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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.

What 4 Months of Off-Season Strength Training Did for This Baseball Program

Results and data speak for themselves.

In this article, I will be breaking down the results of 8 baseball teams ranging from 13u to 18u which we had the pleasure of working with this off-season and winter here at Champion Physical Therapy and Performance. I will provide examples and how to’s of several exercises as well! See how this baseball program increased power, strength, and performance!

If you are not a subscriber to Esposito Strength Club, make sure you click here to subscribe so you don’t miss out! You will also get access to all my Free Online Baseball Courses!

 

Why We Tested Our Athletes

First off, we like to test and collect data for many reasons. The main priority for us is knowing whether our program was successful or not successful.

I am a true believer in assessing myself as a strength coach and if something was implemented that did not achieve the results I would want or expect, I definitely don’t want to continue to make the same mistake the next year! As a coach, we also have to progress and develop our programs and coaching abilities.

 

What Data?

This is an area which I don’t know why many programs or coaches do not implement.

It’s all about your athletes getting better right? A huge game changer for us once the off-season ended was handing out progress reports of starting and ending data for each athlete. We held team meetings where we discussed results, goals and much more.

What’s even more important is the kids continued to train even after their “program” ended. This is awesome as many kids just simply stop training during the season.

Don’t make that mistake of not training! For more on that Click here for 5 Mistakes Baseball Players Make in-Season 

I believe there are two main excuses as to why most don’t test their athletes…those are:

  1. You don’t have (make) time.
  2. You are afraid you and your coaching philosophies will be proven wrong.

 

Look, I get it from a time perspective, but you are in full control of the practice plan and strength program. You make the time!

If you are afraid of being shown your training program really wasn’t as effective as your marketing led that to be…well either grow and make changes or stop coaching.

 

The Other End of the Spectrum

While testing can be a great thing, I do need to touch on the other end of the spectrum: over analyzing or collecting data just to say you collected it.

I have seen it before. I have seen some of the most unnecessary tests and assessments performed. I don’t know who actually cares to measure or needs to know the hand size of a 10-year-old baseball player but I’ve seen it done.

Sick, your 11 now and your hand grew 1/8 of an inch, our training is so good

Was it the training that caused that? Probably not as much as the sun going up and down a whole bunch.

Look, that even happened in our off-season tests. We measured the athletes’ height…but I did not include it on the final reports, many kids are in puberty and maturing…that’s a VERY big variable for me to say had nothing to do with getting taller.

If you are going to collect data, use it! Find out what went right, what went wrong, and how to make adjustments to help the athletes next season!

 

What We Tested

As we entered the off-season training, we needed to make a list of tests and measurements that were:

  • Applicable to the athletes
  • Made sense for baseball players
  • Able to be consistently replicated
  • Take 3 Sessions to perform
    • We did not want to lose too many training days

 

Our Training Parameters

I wanted to break this down a bit more for the coaches and parents who run baseball programs. I am sure some of you have a similar layout to roster structure.

  • 8 Total Rosters
  • 120 Total Athletes
  • 3 days a week of Strength Training
  • 1 Hour Per Training Session
  • 4 Total Months
  • 48 Total Workout Sessions
  • 6 of those sessions were allocated to testing, goal setting, and result breakdown and exit meeting

 

What We Tested

During the first week (November) and last week (February/March 15) of the strength program, we measured the following:

  • Body Weight
  • Grip Strength on Right and Left Hand
  • 60 Yard and 10 Yard Sprints (weather permitting)
  • 300 Meter (weather permitting)
  • 5-10-5 Pro Agility Test
  • Broad Jump
  • Lateral Bound on Left and Right Foot
  • Vertical Jump Height
  • Med Ball Stepping Overhead Throw

 

We used the GFlight to measure jump height. I absolutely love the GFlight. It’s portable, convenient, and consistent with its data and performance. Here’s a recent post for more and my review. Want a GFlight? Pick one up here and use code ESPOSTRENGTH for savings!

