Little League Baseball Injury Awareness
By: Lydia Williams, ATC
Over the past decade, the competitive bar has been on the rise for Little League baseball players, which leaves athletic trainers to question whether pushing adolescent pitchers places them at an increased risk for future injury. With the increase use of curve balls and breaking balls in prepubescent (before puberty or less than 12 years old) pitchers, the risk for significant injury is potentially for Little League Baseball Injury increased. When comparing the frequency of elbow surgeries between 1994 to 1999 and 2000 to 2004 there was a 4-fold increase seen in collegiate baseball pitchers and a 6-fold increase seen in high school pitchers.
Another study involving 298 baseball pitchers ranging in age from 9 to12, found a positive correlation between elbow pain and the player’s increase in age and weight, decrease in height, lifting weights, playing outside the league, decrease satisfaction with pitching, pitching with arm fatigue, and the number of pitches thrown in a season. And yet, a third study of 27 high school baseball pitchers who all had ulnar collateral ligament reconstruction reported that all 72% of the pitchers had a speed greater than 80 mph, 69% of the pitchers threw 10 or more months out of the year, and 67% of the pitchers were throwing curve balls prior to the age of 14.
Although the studies support the potential risk of significant injury for young pitchers, there are few studies that identify what the risk factors are that predispose these adolescent athletes to injury.
Little League Baseball Shoulder Injury Potential Risk Factor
In a study by Olsen et al, 95 adolescent pitchers who experienced shoulder or elbow surgery and 45 adolescent pitchers who never had a significant pitching related injury completed a survey composed of questions related to medical history, playing history, and potential risk factors for injury. The control group pitched 5.5 months out of the year, whereas the injured group pitched 7.9 months. Pitchers who threw more than 8 months per year were at a 5 times greater risk for an injury requiring surgery. The injured pitchers pitched on average 6 innings per appearance where their counterparts only pitched 4 innings. This difference includes 22 more pitches per game by the injured group. Pitching over 80 pitches per game places pitchers at a 4 times increased risk for injury requiring surgery than those who pitch less. USA Baseball, the national governing body for the sport, recommends a 14-year-old pitcher throw less than 75 pitchers per game and less than 3000 pitches per season. Pitchers should rest 3 months per year. During the rest period, they can play other sports; but they should completely refrain from pitching.
In the Olsen study, within the injured group, 52% frequently pitched with arm fatigue where as only 11% of the control group pitched with arm fatigue. Nearly 67% of the injured group pitched regardless of arm pain, whereas 42% of the control did not. The study found through multivariable analysis that pitchers who pitch with arm pain are 36 times more likely to become injured. Thus, it is essential for coaches and parents to listen to their athlete’s complaints of arm, shoulder, or elbow pain. In fact, coaches should ask pitchers if they experience pain before, during, or after throwing. Additionally, coaches and parents should watch for diminished throwing mechanics, a loss of velocity, or a decrease in the pitcher’s stamina.
Common Overuse Elbow Little League Baseball Injuries
Dr. Edward McFarland, an associate professor of sports medicine at Johns Hopkins University, has stated that 2 common injuries in Little League baseball are “Little League Shoulder” and “Little League Elbow”. Both of these are contributed to over use and throwing too hard, too much.
Little League Shoulder is classified as a fracture in the growth plate (location of bone growth for adolescents) of the proximal humerus commonly seen in boys 11 to 16 years of age given that this is their major growth spurt. Humeral growth plates do not close (stop growing) until the age of 18 to 21. This fracture is caused by continuous rotational stress experienced during pitching and can be seen in catchers given that they throw just as much. The athlete can experience pain in the axilla or armpit. An x-ray is needed to positively identify the fracture. Treatment of Little League Shoulder is conservative with rest for 3 to 4 weeks.
Little League Elbow is more common than Little League Shoulder. Frequently seen in athletes between the ages of 8 and 15, Little League Elbow is not caused by just baseball. It is seen in many racquet sports and usually involves the athlete’s dominant extremity. During the acceleration phase of throwing a large valgus force is place upon the elbow resulting in stress to the medial side. Sidearm throwing or just poor mechanics can increase this stress even more. The medial epicondyle is the weakest point in an immature elbow and can result in an avulsion fracture. If the growth plates have closed, injury to the ulnar collateral ligament is common. The athlete will gradually complain of pain just as with Little League Shoulder. More than likely, he or she will have trouble loosening up and pain will increase with distance, number, and velocity of throws. The athlete may also be tender just over the medial epicondyle and have pain with wrist flexion and pronation. If he or she can relate the pain to a particular throw it is more likely an avulsion fracture than medial epicondylar apophysitis. Again, treatment is relatively conservative. Upon removing the athlete from all throwing activities, anti-inflammatory medication and icing 3 to 4 times a day should begin. Typically, time and rest are the key to healing; however, improper management or continued use of Little League Elbow can contribute to osteoarthritis.
- Fleisig GS, Kinglesy DS, Loftice JW, et al. Kinetic comparison among the fastball, curveball, change-up, and slider in collegiate baseball pitchers. AM J Sports Med. 2006;34:423-430
- Lyman S, Fleisig GS, Waterbor JW, et al. Longitudinal study of elbow and shoulder pain in youth baseball pitchers. Med Sci Sports Exercise. 2001;33:1803-1810.
- Olsen SJ, Fleisig GS, Dun S, et al. Risk factors for shoulder and elbow injuries in adolescent baseball pitchers. AM J Sports Med. 2006;34:905-912.
- Contemporary Pediatrics. http://www.contemporarypediatrics.com/ Accessed November 14, 2006
- Reinberg, S. Red Orbit Breaking News. “Injures Can Bench the Kids of Summer.” www.redorbit.com/news/stories/2/2004/05/02/story003.html Accessed November 14, 2006.
Lydia Williams, M.Ed., ATC is a graduate of the Hughston Athletic Training Fellowship and completed her Masters of Education in Health and Physical Education, with teacher certification from Columbus State University in May of 2007. While a member of the Fellowship, Lydia served as the Head Athletic Trainer at Northside High School, Columubs, Georgia.
Lydia is a graduate of The University of Georgia earning a Bachelor of Science Degree in Education with an emphasis in Athletic Training in 2005. She was also a recipient of the Dr. Butch Mullherin Athletic Training Service Award, served as the University of Georgia’s Sports Medicine Club President, and was a founding member of Iota Tau Alpha, an Athletic Training Education Honor Society.