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The Four Myths of Youth Baseball Injury Prevention

I recently spent a weekend with many high school baseball players as part of a summer academy here in Southern California. The experience was great—the teaching, instruction on technique and performance, as well as lessons on leadership were memorable—and wow, these kids are great players, too.

I had a chance to speak with a lot of the players, not only on some of their minor varied injuries, but to address injury prevention as a whole with the players. As I reflected on my time speaking with the coaches and players, it was apparent to me that there is a lot of myths regarding injury prevention and overall arm care. These myths seem to be perpetuated by travel ball coaches and the media.

I wanted to briefly address some of the main myths that I have seen or encountered that may be prevalent in other communities or teams. These myths don’t represent any certain team, organization, or specific area, but include a collection of thoughts that I think can be very helpful for parents, coaches and players alike.

 

Myth 1 – “Rest is Rehab After an Injury”

One of the most interesting conversations I had with an athlete this past weekend was regarding a previous injury that he sustained to his shoulder.

He told me that he was instructed to “shut it down,” and rest from baseball activities. He said he did just that, for two months. I asked the athlete what type of stuff he did during that period of inactivity from baseball.

He quickly told me, “nothing, I rested and felt better afterwards.”

While a period of rest is important, particularly to curb the cumulative “microtrauma” that is taking place over the course of a season or summer, rehab should always be an active process.

As an athlete, especially during a “resting” phase after injury or even between starts or tournaments, there should always be a varying level of rehab that does not include throwing the baseball. Throwing a baseball should be reserved for certain activities that may include bullpen sessions or mechanics-driven instruction.

However, I would stress to all the youth players a few things. It’s incredibly important to not focus on just the “reactive” side of injury. This includes the “my shoulder hurts” or “my elbow is really tight and bothersome.”

Instead, focusing on a “preventative” approach is often more beneficial. In this way, we can work on keeping arms healthy and prevent future injury, as opposed to just addressing an athlete who is in pain.

To reiterate, “resting” during a baseball season or during a period of injury, should not be completely passive. This should not be complete rest. This should be relative rest.

Relative rest includes soft tissue mobility to restore range of motion or resistance band work to increase muscle activation. Baseball players should continue to improve the resiliency of their bodies and arms to tolerate the stresses of playing baseball during the times in which they are not actually playing.

 

Myth 2 – “Playing Year Round Builds Strength and Ability”

In my opinion, one of the greatest threats to the health of a youth baseball player, is simply playing baseball year-round.

By playing baseball during the entire course of a year, the athlete never has the opportunity to halt the cumulative microtrauma of throwing a baseball over the course of a season. Year-round play also prevents the ability for a true off-season to rest and address deficits in strength and coordination that can actually help baseball performance.

Dr. Glenn Fleisig of the American Sports Medicine Institute in Birmingham, AL, best describes this level of sports participation in a 2012 article stating that pitching competitively more than 8 months per year increased the odds of surgery by 5 times. That’s truly startling, and represents one of the easiest ways to avoid injury – don’t play as much.

While I do advocate for having a period of no baseball throwing, I think it is still important to perform active exercise, especially for the core and the lower half. Proper training of the core and lower half can reduce the athlete’s risk for injury. This is similar to the first myth. Rest does not mean do nothing.

Lastly, throwing all year can obviously bring upon concerns of arm fatigue. Dr. Fleisig continued in the same article above by reporting that a pitcher who regularly pitches fatigued was 36 times as likely to require surgery.

While these numbers are staggering, they both represent modifiable ways that we can avoid injury. In other words, playing year-round and playing fatigued are both factors that can be avoided through proper communication.

 

Myth 3 – “Throwing Faster is Due to Just Weighted Baseballs”

Velocity is the name of the game, especially in youth baseball. Athletes are infatuated with how fast they can throw, as they believe that it is the sole determinant of success and college opportunities.

We are truly in the “velocity era,” in baseball now. Injuries occur more and more, not only in terms of frequency, but as well in a variation of the type of injury.

This article is not necessarily to address the benefits or disadvantages of weighted baseballs, I want to briefly touch upon the misconception that arm strength via the use of weighted baseballs are the ultimate solution.

