With one pitch, a baseball team can watch its hopes for a World Series championship evaporate.
In the current spring training alone, Atlanta Braves pitchers Brandon Beachy and Kris Medlen, A's opening-day starter Jarrod Parker, Diamondbacks ace Patrick Corbin, Royals reliever Luke Hochevar, and San Diego Padres starter Cory Luebke have all gone down to season-ending elbow injuries.
All of them will require Tommy John surgery. For Medlen, Beachy, Parker and Luebke, this will be the second time they undergo the procedure.
Perhaps more worrisome, though, is the trend for younger pitchers to be increasingly shut down by these injuries. Dr. James Andrews has reported increases in the shoulder and elbow surgeries he has performed in recent years. Specifically for elbow surgeries, like the Tommy John operations faced by the pros above, he has seen a four-fold increase in those operations among college pitchers and a six-fold increase for high school pitchers.
A survey performed at sites across the country aimed to determine the risk factors for shoulder and elbow injuries among youth pitchers. Researchers surveyed pitchers between the ages of 9 and 18 and asked questions about their pitching behaviors over the previous 12 months. Specifically they looked at risk factors thought to be associated with injuries, like pitching year round, playing catcher on non-pitching days, and playing only baseball.
The survey, recently published in the American Journal of Sports Medicine, reveals four worrisome trends among youth pitchers. It is easy to get lost in the statistics, but they all have one underlying theme.
1. Pitching for multiple teams with overlapping seasons.
More than 30 percent of the kids pitched for multiple teams in the same season. Not surprisingly, these young throwers were more than three times as likely to develop arm fatigue and almost twice as likely to experience arm pain.
2. Pitching on consecutive days.
Young players that threw on back-to-back days had more than four times greater risk of arm tiredness and 2.5 times greater risk of arm pain. Nearly 44 percent of young pitchers threw on consecutive days in the previous 12 months.
3. Pitching in multiple games in one day.
Only 19 percent of kids pitched multiple games in a day. That's fortunate given that these pitchers had 89 percent greater odds of developing arm pain.
4. Pitching with arm fatigue or arm pain.
This practice is by far the riskiest for a young thrower, and it's the reason the first three behaviors are problematic. The odds of suffering a pitching injury among young pitchers who often threw with tired arms were almost eight times greater than for kids who never pitched with arm fatigue.
Likewise, compared to pitchers who never threw with arm pain, the kids who often pitched through pain were 7.5 times more likely to suffer an arm injury.
Despite the risks, 69 percent of kids in the survey said they often or at least sometimes pitched with tired arms, and 38 percent did so with arm pain.
The prevailing message in all of these risk factors is overuse. Injuries occur when kids do too much too soon, without enough time to rest and recover. Overuse is especially risky in kids who haven't hit puberty. Their bones are still growing and are especially weak at the growth plates. They also lack the muscular stability of the shoulder and elbow that older pitchers have. Kids can suffer injuries with repeated stress over time.
The good news is that these are correctable problems. The first three risks - pitching for multiple teams in the same season, pitching on consecutive days and pitching multiple games in one day - are easily avoided. They just require common sense. Pitch for only one team per season and rest between outings.
The last risk factor could be more challenging because it is rooted within the culture of sports - no pain, no gain. We know kids often deny symptoms in order to play. We know that coaches and parents often push kids to play through pain in order to win or succeed now at the risk of injuries down the road.
This study is clear. Kids are much more likely to suffer serious arm injuries pitching with arm pain or with a tired arm. We need to keep the long-term health of the pitcher in mind and stop this practice.
Give young pitchers adequate rest when they're healthy and enough time to recover when they're tired or hurting, and we can keep kids on the mound and out of the operating room.
Dr. David Geier is an orthopaedic surgeon and sports medicine specialist in Charleston. For more information about baseball injuries and other sports medicine topics, go to his blog at drdavidgeier.com.
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