Abstract & Commentary
Synopsis: Increased pitches per game and per season, as well as throwing curves or sliders, were associated with increased incidence of shoulder and elbow pain in young players.
Source: Lyman S, et al. Am J Sports Med. 2002;30:463-468.
Elbow and shoulder pain is thought to be an early sign of injury to a pitcher’s arm. Some elbow pain can be a sign of permanent injury to the elbow and may prematurely end a child’s throwing career. This prospective study evaluates the association between pitch counts, pitch types, and shoulder and elbow pain in Little League pitchers. Approximately 450 young baseball pitchers were followed for one season and throwing data were collected. Half of the pitchers experienced elbow or shoulder pain. Pitchers throwing a curveball were associated with a 52% increased risk of shoulder pain and those throwing a slider were associated with an 86% increased risk of elbow pain. Additionally, a significant association between the number of pitches thrown in a game and during the season and the rate of elbow pain and shoulder pain was identified.
Lyman and colleagues conclude that pitchers in this age group should be cautioned against throwing curveballs and sliders because of the increased risk of elbow and shoulder pain. Limitations on both the number of pitches thrown in a game and during a season can reduce the risk of pain.
Comment by James r. Slauterbeck, MD
Little League baseball is exciting to participate in, to watch our kids play and to coach, but poor throwing techniques can be injurious to kids’ elbows and shoulders. Sore elbows, ice packs, and Tylenol are common maladies of the game but may have long-lasting effects on the children pitching in youth baseball.
Although this article does not address the association between curveballs and sliders and apophysieal or epiphyseal elbow radiographic changes resulting from throwing errors, an association between certain pitch types, number of pitches, and pain were identified. It is important that Lyman et al take the next step to identify if pitchers throwing breaking balls are more likely to sustain career ending or modifying injuries.
For now this article should serve as a possible warning among those physicians and parents who have or are responsible for Little League pitchers on the mounds. We should consider meeting with the local Little League officials and present suggestions to the leagues as to increased pitching limitations. Some of the recommendations in this article may be a bit stringent but certainly offer a platform for discussion. Maybe it is time to revisit the current throwing limitations placed upon our future Major League pitchers to make the game safer. Perhaps a solution may be to place a limit the number of pitches in a game and season and have youth pitchers perfect an off speed pitch like the change up over the curve ball or slider.
Dr. Slaughterbeck, Associate Professor, Department of Orthopedic Surgery, Texas Tech University Health Sciences Center, Lubbock, TX, is Associate Editor of Sports Medicine Reports.
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