I believe that aside from improving mechanics, which can easily stress the shoulder and elbow in ways that are potentially harmful, lower body rotational strength, improving muscle mass, and increasing generalized body weight in an effective manner are the most critical factors towards improving velocity.

While arm strength, a resilient rotator cuff, good shoulder range of motion, and adequate thoracic spine mobility are all important to tolerate the demands of throwing a baseball, developing a powerful lower half rotational component can greatly impact the force that is even able to be dissipated through the arm.

Lastly, I spent a lot of time with skinny baseball players this past weekend. Granted some of these kids are only 15 or 16 years old, but a few of them can throw in the upper 80’s. While this is fairly impressive, I can only imagine the improvements in velocity that will simply take place from not being 140 pounds.

Young athletes can easily get caught up in the newest training tools such as weighted baseballs, but the easiest way to develop velocity without actually throwing is to improve lower half strength and rotational power in addition to simply becoming bigger and stronger by gaining effective muscle-dominant weight.

Everything else is just gravy.

 

Myth 4 – “Innings Pitched in Different Settings Don’t Aggregate”

One of the most troubling conversations I had with a youth athlete this weekend was with one who had shoulder discomfort. He told me he made over 20 outings this past season as a starting pitcher during his high school season and that he recently participated in a weekend college showcase by throwing 95 pitches.

Admittedly, the athlete told me that he was fatigued and sore, but he felt that the pitches thrown recently in the showcase should be considered differently than the ones he threw recently as his high school season ended.

It’s important to note that all pitches count towards the cumulative stress on your throwing arm, whether it be during a live session or simply to the catcher as part of a bullpen setting.

Dr. Fleisig reported in the same 2012 article that averaging more than 80 pitchers per game at the youth level almost quadrupled the chance of surgery.

I often tell young players that they need to be their greatest advocate. Understanding and communicating their pitch counts, conveying feelings of fatigue, and being able to say “no.”

 

Final Thoughts

While these myths represent a brief snapshot of conversations I had this past weekend, other players, coaches, and health care providers can probably relate to these myths in some way.

Ultimately, from an injury rehab profession perspective, I think a lot of our attention is towards injury reaction and rehab, when it should shift to injury prevention with a good grasp of the modifiable injury risk factors for optimal baseball performance moving forward.

A New Injury Epidemic in Baseball Pitchers: Blisters

Injuries to baseball pitchers. You’re probably thinking of an assortment of shoulder and elbow pathologies. The most common ones include labral injuries of the shoulder or ulnar collateral ligament tears of the elbow requiring a Tommy John procedure.

One growing injury trend impacting pitchers at all levels, particularly in collegiate and professional baseball, is blisters. You heard that right. Blisters are causing well over several months per season of cumulative days missed at the Major League Baseball (MLB) level.

These injuries can be particularly debilitating to the throwing hand of pitchers. They can decrease performance through improper ball handling and command, and may result in an inability to throw a baseball without pain or discomfort.

Due to blisters becoming such an issue in baseball, let’s step back and quickly look at the data. Let’s review how these injuries are occurring, as well as discuss ways in which medical professionals can not only treat these injuries but work to prevent them in the first place.

 

Are Blisters in Baseball Pitchers an Epidemic?

During the 2016 and 2017 season each, approximately 190 days were missed in the MLB by pitchers due to blisters. For comparison, between 2012-2015, less than 190 days combined were missed.

So, what happened at the start of 2016?

In a recent article from “The Ringer,” former Dodgers head athletic trainer Stan Conte stated that there’s “no question that there is an increase from previous years.” He continues by stating “the million-dollar question is why. I think we all the talk about the perceived changes in the ball, that has to be on the top of the list.”

The Ringer indicated amongst their incidence data provided below, that “seam-height data” of the baseball testing they had provided from the MLB, that the seams on baseballs itself are lower now than they were before 2016. Can seam height truly dictate the incidence of blisters?

 

Why Do Blisters Occur?

Aside from the growing issue that blisters potentially pose to baseball pitchers, it’s critical for training room medical professionals to understand how to address these issues.

Blisters can form on any finger of the throwing hand of a pitcher. However, typically speaking, most blisters form on the middle finger. This is most likely due to the middle finger being the last point of contact during a fastball pitch.

