From the first inning of tee-ball to the Little League World Series, spring and summer baseball is a worldwide right of passage. But in their attempts to throw farther and faster, millions of Little Leaguers risk arm and shoulder injuries.
"Little Leaguers often throw over 100 pitches per game -- almost twice that of a professional pitcher -- placing substantial stress on a developing arm," says physical therapist Bob Gorinski, DPT, clinic director of First Choice Rehab in Bowmansdale.  Gorinski, whose office sponsors a local Little League team, says "larger and more mature kids sometimes use their strength to compensate for poor pitching mechanics, and may be trading six innings of domination for years of elbow and shoulder problems."

Pitchers run the greatest risk of injuries resulting from improper mechanics and overuse, leading to a condition known as "Little League Elbow," a chronic inflammation of the growth plate in the elbow joint. In his practice, Gorinski has seen children as young as 8 years old with this condition. "Pitchers who continue to pitch through the pain may eventually cause the growth plate to separate from the joint, requiring surgery to re-attach it," warns Gorinski.

Baseball's Safety Advisory Committee recommends that children 8 to 14 years of age learn to thrown only the fastball and changeup. Pitches that involve deviation and flexion of the wrist (curveball, slider, etc) should not be introduced until 14 to 16 years of age. "Little League Elbow comes with the throwing of too many curveballs too soon," adds Gorinski. "Younger pitchers lack the neuromuscular control and stability in their bones to withstand the forces placed across the elbow when throwing technical pitches."

Most Little Leaguers mistakenly throw with all the force coming from the arm instead of the trunk, observes Dr. Gorinski. "When a child comes to me with Little League Elbow, I tell him or her that the key to throwing harder is not only arm strength, but trunk, hip,... total body strength. Focusing on the arm without giving attention to the rest of the system often produces little or no lasting results."

Bob recalls a friend from his childhood: "I played baseball with my friend, Chris, beginning in T-ball. By high school, he was approximately 5-foot 10-inches and only 160 pounds. But he could throw very hard and with great control. His perfect throwing mechanics gave him a very successful career at a Division I college."

Shoulders are also in danger during pitching. Because the shoulder is the most mobile joint in the body, it is also the most unstable. The four muscles surrounding the shoulder, called the rotator cuff, are stressed during the acceleration and deceleration phases of pitching. To reduce the risk of injury, says Gorinski, it is important that the muscles of the trunk and posterior shoulder be strong and flexible.

The American Physical Therapy Association, (APTA),  recommends three important upper body stretches: the inferior shoulder stretch, the posterior shoulder stretch, and the rotator cuff stretch. "Once kids understand proper throwing mechanics, they need to concentrate on a pitching maintenance program that consists of strengthening, stretching, proper pitching rotation, and periods of active rest," Gorinski concludes.

Click here to view the exercises (.pdf)

PHYSICAL THERAPIST TIPS ON HOW TO AVOID ARM INJURIES

• Above all, teach young athletes to understand that pain is the first sign of a problem. Athletes of all ages should pay close attention to the early indications of overuse.
• Coaches should know and teach proper pitching mechanics, and work their players into pitching only after proper form is achieved.
• If possible, begin a strength and conditioning program at least a month before the season begins, placing particular emphasis on the muscles of the hips, trunk, upper back, and posterior shoulder.
• Carefully progress the frequency and intensity of throwing, especially in the early spring. Players should start with short tosses and gradually work up to throwing greater distances. Increasing the velocity should be the final step.
• If the shoulder or elbow is sore or tight, apply ice to the area for 10-15 minutes to help diminish pain, spasms, and inflammation.