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Pearls and Pitfalls for high school baseball players: Developing your skills and preventing injury
The WBP™ High School to College Baseball Recruitment Planning Program
By Michael Q. Freehill, MD

Coaches, players, and parents are becoming more aware of the potential impact playing baseball for an extended period of time over the course of a year can have on an individuals’ potential for injury. Studies have suggested that playing baseball for more than nine months in a year increases the rate of upper extremity injuries in particular. This carries over to the intercollegiate athlete also as injury surveillance by the NCAA has demonstrated that shoulder and elbow injuries rank among the top two in terms of body parts injured for the baseball player. Many intercollegiate baseball players participate throughout the summer in wood bat leagues and a variety of other amateur leagues thereby extending their season for several months. 
 

It is the concern of both parents and athletes alike that if they do not play baseball year round that they will not be able to develop the skills needed to reach a higher level. This in fact goes against what multiple studies have demonstrated in terms of injury prevention and developing into a higher level player. One prime example is Joe Mauer, the 2006 American League Batting Champ. During his high school years, Joe was an all-state athlete in three sports; baseball, basketball, and football. He actually received a scholarship to play at Florida State University under Bobby Bowden as a quarterback. However, he elected to play in major league baseball as he was the number one draft pick by the Minnesota Twins, and ultimately he has developed into an all-star caliber catcher. A recent interview with his father indicated that he felt it was very important that Joe participated in multiple sports not only to develop skills in other areas, but because it made Joe a better all around
athlete.

We also know that pitchers who reach higher levels of competition frequently were not the players who were over-utilized in their little league or early high school years. If we carry this over to the intercollegiate arena, we know that major league baseball teams are frequently concerned about the impact the NCAA Division I pitcher of the year can have on the next level.

Frequently this pitcher has been overused through his collegiate course because he is effective and capable of winning multiple games. As such these pitchers frequently do not have a great impact on the major league level due to subsequent injuries and ultimately loss of playing time.

The article will outline strategies for developing baseball skills, but also preventing injury and identifying issues that may arise during a course of the season that may be indicative of problem.

Factors for Injury Risk

We have Dr. James Andrews to thank for extensive information regarding factors that can lead to greater injury rates in adolescent high school and collegiate baseball players. Many other authors have also provided information on youth baseball pitchers that can carry over to the high school and collegiate athletes.

In general the current recommendations are to play baseball no more than nine months per year. A more recent study indicated pitchers outside of other position players may be at risk if they play greater than eight months per year. One study that examined high school pitchers who had previous surgery indicated those who never had any surgical procedure pitched five and a half months or less per year while those who ended up having a surgical procedure pitched greater than eight months per year. These injury rates however do not appear to carry over to position players such as outfielders or infielders who have a tendency to throw significantly less during the season. Furthermore, playing in multiple showcases (the player may participate in multiple games over a few days) and playing in more than one league during the season are factors that lead to increasing injury rates.

More recently pitch counts have come into play in terms of injury prevention for pitchers. The Little League World Series recently adopted pitch counts; however these may be too liberal in terms of injury prevention. Studies monitoring injured pitchers have demonstrated that pitchers who average more than six innings per appearance and pitch more than eighty pitches per game are nearly four times at increased risk for injury requiring some type of surgical repair compared to pitchers who throw fewer than eighty pitches per game. Currently, USA Baseball recommends freshman, or fourteen year old pitchers, throw fewer than 75 pitches per game and fewer than 3,000 pitches per year. There is some concern that these may be too liberal and may not be adequate enough to prevent further injury.

Further studies have also demonstrated that injured pitchers throw harder and were more likely to be regular starters. Pitchers who threw greater than 88 miles per hour had a significantly greater increase of injury. Ironically this seems to correlate with the pitchers body habits as those who are taller or heavier have a tendency to throw with greater velocity. It is therefore recommended that parents and coaches watch closely the pitcher who may have developed physically earlier than his counterparts. This player may be at risk for further injury earlier in his career.