In addition, these blisters can also occur more frequently on the thumb or index finger, as well. I’ve had pitchers tell me in the past that during a circle change-up pitch, they can even get contact between the nail of their index finger and the inside part of their thumb upon ball release.

Overall, blisters form due to the friction that occurs between the ball (or seam of the ball) and the end of a finger.

This repetitive load and friction that occurs with the hundreds and thousands of pitches thrown, can lead to a focal irritation and breakdown of skin.

 

How to Prevent Blisters

There are several ways in which baseball pitchers have attempted to address blisters. Mark Vinson of the Tampa Bay Rays states that “some pitchers use spray-on antiperspirant, which has been shown to help prevent sweat and reduce added moisture from sweat.”

He also recommends that pitchers place their “throwing hand into a bag of rice in between innings to help reduce moisture on their fingers” as well.

The goal of these preventative measures is to maintain integrity of the skin on the fingertip, and ultimately reduce the likelihood of “pruning” from developing from prolonged moisture that can take place from sweat.

However, once a blister has formed, it’s imperative that treatment begins quickly to avoid any potential of prolonged missed time from competition.

 

Treating Blisters in the Baseball Pitcher

The blister, whether filled with clear serous fluid or blood, can often best be addressed by having a sterile drain be applied with a needle to the affected area.

Most importantly, while the drainage should provide instantaneous relief, it’s critical that the blister be monitored to ensure that it does not open up, creating a secondary skin avulsion.

In the cases in which a “chunk” of the skin has been removed through a skin avulsion, it can cause a significant amount of missed time. This is due to basically having an “open wound” on a finger that is constantly becoming further irritated by throwing.

Outside of having a needle drain the blister, other more conservative measures include Dermabond, which is essentially like a “skin super glue” that can perform as another barrier of friction over the injured finger.

If the skin on the finger begins to open up , pitchers may have to address any potential infections that occur. Vinson states that Betadine mixed with water can be useful as “Betadine helps to clean the area, prevent infection and toughen the skin around the affected area over the long-term.”

 

Summary

It’s clear that the incidence of blisters among baseball pitchers at the Major League level is rising dramatically. The reason for this new epidemic is less clear. Is it due to the type of pitches thrown, the seams of the baseball, or other factors? We don’t have an answer.

In the meantime, it’s important for training room professionals and coaches to try to prevent blisters from occurring at all. When they inevitably do occur over the course of a season, training room staff should be educated on how to address these injuries so that the pitcher can return to the field in a pain-free manner.

10 Keys to a Better Long Toss Session for Baseball Pitchers

Note from the Editor-in-Chief: We love long toss at Elite Baseball Performance, especially programs that are smart, individualized, and well structured for the right time of year.  Alan Jaeger has done a lot of great work in this area and has really helped popularize long toss in general.  Dale does a great job discussing some of these concepts and points he uses to get the most out of long toss below.  If you are interested in learning more, we encourage to learn more from Alan’s Thrive on Throwing 2 program and be sure to check out his J-bands for your arm care program.  

 

In baseball, there is no substitute for a well-conditioned and healthy arm. Virtually no baseball specific activity can be done successfully if you have a weak or an injured arm. You can’t make accurate throws if you’re an infielder, you can’t gun down a runner from the outfield, and you certainly can’t pitch well.

I’ll say it again: the bottom line is that a baseball player needs to have a strong, conditioned and healthy arm to play the game. It can be the deciding factor as to whether a player moves on to the next level.

In this article, you’ll learn how to better structure and improve your long toss sessions/

“Your arm is your life line as a player — it can either be an asset or liability. Be proactive — it is one of your five major tools, so treat it that way.”

 

 

When Should a Player Implement a Long Toss Routine?

The primary goal of any throwing program should be to put the arm in the best position possible to be healthy and perform at the highest level. The next priority is to build strength, endurance and accuracy. The most important time to establish a throwing program is during the offseason, for two main reasons:

 

  1. No Interference From Games and Practices

When a player is in the offseason, there are no demands of games or practices giving players the freedom to follow a sound throwing routine. This freedom allows players to throw based on their own personal needs and work on specific mechanics. Also, in the absence of excessive game related throwing, the player will be better able to recover adequately between sessions.

