Reducing Arm-Trouble Risk for Young Pitchers Using Pre-Season Prevention

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Teenage pitchers, during their early development and rise though the baseball ranks, have constantly had to be concerned about balancing their growth as a player against the inherent physical risks associated with the unnatural act of throwing a baseball.

For growing pitchers, both the sheer force required to throw a fastball, as well as the considerable torque needed to snap off an effective curveball, have been shown to be hazardous to the shoulder and elbow, respectively. As such, limitations, such as pitch counts, have been added over the years to help protect young arms from overuse. Yet despite these changes, serious injuries with life-long implications have continued to mount.

But there's encouraging news in the field of injury prevention. Recently, the American Orthopaedic Society for Sports Medicine released a study concluding that "preseason prevention programs are beneficial to young baseball pitchers."

In that it is the first study to look at a "well-monitored preseason training program," the AOSSM found that young pitchers who took part in such programs saw improved strength and arm flexibility, while reducing the chance of having a subsequent injury.

"Pitchers participating in this targeted prevention program demonstrated reduced internal rotation and horizontal adduction deficits," said the study's corresponding author Dr. Charles A. Thigpen, from ATI Physical Therapy in Greenville, SC. Horizontal adduction pertains to extending one's arm out to the side, and then rotating it 90 degrees until pointing directly forward.

As part of the program, an athletic trainer oversaw young pitchers -- 15-to-16 years old, according to the study -- as they lifted dumbbell weights, trained with elastic tubing and took part in "focused flexibility program[s]."

The study found that, in exchange for an hour of the pitchers' participation each week, pitchers with past injuries cut their risk of another injury by 75 percent, as compared to pitchers in general, non-specific arm-care programs.

Several previous studies show that common baseball overuse injuries have become a serious concern in the United States. A 10-year prospective study issued in 2011 by the American Sports Medicine Institute (ASMI) found that youth pitchers had a 5 percent chance of sustaining a serious throwing injury, involving the elbow or shoulder. While on its face that sounds low, the idea that a non-contact, sports activity can lead to serious injury is alarming in itself.

Also, a 2014 study published in the journal Radiology found that young pitchers throwing over a hundred pitches a week are susceptible to the overuse injury of acromial apophysiolysis. This condition could significantly deter natural shoulder development and cause rotator cuff tears later in life.

"Pitching places incredible stress on the shoulder. It's important to keep training in the moderate range and not to overdo it," said Dr. Johanes B. Roedl, radiologist. "More and more kids are entering sports earlier in life and are overtraining."

So there's general consensus that overthrowing plays a significant role in young pitcher sustaining injuries. The ASMI suggests that youth pitchers between the ages of 15 and 18 limit themselves to two games a week, and 50 pitches a game.

But as U.S. youth baseball participation declines, the pressure grows for those who do play to increasingly play year-round, and for multiple teams. So studies such as this one may point out the alternative solution: consistent participation in, and commitment to, injury-prevention programs.

"If we can encourage parents, coaches, and youth baseball organizations across the country to adopt similar programs, athletes may have a better chance for reducing time off the field because of injury," says Dr. Thigpen, "especially considering the increased effectiveness of the program in preventing subsequent arm injuries."