Pitching Injuries: It’s Not Just What You’re Doing; It’s What You’ve Already Done

Written on May 18, 2011 at 6:22 am, by Eric Cressey

Three weeks ago, this article on pitching injuries became the single-most popular piece in EricCressey.com history:

Your Arm hurts?  Thank Your Little League, Fall Ball, and AAU Coaches

In that feature, I made the following statement:

We can do all the strength training, mobility work, and soft tissue treatments in the world and it won’t matter if they’re overused – because I’m just not smart enough to have figured out how to go back in time and change history. Worried about whether they’re throwing curveballs, or if their mechanics are perfect?  It won’t matter if they’ve already accumulated too many innings.

While athletes might be playing with fire each time they throw, the pain presentation pattern is different.  You burn your hand, and you know instantly.  Pitching injuries take time to come about. Maybe you do microscopic damage to your ulnar collateral ligament each time you throw – and then come back and pitch again before it’s had time to fully regenerate.  Or, maybe you ignore the shoulder internal rotation deficit and scapular dyskinesis you’ve got and it gets worse and worse for years – until you’re finally on the surgeon’s table for a labral and/or rotator cuff repair.  These issues might be managed conservatively if painful during the teenage years (or go undetected if no pain is present) – but once a kid hits age 18 or 19, it seems to automatically become “socially acceptable” to do an elbow or shoulder surgery.

Sure enough, just yesterday, reader Paul Vajdic sent me this article from the Shreveport Times. The author interviews world-renowned orthopedic surgeon Dr. James Andrews about the crazy increase in the number of Tommy John surgeries he’d performed over the past decade.

A comment he made really jumped out at me, in light of my point from above:

“”I had a kid come in, a 15-year-old from Boca Raton, (Fla.), who tore his ligament completely in two,’ Andrews said. ‘The interesting thing is when I X-rayed his elbow with good magnification, he has a little calcification right where the ligament attaches to the bone. We’re seeing more of that now. He actually got hurt with a minor pull of the ligament when he was 10, 11, 12 years of age. That little calcification gets bigger and, initially, it won’t look like anything but a sore elbow. As that matures, it becomes more prominent. It turns into an English pea-size bone piece and pulls part of the ligament off when they’re young.’”

In other words, it takes repeated bouts of microtrauma over the course of many years to bring an athlete to threshold – even if they have little to no symptoms along the way.  Injury prevention starts at the youngest ages; otherwise, you’re just playing from behind the 8-ball when you start training high school and college players.

In addition to walking away with the perspective that young kids need to be strictly managed with their pitch counts, I hope this makes you appreciate the value of strength and conditioning programs at young ages, too.  For more information, check out my post, The Truth About Strength Training for Kids.

We can’t prevent them all, but I do think that initiatives like the IYCA High School Strength Coach Certification in conjunction with pitch count implementation and coaching education are a step in the right direction.

Sign-up Today for our FREE Baseball Newsletter and Receive a Copy of the Exact Stretches used by Cressey Performance Pitchers after they Throw!

5 Responses to “Pitching Injuries: It’s Not Just What You’re Doing; It’s What You’ve Already Done”

1. Rees Says:
   May 18th, 2011 at 10:37 am

   That’s a good post.

   Personally I’m running into pitching coaches that want their kids throwing year round, and I want my guys to have healthy bodies.

   Thankfully I’m in Iowa where it gets too cold to play outside year round.

   What are your thoughts on pitch count/age level?

   Obviously a 14 year old kid doesn’t need to be learning a curve ball yet, but total pitch counts are a different deal. Especially when you consider a full week of practice, warm up, bull pens, most kids also play in the field until college, etc. What are your thoughts?

2. Tad S. Says:
   May 18th, 2011 at 1:07 pm

   Once agian, Well said Eric. I once heard or read that the #1 predictor of an injury, is past injury. By that token, I can see why you would HAVE to consider all the asymptomatic microtruama that accompanies the high pitch count to be a predictor for future injury. It can never hurt to be pro-active with younger athletes, and can’t be stated enough.

3. James Says:
   May 18th, 2011 at 2:33 pm

   Echo the above comments, follow with a question–when to start strength training, and what to do? Clearly every child is different, and so are their experiences. A 12 year old playing rec ball has a completely different volume of potential trauma than a 9 year old playing 45-50 travel ball games in the spring season alone. Factor in physical and emotional maturity as wild cards and it’s hard to know as a parent when and what to do for your kids. Thoughts?

4. Rick Finley Says:
   May 18th, 2011 at 5:49 pm

   Eric – That is a great article. We have 2 kids on my select team (15 u) that finished High School and have arm injuries.

   You can also put blame on the parents. I’m seeing alot of kids that don’t have agility or speed.
   On my team we do a lot of speed & agility training, Sprint work, explosion jumps,jump rope,
   boxing (Heavy bag/Speed bag training for hands, and mental toughness). I started this type training when my son Ricky was 11 yrs old. This training made him the 1st Team All State Div.1 baseball player in Ohio 2009. He received scholarships offer from everywhere, and he’s only 5’4″. 2009 Buckeye Scout #31.

   I also think alot of parents, don’t understand how to train their kids, or haven’t played the game. I believe weight training is essential to a kids overrall development.

   Eric – You have lots of knowledge!

   Rick Finley

5. Brian Bowness Says:
   May 19th, 2011 at 7:42 am

   Solid post, Eric.

   I think the overwhelming factor has more to do with misuse (consistently poor technique) as opposed to overuse (pitch counts).

   You said:

   “Maybe you do microscopic damage to your ulnar collateral ligament each time you throw – and then come back and pitch again before it’s had time to fully regenerate.”

   What caused the UCL to microscopically tear? Repetition, possibly. Incorrect technique, absolutely.

   I think it’s important to point out that once a player has UCL Replacement Surgery, the new UCL cannot regenerate due to zero blood supply. If that player resumes throwing using his old technique, it won’t be long before he destroys his replacement UCL.

   I’m not saying that overuse is something to dismiss, especially if we’re talking about youth ball players playing competitively 10-12 months out of the year. I mean, it’s great that Little Johnny won a trophy, but what motor skills or knowledge of the game has he developed in the process? What toll does does this year ’round season take on his physical maturation?

   The problem with overcoming the misuse factor: incompetent private pitching coaches. (I guess we could throw in team coaches as well.) If I had a nickel for every former pitcher telling kids “this is what worked for me,” while dismissing the zipper on his elbow as “part of the game,” an unfortunate accident, etc…

   In any event, you’re right on point. Despite what a certain closer-turned-expert on MLB Network believes, one pitch doesn’t create an injury. It takes time, (I forgot to mention poor conditioning!) and a consistently poor technique to develop a significant injury.

   Keep up the great work!

Leave a Reply

Name (required)

Mail (will not be published) (required)

Website

Security Code: