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Reducing InjuryManaging Pain
Enhancing Performance
The Young Thrower
Kyle Ridgeway PT, DPT
Justin Dudley PT, DPT
ObjectivesPitch Counts
Shoulder/Elbow Anatomy
Risks for Injury
Medical Care
Injury Prevention
Rehabilitation
Return to Sport
Training
Thank YOU!
Fastest Motion in Sports
7,000 degrees per SECOND
How many months a year do MLB pitchers throw??
9 Months
3 months of NO throwing
REST, Conditioning, Rehab, Preparation
Pitch CountsTwo Major Studies
1996 USA Baseball Medical & Advisory CommitteeExpert Survey
2002 American Journal of Sports Medicine StudyEpidemiological Study
Pitch Counts2002 Study; American
Journal of Sports Medicine 476 baseball pitchers ages 9-
14 followed x1 seasonPre-season and Post-season
Questionaires Types of pitches Stiffness and pain in elbow and
shoulder Injury and Performance
interviews following each game
Pitch count logsVideo analysis of pitching
mechanics
2002 Study; American Journal of Sports Medicine
50% reports elbow or shoulder pain at least once during the season
Pitchers who threw sliders were 86% more likely to experience elbow pain during the season
Pitchers who threw curve balls were 56% more likely to experience shoulder pain during season
Pitchers who threw change-ups were 12% less likely to experience elbow pain and 29% less likely to experience shoulder pain during season
2002 Study; American Journal of Sports Medicine
As pitch counts increased, the number of shoulder and elbow pain cases increased
The incidence of elbow and shoulder pain increased with the number of pitches thrown in a season
USA Baseball Medical & Safety Advisory Committee
Recommendations
Coaches & Parents
LISTEN and REACT to complaints of arm pain
A pitcher who complains or shows arm pain during a game should be removed immediately
Medical Attention: Pain not relieved in 4 daysRecurs immediately upon return to
throwing
Pitch Count Recommendations
9-10 Year Olds
GAME: 50 WEEK: 75 SEASON: 1000 YEAR: 2000
11-12 Year Olds
GAME: 75WEEK: 100SEASON: 1000YEAR: 3000
13-14 Year Olds
GAME: 75WEEK: 125SEASON: 1000YEAR: 3000
USA Baseball Medical & Safety Advisory Committee
Recommendations
GAME Pitch CountWarm up pitches
No breaking pitches until bones mature13 years old
FOCUS: Good Mechanics and Control
NO MORE than 9 Months of Competition
Pitchers
Injury CausesPitch Count, Pitch Count, PITCH
COUNTOVERUSEShowcasesPlaying year roundImproper Activity to Rest Ratio
Poor Shoulder ROM/Flexibility
Poor Elbow ROM/Flexibility
Elbow & Shoulder
Kids who required surgery TWICE as many pitches as those who did not….
After ONE game pitchers loose some shoulder and elbow range of motion
BEST Predictors of InjuriesNumber of pitches
History of previous injury to area
RecommendationsGames
In-season
Painful
Off Season
GamesWarm Up: Full Body and Shoulder
NOT all throwing
Pitch CountsCOUNT full speed, warm up
pitches/throwsLimit between inning warm up throws
Post Game Stretching: Elbow and Shoulder
In SeasonFlexibility post throwing (ALL Positions)
Light shoulder exercises
Mix Up Demands, Practice, and Training
LISTEN AND OBSERVE
Consequences: Devastating
“Elbow Pain” Torn UCL = Tommy John Surgery
Shoulder Pain, “Little Leaguers Shoulder”Fracture of Humerus
Seek additional medical care
Pain greater 3-4 days
Pain immediately returns
Unable to walk (weight bear) >3-4 steps
Pain is getting significantly worse
Not improved with rest
When in Doubt…
REFER THEM OUT
Training: Throwers 10Less often, less weight in season
Make a part of practice at least in pre-season
NOT TO FATIGUE
3 sets of 8-12
Slow, good control, EXCELLENT form
http://www.mikereinold.com/2010/05/little-league-injury-prevention-program.html
Other Considerations
Lower Body Strength, Power, Control & BalanceSingle Leg BalanceLungeSquats
Core Strength & Control
Lower Body Flexibility
Higher Level Shoulder Exercises
NOTE: Not well understood/researched
Out of SeasonRELATIVE REST > NO THROWING
Strengthen small stabilizers of shoulder and shoulder blade
Total Body conditioning including strength and resistance
Baseball Players CAN and SHOULD lift weights
Injury Prevention
http://www.mikereinold.com/2009/04/little-league-pitching-injuries.html
Resources: Mike ReinoldCurveballs:
http://www.mikereinold.com/2009/08/is-throwing-curveball-dangerous-to-our.html
Youth Injuries:http://www.mikereinold.com/2012/02/the-real-reason-why-there-are-so-many-youth-pitching-injuries.html
Resources: Eric Cresseyhttp://www.ericcressey.com/baseball-
content
Referenceshttp://www.asmi.org/asmiweb/usabase
ball.htm
Effect of pitch type, pitch count, and pitching mechanics on risk of elbow and shoulder pain in youth baseball pitchers. Am J Sports Med. 2002 Jul-Aug;30(4):463-8. Lyman S, Fleisig GS, Andrews JR, Osinski ED.