Arm Pain in Youth Baseball Players: A
Survey of Healthy Players

EC, Morrow ZS, Luchetti TJ, Mishra-Kalyani PS, Gualtieri AP, Lee RW, Ahmad CS. Am
J Sports Med. 2014 Nov 3. doi: 10.1177/0363546514555506. [Epub ahead of print]

Home Message: Healthy youth baseball players, despite actively competing in a
summer league, reported arm pain and fatigue that resulted in a decline of
enjoyment in the game and feeling encouraged to continue playing despite
experiencing pain.

The prevalence of overuse
injury in youth sports has increased in recent years, particularly in baseball.
Pitch counts, pitch type, and throwing mechanics have been implicated as
potential sources of injury in baseball and have, therefore, been the focus of
prevention strategies. Despite these efforts, overuse injuries persist in this
population, which suggests we need new approaches to identify at-risk athletes.
The authors of this study surveyed healthy youth baseball players about the
presence of arm pain, nature of the pain, its frequency, and its impact on playing
and performance. They hypothesized that a large number of actively competing
youth baseball players would report experiencing arm pain during activity. The
survey instrument was divided into two portions: a demographic information section,
which included questions related to the participant (age, injury history,
playing history), and a second section with 14 questions related to the
presence of pain in the participant’s throwing arm. Participants responded to
these questions based on a 5-point scale of “never”, “rarely”, “sometimes”,
“often”, and “always”. The authors administered the survey to 218 youth players
(average age: 15 years) participating in a summer baseball league. Of the 218
administered, 15 surveys were excluded in their data analysis. Surveys were excluded
if the participant completed it in the presence of a parent or coach, so as not
to influence the validity of responses. Within these responses, 89% noted they
were currently playing pain free but 23% reported a previous overuse injury.
When asked if their arm hurt while throwing, 74% responded with “rarely” and
“sometimes”. Concerning pain present the day after throwing, 80% reported
experiencing pain (37% “rarely”, 31% “sometimes” 11% “often”, 1% “always”). A
majority (71%) of participants did not feel that arm pain was a limiting factor
in the number of teams/leagues that they could participate in. Additionally,
the authors included questions related to the psychosocial effects of
experiencing arm pain while throwing. Many participants (55%) reported that arm
pain made their playing experience less enjoyable and almost half (46%)
responded that they were encouraged to continue to throw despite pain. Finally,
pitchers reported pain more frequently than position players, including
experiencing pain the day after throwing.

Seventy-four percent of
respondents indicated that during throwing their arm hurt “rarely” or
“sometimes”, yet a large majority (89%) indicated they were participating
pain-free. This discrepancy is concerning in that players continue activity
even in the presence of pain. Player, coach, and parent education may be
beneficial to capture early warning signs in asymptomatic athletes and then to intervene
with rest, preventative exercise, or a review of their throwing mechanics.  The finding that pitchers were more likely to
report pain with throwing may seem alarming at first, however, those athletes
(and their coaches and parents) may be more sensitive given media attention on
injuries in professional pitchers. It is imperative for clinicians to be
cognizant of “baseline” pain that an overhead athlete may experience despite
not manifesting a recordable injury. Gathering this type of information at the
pre-participation physical would serve to aid in prevention strategies for both
healthy athletes and athletes with a history of upper extremity injury.
Additionally, continued conversation with all athletes regarding arm pain, not
just those with an injury, over the course of a season may aid in identifying
athletes at risk.

Questions for Discussion: Do you screen overhead
athletes for pain on a regular basis? If so, how do you use this information to
aid your treatment?

By:  Laura McDonald
by: Jeffrey Driban

Makhni, E., Morrow, Z., Luchetti, T., Mishra-Kalyani, P., Gualtieri, A., Lee, R., & Ahmad, C. (2014). Arm Pain in Youth Baseball Players: A Survey of Healthy Players The American Journal of Sports Medicine DOI: 10.1177/0363546514555506