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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.