Excessive Throwing Puts Baseball Players at Risk

Year-round pitching can lead to devastating injuries for baseball players. A Michigan Medicine orthopaedic sports medicine surgeon and researcher explains why research on the subject is valuable to athletes of any sport.

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Author | Kylie Urban


When the pros take the field next week for opening day and the return of Major League Baseball, many of the sport's Little League and high school athlete counterparts also will be back in action.

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With that, however, comes a hazard that doesn't discriminate by a player's age or skill level: musculoskeletal problems tied to excessive pitching.

"We're seeing patients as young as 8 years old with injuries they have sustained from overusing their arms in baseball," says Michael T. Freehill, M.D., associate professor of sports medicine and orthopaedic surgery at MedSport, part of the University of Michigan Comprehensive Musculoskeletal Center.

Freehill is no stranger to baseball — he played professionally for eight years, first with the California/Anaheim Angels organization and later the Texas Rangers organization before retiring to pursue medicine and his career as an orthopaedic surgeon specializing in shoulder and elbow injuries.

He recently joined the faculty at Michigan Medicine from his position as medical director of sports medicine at Wake Forest University. He will serve as a sports medicine team physician to U-M Athletics, including the baseball team, and the Eastern Michigan University baseball team, in addition to seeing patients.

Freehill and colleagues see arm injuries from baseball athletes of every age, but one position on the field stands out: pitchers. That disparity has compelled him to conduct research on the dangers of overuse injuries.

He spoke recently about the ongoing work and how it might keep players safe.

For those who aren't avid baseball fans, what defines a player's pitch count?

Freehill: The pitch count is the number of pitches a pitcher throws in one game.

Unfortunately, I always point out that the pitch count isn't always representing the full picture of how much a player is throwing. For example, how much is a pitcher, at any age or athletic level, throwing during warmups before they even hit the mound? How about the throwing in between innings, etc.? All these throws and pitches add up and should really be considered in deriving a safe and effective total pitch count.

Why does a pitch count matter to an athlete?

Freehill: A player's pitch count is essentially showing how much they are using their shoulder and arm over and over again in a particular game. This is of importance because as a thrower fatigues, the muscular or soft tissue contributions become less effective at protecting the arm. The ulnar collateral (Tommy John) ligament will see more of the stresses of throwing when the muscles fatigue, thus increasing the potential for injury.

Why does a pitch count matter to a physician?

Freehill: We see overuse injuries all the time, and not just in baseball athletes. Overuse injuries are common in all sports.

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In fact, it was presented at team physician day at the Major League Baseball winter meetings in Washington, D.C., this past year that sports specialization increases the likelihood of injury. What is of more interest is that sports specialization does not seem to demonstrate an increased chance of those athletes reaching higher levels in that particular sport. In fact, some major league organizations do not look at single-sport athletes on their draft board. At least through high school, they want to see a better, healthier and well-rounded athlete.

Why should a subject like pitch counts be studied?

Freehill: Unfortunately, there isn't a large repository of literature or research with high-level evidence regarding pitch counts, mechanics and the overuse phenomenon. As researchers and physicians, we know these throwing injuries are not only occurring, but are becoming increasingly common based on what we are consistently seeing in clinic. However, the most precise methods to avoid these injuries are difficult to pinpoint other than what we believe to be throwing too much.

Dr. James Andrews, an orthopaedic surgeon and founder of the American Sports Medicine Institute, has been a leader in the field and has made strides in trying to help alleviate these throwing injuries in young athletes by looking at pitch counts and suggesting general guidelines. This is a great starting point, and now it is up to us to continue to research and increase the level of evidence with well-designed studies with strong methodology. This research would allow us to further modify pitch counts and amounts of throwing to protect the young athletes, yet allow them to develop their arms to be competitive baseball players.

Throwing and baseball research is difficult because there is some discrepancy where the science side doesn't quite understand the nuances of throwing, and the baseball side doesn't understand the nuances of anatomy and injury process. If we can bring the two sides together, it will lead to more comprehensive knowledge with the ability to prevent more arm injuries, while hopefully maximizing throwing productivity and effectiveness.

You have been researching the subject for several years. Will you continue that research at U-M?

Freehill: My previous work has mainly been focused on professional pitchers and NCAA Division I athletes.

I look forward to working with the excellent team here at the University of Michigan to expand this type of research to throwers of all ages to make a broader impact.

What should parents and athletes keep in mind to avoid these injuries?

Freehill: I feel the best advice we can give kids at this time is to play multiple sports. Allow them to develop as athletes. With time, they will perhaps become more specialized in one sport, but that should not occur before high school. A great reference for parents with guidelines and recommendations for amounts of throwing and rest can be found at the MLB Pitch Smart website.

More Articles About: Industry DX Sport Injuries Injury Prevention Sports Medicine & Fitness Bones and Muscles and Joints (Orthopaedics)
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