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Overuse in Throwers

As young athletes stray from playing multiple sports to focus on a singular sport, there has been a noticeable increase in overuse injuries. Regardless of pitch counts, inning limits, or other variables that can be manipulated, injuries are an unfortunate certainty in sports. Unlike death and taxes, not every athlete is going to wind up needing a UCL reconstruction or their rotator cuff repaired. Nonetheless, the volume of throwing athletes that are seeing an orthopedist is undeniably on the rise.

After reading research/blogs/twitter feeds/etc., there are a couple things that come to mind:

1) Parents say that they are implementing a pitch limit but their kid may play in multiple leagues. I’m curious as to if the parents are using one pitch limit for the leagues collectively or if they are using individual limits for each league. For example: Little Johnny plays for 3 teams and the hypothetical pitch limit is 90 pitches. Is Johnny throwing 90 pitches per team, essentially throwing 280 pitches, or is he throwing 30 per team, reaching his 90 pitch limit? A parent who thinks Little Johnny is the next Nolan Ryan/Roger Clemens reincarnation may be the former. However, the real talent may be harnessed in the latter player. Regardless of the situation, how do we actually know which player is observing a “correct” pitch count?

2) Within limits is there a limit of breaking-ball, off-speed, fastballs thrown? For younger athletes who claim to know how to throw a breaking-ball they may tend to use it more frequently. I read an article (or tweet, I can’t remember which) where a former MLB player astutely pointed out that pitchers are “pitching backwards”. For the non-baseball-buffs out there, pitching backwards means they are starting the at-bat by throwing breaking/off-speed pitches before they go to a fastball. Thus, increasing the number of pitches that increase the valgus forces and torques pitchers apply to their elbows in any given inning. An elite and effective pitcher wants to get out of an inning in 12-15 pitches, yet we are seeing pitch counts for pros exceed 100+ pitches. High school and youth athletes are approaching the same pitch limits as professionals with mechanics that are not as fine-tuned and musculoskeletal systems that pale in comparison to those of the athletes we see on TV.

As athletic trainers we can only do so much as to protect our athletes/patients from injuring themselves. We are armed with the knowledge from research and information from leading doctors that steer us in the direction that says that overuse injuries can be avoided; the athletes and a lot of the times even parents refuse to acknowledge this information even exists. There comes an unfortunate point in time where our hands become tied and they need to start listening. That time may come when their 14-year-old reincarnated Ryan/Clemens needs Tommy John surgery because they decided to pitch 10 out of the 12 months of the year. All while still pitching in the 2 “off-season” months.

Comments

  • Great post! As a former baseball Athletic Trainer there definitely needs to be a reform on how to monitor the number of pitches at the youth level collectively across leagues. Most kids who play in multiple leagues wind up pitching the 90 pitches for multiple teams, playing another position with no rest, and not having a true off season for recovery. This is where educating parents is critical because ultimately they are the ones who are making the decisions on how much they participate.
    One thing I'd definitely like to add to this is for the extremely neglected softball pitcher. There is no pitch count, there is no starting pitcher rotation, there are hardly ever any relievers if any at all, there is no record keeping in the dugout of types of pitch and velocity, and these pitchers never follow a shoulder maintenance program. Most programs have 1 or 2 starting pitchers vs. the baseball rotation of 4 or 5 starters with several relievers. There is also very little research out there being done to study softball pitchers. There needs to be just as much intervention for these athletes as baseball players.
    Audric Warren MS, ATC, CAFS, NASM-PES, NASM-CES
  • Audric - awesome point about the softball pitchers. They definitely are neglected in comparison to their baseball counterparts. I think it is safe to assume that most practitioners are guilty of it and use the excuse it being a more natural throwing motion compared to that of a baseball overhead throwing motion.

