Jan 29, 2015
Debate on Young Arms Continues

By Nate Dougherty

This season, Little League Baseball instituted pitch counts that limit young players to a certain number of pitches per game based on their age, and also required set rest periods between appearances depending on the pitch count of the previous outing. The changes, which have been well-received, are part of an effort to curb overuse injuries to young pitching arms in hopes of avoiding surgery down the road. However, there is also new research from the American Orthopaedic Society for Sports Medicine (AOSSM) that says not all young pitchers who log a large number of innings are headed for the surgeon’s table.

A new study presented at the 2007 annual meeting of the AOSSM shows frequent arm use can improve performance and durability for young players, but only as long as they don’t overdo it. The study, which followed 32 male baseball players between 13 and 21 for six years, shows the more a young player throws the ball, the stronger their external shoulder rotation becomes. That means they will throw faster and have a better chance of staying injury-free, although there’s still a point where too much of the repetitive motion will start to break down the shoulder.

“In the old days kids pitched in the summer and then played basketball or football in the winter,” says Scott D. Mair, MD, Associate Professor of Orthopedic Surgery at the University of Kentucky-Lexington and principal investigator in the study. “That was better for growing children. Now, some children play baseball 12 months a year. That can be a problem. Shoulder changes that go beyond adaptation can lead to pain and even growth plate injuries.”

But just how much is too much? Many young athletes, especially those with the luxury of living in warm climates that allow them to play ball year-round, are finding out for themselves. Young pitchers who play more than eight months out of the year find themselves five times more likely to need surgery than their counterparts who pitch 5 1/2 months in a year, a recent study showed. With the increasing prevalence of travel squads, that translates to a lot more surgeries, even if they occur years down the line.

Dr. James Andrews of Birmingham, Ala., one of the nation’s leading specialists in Tommy John surgery, says he’s seen a boom in the number of high schoolers who receive the elbow ligament surgery. He performed nine of the operations on high school players from 1995-98, 61 from 1999-2002, and 148 from 2003-06. “When they finally break down, you can trace it back to when they were 10, 11, 12, 13 years old,” Andrews said during a recent presentation.

This kind of breakdown is becoming so common, it’s even got a name–Little League elbow. This is caused by an injury to the growth plate inside the elbow joint brought on by excessive throwing, and it primarily strikes players from ages 12 to 14.

“The combination of the joint being immature, and the increased competition and intensity level at that age, definitely increases the chances of injury to the growth plate in the elbow, sometimes causing it to separate,” says Dr. Raphael Longobardi, MD, of the University Orthopaedic Center in Hackensack, N.J. “In some cases, if not detected early, it can lead to surgery.”

The Little League ruling has been getting a good reaction so far. In a May survey of 1,777 league presidents, it was supported by 92 percent of league boards of directors, 90 percent of umpires, 84 percent of managers, 81 percent of parents, and 71 percent of players.

“If it saves one kid’s arm, it’s worth it,” Vince Pasquini, a coach in the Hershey, Pa., Little League told the Patriot-News.

Nate Dougherty is an Assistant Editor at Training & Conditioning.

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