There’s A Lot We Don’t Know About Baseball and Softball Injuries

By Dev Mishra, M.D., President, Sideline Sports Doc, Clinical Assistant Professor of Orthopedic Surgery, Stanford University

Key Points:

  • There are likely many factors involved in shoulder and elbow injuries for young throwers
  • The available data suggests that there are steps a young thrower can take now to minimize risk.
  • These steps include: play less than 8 months out of the year; play more than one sport; maintain shoulder motion as close to the non-throwing shoulder as possible; and improve lower extremity and core strength

I’m still thinking back on a recently published study of MRI abnormalities in young baseball players. I wrote about this in a blog post and noted that in this small study 100% of the players had an abnormal shoulder MRI scan if they were single sport athletes and played more than 8 months out of the year. Sure, a larger study will likely show a different percentage but it still should give us all reason to ask: why does this happen?  And why did 74% of young players report some arm pain during play in another study? Is this just the new normal, the physical price paid to play the sport? The data are compelling and a bit scary, but still it’s not easy to connect the dots and identify specific causes of problems. There’s a lot we still don’t know.

There is a lot of outstanding research taking place now, attempting to answer the question: “why”. We’ll likely find that there are several factors that can conspire together to create injury risk, loss of performance, and loss of sport enjoyment. I’d like to highlight a few excellent studies recently published in the journal Sports Health.

Here’s an excellent study that starts to define what the normal pitching motion should look like in a young pitcher. The authors defined ranges for the normal shoulder rotation and elbow load and found interestingly that loads are actually less for curveballs compared to fastballs, and yet current pitching recommendations suggest avoidance of curveballs until around age 14. The culprit may actually be abnormal lower extremity and trunk mechanics in the young pitcher. Possible solutions: lower extremity and core strength should be a conditioning focus for the young thrower.

In another study the authors did a retrospective analysis of previously published data and found that shoulder rotational deficits correlated with risk of shoulder and elbow injuries in early adulthood. These authors feel that with the onset of puberty and the accelerated growth in the young body, it seems that repetitive overhead activity leads to changes in bone shape. Once the young thrower is finished growing the continued repetitive stress in throwing is transmitted to the soft tissues. Possible solution: improve shoulder, elbow, and trunk range of motion with a program such as the Yokohama Baseball-9.Sideline Sports Doc Logo

These and other studies point to the fact that there are multiple factors involved in creating the recipe for upper extremity injury. There’s a lot we still don’t fully understand. But there are reasonable steps any young thrower can take right now to reduce injury risk and maximize sport performance and enjoyment. Play less than 8 months in a year and play more than one sport. Keep shoulder motion as close to the non-throwing shoulder as possible, and keep lower extremity and core strength up.

Overthrowing: Abnormal Shoulder MRIs In Young Baseball Players Without Shoulder Pain

By Dev Mishra, M.D., President, Sideline Sports Doc, Clinical Assistant Professor of Orthopedic Surgery, Stanford University

Key Points:

  • A recent medical study showed that more than 50% of throwing shoulders in young baseball players without shoulder pain had MRI abnormalities
  • These MRI issues have the potential to cause long term issues for the shoulder
  • Players who played more than 8 months out of the year and were baseball-only athletes had a 100% chance of an abnormal MRI, regardless of playing position

At least once a week I’ll see a young athlete in the clinic with shoulder pain and at theYouth Pitchers end of a careful discussion, physical exam, and further discussion with the parents I’ll hear “that’s great, now can he have his MRI this afternoon”. The desire for an MRI is normal and natural on the part of the parents, after all this is what the media tells us will happen in a professional athlete.

(And btw the truth of that interaction with a pro athlete is frequently very different than what’s reported). But this study, published about a month ago in the Orthopaedic Journal of Sports Medicine provides valuable insight. An alarmingly high number of non-painful throwing shoulders in young athletes will have MRI abnormalities compared to the athlete’s own non-throwing shoulder.