    You also bring up a great point of there being a limited number of pitchers on a softball pitching staff. There may only be one or two, but the number one is becoming the work-horse and will pitch a majority of the innings. If there are 100 innings in a softball season, the number one will pitch 80 while the second pitcher will throw the remaining 20. There is no comparison. Another component that is not taken into consideration is the warm-up throws and any bull-pens/pitching lessons that take place between games. There may come a time when softball pitchers are taking care of themselves just as much as baseball players, hopefully that day is sooner rather than later.
  • Frank- yeah softball has some catching up to do. Your absolutely right about the bullpen sessions between games that are lacking. The research hasn't been done yet to appreciate the ramifications of overuse on the sports medicine side and the effects of proper functional training on the sports performance side.
    You bring up a point about softball that most people take for granted in the belief that it is a more "natural motion". Realistically the only portion that is truly naturally would be the follow through. However because the arm can rotate up to 5,000 degrees per second during wind up, the high amounts of stress on the suprispantus and infraspinatus during wind up, and the high volumes of extreme shoulder flexion and abduction the softball pitcher is just as susceptible to injury as the baseball pitcher.
    Audric Warren MS, ATC, CAFS, NASM-PES, NASM-CES
  • Great points here guys.

    I truly believe that the specialization of athletes at a young age is a detriment. I also believe that the focus becomes so much the sport the rest of their kinetic chain is ignored. Add in the excessive volumes and you have a recipe for disaster. Unfortunately I do not see a change in volume or duration in the future so I think there needs to be a push for better screening and preparation tools for the athletes at all ages. Tools that are accessible to the parent and or baseball/softball coach too, as the likelihood of AT presence at all levels may be low.
    Anna J. Hartman MS, ATC, CSCS, PMA-CPT
    www.movementrev.com
  • Anna great points! AT access at the lower levels (other than possibly football) is extremely unlikely; thus limiting the screening and preparation afforded to the athlete. Credible personal trainers may be a great resource for these athletes to rely on but the credibility part is few and far between and, like anything else, comes with a price. How do we as ATs reach these young athletes as a catalyst for the increased screenings before it is too late?

    I am all for doing a "community service" and sitting down with little leagues pro-bono; however, at some point our services/level of education/knowledge recognition and demand monetary compensation or ATs will continually be trampled on by the lay public.
  • To make it simple enough for coaches who may not have a sports science background is key. Something like the coaching education in football http://medicalxpress.com/news/2015-07-strong-football-injuries.html or the prevention programs in soccer http://f-marc.com/11plus/11plus/ .

    Even encouraging parents/coaches to implement the FIFA 11+ would likely help though designed for soccer, its emphasis on core control and single leg balance would greatly decrease the risk of UCL tears at any level of play.
    Anna J. Hartman MS, ATC, CSCS, PMA-CPT
    www.movementrev.com
  • Frank/Anna

    You both make very valid points in trying to reach the youth sports. A simple and time feasible idea I've seen that gets the lay person or coach understanding, the Athletic Trainer involved in the community, and the parent and athlete all in the same room is a bi-weekly or monthly talk at a local clinic or school about injury prevention educating everyone about overuse, it's ramifications, how to prevent them, and I've even seen some people offer screenings at the end of these talks. Although you may not get every member of a team involved you'll still reach quite a few.
    Audric Warren MS, ATC, CAFS, NASM-PES, NASM-CES
  • Hi, every one . The topic is very important for our youth playing sports out there. Yes, there are many little teams implementing pitch count and other tools to avoid over use injuries. The real issue here is that teams are playing a weekend tournament of 5-6 games without including the finals with only 12 kids per teams. It is ridicules to think that they will go through all those games with only 12 kids. If a kid pitch one game he has to play another position the next game or even the same game. Some of them start one game throw 5 innings and come in as a reliever the next game 3 hours later. This issue has to be addressed as a group, parents- coaches. Teams need to have at least 16 kids to decrease the load of work on them, and God safe a kid if he has a good arm. I know it's difficult for Parents to make the effort to pay fees and to take their kids to different cities and spend all day in a baseball park to see them playing only few innings, but for thier own safety a kid who throws 4-5 innings no matter what pitches he did throw "fastball or curveballs", he needs to sit out for the day, no go and be a catcher the rest of the game. Also coachs/teams or even leagues have to implement a injury prevention program, arm strengthening program, conditioning program, a program where kids learn how to take care of thier own body, or to have the knowlegeds of the needs of thier muscles after playing so many games in a weekend, but this will be in a perfect world. Also to have a AT in a kids tournaments cost money and some of the coaches and parents think it's unnecessary.
  • I know that we have touched on pitchers in both softball and baseball has anyone heard of a protocol/continuum that is used for catchers to limit the amount of throws they have? I only ask as they throw just as much as the pitcher, not at the same velocity, but still quantity matters. Just wondering if anyone else has an opinion on that.
    Audric Warren MS, ATC, CAFS, NASM-PES, NASM-CES
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