Sports Medicine Research: In the Lab & In the Field: Predicting Elbow Injuries in Youth Baseball with a Preseason Checklist (Sports Med Res)
Wednesday, April 1, 2015

Predicting Elbow Injuries in Youth Baseball with a Preseason Checklist

A Preseason Checklist for Predicting Elbow Injury in Little League Baseball Players

Yukutake T, Kuwata M, Yamada M, Aoyama T. The Orthopaedic Journal of Sports Medicine 3.1 (2015): 1-7 doi: 10.1177/2325967114566788
  
Take Home Message: Using a preseason checklist with Little League Baseball Players may help to determine which young athletes are at risk of developing elbow injuries.

Little league elbow, epicondylitis, and osteochondrosis dissecans are just a few conditions that affect many young baseball players in the early years of their careers. These conditions occur due to a number of different circumstances including; overuse, improper pitching mechanics, repetitive microtraumas to the elbow, etc. Identifying risk factors that contribute to injury would allow us to educate parents and coaches to assist in preventative efforts. Therefore, the purpose of this prospective cohort study was to use a risk-evaluation checklist to predict injuries over the course of a season among young baseball players. The authors sent preseason checklists to 134 Little League baseball teams in Japan and 955 Little League baseball players completed the preseason checklist. The athletes with their parents filled out a 20-question checklist pertaining to the athlete’s pitching arm, baseball practices, mechanics, structure/flexibility of the elbow, pain, previous injuries, among others. The athletes also sent back a follow-up survey six months after they completed the preseason checklist. In the follow-up survey, the athlete and parents recorded if the athlete sustained an injury during the season. An elbow injury was an injury to the dominant arm that required medical treatment. Overall, 389 athletes (age ~10 years) completed the checklist and follow-up survey and had no existing elbow injuries during preseason. Fifty-three athletes reported sustaining an elbow injury during the season. The authors found that athletes were more likely to sustain an elbow injury during the season if they reported during preseason that they 1) experienced pain within the past 12 months, 2) had a previous injury that required treatment, 3) practiced more than 4 days/week, 4) practiced individually 7 days/week, 5) normally participate in games, or 6) felt fatigue while playing. From these results the authors created a 6-item checklist to assess the risk of elbow injuries, which may be used by youth baseball parents and coaches. Players who answered yes to three or more of these items had a higher injury rate (33%) than those who only answered yes to two or less items (6%).

This study adds to the growing literature which demonstrates excessive throwing contributes to elbow injuries. It is extremely important coaches and athletes adhere to limiting the number of pitchers to help prevent elbow injuries in young athletes due to the forces put on an athlete’s arm and fatigue caused by throwing if not properly managed. This checklist can be used by athletic trainers and other sports medicine clinicians working with young baseball players to determine if an athlete is prone to an elbow injury during the season. It is also a simple enough tool that it can be used by coaching staffs, parents, and others involved with youth athletics before the season starts to assist in prevention. It will be helpful to see if this checklist works well in other populations; such as, older baseball players and players from other countries. Creating pitching limits and developing maintenance programs to prevent fatigue and stress from throwing is pivotal in sustaining health among youth baseball athletes.

Questions for Discussion: Do you see this checklist as a helpful form to detect possible elbow injuries for those who are not health care professionals? What other methods have helped you determine whether or not a young athlete is more at risk for elbow injury?

Written by: Bailey Shiller and Adam Rosen
Reviewed by: Jeffrey Driban

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Yukutake, T., Kuwata, M., Yamada, M., & Aoyama, T. (2015). A Preseason Checklist for Predicting Elbow Injury in Little League Baseball Players Orthopaedic Journal of Sports Medicine, 3 (1) DOI: 10.1177/2325967114566788

8 comments:

15145931 said...

Yes the checklist seems like a simplest method to detect possible elbow injuries.Bones of a young athlet are very weak this means they are in great risk of having elbow injury

Adam Rosen said...

Thank you for the comment. While this checklist is certainly useful, I think incorporating it effectively into clinical practice is the more difficult aspect. If you have athletes who report “yes” to 3 or more questions, what is the next step? Do you remove them from play? Allow them to play and monitor them closely? Perform some sort of prehabilitation and attempt to prevent the injury? I realize at this point there is no correct answer but I think this would be the logical next step in this line of research.

