Q: My son is interested in playing baseball this season, but he has never played the game previously. What are the risks of injuries? Is there anything I can do to prepare him before the season starts to strengthen his body?
A: A recent study regarding shoulder injuries in high school baseball was published in Pediatrics (March 2010). The risk of injuries overall for baseball players was 1.72 injuries per 10,000 athlete exposures. In other words, it was not that high.
The most common injury was of the shoulder, with muscle strains and incomplete tears at the top of the list. Other shoulder injuries included were: contusions, dislocations, tendon strains, inflammation, ligament sprains, stress fractures and torn cartilage. Shoulder separations and nerve injuries were the least common.
Most of the injuries occurred in pitchers, mainly strains and tears resulting from the stress put on the arms of pitchers due to overuse. Close to one-fourth of high school baseball players pitch. About 80% of the shoulders injuries were new and 10% were recurrent from the previous year. Also of interest is that most of the shoulder injuries took place during practices as opposed to games.
It helps to understand that the biomechanics of pitching is not very natural. Growing boys have quite a bit of musculoskeletal power in their upper bodies, which sets them up for injuries related to the fast acceleration and the rapid deceleration associated with pitching.
The research suggests that being a pitcher in softball may be safer than in baseball. The distance between home plate and the pitching mount in softball is only 40 feet as opposed to about 60 feet in baseball. In softball, the throwing mechanism is also different: players use a windmill delivery which puts less strain on the shoulder. Thus, in softball it was found that pitchers got injured only half as often as baseball pitchers.
Contact with the playing surface is also far less likely in softball than in baseball. Given baseball players tend to slide head first towards a base, they are at an increased risk of shoulder injuries when landing on the shoulder of an outstretched arm. Ideally, a player should land on his or her chest and not the shoulder.
Baseball catchers do not get as much rest as pitchers and they face quite a number of balls during an average season. One would therefore expect them to also be injury prone, but according to the Pediatrics study this was not the case. Catchers only ranked in third place for injuries after pitchers and the center field position. Left field and first base were the next most common positions on the field for injury risk. Short stop was the position least likely to set a player up for injuries.
Obviously at this time of the year many players are gearing up for better weather. With that comes the time to play ball outside on soft green grass, sipping lemonade, and enjoying the sounds and smells associated with baseball. But it is not too late to prepare for the season in a way that would reduce the risks for injuries.
Good coaches are worth a lot not just in terms of teaching both mental and physical skills, but also in preparing players to play safely. For starters, proper stretching and warm-up cannot be over emphasized. In addition, supervised weight training has also been shown to reduce the risk of injury. Overuse injuries can be prevented by wise coaching where star players are not asked to pitch too often. Sport medicine experts suggest only 100 to 150 pitches should be thrown in a three day period.
It may be a cliché when a player is told to listen to his or her body. But if there is a pattern of recurrent pain and discomfort one should not ignore it or foolishly hope it will subside over time. It may be wise to see a sports physiotherapist in advance and to learn some proactive exercises that can be done to strengthen the shoulder and elbow areas.
On very hot days extra care must be taken to hydrate players well in advance and to replace electrolytes such as potassium and sodium before it is too late. The recovery time after games can also be assisted by eating a diet rich in natural anti-oxidants, especially fruits and vegetables with a high anti-oxidant capacity such as berries and oranges. Whole food supplements have been shown to work better than antioxidant vitamins such as vitamin C, E and beta-carotene (Vit A).
Lastly, the authors of the Pediatrics study suggest a closer collaboration between coaches, sport medicine clinicians, and researchers. One novel way may involve video analysis of specific shoulder injuries and pitching mechanics.
For more information, see: http://www.medco-athletics.com/education/elbow_shoulder_injuries/index.htm
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