchSmart recommendations and follow them with their young pitchers show significantly reduced injury rates compared to parents who were unaware of those recommendations.

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Are Weighted Baseball Training Programs Safe And Effective?

Over the last several years baseball pitching at all levels from professionals to youth leagues has become increasingly dependent on pitch velocity and power.According to Pitch/FX data, the average fastball velocity in MLB has gone up each year since tracking began in 2008, from 90.9 MPH to 93.2 MPH in 2017. 

This intense focus on pitch velocity has resulted in the development of several speed enhancement programs.One of the most popular forms of speed enhancement programs utilizes underweight and overweight baseballs.In spite of the intense interest in this area there is very little high quality evidence that we can lean on. At this time we simply don’t have the answer to whether weighted baseball training programs are safe or effective.

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Predicting Baseball Related Arm Injury

It would be great if we could take a young baseball player and be able to accurately predict arm injury risk for that player. If we could identify specific factors we could take steps proactively to prevent injury. A recently published study shows that we are closer to being able to identify cause and effect for elbow injuries in young baseball players but still need quite a bit more data to conclusively show cause and effect for shoulder injuries.

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Real-Time Mobile Sensor Data Shows Pitchers’ Arm Fatigues Quickly

Many people have a sense that injuries happen more often when you’re tired. We see this all the time in the orthopedic clinic: someone tears an ACL on the last planned run of a long weekend of skiing; a volleyball player injures her ankle after the final game of a long series of tournament games. There is a common belief that fatigue plays a major role in increasing injury risk, but proving this can be difficult. A recent study on pitching mechanicsperformed at the Henry Ford Health System in Detroit, takes an interesting step in connecting the dots between fatigue, biomechanics, and possible injury risk. A wearable motion capture device allowed for real-time data acquisition in a simulated game setting.

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New Treatment For Elbow Ligament Injury: Possible To Cut Rehab Time In Half

The ulnar collateral ligament in the elbow is a critical stabilizer, and one that gets stressed during the baseball pitch. We’ve seen a substantial increase in tears of the ulnar collateral ligament in all age groups but especially in teenage pitchers. The standard of care for those athletes choosing surgery is a ligament reconstruction commonly known as “The Tommy John” procedure. The traditional surgery has undergone refinements over the years and has a high success rate, but the downside is that return to competitive pitching takes more than a year, often around 16 months (that’s two seasons of sport…). But a new procedure offers the chance to potentially cut the rehab time and return to play time to less than half.

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