Alexander Dailey, ATC said...

The checklist seems to be a beneficial tool, especially in little league baseball players. A good history and evaluation can help determine a good course of action. However, the checklist should not be the only tool to consider.
Another consideration should include a prevention program that incorporates shoulder range of motion evaluation and maintenance, integrate movement patterns, posture (especially transverse abdominis and pelvic floor activation), scapular stability, rotator cuff strengthening, and stability at end range. This may seem comprehensive, but prevention (especially of elbow injuries) must start at the core and scapular stabilizers. In addition, faulty movement patterns (which can be assessed through watching film and utilizing a screen such as the FMS or SFMA) should be considered to help guide a prevention program.
As a whole, the importance of a prevention program that is specific to the demands of the little league player must be emphasized. Prevention can also take place with rest outside of the competitive season, as the accumulation of stresses on younger athletes could predispose them to overuse injuries (another reason why the checklist can be beneficial).

Adam Rosen said...

Alexander, thanks for responding and contributing to the conversation. Absolutely, this should not be the only tool clinicians use to assess risk of injury in this population. Many of the items you have mentioned have been studied recently, and evidence suggests shoulder range of motion, (Garrison, 2012) scapular dyskinesis (Kibler, 2013), and scapular malpositioning (Myers, 2005) contributes to shoulder and elbow injuries. Movement patterns may be eventually be demonstrated to play a role but I’m not familiar with any current research on the relationship between functional movement patterns (FMS) and elbow/shoulder injuries in baseball players specifically. I think the underlying alterations in ROM and scapular movement/malposition would likely contribute to these movement pattern alterations anyway, and may be the underlying cause of those dynamic changes. The great thing is ROM and scapular measurements don’t require additional certifications or clinical tools outside of those already found in the athletic training room. Prevention program are the next logical step in the literature, however they should be tailored to the individual regarding the alterations observed on the screening.

Kaitlyn Grossman ATC said...

I think this is a really interesting article! This topic fascinates me. I love to see what health care professionals are doing to work on prevention of injuries. This is a really important issue, especially in a young population. This topic especially needs to be addressed as there are so many elbow injuries in baseball players who specialize early.

Playing devils advocate, I think there should be some objective assessment to go along with this questionnaire. I think if this was implemented, parents and athletes would lie, as they do on SCAT symptom checklists just to play. I think it is important to assure their answers match their objective assessment. Although, I understand an objective assessment is not possible in all settings, like in little league.

Really interesting topic! I am passionate about efforts in preventative care!

Adam Rosen said...

Kaitlyn, welcome to the conversation! It was definitely an interesting article and we are happy to not be the only ones passionate about preventative care. We hope parents wouldn’t lie about their little leaguers (10 year olds) health, however you never know with self-report questionnaires. I absolutely agree other objective measures are important as well, some of which are mentioned above. This is a tough population to wrangle in order to get those measures. I think the easiest way would be some sort of league-wide preseason screening which I haven’t heard of yet, but I wouldn’t be surprised to see this done in the future. Do you have any additional thoughts on ways to assess these youth athletes, who likely don’t have a fulltime health care provider regularly working worth them?

Jennifer Joseph said...

I believe having a checklist is a great tool for clinicians to be aware of high risk athletes. At the youth level, I feel it may be hard for the young athletes to truly differentiate between pain and general soreness. With surveys, us as clinicians really have to trust patient reporting. Would any items on the check list "if checked" be more of a red-flag than others on the check list? Also what recommendations would you have prevention wise depending upon what symptoms were checked "yes" on the check list? Again, at the youth level, patient compliance with a strengthening program may be difficult, as well as an athlete who plays multiple sports. Great topic for discussion.
- Jennifer Joseph.

Adam Rosen said...

Jennifer, you bring up some insightful comments which are appreciated. According to the results the two questions which had the highest odds ratios according to the statistical analysis were "Are you a regular player" and "had a previous injury that required treatment". At the youth level these questions make sense, those who excel at the youth level typically play the most and more frequently on multiple teams. Also as with most injuries, previous history is often a predictor of future injury. As for the second part regarding youth athlete compliance, it's all about parental education. As health care providers we have the obligation to inform and educate when possible and the parents are going to hopefully be allies in that regard. Thanks for contributing to the conversation!

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