Wednesday, April 12

Youth baseball issues

As the days of spring grow longer and warmer, boys and girls throughout the country are taking out their balls, bats and gloves in anticipation of a new baseball season. From T-ball and Little League games to American Legion contests, youngsters of all ages will not only learn the important lessons of victory and defeat, they also may be getting their first chance to simply experience the sheer thrill of making solid contact with a pitch or running the bases. For many, this is when the game of baseball becomes a lifelong passion.

And though a kid's enthusiasm should not be discouraged, there can be a downside when a growing younger player throws too hard, too often, and with improper technique, or tries to throw types of pitches that his arm isn't ready for. Injured elbows and shoulders are frequently the result. "The growth plates in these joints bear the brunt of the stress on a young throwing arm", says Dr. David Lintner, a member of the Association of Professional Team Physicians (PTP) and team physician for the Houston Astros. "Proper throwing mechanics and a patient approach, both by teaching coaches and learning players, is so important (to prevent injuries)."

Join Dr. Lintner as he talks about the special considerations that younger baseball players may have and how best to nurture and protect a budding talent.

What are special considerations for younger arms?

Dr. Lintner: Most problems occur in the shoulder, upper arm and elbow and arise in younger arms primarily during growth spurts. For the most part, these injuries revolve around preadolescent growth plates. Growth plates are layers of cartilage inside the bone that generate new bone and this cartilage layer is significantly weaker than the surrounding bone. In addition to the normal muscle soreness that you'll see at any age with people who throw a baseball, we'll also see inflammation and possibly stress fractures through the growth plates. Also, the ligaments that stabilize the elbow are attached immediately adjacent to the growth plate and can actually pull a piece of bone off if subjected to enough stress. The growth plates in the shoulder and in the elbow are the areas of greatest concern because these joints bear the brunt of the stresses of throwing.

What can be done to prevent youth baseball league injuries?

Dr. Lintner: You can look at that from a few approaches. Skill-building is very important, particularly proper throwing mechanics-- keeping the elbow high and the shoulder closed. These things are usually taught at the higher levels and are important for performance at an older age, but at a younger age they are important for injury prevention. Sliding is another good example of the importance of teaching fundamental skills. It requires a lot of patience from a coach because it's hard to get a younger player to do what he has been instructed because he doesn't have the muscle control of a maturing adolescent. You can teach them the proper footwork for sliding, but they may have trouble from a physiological standpoint reproducing what they see. Also when they are watching TV or at a baseball game, young kids see a lot of professional players slide head first which, if improperly done, can be dangerous. At the young ages, they don't have the trunk strength or arm strength or shoulder strength to execute the slide compared to the larger muscle mass of an older player. They must be discouraged from sliding head-first and taught to slide foot first and taught correctly.

For most young children, it is not advisable or appropriate to have a supervised pre-season for a sport. As they start practicing early in the season, it is important that sound instruction is occurring from day one. When it is the beginning of the season, kids are excited and often very enthusiastic, so it should be emphasized that they should not overdo it, to not throw overly hard or they won't be able to throw tomorrow or the next day. You need to temper the kids enthusiasm and reinforce the proper techniques right off the bat, so to speak. Also, you need to limit the amount of throwing at the start and help them appreciate the idea of starting slowly.

One of the things that begins to be important as the child gets older, maybe 12 or thirteen is the overall conditioning of the player. If he's been active in other sports like basketball in the winter, it makes that spring transition to baseball a little easier. If he's been on the couch all winter waiting for baseball to start, you have to slowly increase his activity level before practice begins. But with active athletic kids, the biggest cause of injuries is over-enthusiasm by the kids and sometimes the coaches as well.

