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12900 Saratoga Ave., Suite A-1, Saratoga, CA 95070Phone (408)
973-7700 Fax (408) 973-1600
[email protected] www.optmsaratoga.com
PLAY BALL!SHOULDER & ELBOW CARE FOR YOUNG THROWERS: TREAT
THE WHOLE, NOT THE PA
iven the truth that there are many variables that may lead to
injury of a particular body part, the OPTM Physical Therapy
ofaratoga team believes it is vital to consider and address all
possible factors when working with an individual to rehabilitate
anjury, improve functional performance or reduce the chance of
getting hurt. When working with young throwers and providing r
their shoulder or elbow, based on what research shows and leading
experts say, we believe that a comprehensive approachcludes much
more than just specific treatment to the upper extremity
itself.
is estimated that 2.2 million young Americans between the ages
of 4-16 play baseball annually. 50% of little leaguers betweee ages
of 9-14 will experience shoulder or elbow pain.
Who is at risk for injury?
ccording to the American Physical Therapy Association and Kevin
Wilk, DPT, a leading authority in sports rehabilitation andrector
of Rehabilitative Research with the American Sports Medicine
Institute, youth baseball players are at risk due to thellowing
factors:
- Ageo Elbow joints (bones, ligaments, growth plates) in youth
are not fully developed and hence, are susceptible to
overuse injuries- Pitch Type
o Curve balls and breaking pitches appear to put more stress on
the growth plate of the elbow compared to othetypes of pitches
- Pitch Frequencyo Pitching too frequently without adequate
resto Pitching too many gameso Individuals that pitch more than 100
innings per year are 3-4 times more likely to sustain a shoulder
injury
- Improper Mechanicso Improper movement through the lower
extremity, trunk and/or upper extremity will lead to added force on
the e
and shoulder
Where does the velocity come from?
esearch indicates that 54% of the force required to throw comes
from the coreower extremities and trunk), and 21% is generated from
the shoulder. The core ise engine for force generation, and a
foundation to minimize loads on the shouldernd maximize performance
of the upper extremity. The upper extremity is aownstream segment
in the kinetic chain of throwing, which has a major role inrce
regulation. Mechanical flaws in the core will place added
dependency one upper extremity to become a force producer, which
adds stress to the
houlder and elbow, making it susceptible to injury.
A plyometric anterior hop to lunge withrotational reach loads
the trunk, lower
and upper chain in weight acceptancephase of throwing.
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What are the key mechanical issues with throwing and
injuries?
a review of several research studies of injured throwers, a
range of 55-100% of the subjects had a combination of the
followiweakness and/or abnormal motion of the trunk and a lower
extremity, 2) scapular dyskinesis (poor shoulder blade
control),
lenohumeral Internal Rotation Deficit (loss of internal rotation
of the shoulder). A high percentage of the subjects presented wl
three flaws. Therefore, when working with an individual with a
shoulder or elbow throwing injury, it is important toerform a
comprehensive evaluation of the entire body to screen for and
consequently address all potential causes toroblem.
hrowing requires efficient and coordinated sequential motion
throughout the entire body, which minimizes loads on the individody
segments and maximizes throwing performance. Treatment of just the
shoulder or elbow itself may not be sufficient inorrecting the
cause(s) of the problem. The evaluation should include examination
of the strength, flexibility, and motion of theuscles and joints
associated with the foot, ankle, knee, hip, pelvis, spine,
scapulohumeral and glenohumeral complex.ysfunction in any one or
combination of those areas can result in added compensatory stress
to the shoulder and elbow, resupain and injury in the upper
extremity with throwing.
Conclusion
here are many causes that are associated with throwing injuries
in the young athlete. It is important that athletes,
parents,oaches, athletic trainers and physical therapists are aware
of and address all the possible variables that can contribute to
uppxtremity injuries. Awareness of and adherence to professional
recommendations and guidelines to avoid injuries should redu
e incidence of injuries and maximize performance. Given the
complexity of throwing and the multiple potential causes ojuries,
it is imperative that a skilled physical therapist perform a
comprehensive evaluation of the entire body, not jue shoulder or
elbow, when focusing on injury prevention or screening for causes
of throwing injuries. Based on the
ndings in the research literature, it is recommended that a
customized exercise program for each individual incorporate
exerciat will improve strength, range of motion, and flexibility of
the lower extremities, trunk and upper extremities, which will help
kehletes on the field and performing at their best. The OPTM
Saratoga team can help do that with a comprehensive approa
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Recommendations for preventing injuries in youth baseball
pitchers (according to thAmerican Sports Medicine Institute):
1. Watch and respond to signs of fatigue. If a youth pitcher
complains of fatigue or looks fatigued, let him rest from
pitchinand other throwing.
2. No overhead throwing of any kind for at least 2-3 months per
year (4 months is preferred). No competitive baseball pitcfor at
least 4 months per year.
3. Do not pitch more than 100 innings in games in any calendar
year.4. Follow limits for pitch counts and days rest.5. Avoid
pitching on multiple teams with overlapping seasons.6. Learn good
throwing mechanics as soon as possible. The first steps should be
to learn, in order: 1) basic throwing, 2)
fastball pitching, 3) change-up pitching.7. Avoid using radar
guns.8. A pitcher should not also be a catcher for his team. The
pitcher-catcher combination results in many throws and may
increase the risk of injury.9. If a pitcher complains of pain in
his elbow or shoulder, get an evaluation from a sports medicine
physician.
10. Inspire youth pitchers to have fun playing baseball and
other sports. Participation and enjoyment of various
physicalactivities will increase the youth's athleticism and
interest in sports.
Relevant Resources:
merican Sports Medicine Institute: Position Statement for Youth
Baseball Pitchers, Pitch Count Recommendations, Restchedule -
http://www.asmi.org/asmiweb/position_statement.htm
ttle League Baseball Organization Regular Season Pitching Rules
-
tp://www.littleleague.org/assets/forms_pubs/media/pitchingregulationchanges_bb_11-13-09.pdf
