Physicians Warn of Overuse Injuries in Young Athletes

Orthopedic sports medicine specialists report an increase in the number of overuse injuries they are treating in young athletes, especially those in throwing sports such as baseball, softball, and football.

"We are definitely seeing more cases of overuse injuries in young athletes," reports Champ L. Baker, Jr., MD, president of the American Orthopaedic Society for Sports Medicine (AOSSM) and an orthopedic surgeon based in Columbus, Georgia, where the new Little League World Champions, the Columbus Northern Little League team, also reside. "In nearly every youth sport across the board, these kids are being pushed harder and longer to succeed at a level that is not compatible with their growth and development. As a result, they are sustaining the same injuries as older players, but at a much younger age."

"We don't want little Johnny to end up like Tommy John," Baker says, referring to the former major league pitcher who had ground-breaking reconstructive surgery on his elbow over 30 years ago. (The procedure, ulnar collateral ligament reconstruction, is more colloquially known as "Tommy John surgery.")

Overuse Injuries Compromise Future Ability

Overuse injuries generally result from repetitive wear and tear on joints, bones, muscles, and many of the soft tissues in the body. Overhead throwing athletes are especially susceptible, as rotational speed in the shoulder may exceed 7,000 degrees per second. The stresses and velocities are among the highest recorded in human biomechanics, and the effects of those forces on developing bodies make the younger athlete more susceptible to overuse injury.

A study of 130 adolescent pitchers published in the June 2006 issue of The American Journal of Sports Medicine found that injured throwers pitched significantly more months per year, more games per year, innings per game, pitches per year and warm-up pitches before a game. They were also more likely to be starting pitchers and those who pitched with higher velocity (greater than 85 mph) and threw more often with arm pain and fatigue.

"The overriding factor for risk of injury is overuse," concludes orthopedic surgeon James R. Andrews, MD, of Birmingham, Alabama, one of the study's co-authors. "The type of pitch thrown, pitching mechanics, and size and age of the pitcher were not as significant as the frequency of pitches, regardless of where they were thrown: in practice, competition, or exhibitions. The group of injured pitchers in our study were throwing more often, pure and simple."

Andrews and co-authors recommend adolescent baseball pitchers avoid pitching more than 80 pitches per game, avoid pitching competitively more than eight months per year, and avoid pitching more than 2,500 pitches in competition per year.

"I see hundreds of young athletes in our clinic whose tremendous athletic ability has been compromised, or even cut short, because their musculoskeletal systems have not had a chance to mature," Andrews says. "'Swifter, Higher, Stronger' [the Olympic motto] really shouldn't apply to adolescents. Guidelines to protect these young athletes from overuse injuries have been developed based on numerous scientific studies that prove these kids are being damaged by asking them for too much too soon."

Guidelines Protect Young Players

To protect all young athletes, sports medicine specialists recommend coaches adhere to guidelines promulgated by the various organized youth sports leagues. Youth baseball is "catching" on: beginning with the 2007 season, Little League Baseball will require the monitoring of pitch counts for pitchers in all its divisions. Pitches allowed per day will range from 75 for ages ten and under to 105 for ages 17-18. Periods of rest are also mandated in the new rules.

In May 2006, the USA Baseball Medical & Safety Advisory Committee issued new guidelines which also recommend limits on pitches thrown per age, but goes one step further than the Little League's requirements by addressing specific types of pitches that can be thrown safely by youngsters; e.g., breaking pitches such as curve balls and sliders should not be thrown until skeletal maturity.

The American Orthopaedic Society for Sports Medicine (AOSSM) has produced a booklet for parents, coaches, athletic trainers, and others interested in learning more about preventing injuries in young throwers. "Prevention and Emergency Management of Youth Baseball and Softball Injuries" is available as a free download from the AOSSM website: www.sportsmed.org

"It's exciting to see these young players succeed, and winning the Little League World Series is a remarkable achievement for any team," says AOSSM President Baker. "But we, both as fans of the game and as healthcare professionals, want to see these kids develop into healthy players who are still enjoying and playing the game years from now. We want them to reach the big league with their bodies intact."

Physicians Warn of Overuse Injuries in Young Athletes

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Physicians Warn of Overuse Injuries in Young Athletes

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Northwestern Offers New Blended Learning Programs

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