Sports Medicine Research: In the Lab & In the Field: Pitching: We Can Have too Much of a Good Thing (Sports Med Res)
Monday, July 14, 2014

Pitching: We Can Have too Much of a Good Thing

Risk-Prone Pitching Activities and Injuries in Youth Baseball: Findings From a National Sample

Jingzhen Yang, Barton J. Mann, Joseph H. Guettler, Jeffrey R. Dugas, James J. Irrgang, Glenn S. Fleisig and John P. Albright. Am J Sports Med 2014 42:1456.

Take Home Message:  Young pitchers who engage in “risk-prone” pitching activities are more likely to report arm tiredness and pain, which is related to shoulder and elbow injuries.

Millions of children play youth baseball each year and many players adopt early sport specialization, which means they are playing long competitive seasons, training year round, and play in multiple leagues. Unfortunately, many young baseball players suffer elbow and shoulder injuries. To optimize pitching recommendations and prevention programs it is important for us to understand the pitching activities of youth players and how these activities relate to injuries.  Therefore, Yang and colleagues surveyed youth pitchers (9 to 18 years of age) to describe 1) “risk-prone” baseball-related activities that do not meet the American Sports Medicine Institute (ASMI) recommendations, 2) age differences in reported pitching-related arm problems and injuries, 3) the relationship between “risk-prone” activities and pitching-related arm problems, and 4) how reported arm problems relate to pitching-related injuries. In this study, 754 young male baseball pitchers (along with their parents in some cases) completed questionnaires provided by their physicians that encompassed multiple pitching facets including: pitching frequency, pitching volume, pitch type thrown, rest and recovery, shoulder/elbow problems, treatments, and preventative/protective care.  The authors identified pitching-related arm pain as experiencing arm pain while pitching at any point during the previous 12 months.  The majority of pitchers (69%) reported experiencing arm tiredness while pitching, 38% experienced pain within the past 12 months while pitching, and 31% reported having a pitching-related elbow or shoulder injury in the prior year. The authors identified the following 7 “risk-prone” activities: 1) > 8 months of competitive pitching (13% of pitchers), 2) participating in leagues with no pitch count or innings pitched limits (44% of pitchers), 3) pitching on multiple teams with season overlap (30% of pitchers), 4) pitching on back-to-back days (44% of pitchers), 5) pitching in more than 1 game/day (19% of pitchers), 6) playing catcher when not pitching (10% of pitchers), and 7) playing baseball 12 months/year at the exclusion of other sports (31% of pitchers).  Pitchers who pitched on back-to-back days were more than 4 times as likely to experience arm tiredness and more than 2.5 times as likely to experience pain while throwing.  The pitchers who played and pitched on multiple teams during the same season were also more than 3 times as likely to experience arm tiredness and had 85% greater odds to experience pitching-related arm pain.  Pitchers who threw curve balls were 66% more likely to experience arm pain than pitchers who did not throw curveballs; however, the authors found no relationship between arm pain and throwing sliders or sinkers. When compared to pitchers that never experience arm tiredness or pain, pitchers who often pitched with arm tiredness or arm pain were almost 7.5 to 8 times more likely to report a recent shoulder or elbow injury. 

While the findings in this study might seem relatively straightforward because arm fatigue, pain, and injury seem to go together, the simple fact is that more studies like this are going to be warranted in the future.  It is important to note that this study was a survey that captured activities, injuries, and symptoms over the past year. Therefore, we are unable to verify that fatigue and pain caused the injuries or if the injuries led to pitching with fatigue and pain. This study is an important advancement in our knowledge because most previous studies have relied upon biomechanical analysis. Having a handle on a child's pitching volume is going to be crucial to understanding injury patterns and prevention.  It is beneficial for us to have this data regarding risky baseball activities because it can help us educate our players and coaches as well as help us develop injury prevention programs.  Furthermore, it appears that there is a lot of work that will need to be done in terms of educating parents about the pitfalls and perils of early sport specialization, and that taking a long-term approach to athletic development is not only the best route for athletic prowess, but, more importantly, a better approach for the child's physical health. 

Questions for Discussion: Were you surprised by any of the findings in this study?  Are you surprised at the number of athletes participating in the “risk-prone” activities, if so which ones?  Do you believe the odds simply confirm what many clinicians have known anecdotally all along?  What advice do you give your young throwers and their parents about keeping their arm healthy throughout the year?

Written By: Mark Rice
Reviewed By: Jeffrey Driban

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Yang, J., Mann, B., Guettler, J., Dugas, J., Irrgang, J., Fleisig, G., & Albright, J. (2014). Risk-Prone Pitching Activities and Injuries in Youth Baseball: Findings From a National Sample The American Journal of Sports Medicine, 42 (6), 1456-1463 DOI: 10.1177/0363546514524699

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