Sports Medicine

Baseball Injuries
Keith J. Loud, MD, FAAP Sports Pediatrician March 20, 2013

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Overuse Injury
An overuse injury is microtraumatic damage to a bone, muscle, or tendon that has been subjected to repetitive stress without sufficient time to heal or undergo the natural reparative process.

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Classification
(1) pain in the affected area after activity (2) pain during the activity, without restricting performance (3) pain during the activity that restricts performance (4) chronic, unremitting pain even at rest

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Unique Injuries in the Skeletally Immature

Physeal Injuries Epiphyseal Injuries Apophyseal Injuries

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Types of Injury
Rotator cuff tendinopathy/multi-directional instability Little Leaguers Shoulder and Elbow Patellofemoral pain
Osgood-Schlatters /Sinding-Larsen-Johansson

Osteochondritis dessicans Severs calcaneal apophysitis

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Anatomy

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Little League Shoulder

Proximal humeral physis stress injury Symptoms:
Shoulder pain Easy fatigability Decreased velocity/accuracy/performance

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Widening of Physis

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Little League Elbow

Medial epicondyle apophysitis
Avulsion in severe cases

Symptoms:
Elbow pain with/after throwing Decreased velocity/accuracy/performance

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Anatomy/Pathology

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Treatment
Rest
At least 6 weeks, up to 6 months No throwing for at least 3 months

Good structured rehab to return safely to throwing

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Prevention???
Injury surveillance (eg, incidence, prevalence) Identification of risk factors for injury Preparticipation physical examinations (PPEs) Proper supervision and education (coaching and medical) Sport alterations Training and conditioning programs Delayed specialization

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Identification of risk factors

Arm pain and fatigue for young throwers Decrease pitch counts Consider
Generalized hypermobility Genu valgus Midfoot hyperpronation Leg length discrepancies

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Proper supervision and education

Educate participants (and providers) Certification/credentialing of youth sport coaches Available medical supervision (certified athletic trainers)

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Sport Modification

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1.

2. 3. 4. 5. 6. 7. 8. 9.

Position Statement for Youth Baseball Pitchers, American Sports Medicine Institute, June 2012

Watch and respond to signs of fatigue (such as decreased ball velocity, decreased accuracy, upright trunk during pitching, dropped elbow during pitching, or increased time between pitches). If a youth pitcher complains of fatigue or looks fatigued, let him rest from pitching and other throwing. No overhead throwing of any kind for at least 2-3 months per year (4 months is preferred). No competitive baseball pitching for at least 4 months per year. Do not pitch more than 100 innings in games in any calendar year. Follow limits for pitch counts and days rest. Avoid pitching on multiple teams with overlapping seasons. Learn good throwing mechanics as soon as possible. The first steps should be to learn, in order: 1) basic throwing, 2) fastball pitching, 3) change-up pitching. Avoid using radar guns. A pitcher should not also be a catcher for his team. The pitcher-catcher combination results in many throws and may increase the risk of injury. If a pitcher complains of pain in his elbow or shoulder, discontinue pitching until evaluated by a sports medicine physician.

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Baseball Pitch Counts

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Delayed specialization
1-2 days/week totally off Increase volume by no more than 10% each week 2-3 month break from every sport Only 1 competitive team per season Special precautions for younger athletes participating in compressed multigame tournaments

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Delaying specialization, taking a break

CLIN PEDIATR 2010 49: 731 originally published online 22 March 2010 Overuse Injuries in High School Athletes

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Parent/Athlete Survey Risk Factors Comparing Acute Versus Overuse Injury Categories

Sleeping 6 or fewer hours the night before the injury was associated with all the fatiguerelated injuries (p = 0.028)

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Burnout
Overtraining syndrome = a series of psychological, physiologic, and hormonal changes that result in decreased sports performance.

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Recognition of Burnout
Adult Chronic muscle or joint pain Personality changes Elevated resting heart rate Decreased sports performance Pediatric Fatigue Lack of enthusiasm about practice or competition Difficulty with successfully completing usual routines

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Prevention
1. Keep workouts interesting, with age-appropriate games and training, to keep practice fun. 2. Take time off from organized or structured sports participation 1 to 2 days per week to allow the body to rest or participate in other activities. 3. Permit longer scheduled breaks from training and competition every 2 to 3 months while focusing on other activities and cross-training to prevent loss of skill or level of conditioning. 4. Focus on wellness and teaching athletes to be in tune with their bodies for cues to slow down or alter their training methods.

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