For velocity readings for the Med Ball Throws, we used Pocket Radar. Similar to the GFlight, it was easy to use, portable, and consistent. Here’s a great post from Mike Reinold on 3 Ways Pitcher’s can use radar to enhance performance…and check out the flame-throwing lefty in his videos…

Some of the goals of the baseball program were to simply get bigger and stronger. We only had an hour with the teams, and one of the areas we chose to not allocate much time to was speed and agility. As a strength coach, I do know many of these kids are multi-sport athletes, so that was not a major concern for me. Playing basketball, hockey or other sports gives plenty of agility and footwork.

We also know there is a high carryover when you perform strength lifting and plyometrics that translate into force production of sprinting and change of direction.

We chose several power development markers (broad jumps, lateral bounds, vertical, med ball) to track. We know these have a very strong correlation to baseball players performance and development.

 

Estimated 1 Rep Max

For our older athletes (15u, 16u, 17u, 18u) we used an estimated 1 Rep Max (e1RM) to safely find working weights for athletes. This also lets us have a better idea of appropriate weight selection for athletes, without the risk of performing a true 1 rep max test.

Every phase of the off-season for the older teams was specific in regard to developing strength and power and then using the new found strength to become explosive. This helps translate to on-field performance!

We had 3 main exercises we chose to track e1RM. Those were pushups, squats, and deadlifts.

Want to know your estimated 1 rep max…bookmark this link and use this 1 Rep Max Calculator

 

Here are some videos of the testing we performed this off-season!

 

The Results

These kids absolutely crushed their lifts. We were very clear from the beginning that the results would not happen overnight. Showing up consistently, lifting with good form, and properly increasing their weights was a great start.

While we had great results across all of the testing data, some of the areas that stood out were the power development of the Broad Jump, Vertical, and Lateral Bounds. On top of that, we created very good symmetry in the body from Right to Left on both Lateral Bounds and Grip Strength

We had a 42.98% increase in Right Leg Lateral Bound. For right-handed hitters and throwers, that is HUGE. More force to generate with will translate into higher velocity, and more power when hitting!

One of the other benefits to note is many athletes gained body weight during the off-season. While we gained weight, we also increased all power metrics…AND our running numbers either stayed at the baseline or improved. Even though we gained weight, our running did not get slower!

See the charts below for a full breakdown by age group!

 

 

 

 

 

 

How We Got Results

#1 Item that helped with results: showing up! That was something that was awesome this off-season. Almost all of these athletes were committed to coming to the gym and 100% bought into their personal development!

With that set, setting the foundations for this year and long term success was our top priority for these athletes. The programs were designed to hit the major areas for youth and developing athletes:

  • Strength and Power
  • Stability
  • Proprioception
  • Force Acceptance
  • Force Development
  • Med Ball Work
  • Plyometrics

 

We focused on what I call the pillars of strength: push, pull, hinge, squat, carry, core, balance. All of our workouts incorporated some type of movement or skill associated with those pillars.

 

Program Design for 13u and 14u Players

For our youth athletes, we always focus or the learning and mastering the basics. For a vast majority of this age group, it was their first time lifting or following a sports performance program.

This age group sets the tone and prepares them for heavier loads at older ages. You will be way ahead of everyone when you get into your 15 and older range from a strength development perspective.

We kept our rep ranges in the 8-12 for most of the exercises and focused on quality over quantity. Our progressions were designed to maintain their focus during the entire lift to be self-aware of their movement and patterns. For example, using 1 weight in a contralateral hold challenges your lateral flexion while performing a reverse lunge. This is a great progression for a standard reverse lunge.

 

Program Design for 15u, 16u, 17u, 18u Players

We had 4 significant phases for this age range during the off-season.

