Little League Baseball Can we make it safer?
Carl W. Nissen, MD
Is there a problem?
Injury rate rising at epidemic rates
2000 vs. 2004
6 fold increase – Birmingham, Al 7 fold increase – Gainesville, Fl 10 fold increase – Hartford, Ct
10 years ago – Shoulder and elbow surgeries in skeletally immature throwers was virtually unheard of
Phases of Throwing
Pitching Biomechanics
Phases of Pitching
Wind-up Stride Arm Cocking* Arm Acceleration* Follow-through
Pathomechanics
Overall motion lasts 2 sec Injury occurs between late cocking and deceleration phase of throwing Injury occurs in less than ¼ of that time
Possible Problems
Shoulder
Rotator cuff tendinitis
Internal impingement Partial tear Rotator cuff strain
Elbow
OCD Impingement lesions UCL sprain
„Tommy John‟
Pitching Biomechanics
Early cocking
Mostly a function of shoulder activity Few elbow related problems seen here
Scapular (shoulder blade) muscles tilt glenoid superiorly to match abduction of humerus
Pitching Biomechanics
Late cocking
Shoulder
Anterior shoulder structures on maximal tension Body position – both stable and coiled – important
Elbow
Elbow is flexed to 90 deg Moderate valgus force exists
Need strong CORE muscles and good flexibility
Pitching Biomechanics
Concerns seen during late cocking
Scapular dyskinesis (leads to low elbow) Anterior instability (leads to internal impingement) Hyperangulation
Pitching Biomechanics
Acceleration
See high angular rotations about shoulder
Internal rotation: 7600 deg/sec
See high angular rotations and forces at elbow
Elbow rotation: 2500 deg/sec Elbow valgus stress: 60N
Pitching Biomechanics
Concerns seen during acceleration
Poor elbow position
High UCL strains
Unstable base and/or over extended spine
Leads to arm throwing
Overuse
Excessive use of muscle group(s) that are not conditioned for the intended action and pain and dysfunction result leading to poor performance
Overuse Treatment
Shut down pitching activities „Active rest‟ Establish normal motion and strength Interval throwing program
Injury Etiology
Largerly unknown Multiple theories
Wrong pitches Too many pitches Improper coaching Under developed arms
Much controversy
Pitch Recommendation
USA Baseball
Prior to age 14
Fastball and Change-up only
After age 14
Curveball permitted
After age 16
Slider permitted
Pitch Counts
USA Baseball
Position statement 2004
Game Age 9-10 Age 11-12 50 75 Week 75 100 Season 1000 1000 Year 2000 3000
Age 13-14
75
125
1000
3000
Fatigue Study Example
Little League pitchers
Age 14
Pitched simulated game
65 pitches approved as per printed literature
Uninvolved observer one day
Average live pitches (>75% effort)
105 !!!
Baseball Folklore
„Rubber arms‟ Curveballs are stressful Surgery or injury leads to loss of „pop‟ and makes pitchers throw „junk‟
Recent Literature
No kinematic and kinetic differences between curveball and fastball
College age pitchers AJSM March 2006
Lower elbow stresses throwing curveball vs. fastball
College pitchers AOSSM 2005
Prevention
Off-season
Have one
Cross training
Other sports CORE exercises
Lifting in-season
Low weight – High repetition
Prevention
Stretching
Tightness can be relative Loss of 10 degrees in shoulder rotation is significant
Prevention
No multiple teams Pitches aren‟t just thrown with a batter in the box “Resting” your pitcher doesn‟t mean catching or playing third base Stop at any signs of fatigue or pain
Prodrome almost always present
Signals
Loss of control More time between pitches Harder to warm up Bouncing pitches
Shoulder
Sailing pitches
Elbow
Thank you