Troubling Trends in Arm Injuries
Kids who play baseball today often don’t just play a few innings in the backyard. In fact, according to a survey by the Sports Fitness & Industry Association, more than 25 million kids played baseball or softball in 2018, and nearly 15 million of those were "core" players who played 13 or more games in a year.
The result is these young players are putting their bodies and their baseball dreams in jeopardy. There are numerous injuries that occur within the throwing athlete. The most common injuries occur in the elbow and shoulder. These injuries typically are seen in high-performing college and professional players. But over the past year and a half with COVID, there seems to be an additional uptick in overuse injuries in the throwing athlete.
What can parents do to keep their athletes healthy, and their baseball dreams alive? Brian Harvey, DO, Sports Medicine Physician, and Jason Yoder, DPT, Sports Physical Therapist, both with the Children’s Mercy Kansas City Sports Medicine Center, discuss the troubling arm injury trends they’re seeing in young baseball players, including diagnosis, treatment and prevention.
Q. Why are young athletes at risk for arm injuries?
Dr. Harvey: Young athletes have growth plates throughout their body which typically fuse as the player reaches the end of adolescence or skeletal maturity. Several of those growth plates are in the elbow and shoulder. Most notably, the medial epicondyle growth plate (located on the inside of the elbow) as well as the proximal humerus (in the shoulder). This is where a lot of the irritation occurs when a player throws too much. Because this is such a common problem for kids who play Little League baseball, it’s been dubbed Little League elbow and shoulder respectively.
Q. What are the symptoms of Little League elbow/shoulder?
Dr. Harvey: The most obvious symptom of Little League elbow is pinpoint pain on the inside of the elbow or elbow pain that lasts longer than 24 hours. The same is true for the shoulder with pain or tenderness reported on the upper arm. That pain doesn’t mean that the player has torn a tendon, ligament or has “blown out” their elbow or shoulder. There can be a wide spectrum of injury severity that needs to be checked by a medical professional.
Jason: In addition, because of the overhead nature of baseball, a player may experience general arm soreness. It’s normal for the player to feel like they have worked out, but the player shouldn’t be so uncomfortable they are in pain, and they shouldn’t have pain immediately upon throwing. If the player feels pain within their first few throws, they need to be evaluated. And if your player complains that their arm is fatigued, that also can be a sign of injury.
Q. What causes arm pain?
Dr. Harvey: In almost all cases, elbow or shoulder injuries are the result of throwing too often, throwing without using the proper body mechanics, fatigue, and/or poor strength and mobility throughout the body. The most common positions we see affected are pitcher and catcher, but we can see it in any player.
Q. If my child has arm pain or symptoms, how is it treated?
Jason: The best initial treatment is with rest. We typically recommend the player NOT throw for six to eight weeks pending the severity or medical diagnosis before returning to the field, and then the player should only return to play after being assessed by a professional.
Dr. Harvey: Many of these injuries could be prevented if the player had been taught to strengthen their core and use proper body mechanics when throwing, pitch counts, not throwing with fatigue, and performing proper arm care.
Jason: We also don’t recommend players ice their shoulder or elbow after throwing. Though they may see major league and college players do this, it can mask an underlying problem or injury in younger players. Instead, we encourage players to take a more active approach to their post-game routine, cooling down with stretches and strengthening.
Q. What are the dangers of throwing with arm pain?
Jason: As with any pain or symptoms, ignoring them can lead to a worsening of the athlete’s presentation, diagnosis and potential return to play. It is difficult to appreciate the difference between pain and soreness at times, but caution should be used.
We often see players who continue to play, despite recommendations to rest. These players are at risk for much more serious injuries to their elbows and arms, such as an avulsion fracture or an ulnar collateral ligament (UCL) injury, or labral issues in the shoulder.
Dr. Harvey: Historically, these more serious injuries have only been seen in high-level college and professional athletes and sometimes must be treated with surgery to repair a torn ligament, commonly called Tommy John surgery. Unfortunately, over the past 10 years, we have seen UCL injuries in younger and younger players, some as young as 10 or 11. UCL reconstruction is a major surgical procedure, does not guarantee a return to the same level of play, and can require extensive rehabilitation. The same can be said for injuries in the shoulder.
Q. Why are you seeing more players with arm injuries?
Jason: Many players are on multiple traveling teams, play catcher and pitcher in the same game, or are playing baseball year around and are not taking time off to give their bodies a chance to recover from the physical strain. These athletes are throwing too much, while fatigued, and are not using proper body mechanics, adding up to more injuries. Overall, the body can only handle so many repetitive tasks without issues arising.
Q. What can you do to reduce the risk of arm injuries?
Dr. Harvey: The biggest thing is to not throw when tired or fatigued at a young age. Organizations, such as Little League Baseball and Pitch Smart provide suggested pitch counts based on the player’s age. Adhering to these pitch counts can help reduce injuries. Players also need to learn proper throwing mechanics in order to move more efficiently and be more effective. Often, players haven’t been taught to throw from the ground up, using their legs and core as stabilization.
Here are a few other pro tips to prevent injury from Jason and Dr. Harvey:
- With the advancement of technology and analytics, they need to be used and incorporated in the correct way at a young age. Though the pros use this technology and train at this high level, 10-year-olds shouldn’t be concerned about their velocity, horizontal break or spin. They should be playing for fun and camaraderie.
- Weighted balls, which are often used by pitching coaches and even in rehabilitation, don’t cause arm pain if they are used appropriately. Be sure you understand the risks and benefits of using weighted baseballs to train.
- Don’t let your athlete specialize in a sport at an early age. Encourage kids to play a variety of sports and rest between seasons. This exposes them to different movement patterns and helps them develop better motor control and coordination overall.
- Encourage players to rest in the off season, but to continue to work out with a strength and conditioning routine. Injuries also happen when a player hasn’t continued to be active in the off months, then suddenly begins to play without slowly ramping up to the level of activity needed to play ball. If your player hasn’t continued to be athletic for a few months, then comes to a showcase and expects to perform at peak, they risk injury.
Q. Are there other tips to keep my student-athlete healthy?
Jason: Yes. Don’t be in a rush for your student-athlete to peak in middle or high school. As a society, we place way too much pressure on players at younger and younger ages. If a player’s goal is to receive a college scholarship or to play in the major leagues, you want your player to stay healthy and peak later in their high school career.
And parents, if you feel like your student-athlete is being played too much, is throwing too much, or is experiencing pain, speak up. At the end of the day, being healthy is the key to playing any sport at any age.
Learn more about the Sports Medicine Center and Children's Mercy.