by Nora Gilman, MS, LAT, ATC
For youth baseball players, some of the most common concerns are preventing elbow injuries such as ulnar collateral ligament (UCL) pain, the structure involved in the "Tommy John" surgery epidemic or osteochondral defects from overuse.
Some arguments or explanations for the prevalence of elbow injuries in baseball pitchers depends on who you ask. Most parents explain to me that their son is growing while some parents complain that their son does not stay on top of his shoulder exercises. Both play some role but are still lacking in any real epidemiology.
One of the most interesting arguments I've heard is the mechanics of throwing is not a natural movement for the human arm. A physical therapist for the LA Dodgers debunked this myth and explained to me and other sports medicine professionals at a seminar that humans advanced as a species when we learned to throw. This is because we could stand at a distance from a larger, dangerous game and take the animal down with a spear which required not only throwing, but producing velocity. Prior to hunting larger game, early homo sapiens relied on gathering and hunting small game which did not yield as much meat and other resources such as fur for warmth. Our humerus and forearm bones have evolved to adapt to such torque, granted, the younger you start learning those mechanics, the better.
Recently, the New York Times sought input from baseball coaches and released an article suggesting a different explanation which is more of a paradigm shift in what we teach baseball players and what is asked of them.
“They scorch line drives, they hurl blazing fastballs. But something is often missing”— Jack Thompson, high school baseball coach
Youth baseball players face a dilemma. Modern baseball is largely focused on the end result of a college scholarship and hardly skids over the process of teaching fundamentals. The burning desire to get noticed means paying for individualized pitching or hitting lessons or playing year-round on a traveling baseball team to showcase their skills. The result are kids that can hit a 400 foot ball over a fence or pitch a fastball in the 90s but fail at throwing a smooth 'out' at first base. Most of their time is spent on power skills in a sport that requires strategy and committing low errors. The dilemma occurs when recruits stop looking for routine skills.
The result is consequences beyond knowing the basics. Overuse injuries occur despite implementing surveillance strategies such as pitch count. The paradigm shift points all arrows to the dramatic increase in velocity and power as the cause. The volume certainly aids in prevalence as well.
We ask our adolescents to perform skills seen at the professional or Division I level. It's a hard spot to ask adolescents to hit softer and throw lighter. When a casual game of backyard catch disappears, providing our youth the means to keep up with the demand is crucial.