We’ve all seen the pitcher whose arm seems to dangle at his side and yet he continues to throw into the late innings as he may have a no hitter or shut-out in progress and does not want to give the ball. Studies have demonstrated that pitching despite arm fatigue is a major risk factor in injury to the player. A pitcher who regularly pitches despite arm fatigue is at 36 times the increased risk of injury compared to the player who does not throw when his arm is sore or fatigued.

Therefore, it is vitally important that the parents and coaches recognize when a young pitcher seems to having difficulty with arm fatigue or pain.
Unfortunately many of the studies revolve around the pitcher and few if any studies have been performed on the position players such as the infielder or outfielder. Many characteristics however can be carried over to the position player. It is still important to develop other skill sets and to develop other muscle groups in terms of preventing injury in the position player.

Injury Prevention

We’ve discussed the factors that may lead to injury in the baseball player, particularly the pitcher. The next question, however, is how to prevent additional injuries from occurring. One inquiry that frequently presents is what other sports should play during the off-season from baseball. In general, avoidance of over-head sports such as tennis or swimming is advisable. These are typically high repetition sports involving the upper extremity and can lead to additional injury as a result of the compounding factors from baseball. In terms of playing other sports, including contact sports like football or hockey, the athlete will have an opportunity to develop other muscle groups throughout the season that will carry over to the baseball season. This is very important for the explosiveness athletes can develop playing sports such as football, hockey, or soccer where quick acceleration, speed, and explosive movements are a necessity for success. This will carry over to the baseball season where players can often develop greater quickness in the fielding positions and more power with their hitting. In addition, these sports focus on balance and agility, both of which have excellent carryover to baseball.

Proper training, both in-season and off-season are also vitally important for injury prevention. Probably the most important exercises that an athlete can perform are those involving the core muscle groups including the lower extremities, the abdominals, and the torso area. These exercises should be performed in conjunction with an instructed shoulder and scapular stabilization program to aid in development of arm strength. The challenge for the athlete is getting motivated to do core strengthening exercises. These are frequently not the most visible exercises, and the old saying “Curls for Girls” often takes precedence over performing exercises that
will actually aid in athletic performance. Exercises such as squats, power cleans, dead lifts, and those that develop general core strength are advisable as long as they are done with appropriate mechanics and guidance from an experienced trainer. Weight training in conjunction with a Swedish ball has allowed for an abundance of core strengthening exercises that can apply to the baseball player.

Also medicine ball workouts help develop the core strength around the abdominals and lower back which is necessary for the transfer of power when hitting and throwing, but also important for injury prevention throughout the season.

General Guidelines for Training and Injury Prevention

Greater than 65% of injury time in the amateur baseball player is secondary to shoulder and elbow problems.
To avoid this situation some general guidelines should be considered.

1. Avoid playing baseball for more than 9 months during the year. This may be liberal as recent studies have demonstrated that even 8 months can lead to overuse injuries.

2. Limit exposure to showcase events that consist of multiple games over a few days.

3. Monitor pitch counts carefully, especially in players under the age of 16. Generally speaking, pitchers under the age of 16 should not through more than 75 pitches in a game every 4th or 5th day and no more than 3000 pitches in an entire year maximum. These numbers should be cut nearly in half in pitchers under the age of 14.

4. Consider other sports throughout the year, but avoid those requiring repetitive overhead actions such as tennis or swimming. By playing additional sports, the athlete develops other muscle groups that will aid in overall athletic performance.

5. Training should consist of core strengthening, rotator cuff and scapular stabilization exercises, and resistance training with weights to develop explosive power, quickness, and speed. Plyometric training under the guidance of a knowledgeable coach or trainer can provide for even greater explosiveness.

6. Stop pitching or throwing if your arm becomes sore or fatigues easily. Injury rates increase significantly if athletes continue to pitch with pain. In addition, poor mechanics that often cause problems become even more of an issue. If a period of rest for 7 days does not provide relief of shoulder or elbow soreness, then the athlete should seek medical attention.

Overall, the goal is to gain strength and power to enhance performance and avoid injury. Following these general guidelines can be a good start to a successful amateur career and beyond.