Reducing InjuryManaging Pain

Enhancing Performance

The Young Thrower

Kyle Ridgeway PT, DPT

Justin Dudley PT, DPT

ObjectivesPitch Counts

Shoulder/Elbow Anatomy

Risks for Injury

Medical Care

Injury Prevention

Rehabilitation

Return to Sport

Training

Thank YOU!

Fastest Motion in Sports

7,000 degrees per SECOND

How many months a year do MLB pitchers throw??

9 Months

3 months of NO throwing

REST, Conditioning, Rehab, Preparation

Pitch CountsTwo Major Studies

1996 USA Baseball Medical & Advisory CommitteeExpert Survey

2002 American Journal of Sports Medicine StudyEpidemiological Study

Pitch Counts2002 Study; American

Journal of Sports Medicine 476 baseball pitchers ages 9-

14 followed x1 seasonPre-season and Post-season

Questionaires Types of pitches Stiffness and pain in elbow and

shoulder Injury and Performance

interviews following each game

Pitch count logsVideo analysis of pitching

mechanics

2002 Study; American Journal of Sports Medicine

50% reports elbow or shoulder pain at least once during the season

Pitchers who threw sliders were 86% more likely to experience elbow pain during the season

Pitchers who threw curve balls were 56% more likely to experience shoulder pain during season

Pitchers who threw change-ups were 12% less likely to experience elbow pain and 29% less likely to experience shoulder pain during season

2002 Study; American Journal of Sports Medicine

As pitch counts increased, the number of shoulder and elbow pain cases increased

The incidence of elbow and shoulder pain increased with the number of pitches thrown in a season

USA Baseball Medical & Safety Advisory Committee

Recommendations

Coaches & Parents

LISTEN and REACT to complaints of arm pain

A pitcher who complains or shows arm pain during a game should be removed immediately

Medical Attention: Pain not relieved in 4 daysRecurs immediately upon return to

throwing

Pitch Count Recommendations

9-10 Year Olds

GAME: 50 WEEK: 75 SEASON: 1000 YEAR: 2000

11-12 Year Olds

GAME: 75WEEK: 100SEASON: 1000YEAR: 3000

13-14 Year Olds

GAME: 75WEEK: 125SEASON: 1000YEAR: 3000

USA Baseball Medical & Safety Advisory Committee

Recommendations

GAME Pitch CountWarm up pitches

No breaking pitches until bones mature13 years old

FOCUS: Good Mechanics and Control

NO MORE than 9 Months of Competition

Pitchers

Injury CausesPitch Count, Pitch Count, PITCH

COUNTOVERUSEShowcasesPlaying year roundImproper Activity to Rest Ratio

Poor Shoulder ROM/Flexibility

Poor Elbow ROM/Flexibility

Elbow & Shoulder

Kids who required surgery TWICE as many pitches as those who did not….

After ONE game pitchers loose some shoulder and elbow range of motion

BEST Predictors of InjuriesNumber of pitches

History of previous injury to area

RecommendationsGames

In-season

Painful

Off Season

GamesWarm Up: Full Body and Shoulder

NOT all throwing

Pitch CountsCOUNT full speed, warm up

pitches/throwsLimit between inning warm up throws

Post Game Stretching: Elbow and Shoulder

In SeasonFlexibility post throwing (ALL Positions)

Light shoulder exercises

Mix Up Demands, Practice, and Training

LISTEN AND OBSERVE

Consequences: Devastating

“Elbow Pain” Torn UCL = Tommy John Surgery

Shoulder Pain, “Little Leaguers Shoulder”Fracture of Humerus

Seek additional medical care

Pain greater 3-4 days

Pain immediately returns

Unable to walk (weight bear) >3-4 steps

Pain is getting significantly worse

Not improved with rest

When in Doubt…

REFER THEM OUT

Training: Throwers 10Less often, less weight in season

Make a part of practice at least in pre-season

NOT TO FATIGUE

3 sets of 8-12

Slow, good control, EXCELLENT form

http://www.mikereinold.com/2010/05/little-league-injury-prevention-program.html

Other Considerations

Lower Body Strength, Power, Control & BalanceSingle Leg BalanceLungeSquats

Core Strength & Control

Lower Body Flexibility

Higher Level Shoulder Exercises

NOTE: Not well understood/researched

Out of SeasonRELATIVE REST > NO THROWING

Strengthen small stabilizers of shoulder and shoulder blade

Total Body conditioning including strength and resistance

Baseball Players CAN and SHOULD lift weights

Injury Prevention

http://www.mikereinold.com/2009/04/little-league-pitching-injuries.html

Resources: Mike ReinoldCurveballs:

http://www.mikereinold.com/2009/08/is-throwing-curveball-dangerous-to-our.html

Youth Injuries:http://www.mikereinold.com/2012/02/the-real-reason-why-there-are-so-many-youth-pitching-injuries.html

Resources: Eric Cresseyhttp://www.ericcressey.com/baseball-

content

Referenceshttp://www.asmi.org/asmiweb/usabase

ball.htm

Effect of pitch type, pitch count, and pitching mechanics on risk of elbow and shoulder pain in youth baseball pitchers. Am J Sports Med. 2002 Jul-Aug;30(4):463-8. Lyman S, Fleisig GS, Andrews JR, Osinski ED.