WHY DOES MY ELBOW HURT?

Baseball-related elbow injuries are becoming too common an occurrence, and are frequent reasons baseball players seek medical attention. Elbow injuries start at the younger levels, and develop into career-ending injuries at the high school, college, and professional levels. Understanding what causes these injuries will pay off when athletes get to their teen and adult years. By maintaining proper strength, conditioning and biomechanics, and by monitoring pitch counts, athletes will be more likely to avoid elbow injuries.

Poor Strength and Conditioning

Many young athletes lack a general understanding of proper techniques that will prepare their bodies to compete. Conventional wisdom argues that working out is bad for pitchers. Science has proven otherwise. In order to compete and throw at high velocities, pitchers must be just as strong as any other athlete on the field. Due to the complexity of the pitching movement there often are muscle groups that get neglected. Rotator cuff and hip mobility/strength are often overlooked, but are crucial in maintaining healthy elbows.

Rotator cuff strength is crucial in maintaining a healthy elbow, more precisely a healthy Ulnar Collateral Ligament (UCL). This is the ligament that needs “Tommy John” surgery to repair. A report in the International Journal of Sports Physical Therapy shows that changes in rotator cuff strength are associated with elbow injuries in baseball throwers. The study found that players with Tommy John injuries had a “30% deficit in ER rotator cuff strength, compared to the throwing arm of healthy players” (Garrison).

Hip strength and mobility is crucial in providing a good base for the shoulder and elbow to effectively generate force to the ball. Weak hips with low mobility make it difficult to create scapular upward rotation. Bilateral differences in shoulder total rotation and flexion have a significant effect on the risk of elbow injuries in pitchers (Wilk).

This evidence suggests that rotator cuff strength and full hip rotation mobility are required for healthy overhead throwing, and that flexibility and strength training targeting these parts of the body should be a part of any thrower’s strength and conditioning program.

Poor Biomechanics

Poor biomechanics negatively impact throwers on every front. A common faulty movement pattern called “early trunk rotation” is caused by poor biomechanics. High velocity pitchers do not start trunk rotation until their front foot lands. They are actually rotating the trunk against the hips, to build more torque and give the body more time to transfer the energy from the lower body to the upper body. By rotating the trunk early they cut off all the energy from their lower body, and put their elbow in a susceptible position for injury. A report by the Orthopedic Journal of Sports Medicine found that “early trunk rotation was associated with significantly elevated risk of injury requiring surgery”(Douoguih). Fixing this biomechanical flaw will increase health and performance.

Overuse

Overuse of pitchers by coaches has become one of the leading causes of injury in player’s elbows. Research by Dr. James Andrews of the American Sports and Medical Institute (ASMI) looks into Ulnar Collateral Ligament (UCL) reconstruction surgery in high school players, and why elbow injuries occur. The risks included year-round throwing, seasonal overuse, and event overuse. Year-round overuse is when an athlete pitches throughout the year without recovering the shoulder, elbow strength and range of motion. Seasonal overuse is throwing too much over the course of a season. Event overuse is pitching too much within one game. This research illustrated that “85% of patients demonstrated at least one overuse category” (Petty, Andrews).

In order to prevent year-round overuse, athletes should take time off from competitive throwing for a few months every year. Seasonal overuse can be avoided by leaving adequate time in between pitching performances to recover from fatigue, and possible ligament and muscle damage. To prevent event overuse, pitchers should be put on strict pitch counts, so they don’t throw too many pitches in each outing. It is important for these counts to be strict, because five to ten pitches here and there means nothing in the short term, but over the course of a career these extra “few” throws could make the difference. With that being said, all of these numbers should be individualized to each player’s body size, strength, and mobility.

Conclusion

With the increasing competitiveness of youth baseball, more athletes are being evaluated and treated for a variety of elbow injuries. Studies have shown that the incidence of elbow pain in baseball players is between “20% and 30% for 8 to 12-year-olds, approximately 45% for 13 to 14-year-olds, and over 50% for high school, college, and professional athletes” (Feeley).

Don’t be another statistic; athletes should not leave their career to luck. There are many things they can start doing today that will decrease their risk of injury illustrated above. At the end of the day it is their career. Athletes need to take control, and start putting in the work before it is too late.

References

Douoguih, Wiemi A., et al. “Early Cocking Phase Mechanics and Upper Extremity Surgery Risk in Starting Professional Baseball Pitchers.” Orthopaedic Journal of Sports Medicine, vol. 3, no. 4, 2015, p. 232596711558159., doi:10.1177/2325967115581594.

Feeley, Brian T., et al. “When Is It Too Early for Single Sport Specialization?” The American Journal of Sports Medicine, vol. 44, no. 1, 2015, pp. 234–241., doi:10.1177/0363546515576899.

Garrison, J. Craig, et al. “Baseball Players Diagnosed With Ulnar Collateral Ligament Tears Demonstrate Decreased Balance Compared to Healthy Controls.” Journal of Orthopaedic & Sports Physical Therapy, vol. 43, no. 10, 2013, pp. 752–758., doi:10.2519/jospt.2013.4680.

Petty, Damon H., et al. “Ulnar Collateral Ligament Reconstruction in High School Baseball Players.” The American Journal of Sports Medicine, vol. 32, no. 5, 2004, pp. 1158–1164., doi:10.1177/0363546503262166.

Wilk, Kevin E., et al. “Deficits in Glenohumeral Passive Range of Motion Increase Risk of Elbow Injury in Professional Baseball Pitchers.” The American Journal of Sports Medicine, vol. 42, no. 9, 2014, pp. 2075–2081., doi:10.1177/0363546514538391.