Injury to the shoulder is one of the most common injuries seen in an orthopaedic practice. According to the American Academy of Orthopaedic Surgeons (AAOS), there has been a five-fold increase in the number of serious shoulder and elbow injuries among youth baseball and softball players since 2000. Most shoulder injuries involve injury to the muscles, ligaments and tendons rather than the bones of the shoulder.

Shoulder problems can develop slowly in athletes who are involved with intensive training or activity. They most commonly occur with baseball pitchers and catchers, but they are also frequently seen in athletes who are involved in overhead sports, like softball, volleyball, swimming and some track and field events. Baseball and softball are the third and fourth most popular high school sports. If you’re a pitcher, you have a 50/50 chance of experiencing pain in the elbow or shoulder during your baseball career. One study noted that 38 percent of high school pitchers experience shoulder pain while another noted that 26 percent of youth players and 58 percent of high school players experience elbow pain during their careers.

Overhead throwing places extremely high stresses on the shoulder, specifically to the anatomy that helps to keep the shoulder stabilized and centered within the socket. The throwing motion also places high tensile stresses on the medial elbow and compressive forces on the lateral elbow. “Little league elbow” is a generic term used for elbow pain in adolescents. Studies illustrate that four to 39 percent of young adolescents will experience medial elbow pain.

When throwing a baseball, the arm moves through the arc of motion at an incredibly high speed and with incredible torque. The rotator cuff and biceps muscles are tested as they attempt to decelerate the arm. When they become fatigued or weakened, they cannot control the arm. This can cause injury to the muscles, capsule and cartilage of the shoulder as well as the elbow. Risk of shoulder injury is 2.5 times greater for pitchers who throw more than 75 pitches in a game. Risk of elbow pain is 3.5 times greater for pitchers who throw more than 600 pitches in a year. Athletes who throw on a tired arm are six times more likely to suffer elbow pain and four times more likely to have shoulder pain than those who don’t throw on a tired arm. Pitchers who throw greater than 100 innings in a year are 3.5 times more likely to be seriously injured, requiring elbow surgery, shoulder surgery or retirement. Studies show that injury risk in throwers is related more to the number  of pitches and innings thrown than it is about the types of pitches thrown.

Because of the increased risk to the shoulder and elbow in adolescent athletes, the American Academy of Pediatrics recommend that all athletes involved in overhead sports should be engaged in a well-supervised exercise program to improve upper extremity motion, strengthen the supporting musculature and develop the endurance of the shoulder, core, legs and arms. Prevention programs should involve education of the parent, coach and athlete. At UOA Sports Performance, our preventative programs also utilize functional movement screening to identify athletes with flexibility, muscular strength, and coordination and endurance issues.

It is advised that overhead athletes should not be involved in one single sport all year round. Rather, they should be encouraged to schedule significant periods of rest from that sport, get involved with other sports that do not involve stress to the shoulder and take mental breaks from their sporting demands.

The physicians at UOA support the recommendations for a pitch count and yearly inning limits for pitchers.

7 Keys for Reducing Shoulder and Elbow Injuries in Overhead Throwers

1. Pitching on multiple teams with overlapping seasons should be avoided.
   • 4% of kids 9-18 reported involvement with multiple teams and overlapping seasons
   • Those to do so are 3x more likely to develop arm fatigue and 2x as likely to develop arm pain
2. Avoid pitching on consecutive days.
   • 43% of young pitchers note that they pitch on consecutive days
3. Avoid pitching multiple games on the same day.
   • 19% of pitchers noted this occurrence
   • 89% likelihood to develop arm pain with this practice
4. Avoid pitching when your arm is fatigued or you are feeling pain.
   • 8x greater risk of injury
5. All pitchers should stretch for 5 minutes after activity.
   • This is the optimal time to stretch as the muscles are fully warmed up
   • Pitchers should focus on stretching the internal rotators of the shoulder, which can become tight with throwing
6. Avoid the “no pain, no gain” mentality.
   • Soreness/pain is an indicator of injury
7. Get involved in a well-supervised shoulder-strengthening program.
8. Don’t forget to strengthen the core, glutes and legs as this is where the real power comes from.

 

UOA Sports Performance and Wellness offers a Rugged Rotator Cuff program. For more information or to sign up, please click here.

References

Yang, AJSM 2014

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Valovich McLeod TC, Decoster LC, Loud KJ, Micheli LJ, Parker JT, Sandrey MA, White C.  National Athletic Trainers’ Association Position Statement: Prevention of Pediatric Overuse Injuries. J Ath. Tr. 2011;46(2):206-220.

Fleisig G, Andrews J, Cutter G, Weber A, Loftice J, McMichael C, Hassel N, Lyman S. Risk of Serious Injury for Young Baseball Pitchers: A 10-Year Prospective Study.Am. J. Sports Med. 2010;20(10): 1-5.

Kaplan KM, Jobe FW, Morrey BF, Kaufman KR, Hurd WJ. Comparison of Shoulder Range of Motion, Strength, and Playing Time in Uninjured High School Baseball Pitchers Who Reside in Warm- and Cold-Weather Climates.Am.J Sports Med. 2011; 39(2): 320-328.

Shouchen, Dun et. al., A Biomechanical Comparison of Youth Baseball Pitches: Is the Curveball Potentially Harmful?Am.J. Sports Med. 2008;36(4):686-692.

Fortenbaugh D, Fleiseg G, Andrews J. Baseball Pitching Biomechanics in Relation to Injury Risk and Performance.Sports Health: A Multidisciplinary Approach 2009;1:314-320.

Davis, J.T., et. al. The Effect of Pitching Biomechanics on the Upper Extremity in Youth and Adolescent Baseball Pitchers.Am. J. Sports Med. 2009;37(8):1484-1491.