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Sports Medicine | Apr 12, 2019

Youth sports have evolved significantly in the past 20 years, as competitiveness has skyrocketed and both children and parents seek ways to gain an edge. In the world of youth baseball, the drive to succeed from an early age has caused many to worry about the effects of intensive long term training by young athletes whose bodies haven’t yet completed growing.

One area of significant concern is baseball pitchers. Young arms can get literally worn out by repetitive motion, leading to more and more young teenagers requiring a major surgery before they even reach the big leagues.

Tommy John surgeries in 15-19 year-olds are becoming common

Tommy John, the four-time All-Star baseball pitcher whose name has been attached to UCL reconstructive surgery, stated in his 2018 AARP article that more than half of all “Tommy John” surgeries were now being performed on kids between the ages of 15 and 19.

This is disturbing to the renowned baseball player, who says he was a major league player for longer than a decade before enough damage was done for him to become the poster child for a then uncommon procedure in the ‘70s.

“One in 7 of those kids will never fully recover,” he says, pointing out that young athletes of today fail to diversify their sports interests, instead focusing in on one to the detriment of their bodies.

Overuse injuries cause teens to need UCL restoration surgery

The available research on UCL tears in teens all points to overuse as the principle risk factor. The following problems may also be present, but are typically contributing factors only, not the root cause of UCL tears:

  • Poor pitching mechanics
  • Poor physical fitness
  • Frequent curveball throwing

An adolescent pitcher may lack the physical development, neuromuscular control, and proper coaching instruction for prolonged pitching, and trying doggedly to master fastball mechanics can lead to sharp or chronic pain, which can be the sign of a tear.

How to Help Prevent UCL Tears

Excessive pitching is one of the primary causes of a UCL tear. Limit pitch counts in total (across days, weeks, leagues and practice)

  • Use the MLB’s Smart Pitch guide, and restrict innings to 100 maximum pitched in any calendar year. Follow limits for pitch counts and rest days, and avoid pitching on multiple teams with consecutive or overlapped seasons.
  • Allow 2-4 months a year off from any sort of overhead throwing, and another 4 months a year with no competitive pitching

While adhering to pitch counts can help, they are only enforceable on the field, and only vertically, meaning a child who plays in multiple leagues or plays multiple games in a day is at risk, as are children who practice for hours outside of formal coaching. Parents should watch for signs of fatigue, including the following:

  • Increased time between pitches
  • Elbow dropping during pitching
  • Player’s trunk upright during pitches
  • Decreased ball velocity and accuracy

If a pitcher complains of fatigue or pain in the elbow or shoulder, pitching should be discontinued until they have been evaluated by a sports medicine physician. Contact Strasburger Orthopaedics for a consultation if your young athlete is having shoulder pain after pitching.