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Common Overuse Injuries in Baseball

Young baseball player sliding into home plateSummer is here, and baseball season is at its peak. Soon, the leaves will begin to curl, kids will go back to school, and people will gear up for a new seasonal sport. With every change of weather season comes the ending of one sport season and the beginning of a new one, but that practice has become outdated for many of today’s young competing athletes.

Athletes used to train hard during pre-season, compete during their season and then rest/recover with light training in the off-season, or enjoy a different sport altogether. Having an off-season or playing multiple sports nowadays seems like an ancient concept to many athletes. Training all year long, as well as starting specialization at a younger age, places athletes at an unprecedented level of risk for overuse injuries.

Specialization, in theory, makes sense. The more time you spend practicing something, the better you will be at it. How could extra coaching and training in one specific sport/position be harmful? Specializing in one specific sport and/or position at a young age stresses a few specific muscle groups used heavily, while playing multiple sports/positions utilizes several different muscle groups, distributing use throughout the body, and therefore not stressing heavily on one group. The truth of the matter is that young athletes are already more vulnerable to injury than their adults and specialization puts them at an even greater risk of overuse injuries at a young age and later down the road.

Beacon Orthopaedics and Sports Medicine regularly treats overuse injuries in young athletes. Each year, Dr. Timothy Kremchek, who is the Official Medical Director for the Cincinnati Reds, is Beacon’s elbow, shoulder, and knee expert. When he is not working with professional athletes, he is in the clinic and operating room treating more and more children with overuse injuries each year. Here are some of the most common overuse injuries in baseball and ways to prevent them.

Overuse Injuries

#1: Rotator Cuff Injuries

The rotator cuff is a group of four muscles (the supraspinatus, infraspinatus, teres minor, and subscapularis) that work together to let you raise and rotate your arm. As such, rotator cuff injuries severely inhibit one’s ability to pitch.

Pitching is hard on the rotator cuff, particularly during the moment right before a pitcher releases the ball and during the follow-through. Moreover, these motions are integral to a good pitch, so there isn’t any way to spare the rotator cuff during pitching. As is the case with so many pitching injuries, the best way to prevent rotator cuff problems is to take time off during the offseason and to make sure the appropriate pitch counts and rest day requirements are followed during the season.

Just as the rotator cuff consists of multiple muscles, there are multiple rotator cuff injury types. The most common rotator cuff injuries are overuse tendonitis (which is when shoulder tendons become painful and swollen), a tear, and impingement (which is when the bursa is pinched by the tip of the shoulder blade). Tendonitis is one of the most common orthopedic conditions in young athletes because it is primarily caused by overuse.

While rest and surgery are both effective treatments for rotator cuff injuries, only an orthopedic specialist can treat the scar tissue that develops. If left untreated, this scar tissue can slow down a pitch enough to destroy a pitcher’s whole career. Scar tissue is especially devastating in young pitchers because it makes it harder to throw with proper form in the future—and using improper form sets pitchers up for even worse injuries in the future.

#2: Labrum Tears

The labrum is a collagen ring that sits between the round head of the humerus (your upper arm) and the glenoid fossa (the socket where the humerus fits). It both cushions and stabilizes the shoulder, and it takes a beating during a pitch. You can think of the labrum as the rounded top of a golf tee. If a golf tee was flat or only half round, then a golf ball placed on top would be unstable and fall off at the slightest breeze. The labrum is the golf tee of the shoulder.

Unlike with many other pitching-related injuries, labrum tears aren’t warded off by good form. During a pitch, the shoulder moves so quickly and forcefully that the labrum gets ripped apart slowly. Since labrum tears are almost entirely caused by overuse, the one line of defense against them is to stop pitching when fatigue sets in. That can be tricky, though—it’s often difficult for a pitcher to tell when they are fatigued, which is why pitch counts and rest days should always be prioritized.

Labrum tears are one of the most difficult shoulder injuries to diagnose. Since the shoulder is such a complex joint, there are many things that can cause it pain. And since the symptoms for labrum tears are so generic—popping in the shoulder, weakness of the shoulder, and pain—it’s difficult to make the connection between shoulder problems and a labrum tear.

It should come as no surprise, then, that labrum tears are often called “baseball’s most fearsome injury.” Professional pitchers only have a 3% chance of making a full recovery after incurring one.

Nonsurgical treatments for labrum tears only consist of rest and pain management. Unfortunately, no amount of rest will restore a damaged labrum, so surgery is usually the only option for a pitcher.

#3: UCL Tears

The ulnar collateral ligament (UCL) is a thick triangular band that connects the upper arm to the two bones of the forearm. Its job is to stabilize the elbow during the throwing motion. When it sprains or tears, a pitcher cannot throw with power or accuracy.

Tears are more devastating than sprains, and usually occur in professional athletes. Tears can be identified by a distinct, audible “pop” in the elbow during a pitch. Afterward, the pitcher will feel pain and looseness in the elbow. Sprains, on the other hand, are the milder injury that occurs more frequently in young athletes—and that’s because sprains come as a result of overuse. Sprains and tears share symptoms: pain on the inside of the elbow, loss of control, elbow stiffness, and swelling.

UCL injuries will never heal completely on their own. They can, however, be prevented by properly warming up, maintaining proper form, and following appropriate pitch counts/rest day guidelines.

If a UCL injury is not treated with surgery, a pitcher will never return to the same level of performance as before. Fortunately, the surgery for fixing a UCL Injury—called Tommy John surgery—has an extremely high success rate. In fact, Beacon is known for their ability to perform Tommy John surgeries. Dr. Kremchek, one of the leading experts on Tommy John surgeries in the nation, has performed Tommy John surgeries for professional ball players such as Jason Marquis (Cincinnati Reds), Robby Sexton (Boston Red Socks), and John Lamb (Cincinnati Reds), but he also performs an increasing number of them on athletes in high school or younger.

See an Orthopedic Specialist

Dr. Kremchek treating an elbow injury in a baseball playerNothing can guarantee an injury-free sports career, but specialized athletes are between 70–93% more likely to suffer an injury than multisport athletes. Such a high number might come as a surprise, but the most common type of sports injury among adolescents isn’t actually a sudden injury like a broken bone or concussion—it’s a repetitive stress injury from overuse. Using improper form speeds the process along, but overuse injuries can happen even with good form.

At Beacon Orthopaedic and Sports Medicine, our board certified and specialty trained orthopaedic specialists can identify the early signs of a condition and properly treat existing injuries. Schedule an appointment with Dr. Kremchek.

At Beacon, we are committed to helping athletes perform at their absolute best all year-round!