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Baseball Injuries

Monday was Opening Day for the Brewers, which means that spring is finally here. In our physical therapy clinic, this is also about the time we start seeing an uptick in the number of high school and college baseball players who come to see us for elbow or shoulder pain.

So, why are shoulder and elbow pain so common in baseball?

Baseball pitch

 Baseball players, especially pitchers, typically have shoulders that are very flexible in external rotation (see picture to the right), which allows them to generate speed as they throw. Over time, they may develop stiffness into internal rotation (the opposite direction) due to tightness through the rotator cuff and other shoulder structures. This can lead to irritation and pain in the shoulder, as well as compensations at the elbow. In the cocking position (see picture to the right), the shoulder is stretched into maximum external rotation and there is also a lot of stress transmitted to the inside of the elbow. To tolerate this position hundreds or thousands of times over the course of a season, the arm needs a good balance of mobility of the joints and stability of the surrounding muscles. 

Overloading the arm with too many throws or throwing with poor mechanics can lead to injuries, especially in a growing athlete. Bones grow more quickly than muscles and this imbalance often leads to injuries near the growth plates of elbow or shoulder. Overuse can also lead to irritation and gradual tears of the rotator cuff muscles or labrum (cartilage) in the shoulder. Excess strain through the elbow can overstretch or tear the ligaments that stabilize the inside of the elbow. This is known as a “Tommy John” injury in baseball circles. If not caught early, some of these injuries may require surgery and a very long recovery.

How someone throws can also be a risk factor for shoulder or elbow injuries. Poor mechanics can lead to increased torque and strain through the shoulder and the inside of the elbow. A good pitching coach can identify throwing flaws and address them in order to prevent problems down the road. Learning good mechanics early on is much more effective–and safer–than waiting until there is a problem.

Preventing Injuries

Current research shows that a high number of pitches is one of the biggest predictors of having either shoulder or elbow pain. Baseball players between 9 and 14 years old were more likely to have shoulder pain if they threw more than 600 pitches throughout the course of the season and elbow pain with more than 800 pitches. In response to this research, Little League instituted pitch counts based off of the player’s age to avoid overtaxing growing joints. The following chart shows the maximum number of pitches allowed by age, as well as the recommended days of rest following a start.

Age                 Daily Max (Pitches) Required Rest (Pitches) Required Rest (Pitches) Required Rest (Pitches) Required Rest (Pitches) Required Rest (Pitches)
    0 Days 1 Day 2 Days 3 Days 4 Days
7-8 50 1-20 21-35 36-50 N/A N/A
9-10 75 1-20 21-35 36-50 51-65 66+
11-12 85 1-20 21-35 36-50 51-65 66+
13-14 95 1-20 21-35 36-50 51-65 66+
15-16 95 1-30 31-45 46-60 61-75 76+
17-18 105 1-30 31-45 46-60 61-75 76+

Information from http://www.momsteam.com/sports/baseball/safety/2014-little-league-baseball-pitch-count-limits-and-mandatory-rest-periods#ixzz4bPUpySeo

It is also important to gradually increase the amount of work the arm has to tolerate, especially at the beginning of the season, after injuries, or after time off. Gradually increasing the distance, speed, and number of throws over several weeks is important to avoid overtaxing the joints as they get used to the stress of throwing.

Along with gradually increasing the work on the arm, it is important to make sure that players, especially pitchers, have adequate rest. Pitching with a sore or tired arm is a significant risk factor for injuries. It is essential that pitchers have days off after starts to allow their arm to recover. Players that play on multiple teams may play year-round, never giving the arm sufficient time to rest and recuperate. It is recommended that athletes play their main sport a maximum of 9 months a year, as specializing in any sport year-round has been associated with a higher incidence of injuries. Players should have a 6-8 week recovery period following their season and focus on rest, off-season conditioning and injury prevention. This may also help with avoiding burnout.

Given the high demands on a baseball player’s arm, every player should have an exercise program that addresses their need for shoulder and elbow mobility and stability. A physical therapist can check for adequate range of motion and strength, take a look at the structures around the shoulder or around the elbow and develop a specific, individualized program to help keep the arm happy and healthy throughout the course of a long baseball season.

Sources:

Brotzman SB, Manske RC. Clinical Orthopaedic Rehabilitation: an Evidence-Based Approach – Expert Consult. 3rd ed. Philadelphia, PA: Elsevier Mosby; 2011.

Straus LB. 2017 Little League Pitch Count Limits and Mandatory Rest Rules. MomsTeam. http://www.momsteam.com/sports/baseball/safety/2014-little-league-baseball-pitch-count-limits-and-mandatory-rest-periods#ixzz4bPUpySeo. Published February 27, 2017. Accessed March 23, 2017.