  • Phase 1 was re-acclimating to the gym after time off, as well as ensuring the lifting movements were ideal!
  • Phase 2 was continuing on our linear progression and added in some Isometric holds, and preparing the body to accept heavier loads.
  • Phase 3 was our heaviest load phase. We reduced the number of reps and increased the number of sets. This allows to safely get under heavier loads all within a linear progressive training approach!
  • Phase 4 was our speed phase. We take the muscle and strength we gained during the previous 12 weeks, and we teach it to become explosive and powerful. We reduce the weight as well to provide the proper stimulus for training, and prepare for tryouts and the season!

 

Just a note, we did not progress the athlete to the next phase just because the program called for it. This was where we would individualize for the athlete. If they required more time to master a movement, we simply allowed them that additional time.

 

How to Videos

Here are some great demos and how to videos of some of the exercises we used through the off-season training program. Many of these were crucial to power development as the data shows!

 

Final Thoughts

This was a great off-season for these athletes as the data shows. It was awesome seeing the progress from start to finish. Thanks to everyone at Champion (Kiefer, Diwesh, Kristy) for being a huge part of the success of these athletes!

We were very excited to show all the athletes at the end of the year meeting their results. It was great to see the kids talk about their goals and seeing their faces when they realized how they did not just hit their goal, but absolutely crushed it.

If you are interested in this type of training and results for your teams, send me a message below!

Long-Term Development Plan for Baseball

In a recent survey I posted on my Instagram and Twitter accounts, I asked a series of questions for baseball players, and their personal experience with their long-term development. I had a tremendous response, including MLB players, Minor League players, players from all NCAA divisions, & high school athletes. Thank you to all who took the time and submitted their answers!

There were 2 important questions that I want to share with you…

 

Question #1

“Do you wish you started strength training at an earlier age to help your long-term development?”

96% responded with a YES.

Of the 4% who said no, were all under the age of 15 when they first started a lifting program.

 

Question #2

“What advice would you give to an athlete in high school about when to start strength training?”

98% of responded by saying they should have already started, ASAP, or prior to high school.

I wanted to break down the long-term development and talk about goal setting, and what exactly is a periodized training program.

 

Planning Out Your Long-Term Success

 

 

What Is Periodization?

This is your planning and process for long-term success. Based on your sport, age, competitiveness, and other factors, planning for your on-field performance is crucial.

Following a periodized program will help layout your foundation for where you currently are, and where you would like to get.

This could be 1 month down the road, 3 months, or a year. Having that plan allows you to steadily progress your workout program as you begin to see results!

 

What Are Macrocycles?

This is the annual plan. Long term, this prepares your athlete or client to peak at their performance day or season.

  • Off-season
    • This is your longer duration phase and where you will see adaptations and building capacities.
    • This is where you should be making the largest impact on your performance.
  • In-season
    • Maintaining what was built during the off-season. Maintaining movement patterns, body positions, and strength.
    • Depending on your age, this can also be used to continue to build on your previous success. This is commonly seen in youth and middle school ages.
  • Transition Phases
    • Post Season work. This helps the body repair, recover, rest, and regenerate. Depending on the age, athlete, sport, this phase can be 3-5 weeks.

 

 

What Are Mesocycles?

Mesocycles are phases/months of training that can range from 2-6 weeks depending on the athlete. The mesocycle is where you can have your adaptations, and changes. With higher level athletes, you can begin to have different program variations (triphasic, contrast, VBT, hypertrophy, etc.) based on goals, and what the athlete is prepared for.

There will be anywhere from 3-10 mesocycles in a macrocycle based on age, sport, and level.

These smaller cycles enable athletes to progressively improve upon an area of their training in a systematic manner. Focusing on making sure the athlete understands the purpose behind their training and can set short-term, more manageable goals to help whatever long-term goals they may have.

 

What Are Microcycles?

