All baseball pitchers are at risk for elbow injuries, but younger pitchers have even more risk for ‘little league elbow’ for a variety of reasons.
For pre-teen and teenaged pitchers there are many influences on this area that have to do with throwing technique, type of pitch, and volume of throwing (pitch count). But the greatest factor to be understood by coaches, parents and players is the physical maturity of muscles, ligaments and, especially, bones in young pitchers.
Moving from the cocking phase into forward acceleration of the ball, the forces on the medial (funny bone) side of the elbow of up to five per cent of the player’s body weight have been recorded during the overhead baseball pitch. Shoulder extension velocity can reach over 3,000 degrees per second and internal rotation can reach 9,000 degrees per second. With these velocities and forces on the shoulder and elbow, you can see why the elbow, a small, fairly complex joint, is susceptible to injury with repetitive movement.
The elbow is basically a hinge joint, and in combination with the wrist it also allows rotation (called supination and pronation) which is the motion achieved when using a doorknob. But pitching places high lateral (valgus) forces on a hinge joint that is not evolved to move laterally. The growth plates and ligaments in the elbow can be injured or damaged with either excessive or repetitive force.
Research on pitch count in the American Journal of Sports Medicine in 2006 revealed that players that are nine to 12 years old had a 35 per cent increase in elbow pain throwing more than 75 pitches a game or 600 in a season. Adolescent pitchers were five times as likely to have elbow injury requiring surgery when pitching more than eight months a year. The same study found that pitchers who ignore arm fatigue had 36 times more chance of sustaining an injury. From 1998 to 2001 several studies had recommended that youth baseball pitchers not throw breaking balls because of the potential increase in force on the arm with these kinds of pitches. However, newer findings are calling these conclusions into question. A 2009 study in Current Sports Medicine Reports and the American Journal of Sports Medicine have found that the forces on the elbow may not be all that different between a curve ball and a fastball for ages nine to 14. However, they recommend that after mastering the fundamentals of throwing and hitting, that pitchers initially focus on the fastball followed by a change-up and finally a curveball since this latter pitch is the most complicated and the most difficult to teach.
Younger players can have difficulty verbalizing pain or fatigue, so in order to more accurately assess this, coaches can use what’s called a volitional fatigue index to monitor players which is simple to use and can be well understood by players, even younger ones. It involves the player rating their fatigue level on a scale of 0 to 10 where 0 is no fatigue and 10 is completely exhausted. However, ultimately the coaches and parents need to be closely watching the biomechanics of the pitcher as time goes on. Fatigue will inevitably start to adversely affect proper biomechanics and this is an important sign that rest is needed.
An additional way to reduce the pitch count is to move the player through different positions, especially for the young players. This reduces the load on the elbow and allows sufficient recovery time between games that are pitched. It also gives the player greater exposure to different movement patterns and helps with overall motor development. This is another reason not to emphasize sport or specialization at an early age.
The baseball pitch, along with the slap shot in hockey, is one of the most complex sequences of movement in sports. It is the position in baseball that is most susceptible to injury, so maintain a genuine dialogue with the athlete about fatigue and pain, do a functional movement screen at the start of the year and monitor biomechanics throughout the season, and pitch volume must be monitored during games and during the season.
• Kerry Senchyna holds a bachelor of science degree in kinesiology and is owner of West Coast Kinesiology in Maple Ridge. For more visit, <a href=”http://www.westcoastkinesiology.com” target=”_blank”> www.westcoastkinesiology.com</a>.