The shoulder is frequently injured in young baseball players. Sports medicine doctors will often treat these athletes for overuse injuries and structural problems. Many of these diagnoses have long-term implications, sometimes requiring surgery and putting young athletes at risk for future problems. You’d be far better off not having any of these conditions.

Author Andrew Pennock and colleagues from UC San Diego orthopaedic surgery performed the study. They performed MRI evaluations on 23 young male baseball players aged 10-12 with no reported shoulder issues, and did MRI scans on the throwing and non-throwing shoulder.

Here were some of their key findings from the MRI portion of the study:

  • 52% of the throwing shoulders had MRI abnormalities that were not present in the non-throwing shoulder
  • They identified 2 key risk factors: year round play (defined as 8 or more months of baseball play per year) and single sport specialization
  • If a player had 1 of the 2 risk factors there was a 71% chance of an abnormal MRI; and with 2 of 2 risk factors there was a 100% chance of an abnormal MRI
  • Player position did NOT correlate with an abnormal MRI, meaning that fielders could also have an abnormal MRI

There were also some interesting observations about player behavior and knowledge of rules and recommendations for shoulder safety. 83% of the players were aware of pitch count restrictions, innings restrictions, and PitchSmart recommendations, and yet it appears that the number of players who actually followed the recommendations was small. In this study, 43% played baseball more than 8 months per year, 22% were single-sport athletes, and 80% of pitchers threw curveballs, sliders, and sinkers.

There are some limitations to this study that require additional investigation. It’s a fairly small number of players, and we don’t actually know what happens down the line to the shoulders with abnormal MRI scans.Sideline Sports Doc Logo

If you’re parents or coaches of young baseball players please have a look at the guidelines and rules in place from Little League Baseball and PitchSmart, and then make a commitment to actually follow the rules. A healthy arm is much better for long-term health and near term performance.

Help For Elbow Injuries In Pitchers? A Prevention Program Offers Hope

By Dev Mishra, M.D., President, Sideline Sports Doc, Clinical Assistant Professor of Orthopedic Surgery, Stanford University

Key Points:

  • Overuse injuries to the elbow are common in young baseball players, and prevention programs are needed to reduce injury risk
  • A recently published scientific study highlighted the potential benefit of a stretching program called the Yokohama Baseball-9, showing a significant reduction in elbow injuries for players who used the program compared to those who didn’t
  • The program has the potential to be a useful tool in reducing numbers of elbow injuries for young baseball players

I’m a big believer in prevention programs for sports injury risk reduction and this week we’ll discuss a program to reduce elbow injury risk in baseball.

I’ve written before about the usefulness of the 11+ warmup program for lower extremity risk reduction in soccer. That program is highly effective. Prevention programs are great in theory but actually proving the usefulness can be difficult. What are required are often lengthy scientific studies with large numbers of individuals. Those types of studies have been done with the 11+ but are lacking for elbow injury prevention programs in baseball. But a recently published study from Japan offers some hope.

The study authors devised the Yokohama Baseball-9 (YB9) program, which consists of 9 flexibility exercises focused on the wrist, elbow, shoulder, and hips.

There were 275 players age 8 to 11 divided into a non-YB9 group and a YB9 group. Players were asked to complete the program at least once a week.

At 1-year, the YB9 exercise group had significantly lower rates of elbow injury and significantly better total range of motion at the shoulder. In a statistical analysis, increased shoulder total rotation, increased nondominant hip internal rotation and improved spine posture predicted lower rates of elbow injury.

This is a good study but there are some weaknesses. 28% of the original group was excluded due to prior shoulder or elbow pain and an additional 15% were lost to follow up. And it is a relatively small number of players who participated.

We need more studies like this so I hope it can be repeated by others, and with larger numbers of players. The fact that 28% of the young players in the original group of potential players were excluded because they already had pain in pretty alarming, and good evidence that we need some solutions to the problem of overuse injuries in baseball pitchers.Logo

Overall, the study is encouraging and provides an interesting new potential avenue for injury prevention.