Q: I am a former swimmer, and am also involved in water polo as well as the martial arts. I am currently recovering from electro-thermal capsular shrinkage of my right shoulder. I am now 6 months post op. I also have instability in my left shoulder, nearly as severe as it was in my right shoulder, which prompted multiple separations and ultimately surgery. I want to know what I can do to increase strength in my shoulders to protect my repaired shoulder and also to avoid surgery on my left shoulder? And, is there anything in particular that I should be sure to avoid?
-- Paul Catenacci, Ann Arbor, Mich

A: From Dr. Bill Bryan, team physician for the Houston Astros:
"An aggressive "midrange" strengthening program should be started by the physical therapists who supervised your opposite shoulder rehabilitation. Otherwise you are probably headed for a thermal stabilization procedure given that your tissues are stretched out and can't be corrected with muscle strengthening. Good luck."

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What about the transition effects from one league to another as a youngster ages?

Dr. Lintner: It's a difficult situation because kids move from league to league not based on their ability, body size or talent but on their age. At age ten, some kids may be as developed as some fifteen-year-olds but others may be more like seven year olds. To lump them all together as an "average ten-year-old" is a difficult proposition. When someone is making the jump from a smaller diamond to a large diamond size, it can be problematic, especially for pitchers because now they have to throw farther from the mound to the plate but also harder because the batters are more skilled. As an unfortunate coincidence, many times the increases in field size occur at the same time as growth spurts when the growth plates are actively producing cartilage. You'll have a higher tendency to injury during the time of growth spurts just as the younger player is trying to throw harder. Most growth plate injuries happen during the 11 to 12 year old range where growth spurts are most common.

Should younger players throw curve balls?

Dr. Lintner: I don't think that the curveball or slider per se damages young arms. I would say that an improperly thrown breaking ball causes problems, not only in young arms but in seasoned arms as well. It's a somewhat controversial subject. I feel that a properly throw curveball is no more damaging to young arms than a properly thrown fastball. The trouble that most young kids get into with throwing the curve is that they radically change the mechanics of how they throw it, often dropping the arm sideways to try to spin the ball so it curves sideways putting enormous stress on the elbow. Whereas a true curveball is an overhead topspin motion, which should look very similar to a fastball except for the wrist motion. The key is teaching and practicing proper form from the beginning. This is an area where you really need a good coach schooled in the fundamentals of throwing. If you talk to major league pitchers, contrary to what you may hear in newspapers or other media, they will tell you that a curveball puts no more stress on their shoulder or elbow than a fastball. Other things, like velocity and number of pitches thrown seem to have more of an effect on shoulder and arm injuries than the type of pitch thrown.

How safe is the equipment that young players use?

Dr. Lintner: They are using softer balls for younger kids now called the RIF (reduced injury factor) and gradually increase the hardness of the ball as the child ages with the idea that a child is not quite so skilled at catching or at least deflecting the ball with his glove. So you reduce the incidence of injury by softening the ball so if it hits him in the chest or face, the impact is minimized. The trade off is that these balls tend to bounce more and grounders can come up at them more quickly. I think this is something that each individual league needs to address but I believe the softer balls are a good idea for the younger leagues.

Aluminum bats, which are under scrutiny in the college game for the velocity the ball gets coming off the bat, really aren't an issue in the younger leagues. But I think they do present the same problem in high school as they do at the college level.

There has been some good research showing that break-away bases are probably the best single thing across all leagues to minimize lower extremity injuries. If you slide into the break-away bases very hard or too late, they release and come out before your ankle is hurt.

Dr. David Lintner, a member of the Association of Professional Team Physicians (PTP), is a team physician for the Houston Astros. Dr. Lintner received his undergraduate degree from Cornell University in Ithaca, NY and his medical degree from University of Rochester. Dr. Lintner completed his residency in Orthopedic Surgery at Rochester and also did a fellowship in Sports Medicine and Arthroscopic Surgery at Baylor College of Medicine in Houston, Tex. He also currently is an Associate Clinical Professor in Orthopedics at Baylor.

The information, including opinions and recommendations, contained in this website is for educational purposes only. Such information is not intended to be a substitute for professional medical advice, diagnosis or treatment. No one should act upon any information provided in this website without first seeking medical advice from a qualified medical physician.

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