Health Tips - Baseball Injuries

Learn About Overuse Injuries

Overuse injuries are extremely common in baseball and they're due to the repetitive nature of the game. Especially in throwers, we see a lot of overuse injuries to the shoulder and the elbow. 

Muscle strains are partial tears or stretch injuries to the muscles. They're graded one, two, or three based on the severity of the strain. Grade one is usually just a stretching injury of the muscle. Grade two is a partial tear. Grade three is a complete tear of the muscle and those are less common, fortunately.

Baseball with the repetitive activity and the high stress that we place on certain muscle groups puts an athlete at risk for those types of injuries.

A labral tear is a disruption or a stretching or some type of an injury to the structure surrounding the socket part of the shoulder called the glenoid. The labrum acts to impact stability to the shoulder. When that's disrupted or torn it can lead to instability symptoms in the shoulder.

Dead arm syndrome is a constellation of symptoms and it can be due to multiple injuries or multiple issues in the shoulder.

Most commonly we see it in throwing athletes or overhead athletes and it's due to an injury such as impingement or a labral tear or a rotator cuff tear in the shoulder. Usually, it presents as decreased control or accuracy in a throwing athlete or decreased velocity. Some of our pitchers that have dead arm syndrome can't throw as fast as they used to or they're not as accurate as they used to be when they have these symptoms.

Thrower's elbow is also known as medial epicondylitis. It's characterized by pain on the inside part of a thrower's elbow, the medial epicondyle. Sometimes, enough discomfort is present that it actually affects the throwing motion. It is due usually to overuse or it can also be due to increased activity all of a sudden and it can also be due to incorrect throwing technique.

UCL elbow strain is similar to medial epicondylitis or thrower's elbow but specifically with a UCL strain, the ulnar collateral ligament or the ligament on the inside part of the elbow is stretched or partially torn. Usually, this occurs over time but can occur suddenly or traumatically. Throwers usually notice it as pain on the inside of their elbow, but it can also lead to decreased velocity and decreased control as well.

Reducing Overuse Risk

I think it's very important when an athlete is going to perform in a game or even in a practice session to warm up before that game or practice session. Stretching is very important and some athletes like to even apply ice to the shoulder and perform other stretching activities before competing in the game. Likewise, a cool down is very important after the game to allow the muscles to recover.

Resting after a game is also very important. Particularly in overhead athletes and throwers, we like to have most of our throwers rest for several days after performing in a game where they throw multiple pitches, 50, 60, 70 pitches. In our younger athletes we like to have them rest for several days.

Some studies have shown that cross training and varying the activity that an athlete, especially a young athlete, performs is very helpful to overall efficiency and overall excellence in a certain type of sport.

We don't want our athletes playing competitive baseball year round. They do need some time off. They do need rest. They do need variability in their activity to perform at their top level during the season.

Pitch counts are very important in reducing injury and they vary by age. We want our younger athletes and throwers to be throwing less than our older athletes.

Generally speaking, we look at seven and eight year olds as having a maximum pitch count per game of about 50 pitches. When you're 9 or 10 years old, 75 pitches is acceptable. Between the ages 11 and 12, 85 pitches are acceptable. When you're in the age range from 13 to 16, 95 pitches are considered the maximum. Then, from 17 to 18, 105 pitches per game is considered to be the maximum.

Having the maximum pitch counts is important because we know that pitching beyond those numbers can lead to overuse injuries, which can limit the amount of time that the athlete actually is able to participate in a season. Permanent or semi-permanent damage to the elbow or shoulder can occur if pitch counts are not followed appropriately.

In addition, it's important to keep in mind the types of pitches that athletes throw. We really don't like our younger athletes to be throwing certain types of pitches like curveballs and screwballs. We like to wait until the bones are a little bit more mature, until growth is a little bit more complete before they're throwing those types of pitches.