As RGIII and Coach Shanahan learned this past weekend, Dr. James Andrews’ advice is not something that you often want to ignore- even in the football world.
That being said, for this week’s installment of “Baseball Research Review,” we highlight one of the more poignant baseball research papers by Dr. Andrews’ group, “Risk Factors for Shoulder and Elbow Injuries in Adolescent Baseball Pitchers.” As part of the newly opened MGH Sports Performance Center, I attended a recent Mass General Orthopedics Journal Club where the Orthopedic Surgeons, Residents, Interns, Physical Therapists and a group of related baseball strength and performance specialists reviewed a few of the important articles in the field. This article highlighted the selection as one of those articles with an important message all of those in the baseball field should be readily familiar with to pass on to inquiring athletes, parents and other specialists.
Risk Factors for Shoulder and Elbow Injuries in Adolescent Baseball Pitchers
The American Journal of Sports Medicine, Volume 34, No. 6
Samuel J. Olsen II, MD, Glenn S. Fleisig,* PhD, Shouchen Dun, MS, Jeremy Loftice, and James R. Andrews, MD
From the American Sports Medicine Institute, Birmingham, Alabama
In an attempt to quantify the risk factors associated with an observed 4-fold increase in elbow surgeries performed by Dr. James Andrews from 2000-2004 versus 1994-1999 along with a 6-fold increase for high school pitchers, 90 adolescent pitchers who had elbow or shoulder surgery were surveyed and statistically compared to the results of another 45 adolescent pitchers with no such history of elbow or shoulder surgery. Survey questions included queries about injury history, playing history, preventative measures taken, and competitive habits.
In comparing the non-injured and injured subgroups, the authors found that pitchers who threw more innings, games, and months were more likely to be injured. In fact, they found that those who pitched more than 8 months were 5 times more likely to be injured. Specifically, they found that individuals who pitched greater than 8 months during the year were 5 times more likely to be injured. There was a 4 time greater risk of injury for those pitching more than 80 pitches per game. Pitching despite arm fatigue yielded the greatest increase in injury rate, at a 36 times rate. Not surprisingly, pitching at 85 miles per hour or higher also increased the injury rate 2.58 times.
Taking into account the findings of their study, the authors developed some recommendations when dealing with adolescent pitchers. The main pieces of advice they had were:
1) avoid pitching with arm fatigue
2) avoid pitching with arm pain
3) avoid pitching too much- meaning limit pitching to less than 8 months out of the year, limiting it to less than 80 pitches per game, and limit multiple showcases
The main limitation to this study, as mentioned by the authors, is that the survey relied on the recollection of these adolescent pitchers. The numbers provide a good guide; however, I’m not sure how accurately you can predict based on rememberences from youth pitchers almost a year past. Additionally, there most definitely will be some memory bias for those who are retrospectively asked how much discomfort or pain they may have pitched through, especially if they later underwent surgery. I don’t know about you, but I can barely remember the number of pitches I threw in a given warm up a year ago, let alone trust some of these adolescent pitchers to recall despite worrying about prom dates, drivers license tests, and college applications, just to name a few. Still, the finding provide a framework to further discuss and elucidate risky pitching practices.
Show Me Strength’s Commentary
As coaches ourselves, we often get questions from parents concerned about their child’s participation, or more usually, lack there-of, in showcase type events during the “off-season” months. Parents worry that if their child does not participate in said showcase, then they will be at a severe disadvantage when it comes to college or professional recruiting. What I tell the parents, and Chad would agree, that it is way more important to stay healthy than to head down to a showcase and blow your arm out. Not only is the player not in mid-season shape when they head down to a place where the temptation to try to “light up the gun” is great, but also, they waste precious time for recuperation, recovery, and building a strength foundation for the upcoming full season. If you are good enough to be recruited by a college or drafted, more likely than not the scouts will have plenty of time to find you during your regular high school or summer season. The risk/reward is just too high. As evidenced directly by this research, participation in throwing activities for the whole year puts the athlete at a significantly increased risk of injury.