Pitching too many innings could end your baseball career

Note: This is the first in a two-part series on pitching injuries in youth baseball. Part 1 will appears in the February 16 edition of The Post and Courier and the STOP Sports Injuries blog. Part 2 will present some tips for parents and coaches to prevent shoulder and elbow injuries in youth pitchers. Also, please check out the Speaking section for a transcript of a talk I gave to the Mount Pleasant Baseball organization.

Major League Baseball pitchers and catchers report to Spring Training this week. For the most part, these pitchers have put in 10-20 years to get where they are now. But a new study in the February 2011 issue of The American Journal of Sports Medicine shows that getting to this point might be a dangerous journey.

Glenn S. Fleisig, PhD et al. studied 481 healthy pitchers aged 9-14 and followed them for 10 years. While the majority of the pitchers retired from baseball for normal reasons, such as losing interest or not being good enough to move on, the researchers found that 5% of them had shoulder or elbow surgery or retired because of a throwing injury.

That number might seem low to most people, but it is really high in the sense that these injuries can be prevented. The study shows that pitchers who pitched more than 100 innings in at least one year are 3.5 times more likely to be injured.

“This study proved a direct link between innings pitched in youth and adolescent baseball and serious pitching injuries. It highlights the need for parents and coaches to monitor the amount of pitching for the long-term success and health of these young athletes,” Fleisig points out.

The underlying influences leading to increased injuries are multiple. I think most of the readers of this column remember when youth sports changed with the seasons. All of my friends and I grew up playing different sports with different seasons until we were older and started concentrating on the sports we liked. Recently there has been an explosion of travel and club teams in multiple sports, especially baseball. Kids used to play different sports and stressed different body parts. Now they play the same sport all year long, leading to repetitive stress on the same body parts year after year.

There also seems to be a misperception of just how serious these injuries are. I remember there was an interview of a high school pitcher on ESPN’s Outside The Lines a few years ago. The young pitcher essentially said that he throws as hard as he can and as often as he can because he knows that he can have surgery and come back even better. It’s amazing that such a mindset exists, but it is actually common. Unfortunately while there are many confounding factors, it appears likely that the younger a pitcher is when he has shoulder or elbow surgery, it is less likely that he will move on to pitch at higher levels.

One solution is to have young pitchers play other positions. The study shows that playing catcher on non-pitching days can increase the risk of injury, but I would suggest trying another infield position, either part- or full-time. By switching to pitching later in their careers, they could potentially preserve their shoulders and elbows. Many worry that all of those years of not pitching will put the player behind the ones who have always pitched, but that is debatable. Legendary pitcher Greg Maddox reportedly has said that kids either have the ability to pitch or they don’t. In other words, if the kid has natural ability, teams and coaches will find and use it.

I’ve given talks to baseball coaches at different levels, and I’ve seen that many coaches don’t want to hear that these kids are being overused. I can hear it in the tone of the questions and see the expressions on their faces. They mention specific pitchers who threw all the time and had no injuries. They argue that kids from the Dominican Republic and Cuba throw off-speed pitches earlier than American kids and have no problems. The problem is that there will always be anecdotal examples of athletes avoiding injuries, and we don’t know how well the majority of the foreign kids pitch long term. But we do have increasing numbers of studies that show higher injury rates with increased pitching.

I do understand the dilemma for the coaches. They want to win. They need to win. Most youth baseball teams have only one or two good pitchers. And to win, coaches need to use them over and over. But they can win with these pitchers now and don’t have to deal with the injuries that occur down the road. Long-term health and success of these kids isn’t their concern.

Parents are often equally responsible. They often worry that their child will fall behind other pitchers. They fear that scouts or coaches won’t see their kid. When I see a young pitcher in my clinic after he gets hurt, it often seems to me that pitching is more important to the parents than the child himself.

I fully expect that this column will be rejected by a number of parents and coaches. I can envision the comments now. “100 innings a year is too low.” “You can’t learn to pitch when you throw that little.” “My pitchers will fall behind the other teams’ pitchers.” “That’s why there are orthopaedic surgeons – to fix these kids’ injuries.” Yes, there are orthopaedic surgeons, including me, who can operate on these pitchers. It’s just unfortunate because throwing injuries in young athletes can be prevented.

I expect that this post will generate a lot of interest among parents and coaches. Please leave your thoughts in the comments section, as I would love your input.

Tags: American Journal of Sports Medicine baseball elbow injuries featured overuse injuries pediatric sports injuries pediatrics shoulder injuries sports injury prevention in children STOP Sports Injuries The Post and Courier