March/April 2020 - 17

Rehab Techniques
" It's in everyone's best interest to isolate the point of fatigue and determine
when it begins to affect production. "
- Corey Dawkins, ATC, said in the book " Baseball Prospectus "
One reason it's important to
protect the arms of young baseball
players is they are in various stages
of growth and development. They
should be shielded from overtraining,
especially throughout their formative
years. Secondly,
there isn't a wealth
of research on adolescent arm
injuries. Therefore, all the medical
professionals need to re-examine and
adjust the current guidelines to reduce
arm injuries and prolong careers. If the
number of elbow and shoulder injuries
has increased during the past few
years, clearly something is wrong.
WHAT'S THE PROBLEM?
In a word: overuse. Coaches,
parents and those closely associated
with the teams routinely allow
young pitchers to throw too many
pitches in games or over the course
of a season. The current guidelines
are not followed or enforced as
they should be. In my experience,
there's little communication between
coaches, fall leagues, high schools
and summer leagues. Some athletes
play year-round without taking the
two- to three-month break that's
recommended by the American Sports
Medicine Institute (ASMI). This is a key
factor in overuse injuries.
Each coach follows pitchers during
their season, but no one seems to
keep up with the previous season's
numbers, year-round totals or innings
pitched. This is another issue that must
be addressed.
Athletes playing baseball yearround
are at particular risk for
elbow and shoulder injuries. The
American Academy of Pediatrics
also recommends that pitchers quit
throwing for two to three months each
year, and it discourages specializing in
one position.
A limit on the number of innings
pitched each year needs to be
established. The ASMI suggests no
more than 100 innings per year, but
most of the high school pitchers I work
with admit exceeding this number. We
must update the current guidelines and
strictly adhere to them, otherwise we'll
continue to see problems in adolescent
baseball players.
THE ROTATOR CUFF
The rotator cuff is a structure
of particular vulnerability in
physically immature athletes who
are still developing. It consists of
four muscles: the subscapularis,
supraspinatus, infraspinatus and
teres minor. These muscles hold the
head of the humerus in the glenoid
fossa, and if any one muscle becomes
strained, it can cause an imbalance in
the cuff and lead to injury.
The glenohumeral joint has greater
mobility in its range of motion than
stability, and it's one of the most
injured joints in the young overhead
athlete.2
strength was shown to decrease
during the season for high volume
pitchers.4
For these reasons, rotator
cuff strengthening exercises should be
standard protocol for preseason and
in-season conditioning to strengthen
and prepare the cuff for the forces
required of overhead throwing.
" For all overhead athletes I
recommend a program with high
volume work during the preseason, "
said KC Bonnin, the strength and
conditioning coach at Liberty High
School in Colorado. " I'll implement Y,
T, Ws, along with internal and external
rotation band work. " This type of
resistance training program helps to
insure adequate rotator cuff strength
prior to the season.
Overuse injuries in pitchers are
believed to be from the repetitive
overhead throwing motion that results
in traumatic stresses to the shoulder
muscles.7,8
Pitching-related injuries
requiring surgery in high school
pitchers has increased, which is
surprising given the amount of medical
knowledge and data available.7
One
possible reason is that the angular
velocity at the shoulder joint exceeds
7,000 degrees per second during the
act of pitching.2,3
This puts tremendous
stress on the shoulder joint. The young
pitcher's shoulder must be flexible
enough to allow the external rotation
required (about 180 degrees) to throw
a baseball and be stable enough to
prevent subluxations of the joint.2
Other conditions include " Little
Leaguer's shoulder, " caused by
repetitive stress to the shoulder's
growth plate, which is more
susceptible during growth spurts.8
Open growth plates are the norm
for adolescent athletes. This is often
overlooked with coaches and parents.
Multidirectional instability (MDI) is
In one study, supraspinatus
another issue that's caused by rotator
cuff weakness. It results in instability
of the glenohumeral joint in two or
more directions.8
With this in mind, adolescents
commonly present with increased
shoulder laxity. This may predispose
them to injury when combined with
the stress of repetitive overhead
throwing.8
point of vulnerability is in the armcocking
and acceleration phases,
where maximal external rotation
occurs.8
These are challenging
mechanical and physiological
conditions that should be considered
when reviewing pitching guidelines for
this age group.
THE ULNAR COLLATERAL
LIGAMENT (UCL)
The elbow is another area of
concern - specifically, the UCL. It's
well known because of the rise in
Tommy John surgeries.
The elbow consists of the humerus,
radius and ulna, and the flexion and
extension of the arm is by structural
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March/April 2020

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