Pitching too many innings can ruin young arms

Editor's Note: Dr. Geier is Director of MUSC Sports Medicine and an orthopaedic surgeon. He writes a sports medicine column for The Post and Courier.

Major League Baseball pitchers and catchers report to spring training this week. For the most part, these pitchers have put in 10-20 years to get where they are now. But a new study in the February 2011 issue of The American Journal of Sports Medicine shows that getting to this point might be a dangerous journey.

Dr. Glenn S. Fleisig did a study that followed 481 healthy pitchers (ages 9-14) for 10 years. While the majority of the pitchers retired from baseball for normal reasons, such as losing interest or not being good enough to move on, the researcher found that 5 percent of them had shoulder or elbow surgery or retired because of a throwing injury.

That number might seem low to most people, but it is really high in the sense that these injuries can be prevented. The study shows that pitchers who pitched more than 100 innings in at least one year are 3.5 times more likely to be injured.

"This study proved a direct link between innings pitched in youth and adolescent baseball and serious pitching injuries. It highlights the need for parents and coaches to monitor the amount of pitching for the long-term success and health of these young athletes," Fleisig said.

The underlying influences leading to increased injuries are multiple. I think most of the readers of this column remember when youth sports changed with the seasons. All of my friends and I grew up playing different sports with different seasons until we were older and started concentrating on the sports we liked. Recently, there has been an explosion of travel and club teams in multiple sports, especially baseball. Kids used to play different sports and stressed different body parts. Now they play the same sport all year long, leading to repetitive stress on the same body parts year after year.

There also seems to be a misperception of just how serious these injuries are. I remember there was an interview of a high school pitcher on ESPN's Outside The Lines a few years ago. The young pitcher essentially said that he throws as hard as he can and as often as he can because he knows that he can have surgery and come back even better. It's amazing that such a mindset exists, but it is actually common. Unfortunately, it appears the younger a pitcher is when he has shoulder or elbow surgery, the less likely he will move on to pitch at higher levels.

One solution is to have young pitchers play other positions. The study shows that playing catcher on non-pitching days can increase the risk of injury, but I would suggest trying another infield position, either part- or full-time. By switching to pitching later in their careers, they could potentially preserve their shoulders and elbows. Many worry that all of those years of not pitching will put the player behind the ones who have always pitched, but that is debatable. Legendary pitcher Greg Maddux reportedly has said that kids either have the ability to pitch or they don't. In other words, if the kid has natural ability, teams and coaches will find and use it.

I've given talks to baseball coaches at different levels, and I've seen that many coaches don't want to hear that these kids are being overused. I can hear it in the tone of the questions and see the expressions on their faces.

I've dealt with parents who didn't want to believe they may be harming their children. Some parents seem to be more concerned with the child's future as a pitcher than with the child himself.

There are parents and coaches who are willing to risk injuries to young pitchers. They presume injuries and surgeries are part of the game.

Yes, there are orthopaedic surgeons, including me, who can operate on these pitchers. It's just unfortunate because throwing injuries in young athletes can be prevented.

Read more about pitching injuries and other sports medicine topics on Dr. Geier's blog at drdavidgeier.com.