These are commonly smaller programs, sometimes a week. This may be seen more during in-season, or if a client is traveling a lot for sport… for example, summer baseball travel. You may have to adjust weekly based on how the body is feeling, games, practices, and travel. This is where client rapport comes in, so you can communicate with them.

I have many athletes who we adjust the workout based around how they walked in the door. Some may come in tight after a game or travel, and just not in a good position to perform the planned lift.

Making that decision can be something that can keep an injury away! For example, if you have a stiff back after a ski trip, just because your program calls for deadlifts, does not mean you have to perform them. Instead, consider performing other exercises that are not strenuous for the back and moving your deadlift routine to a different day until your discomfort is eliminated.

 

Based on that chart, those are some of the questions and what I commonly see after training baseball players from all levels (MLB, MiLB, NCAA, High School, Youth).

Be sure to apply these principles to your training for the best performance results. These principles can be used across all ages for long-term athletic success.

 

Need an Offseason Training Program?

I’m really excited to have recently teamed up with Mike Reinold to release a couple of online offseason baseball performance training programs.  Now you can follow our acclaimed programs from anywhere in the world, just like all the baseball players at Champion.  We give you everything you need to enhance performance, reduce injury, and get ready for the season!

Check them out below:

 

 

7 Steps to Have a Long Baseball Career

Most of us are here because of our shared love for one thing: baseball. Throughout our careers, we all grow to appreciate the little things: the smell of freshly cut grass, the pop of the catcher’s mitt, and taking in the view from the dugout, eager to put life’s troubles aside for the next few hours.

Unfortunately, many of us don’t get to experience these things forever.

So why do we end up parting ways with the game we love? The end of the road usually comes down to one of three things: injury, burnout, or you weren’t good enough to compete at the next level.

 

7 Steps to Have a Long Baseball Career

To help those who’ve had to prematurely walk away from doing what they love most, this article will go over how you can put building blocks in place from when you were playing on your local Little League team all the way through the professional level to ensure your longevity in the game.

 

Little League Building Blocks 

Play Other Sports

Little League and youth baseball are incredible for teaching children the rules of the game. More importantly, it gives kids an opportunity to develop a passion for baseball and associate feelings of joy, fun, and happiness with the diamond.

At the same time, it’s crucial that kids also participate in a variety of other sports.

Early specialization is real, and high-strung parents have no problem locking their child into one sport so they have a shot at a college scholarship. Kids need both physical and mental variability, and exposing them to multiple sports will satisfy both of those needs.

Step one for longevity on the diamond: Play more than just baseball during your Little League years.

Practice Gross Motor Skills, Coordination, and Agility

Prepubescent athletes don’t need to be partaking in a full fledge strength and conditioning program.

Firstly, they don’t have the hormones needed to reap the benefits of heavy resistance training, and secondly, they probably don’t need rigid constraints placed on how they should move.

But, early childhood is a critical period for an athlete to develop good motor skills, coordination, and agility. Because of a child’s plasticity and sensitivity to advancing their motor development, these years are a great time for them to practice moving their bodies in a variety of ways to help integrate visual, vestibular, and somatosensory information.

This will help give them a stronger base to work from later on in their athletic career.

 

High School Building Blocks

Get a Movement Assessment

These are the years when an athlete is constantly trying to adjust to their growing body, is probably playing in more games per year, and may be starting to lift weights.

For all those reasons, it’s now time to start making movement assessments a must.

Because of one’s athletic history, body type, and anatomy movement, compensations may start to rear their ugly head. Finding a quality physical therapist and strength coach who can identify where you move well/poorly and develop a plan to help you mitigate injuries is invaluable.

A well-done assessment will not only show you what you’re good and not good at, it will also direct how you train, warm-up, and even what throwing program is best for you. Get assessments early, often, and make it habit throughout your career.