Common Hand Injuries: Text Thumb; Little League Pitchers: Do’s & Don’ts; Importance of Sleep for Optimal Recovery

Episode 17.35 Rerun

Segment One (01:10): Dr. Nik Verma sitting in this week for Dr. Cole joins Steve andImage result for thumb overuse Nicole Kauppila from Athletico Physical Therapy to discuss Tech Thumb injury.

Each year as we approach the holidays, smartphones are listed as a top gift.  With use of smart phones – tech-related injuries called “tech-thumb” resulting from unnatural movements like constant texting are on the rise.

New smartphones often means even more time straining thumbs, in fact young adults spend a staggering one-third of their waking hours on smart phones. Nicole describes causes, symptoms, prevention and treatment for overuse injuries of the hand.


 Segment Two (11:46): Dr. Nik Verma, Head Team Physician for the Chicago White Sox talks with Steve about how to avoid overuse throwing injuries in young athletes; avoid training in one sport all year long, high pitch velocity and pitch counts that can cause damage from repetitive load on the growth plates of young athletes.

Image result for little league pitcher


Segment Three (20:14): Todd Sayer, PT from ATI Physical Therapy talks about the importance of sleep for optimal recovery; the correct supportive neutral sleep position; avoiding compressed shoulder joint in side sleepers.

How you sleep dictates how you perform, so whether you are falling short on logging enough sleep each night or poor sleep posture is inhibiting a solid day’s performance, making a few simple changes can help to enable a good night’s rest and support your body’s ability to adapt and adjust.

Todd Sayer  is a Senior Regional Director with ATI. He has 18 years of clinical experience specializing in treatment outpatient orthopedic and sports medicine injuries as well as chronic pain and post-operative care.

Overcoming Sleep Challenges and Discomfort

The Risk of ACL Injuries in Baseball

By Mike Headtke for Athletico Physical Therapy

acl injuries in baseball

Anterior cruciate ligament (ACL) injuries are typically associated with sports like soccer or football, however these injuries can occur in any sport – including baseball.

In fact, hitting a baseball is one of the most “violent” total body movements in athletics due to multiple body parts moving in synchronization at high angular velocities. As a result, the knee still can become injured. To show the significant amount of torque the body sustains during hitting, it is a good idea to review what happens to the body during this movement.

The Anatomy of a Baseball Hitter

It is important for baseball players to maintain strong legs and core to prevent injury. While there are various stances that a hitter can take, there are some basics that all stances have in common. There is a weight shift from the back leg to the front leg (where power starts). As the upper body starts to rotate, the core is engaged for the hips to begin rotating in unison with the upper body. As contact is made there is significant force generated through the entire body placing significant torque on the knee joint, with the lead leg also going into extension and back leg flexing.

To put this into perspective, the fastest swing (exit velocity) to be recorded is over 123 MPH. That is all generated by the body with a majority of the energy coming from the legs and core. With that much force going through the legs (and with torque, extension and flexion happening at the knee), we can now see how a meniscus or collateral ligament could become damaged. If the perfect storm were to happen (i.e. rotating about a fixed leg and hyperextending with foot not moving to help slow forces down) an ACL injury could also occur.

An Ounce of Prevention is Worth a Pound of Cure

To prevent potential injuries, it is very important for baseball players to maintain a healthy and strong core, glutes, hamstrings, quadriceps and lower legs. Since hitting is considered a closed chain activity (feet fixed to the floor), it’s good to perform other strengthening activities in closed chain too.

For example, performing squatting or lunging variations can be great to kick on multiple muscle groups in a functional manner. With that said, it is still important to work open chain as well (feet not fixed to the floor) to establish good hip control and strength because these muscles are the big drivers for the swing.

Athletes can also minimize the risk of ACL injury with Athletico’s ACL 3P Program, where prevention begins with a screening to identify potential injury risk factors that can be corrected. For more information, please email ACL@Athletico.com.