I had a parent recently email me that his son’s elbow was hurting and his son would not be available this week or this weekend. This particular player only plays outfield for me, so I wasn’t sure if this was an acute injury from school or another sport, or potentially an overuse injury. I told him “rest would be best” and that I’d see him next week. So I got to thinking… At what point do parents need to put their youth baseball player on the “disabled list” or “DL?” We have pitch counts in Little League® but with AAU travel team play, Interscholastic Sports, and other competitive sports (that involve throwing) who is really keeping track of pitches and/or the violent motion of throwing? And throws back to the pitcher from catchers? And throws across the diamond from the shortstop, who is also your stud pitcher and backup catcher. What is the road map for a parent not trained in exercise science, medicine, or fitness? Advil and ice aside, when do we as parents need to step in and bring them to South County Orthopedic or Elite Physical Therapy for an evaluation? At what point, do we shut down a player? I posed this question to local baseball expert, physical therapist, coach, and yes parent – Coach Jason Harvey of Ken Ryan Express and Elite Physical Therapy. Here is his Part 1 of his response, focusing on the injury itself:
“Arm injuries can happen to any player, at any time, from any position. The youth player is playing with a growing body that has active growth plates, flexibility restrictions, muscle activation issues, poor stability where they need it, and a whole host of other baggage that they bring to the field every day. One of the most common physical impairments that I’ve been noticing in ball players from 8-15 years old is posture. The incredible popularity of the video games like Fortnite has created some major issues with youth players. Players develop some severe postural problems with rounded shoulders, forward head posture, scoliosis, poor mid-back mobility, weakness in the shoulder blades, tightness in the forearm flexors, compression in the wrists, and tension in their biceps. This leads to very poor arm function even before they throw a baseball. The shear nature of a baseball throw puts an enormous strain on the shoulder and elbow. When a player has physical impairments like I described above along with mechanical flaws, the recipe is perfect for some sort of injury to develop. Often times, parents and coaches don’t see these physical impairments and mechanical issues so they just have them play and practice until the injury develops. Their answer is usually rest. After resting for a few days by not pitching or not throwing or playing a position that does not require much throwing, they begin to put them back into the positions that they usually play expecting that the arm will be fine. The problem is that as soon as a player experiences some level of inflammation and pain, the body begins to cause the muscles and tissue around the joints to stiffen and weaken. They also lose a little proprioception. Proprioception is a neuromuscular component of our nervous system that allows us to know where our joints and limbs are without having to consciously look at it or think about it. This is extremely important in throwing. The brain will configure a throwing motion that it believes you will be able to do without causing more damage. This means that your mechanics will change. The player is now dealing with a tight, weak shoulder with altered mechanics. Does this sound like an arm that is going to just get better with throwing?
Sometimes the player is dealing with fatigue. Often times, the brain will shut down the body’s ability to throw hard and with accuracy as it begins to fatigue. As a coach and parent, you must pay attention to these moments in a young player. Whether they are pitching, playing catcher, or playing short stop, when you notice changes in the players accuracy, velocity, and mechanics, it’s always a good idea to use caution and have the player rest.
If your player is complaining of pain when they throw, the player can begin a stretching program to increase flexibility of the shoulder musculature and be supervised during a throwing program for any noticeable changes in mechanics and accuracy. If the player is able to throw pain free after stretching, with no noticeable changes in mechanics and accuracy, they can continue to participate in the game but should not pitch that day. If the player continues to experience pain when he begins throwing during pre-game warm ups, parents and coaches should consider putting the player on the “DL” for one week. The player can be allowed to hit but should not throw. After 7-10 days of rest, the player should begin throwing at short distances and slowly begin to increase the volume and distance of throws. Special attention should also be paid to the players mechanics. During the first day that the player returns to throwing, they should throw 5 on one knee from 15′, 5 standing from 15′, 5 from 25′, 5 from 35′, and 5 from 45′. If the player does not have any pain, they can participate in the game but should only be allowed to play first base or second base where the throws are shorter and volume is typically low. If the player does not have pain the next day, they can add 5 throws and increase distance by 15′. They should continue doing this for at least 10 days pain free before returning to throwing off a mound. When the player is able to throw 30-35 throws with 10 throws from a distance of 80′-100′ without pain, they can begin to return to the pitcher or catcher position. If the player is unable to advance in throwing progression because of pain, the parents should consider bringing the player to sports medicine facility, such as South County Orthopedics or Elite Physical Therapy, where the player will be evaluated for any physical impairments or mechanical flaws that are limiting him or her from being able to throw pain free.