 

  1. Less Wear and Tear From In-Season Throwing

When a player is in season, bullpens and game-related throwing put a tremendous amount of wear and tear on the arm. It has been shown that arm strength, more specifically rotator cuff strength and scapular stabilizer proficiency, actually decreases over the course of the season. Because of this, we don’t want to add any excess stress on the arm during the season.

 

How to Long Toss

A long toss session can be broken into two phases: the stretching-out phase, and the pull-down phase.

 

Stretching-Out Phase

This is the first stage of a long toss session where our goal is to let the arm stretch itself out with a loose arm action. Here we are allowing our arm to throw as far as it wants to throw while keeping throws pain free and effortless. Be aware of keeping sound mechanics.

The goal of this phase is to “stretch out the arm,” creating a greater capacity for arm speed using a longer, looser arm motion. Progressively throw farther and farther until comfortably maxed-out in distance. After peaking in distance, we’ll start the pull-down phase.

 

Pull-Down Phase

After reaching maximum distance during the stretch out phase, we will work back in towards our throwing partner. Because the muscles have been lengthened and the arm has been adequately loosened, we have a greater capacity for the arm to generate speed.

As you come in, you will notice that it will take a great deal of concentration to pull your throws downhill and not sail them over your partner’s head. If you decelerate or ease up on your throw to gain this control, you cannot effectively increase your arm speed.

To pull your throws down to your partner, we will have to accelerate through your release point by taking your maximum effort throw toward your throwing partner. We want to focus on maintaining good balance and creating downward extension through your release point towards your target.

The number of throws during the pull-down phase will vary from player to player. A general rule of thumb is to come in 10 feet at a time with each throw.

Arm speed and endurance comes from the combination of both phases. The additional distance provides the arm with an opportunity to generate more arm speed on longer, looser and well-conditioned muscles. Now that we’re clear on what a long-toss session looks like, let’s discuss some ways to maximize your training effect.

 

Baseball Field

 

10 Tips to Get The Most Out of Your Long Toss Session

  1. Warm up properly using a dynamic warm up.
  2. Always maintain sound throwing mechanics. Don’t let your mechanics degrade by overthrowing.
  3. Keep your throws loose and nearly effortless. You should not be straining to reach your target.
  4. If you max out in the stretching-out phase in terms of distance, don’t worry, just stay at that distance and continue to work there until your arm allows more. Remember, the end point of your throwing distance should still see a nice controlled throwing motion with your normal mechanics.
  5. Remember that the goal of a long toss program is to progressively build arm strength through increasing distance.
  6. Let your arm dictate the number of throws that you perform at each distance. If you feel strong, feel free to throw a few extra, but remember: if at any point you feel sore or fatigued, stop throwing. You should never throw through fatigue and certainly not through soreness.
  7. When returning from max distances to throw from 60 feet, concentrate on finishing through your release and forcing the ball down – it is easy to miss high.
  8. Use a step behind before every throw. It keeps the hips properly closed preventing the arm from flying open too early, especially as you stretch out to longer distances. Add a second crow-hop if necessary to build momentum.
  9. Starting a long toss program early on will help you develop a unique understanding of your arm that will pay big dividends for years to come. Get to know your arm now and put yourself ahead of the competition.
  10. Perform a cool down. Gently stretch and perform a post-throwing mobility routine to help speed up your recovery and maintain muscle tissue quality.

 

Don’t Forget Arm Care & Prehab

Even the strongest arm is vulnerable to serious injury if not properly cared for with functional rotator cuff and scapular stabilization exercises.

By neglecting the importance of a rotator cuff strengthening program and an adequate throwing warm up routine, you are pushing the odds in the favor of injuring yourself at some point.

Elite Baseball Performance has a great free arm care program designed to build your base strength.

 

Use These 10 Tips to Improve Your Arm Strength & Health

Without the opportunity to long toss, the arm won’t gain the strength, length, and endurance it needs. Following a quality arm care and long toss regimen will pay dividends in the long-run. Use the guidelines in this article to have better long toss sessions and build arm strength for years to come.