Spinal Dynamics of Wisconsin - Milwaukee

Body Dynamics supports initiative to help injured professional basketball player from Milwaukee

Clinic discounts physical therapy services for grass-roots effort to assist former Washington High and Seton Hall athlete JR Morris and family

TO DONATE, SEND CHECK PAYABLE TO JR MORRIS FUND TO:
Gary Scott

3429 Vantage Lane
Glenview, IL  60026
Contact Gary at 847-767-0436 or gscott1740@aol.com

Wauwatosa, WI,  April 29, 2008 . . .  Body Dynamics, a Wauwatosa-based physical therapy clinic specializing in orthopedics, has proudly supported efforts to help a Milwaukee native, JR Morris, with challenges faced due to personal setbacks, including a serious knee injury misdiagnosed while trying out for a professional basketball team in Brazil and the sudden death of his sister.  During successful basketball seasons at Milwaukee’s Washington High School, Morris was a Nike All-American and a member of the Wisconsin Scholars AAU team.  He was heavily recruited by several prominent schools including UW-Madison and ultimately played as a guard for Seton Hall. Following seasons from 2002-2005, he left Seton Hall to pursue an NBA career which included sign-on with a Brazil-based team.

Upon learning of Morris’ series of misfortunes, including being stranded in Brazil in mid-2006, a grass-roots group spontaneously came together to help him resume his quest for a professional basketball career and procurement of a college degree.  The group includes many of Morris’ former teammates, Seton Hall alumnae and athletes, and basketball fans.  In addition to Body Dynamics which provided Morris’ physical therapy services, other Milwaukee-area supporters include Keith Bearden, head coach of the Wisconsin Scholars Basketball Club; Dr. Mary Meehan, president of Alverno College; Lakeside Diagnostics; and Mike Stefaniak, senior vice president of The Zizzo Group.

Because Morris had no health insurance, the group created the JR Morris Fund, sought to raise $15,000, set out to arrange for appropriate diagnosis, surgery and rehabilitation, and negotiated with health providers for discounted rates.  Wauwatosa-based Body Dynamics provided three months of discounted physical therapy following a July 2007 knee surgery performed by a Chicago-area physician. 

“Body Dynamics heard JR’s story and didn’t hesitate to consider our involvement,” says Cheryl Timmer, the clinic’s lead therapist.  “We were pleased to join in this sincere, grassroots effort to help someone from our community.  We are happy to support his hard work to return to the sport he loves, and especially proud of his efforts to give back to his community and those who helped him.  He worked diligently to rehabilitate his knee and has promise for a bright future.”

Following surgery while living at his parents’ North side home, Morris spent significant time volunteering with the Boys and Girls Club of Milwaukee, the Milwaukee Community Center, and the Wisconsin Scholars AAU team. 

“JR wants to emulate for others what is being done for him by hundreds of supporters, fans and friends around the country.  He has stated that he wishes to reinvest a portion of his future professional basketball earnings and seeks to establish a committee to help with this effort,” says Gary Scott who helped spearhead group’s efforts.  “We believe in our philanthropic efforts to exceed our financial goal, and are very proud of this young man.  While JR is from limited resources, the entire Morris family has shown a strong work ethic.  They inspire us with Christian values and practice despite their significant tests of faith.” 

“It’s like starting a new life, a fresh start for me,” Morris shared recently with members of the group.  “It’s really a blessing. I never expected anything like this.”

In February 2008, Morris joined the Pennsylvania-based Reading Railers, one of 10 teams that make up the Premier Basketball League, a first-season professional basketball organization.  In March, the Railers advanced to the league’s Eastern Division Championship game, finishing 12-10 on the season.  Morris’ late-season addition to the Railers helped the team win 10 of its last 13 games.  The team’s coach commended Morris for his personal skills and team-focus.  (NOTE:  former Milwaukee Bucks player Todd Day coaches another team in this league.)
Morris, 25, has recently returned to the Milwaukee area to live.  He continues volunteer work, has recently become engaged, and is seeking opportunity to again join a professional team, perhaps in Latin America.  His plan is to return to the Reading Railers in the Fall for their 2008-2009 season.

Body Dynamics, a division of Spinal Dynamics of Wisconsin, was identified as a possible source for Morris’ rehabilitation following an internet search for an orthopaedic physical therapy specialist by a Texas-based physical therapist.  A friend of Morris and former Rufus King basketball player, she became aware of roots efforts to help him.  Body Dynamics’ Timmer, who graduated from Marquette University’s physical therapy program, has significant experience working with extremity and sports injuries for recreational and professional athletes including members of the US Olympic Speed skating team, elite gymnasts, and Birkebeiner skiers.

The group continues to raise money for the JR Morris Fund.  For information about donating, please contact Body Dynamics at 414-302-4609 or visit their Web site atwww.sdwpt.com.

About Body Dynamics
Body Dynamics, a division of Spinal Dynamics of Wisconsin at 2300 N. Mayfair Road in Wauwatosa, delivers outpatient physical therapy services with specialized focus extremities and sports medicine. The clinic serves people of all ages and athletic abilities, addressing orthopedic needs such as basic or complex biomechanical dysfunction, extremity injuries, post-surgical therapy, overuse injuries, foot pain and more.  Sport-specific consultation, exercise recommendation and physical therapy are available for numerous sports including cycling, throwing, gymnastics, golf and running.  Additional information available at www.sdwpt.com or 414-302-4609.