March/April 2020 - 18

Rehab Techniques
CURRENT RECOMMENDATIONS
The ASMI believes that playing
design.6
Various injuries occur to young
elbows, especially the UCL, which is
on the medial side of the joint. With
the forces routinely put on the UCL,
this is an area prone to inflammation,
soreness and tissue damage. This
condition is often referred to as " Little
League elbow. " Unfortunately, I often
hear coaches, parents and athletes
dismiss it as " routine soreness, " and
they only address it with ice.
The overuse of NSAIDs for pain and
inflammation is an ongoing concern
at the high school level. Icing and
NSAIDs for a sore elbow or shoulder
is acceptable in the short term, but
they should be fully evaluated by a
medical professional before the athlete
resumes playing. That way, you can
rule out structural damage.
A positive apprehension or empty
can test for the shoulder, or a positive
valgus test, may indicate structural
damage to the ligaments that require
further intervention from a medical
doctor. This is often disregarded in
the young athlete, with many playing
through the pain. Oftentimes, a young
athlete is allowed to continue playing
through this condition. Required rest
days need to be established and
enforced for specific soreness in the
shoulder or elbow.
FATIGUE
It's imperative a coach, parent or
athletic trainer know what objective
signs to look for when young pitchers
experience fatigue. The nuances
of fatigue can be very subtle to the
untrained observer.
It might be a certain number
of pitches or a slight change in
mechanics. Dropping the elbow and
taking more time between pitches can
be a sign of fatigue.1
Good coaches
can quickly recognize when pitchers
alter their mechanics due to fatigue.
Rarely will a pitcher at any level admit
being tired. It's hard to objectively
measure fatigue, especially in young
pitchers, so we must scrutinize
exactly what's happening when real
fatigue is apparent.
Fatigue can be measured
subjectively on an analog scale of one
to 10. But because of the competitive
environment, I would question the
accuracy of the response during a
game. I would not ask a pitcher, " Are
you tired? " That's unlikely to elicit an
accurate response, because athletes
want to stay in the game.
In high school baseball, it can be
challenging for coaches to determine
when it's time to remove a pitcher
if he's below the required maximum
pitch count.
" 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. " This philosophy can be
applied to younger athletes. This is
the point where the pitcher should be
removed from the game, regardless of
any other condition.
16 | Training & Conditioning | March/April 2020
PREVENTION STRATEGIES
Pitch count is an obvious marker
coaches should pay attention to, but
the question is whether it's enforced.
Only additional research can help us
better understand how many pitches
are enough. But it may be more a
question of enforcement of maximum
pitch counts. Maybe coaches should
increase the days of rest between
outings. Private lessons should be
limited, or at least monitored, so the
number of pitches can be added to daily
or weekly totals. The honor system for
reporting may have to come into play.
Showcases are a concern because
of the demand for maximum velocity,
which can cause a pitcher to
overthrow. The timing of the showcase
- in-season or offseason - also
can be an issue. Playing year-round
should not be allowed, as a two- to
three-month rest period should
be implemented. This might be a
challenge for schools, leagues and
everyone involved.
Because pitching through fatigue
can lead to injury, coaches need to
recognize the subtle signs of fatigue
and take action by removing their
pitchers. There also has to be a base
of physical fitness, because fatigue
year-round is causing more injuries. It
identifies other factors that can lead to
arm injuries, including: private lessons,
showcases, throwing at home after
practice, number of throws during
practice at other positions, playing for
multiple teams in a season, and use of
a radar gun. The ASMI suggests the
maximum number of pitches per game/
week/ year with each age group, and it
recommends days of rest for recovery
between outings. It also includes age
recommendations for learning different
pitch types due to differences in
physiological development.
The pitch limits vary from state to
state. The ASMI is a great resource,
but are its recommendations enough?
We must consider what else needs to
be done to reduce arm injuries.
March/April 2020

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