Elbow Injuries Up in Youth Baseball. Are Coaches to Blame?

LAS VEGAS — Pitchers and their parents beware: Elbow injuries are on the rise in youth baseball, and many coaches aren’t bothering to prevent players from overdoing it, a pair of new studies suggest.

“Very few coaches were tracking pitches as recommended by the American Sports Medicine Institute. Meanwhile, only 13% of coaches were able to identify risk factors for overuse injuries while being aware of the benefit of off-season strengthening,” said resident physician Derrick M. Knapik, MD, of the University Hospitals Cleveland Medical Center, in an interview with MedPage Today.

Knapik was lead author of a study into coach awareness of pitch counts, presented here at the annual meeting of the American Academy of Orthopaedic Surgeons. Another study reported at the meeting showed an increase in elbow injuries among young baseball players even as rates of other injuries sharply declined.

For the pitch count study, researchers sent anonymous 13-question surveys to 82 youth baseball coaches in the Cincinnati and Cleveland metro areas. Sixty-one of the coaches (74%) returned the survey. Nearly all said they coached male athletes (89%), and most (51%) coached children ages 11-12.

Most of the coaches — 56% — said they “always” counted pitches. But many of those weren’t tracking pitches in line with American Sports Medicine Institute guidelines. In all, 92% of respondents were noncompliant with those guidelines, Knapik reported.

Among other things, the recommendations urge coaches to “watch and respond to signs of fatigue (such as decreased ball velocity, decreased accuracy, upright trunk during pitching, dropped elbow during pitching, or increased time between pitches). If an adolescent pitcher complains of fatigue or looks fatigued, let him rest from pitching and other throwing.”

Also, 56% of coaches didn’t follow the USA Baseball Medical and Safety Advisory Committee’s age-based guidelines (published in 2006) regarding the number of pitches that kids ages 9-14 should pitch per game, week, season, and year. And 15% didn’t comply with the committee’s recommendations against throwing breaking pitches (curveballs and sliders), which have been linked to more elbow and shoulder pain.

Only 38% of coaches said they’d benched a player because of overuse injury.

When asked why they didn’t follow guidelines suggesting they track pitches over a variety of time periods, “the majority reported a lack of desire to perform the task of pitch counting,” Knapik said. He called this “the most concerning finding from the study.”

Going forward, parents and athletes need to be taught the importance of pitch counts, Knapik said. They can “assume some degree of responsibility in monitoring pitch counts. However, we believe the majority of the responsibility rests with the coaches.”

In the second study, resident physician David Trofa, MD, of Columbia University Medical Center in New York City, and colleagues, retrospectively analyzed injury data among baseball players age 18 and younger from the National Electronic Injury Surveillance System. They examined the years 2006-2016, when an estimated 665,133 baseball injuries occurred.

While numbers of ankle, knee, wrist, and shoulder injuries all declined by roughly 20%-25% in the 10 years, elbow injuries grew by approximately 30% (P<0.05).

“Given that a large proportion of elbow injuries in adolescent baseball players are due to overuse,” the authors wrote in their abstract, “these findings underscore the importance of developing strategies to prevent elbow injuries and ensure the safety of youth players.”

Pitch counts may not be enough to reduce overuse injury, said John Nyland, DPT, SCS, EdD, athletic training program director at Spalding University in Louisville, Kentucky, in an interview with MedPage Today.

He suggested also monitoring time spent batting and even fielding, since “the elbow is not solely stressed by repetitious throwing, but also by high-volume gripping of the ball and bat.”

Baseball players, he added, should “participate in regular upper extremity stretching, apply an ice massage application post-practice for 5-7 minutes, and eat a proper diet with sufficient dairy products and vitamin D. Avoid early sport specialization in general, and never play any sport for more than eight months without breaks or changing to sports with differing loading patterns.”