B. Rodney Comisar, MD
As winter turns to spring, it marks the beginning of another baseball season. Spring training is upon us, and it is often accompanied by sore arms as a result of all the increased throwing.
Overhead throwing injuries are commonplace and primarily involve the shoulder and elbow. The majority of throwing-related symptoms are overuse problems, a consequence of relative excessive throwing in conjunction with:
- Insufficient rest & recovery time
- Inadequate conditioning & muscle training
- Poor mechanics
- Effects of skeletal immaturity in the pediatric patient
Pitch counts, advocated by the American Sports Medicine Institute, STOP Sports Injuries, and others, are important at all ages, but pitch limits are particularly important at the youth & adolescent levels, as is adequate days rest between starts and seasons. There are well-established recommendations for pitch counts and days rest in between based on age for young throwers. In addition, no overhead throwing for 2-3 months per year is encouraged, as is avoidance of competitive pitching for at least 4 months per year.
Developing shoulder and elbow joints, and more specifically the growth plates, are at risk in youth and adolescent throwers. The repeated high forces of overhand throwing can place undue stresses on the skeletally immature joints of these young athletes. Adherence to guidelines on pitch counts, days rest between pitching stints, and thoughtful, gradual instruction on different pitch types limit arm fatigue and allow for the mastery of fastball throwing mechanics. The change-up should be the next pitch type introduced to young throwers to utilize after the fastball.
Proper throwing mechanics are critical in the avoidance of injuries.
- The kinetic chain, the process by which throwing speed is generated, begins with the muscles of the lower body and spine, with the forces transferred through the shoulder to the arm during the throwing motion.
- The power created by the legs and torso ease the stresses on the throwing shoulder and elbow to reduce the risk of injury.
- Strength training and overall physical fitness aid in developing a reproducible throwing motion and muscle memory to improve performance and lower the chance of injury.
If a pitcher complains of shoulder or elbow pain, throwing should be discontinued immediately until further evaluation by a sports medicine physician.
Participation and learning the game are paramount for young athletes in maximizing their experience in sports. Young athletes should be encouraged to be involved in various sports and physical activities in developing their overall athletic skills.
Dr. B. Rodney Comisar is a board certified, fellowship-trained orthopedic surgeon who specializes in sports medicine related injuries. He has a sub-specialty certification in Sports Medicine. Dr. Comisar offers a full spectrum of sports medicine surgery, including arthroscopy and minimally invasive procedures. Dr. Comisar’s special areas of interest include: multi-ligamentous knee injuries/dislocations; ACL injuries/reconstruction; rotator cuff injuries/tears; patellar instability/dislocation; proximal hamstring ruptures; shoulder instability; and shoulder arthritis including total shoulder replacement and reverse total shoulder replacement.
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