Begin a Structured Strength & Conditioning Program 

When an athlete reaches puberty they have the hormonal capabilities to increase their muscle mass, strength, and power, and participating in a strength and conditioning program will help accomplish all three. Piggybacking off of the last building block, baseball is a unique sport; the repetitiveness of throwing and hitting, and the demands those two actions place on the body, mean that any old football or bodybuilding program won’t suffice for maximizing your performance and keeping you healthy. Find someone who knows the body and knows baseball, then begin making an individualized strength and conditioning program part of your routine.

 

College Building Blocks

Master Time Management

If you’ve made it to the collegiate level you’ve shown that your skills are above and beyond those possessed by the majority of your peers.

Your lack of skills or physicality often isn’t what breaks you at this level; it’s the pressures of having to manage multiple aspects of your life that will hurt your performance.

In high school, you go to school from 8-2, practice and play, go home and eat mom’s cooking, and repeat. You now have to go to multiple classes, study, cook, do your laundry, pay for things yourself, and, on top of that, practice and play.

If you want to be successful at this level and prolong your career, you must develop good organizational skills, learn to make lists, and manage your time.

Become a Creature of Habit

Each ensuing year after high school will become more stressful. You’ll have more responsibilities and the pressure to perform well will continuously increase as you get closer to competing at the next level.

Creating routines and good habits are critical to help minimize stress and set yourself up for success. Creating routines for how you go about your studies, practice, nutrition, training, and mental preparation will allow you to block out unnecessary stress and keep you focused on reaching your goals on the field.

 

Professional Building Blocks

Learn to Love Recovery

By the time you’ve reached the professional level your body will have accumulated a lot of games played or innings thrown–and you’ll want to have many more in your future.

With that said, prioritizing recovery will greatly enhance your chance at having a successful career.

Fitting so many games into such few months means you must learn what your body needs to help your muscles and nervous system recover to the best of their ability every day. Below is a list of common recovery modalities that can be of great help while enduring long seasons:

  • Manual Therapy
  • Mobility Training
  • Improving Quality/Quantity of Sleep
  • Meeting with a Registered Dietician/Nutritionist
  • Limit Alcohol Consumption
  • Self-Myofascial Release
  • Active Recovery Training
  • Cryotherapy
  • Contrast Therapy
  • Sauna
  • Meditation

 

In Summary

Appreciate that being able to have longevity in any sport is a gift – but a gift you can exercise control over.

Respect your body as much as you respect the game and you’ll find you won’t have to prematurely walk away from doing what you love.

If you’re a parent reading this, how can you set your kid(s) up for success? If you’re a coach, how can you get the most out of your high school athletes? And if you’re a college or professional player, how badly do you want to get to the next level and how much are you willing to sacrifice to get there?

Put the right building blocks in place and the game will be good to you.

 

 

10 Recommendations to Reduce Youth Throwing Injuries

For anyone who is interested in youth baseball or softball, I urge you to pay attention to some of the data regarding youth throwing injuries.  Some of the numbers are staggering. I would like to make this entire post HIGHLY based in the available research and evidence – not my opinions.

I am basically summarizing what has been researched and published in this post. Of course, I will elaborate on a few things along the way, but I will mostly let the data speak for itself.
Let’s start with a little background:

  • Baseball/softball remains one of the safest overall sports to play
  • Nevertheless, traumatic and overuse injuries occur regularly
  • More and more young boys and girls are playing baseball/softball every year
  • Despite pitch count rules, the incidence of youth injuries and surgeries is rising
  • Adult throwing injuries are being attributed to injuries suffered as youths

 

The Rise of Youth Baseball Injuries

There is no denying the youth baseball injuries are rising. Below, I have summarized several research publications.  During the 5 years from 1994-1999 compared the 5 years from 2000-2004:

  • 4x increase in elbow surgeries in college baseball pitchers
  • 6x increase in elbow surgeries in high school baseball pitchers
  • 5x increase for injury with pitching >8 months/year
  • 4x increase for injury with pitching >80 pitches/game
  • 2.5x increase for injury with throwing >85 MPH
  • 36x increase for injury when throwing with arm fatigue
  • Injured pitchers threw 34 warm-up pitches vs. 26 warm-up pitches of un-injured pitchers
  • Injured pitchers threw in 4 showcases vs. 1 showcase of un-injured
  • Injured pitchers were 4cm taller and 5kg heavier

In 2006, 450 players (ages 7-11) without elbow pain pre-season:

  • 30.5% reported elbow pain by end of season…of those, 72.3% had physical exam deficits…of those, 81.4% had radiographic abnormalities. This basically means kids with elbow pain actually had pathology, not just soreness!
  • “Little League Elbow” – epicondylitis, apophysitis, physeal plate (growth plate) fracture, osteochondritis dissecans occurs in 20-40% of school aged pitchers

A 10-year study (from 1999-2008) 481 pitchers (ages 9-14) with an elbow injury defined as surgery or retirement due to pain:

  • Pitching >100 innings/year = 3.5x more likely to be injured
  • Playing pitcher and catcher – 2.5x more likely to be injured

A 2015 study on 420 healthy pitchers:

  • 31% had a pitching-related injury (shoulder and elbow)…of those, 3 variables could predict injury 77% of the time
  • Pitcher height
  • Pitching velocity
  • Pitching for more than one team

A 10-year study from 2002-2011 in New York State:

  • There was a significant increase in the number of UCL reconstructions by 193%
  • Becoming more common in adolescent athletes
  • The average age at surgery going down = more kids are having Tommy John surgery at an earlier age

Dr. James Andrews – arguably the most prolific orthopedic surgeon of this era – has presented numerous times throughout his career about his concerns regarding youth injuries and increasing awareness…here is a graph showing the percentage of Tommy John’s surgeries he completes each year on youth (compared to collegiate and professional athletes):

Recommendations – Pitch Count & Playing Time

Through the combined efforts of many people, including Dr. James Andrews and Dr. Glenn Fleisig of ASMI, organizations like Little League Baseball and USA Baseball have adopted rules to help reduce overuse.

Our understanding the stresses placed on the arm, especially while pitching, has led to the institution of rules controlling the quantity of pitches thrown in youth baseball and established rest periods between pitching assignments.

Little League Baseball & USA Baseball have implemented the following pitch count recommendations:

  • 9-10 years of age: 1000/season, 2000/year
  • 11-12 years of age: 1000/season, 3000/year
  • 13-14 years of age: 1000/season, 3000/year
  • Pitcher-to-catcher ban: any pitcher who throws >41 pitches may not play catcher that day

Recommendations – Throwing Guidelines

In addition to the above pitch count rules, several other guidelines can be implemented based on what we have learned through scientific research:

  • Avoid pitching with arm fatigue!
  • Avoid pitching with arm pain
  • Pitch less than 80 pitches/game at ALL adolescent levels
  • Pitch less than 8months out of the year
  • Pitch less than 100 innings in games in any calendar year.
  • Pitch less than 2000-3000 pitches in competition/year (pending age)

The Ongoing Problem

Travel ball does not fall under the umbrella of Little League and USA Baseball and is often under the sole direction of the team and coach. This had led to continued overuse despite the best efforts of the medical community.

A recent national survey of 750 pitchers (ages 9-18) shows:

  • 45% of youth pitchers pitched without a pitch count
  • 43.5% pitched on consecutive days
  • 30.7% pitched on multiple teams
  • 19.0% pitched multiple games in one day
  • 13.2% pitched year-round
  • ~1/3 having a pitching-related injury in the past 12 months,
  • 7/10 reported significant arm tiredness in the past 12 months
  • Nearly 40 percent reported significant arm pain within the past 12 months.
    • Arm Tiredness = 7.8x more likely to have an injury

 

The Impact of Long Toss and Pitch Type

In addition to simple overuse in throwing volume, there are other factors to consider such as long toss and pitch type.

