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My Son’s Elbow Hurts and Other Parental Questions Answered, Part 2

I recently posed a few injury questions to local baseball coach and physical therapist Jason Harvey of Ken Ryan Express and Elite Physical Therapy.  You can see Part 1 of our discussion by clicking here – My Elbow Hurts.
Part 2 of Coach Jason’s answers focus on the recovery phase of a youth baseball player with an acute or overuse arm injury.  Here is Coach Jason with more advice for parents:
“Pitch counts require its own discussion.  
Players should always be slowly progressed using pitch counts.  Coaches should always pay attention to the pitchers mechanics, accuracy, and velocity.  If the mechanics, accuracy, and velocity change, the player should be removed.  This may mean that some players begin to fatigue at 40 pitches while some can go to 60-70 pitches before they fatigue.  It all depends on strength, endurance, and mechanics.  Pitch counts should be built up over time.  
throwing
Generally speaking, a player can throw 30-40 pitches before they start to fatigue.  If they throw less than 35 pitches, the arm usually never goes into recovery mode so the player is able to pitch again later that day if there is another game, the next day, or play positions like catcher or shortstop.  It’s never a good idea to bring a pitcher back into the same game.  At 40-60 pitches, the player’s shoulder will go begin to fatigue and the player should rest for 1-2 days to allow the shoulder to regain full strength before pitching again.  Some caution should be taken regarding the positions that the player re-enters but they are typically okay to play shortstop and any position other than catcher.  At 60-90 pitches, the player’s arm will go into a recovery mode and the player should not pitch for 4 days to allow the shoulder to fully recover.  The player should also be removed from the game and not allowed to play the catcher or shortstop.  The player should even be instructed to throw to the cutoff if they are playing the outfield for all throws.  There should be a discussion with the middle infielder to go out to get the ball from a short throw in the outfield to protect the player’s arm.  
The ranges that I describe are just that.  They are ranges because some players strength, endurance, and mechanics make them fall more toward the lower end of the range, while other players with increased strength, endurance, and mechanics may be able to tolerate the higher ranges.  The presence of an arm care program, strength and agility program, pitching mechanics instruction, and a throwing program will allow your player to ride closer to the top end of the ranges with a greater degree of safety and success.
elite card
– Arm Care Program:  This includes stretching and strengthening exercises for the shoulder.  This will allow the player to regain the flexibility and strength that was lost while pitching.  As I’ve mentioned, players will experience some tightness and weakness in the shoulder following a pitching outing that required their arm to go into a recovery mode.  Performing an Arm Care Program will allow the player to actually increase strength and mobility through the season instead of losing strength and flexibility.  
– Strength and Agility:  The more athletic a player can become by learning how to push from their lower half and use their core to maintain stability through the throwing motion, the more the player will attenuate forces at the elbow and shoulder.  Their neurological development of balance and proprioception in the lower half will enhance the ability and performance of the upper half.   
– Pitching Mechanics Instruction:  When a player gets instruction on their mechanics and can hit the windows of safety that exist in the pitching motion, the player has a better chance at being able to pitch without putting too much force through the elbow or shoulder.  Whether it’s opening the lead shoulder early, the elbow staying too low, the elbow staying too high, the reverse W, not dropping into the rear hip, or the ball not getting above the elbow before the lead foot strikes the ground, a trained professional can work with the player to iron out these flaws that can lead to arm injuries.  
– Throwing Program:  Players should have a throwing program that builds arm strength.  This will include long tossing, bullpens between pitching outings, and structured pre-outing programs.”
For more information on any of these programs, please feel free to email me at: jharvey@elitephysicaltherapy.com.  
Thanks once again to Coach Jason for his advice for youth baseball players – as a coach, a physical therapist, and of course as a proud parent.

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