Health & Safety Resources

Throwing Injuries and Prevention

Today’s competitive sports that involve overhead throwing have led to frequent injuries of the shoulder and elbow.  Many young athletes are playing longer seasons on multiple teams with an increasing pressure to win and push themselves beyond their physical limits.  In this article, we will briefly explore these injuries and the importance of warning signs and prevention.

The throwing mechanism results in tremendous torque to the joints of the upper extremity.  The athletes’ natural ability, muscular conditioning, and proper throwing mechanics all contribute to extended performance.  Failure to pay proper attention to the contribution and integration of all three factors will result in physical breakdown and injury.

Shoulder impingement, sometimes referred to as bursitis, presents as shoulder pain when the arm is overhead and rotated.  Throwing through the pain will strain the underlying rotator cuff muscles, and will certainly result in failure—i.e., declining performance and eventual failure to throw.  Appropriate intervention at the ONSET of pain (BEFORE the rapid decline of performance) allows for the predictable reversal of injury, in most cases.  Athletes, therefore, should not fear reprisal from coaches for hurting!   It is in the athlete’s and team’s best interest to play pain free and in good health.  Sports Medicine trained and/or interested Physicians can assist the athletes’ most rapid, yet safe, return to sport, usually with the assistance of appropriately trained physical therapists and certified athletic trainers. 

Elbow pain, particularly on the inside or medial aspect, is also a very common warning sign.  While muscular strain at the outset is very reversible, ligament rupture and/or bony avulsion fractures from throwing are not.  The “Tommy John” injury to the elbow medial collateral ligament (MCL), at one time an adult problem, is unfortunately seen increasingly in our youth.  Elbow avulsion fractures are also on the rise.  These injuries force these athletes from play for months; many may require surgery.  Yet, early intervention can keep many athletes playing with minimal to no lost playing time.

While early injury intervention is extremely important, PREVENTION is paramount!  Athletes are responsible for sport-specific conditioning.  High torque and repetitive muscular demand, such as placed on a baseball pitcher, requires the utmost of pre-season muscular conditioning and an understanding of proper throwing mechanics.  Regardless of ability, an athlete’s ‘failure to prepare’ will result in ‘failure to perform.’

The 2006 USA Baseball Medical and Safety Advisory Committee issued new age-specific guidelines to limit pitches thrown, with all breaking pitches such as curve balls and sliders to be avoided until growth plate closure.  In 2007, Little League Baseball will require daily pitch count monitoring (ranging form 75 for ages 10 and under to under 105 for ages 17-18) with mandated rest periods.  This new ruling reflects scientific studies that identify the injured throwing athlete to be the one who throws more often (i.e., those who threw more months, more innings, and more games, as well as those who continued to throw with arm pain and fatigue).

A “successful” game or season could result in a short-lived career.  Coaches, parents, and athletes should recognize that any interest in ‘performance longevity’ will never be achieved with a focus on short term success.  Recognized ‘ability’ needs to be cultivated through muscular conditioning and the execution of proper throwing mechanics.  ‘Ability overuse’ is an ‘abuse of ability’; it is detrimental and career limiting.  It can sometimes be difficult to identify in its early stages with athletes wanting to perform and succeed; therefore, it is important for coaches and parents to create an atmosphere of support for the injured and to emphasize the ‘importance of preparation’ for the aspiring ball player.

Today’s societal and peer pressures will not easily allow for the proper cultivation of our young athlete’s ‘ability’—therefore, we must take the ‘responsibility’ to protect our youth.  Adherence to age appropriate pitch count, pre-season sport and position specific conditioning, and a respect for pain as a warning sign of injury.

For further information on this article or for priority appointments for sports injuries please contact Henry Ford Center for Athletic Medicine at 313-972-4216.

Henry Ford Health System’s Center for Athletic Medicine offers a comprehensive approach to sports medicine, including surgical and non-surgical care, sports rehabilitation, injury prevention, and performance enhancement programs.  The HFHS treatment team includes sports medicine fellowship trained orthopedic surgeons, sports medicine fellowship trained primary care physicians, as well as certified athletic trainers and physical therapists.  These health care professionals are supported by the HFHS nationally recognized bone and joint research facility, including the prestigious Herrick Davis Motion Analysis Lab.  HFHS is proud to be health care providers to the Detroit area’s premier sports programs including professional, collegiate, and high school athletes.