What About Long Toss?

  • 2011 Study = Hard, flat-ground throws have biomechanical patterns similar to pitching; however, maximum distance throws produce increased torque & changes kinematics. Therefore, use caution with use of these longer throws in rehab & training

What about flat ground vs. mound pitching?

  • 2013 Study = “There is NO difference in kinematics or kinetics in pitching from a mound versus flat-ground conditions in adolescent baseball pitchers.”

What about curveballs, sliders, fastballs & change ups?

  • In multiple studies (2002, 2006, 2008, 2011) = conflicting information…
  • Most indicate fastballs have a greater overall torque on the shoulder and elbow than any other pitch
  • However, what has been shown in some studies curveballs elicit more force through the shoulder whereas the slider places greater forces through the elbow
  • The changeup is consistently shown in virtually all research to have the least amount of forces (shoulder AND elbow)
  • None of the players in several studies threw anything but fastballs or changeups, so the information is lacking

How to Prevent Youth Throwing Injuries

There is overwhelming evidence that volume and overuse are single-handedly a major contributing factor to injuries in youth baseball. This is hard to deny. Throwing with pain and/or fatigue is the fastest way to be injured. You must listen to your body. Injuries are not always seen “in season” but the cumulative effects can negatively affect the long-term health of a pitcher. Pitch type is not as big of a concern; however, most youth do not have the appropriate control, body awareness/motor control and mechanics to throw efficiently and effectively, therefore breaking pitches are underemphasized early in youth pitching.

10 Recommendations to Reduce Youth Throwing Injuries

  1. Watch and respond to signs of fatigue:
    • Decreased ball velocity, decreased accuracy, upright trunk during pitching, dropped elbow during pitching, or increased time between pitches). If a youth pitcher complains of fatigue or looks fatigued, rest is recommended
  2. No overhead throwing of any kind for at least 2-3 months per year. No competitive baseball pitching for at least 4 months per year
  3. Follow limits for pitch counts and days rest
  4. Avoid pitching on multiple teams with overlapping seasons
  5. Learn good throwing mechanics as soon as possible. The first steps should be (1) basic throwing, (2) fastball pitching, (3) changeup pitching…breaking pitches are not fundamental and youth players need foundation first
  6. A pitcher should not also be a catcher for his team. The pitcher-catcher combination results in many throws and may increase the risk of injury
  7. If a pitcher complains of pain in his elbow or shoulder, discontinue pitching until evaluated by a sports medicine physician
  8. Avoid using radar guns and emphasizing velocity with youth throwers
  9. Minimize showcases, especially in the “off” season
  10. Inspire youth pitchers to have fun playing baseball and other sports. Participation and enjoyment of various physical activities will increase the youth’s athleticism and interest in sports

 

Closing Thoughts

I threw a lot of information at you. But you can use this as a resource in the future. I want everyone to understand NONE of these are rules…just guidelines/suggestions.

But I am not talking about my opinion or something I saw or heard or know a guy who said something I thought made sense. It is research. Actual evidence. Measurable data.

I am not here to start a debate or judge anyone for anything. I am simply packaging the best information I could gather and put it all in one place.

My final thought is this: I love baseball. I want you and your children to play baseball or softball. Let your kids be a part of arguably the greatest sport on the planet – a sport that has some of the best teaching lessons and analogies for life. Work hard to get better and be better. Strive for improvements. Just watch volume and be smart about things. Have a great season!

 

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References:

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  2. American Sports Medicine Institute. Position statement for youth baseball pitchers. http://www.asmi.org/asmiweb/position_statement.htm Accessed March 10, 2016.
  3. Cain EL Jr, Andrews JR, Dugas JR, et al. Outcome of ulnar collateral ligament reconstruction of the elbow in 1281 athletes: results in 743 athletes with minimum 2-year follow-up. Am J Sports Med. 2010;38:2426-2434.
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