Understanding the Epidemic of Youth Pitching Injuries
By Gary Armida, Full Count Pitch Publish Date: February 6, 2009
Young pitchers are in trouble. While that may sound like hyperbole at its finest, it most assuredly isn’t. Rick Peterson succinctly explains the growing epidemic in the amateur pitching market. “In the last 10 years Tommy John surgeries have increased by 700 percent in the amateur pitching market. Something is obviously wrong here.” This statistic also correlates with the increased spending on pitching injuries on the Major League level. “Although we said this in the last article its worth repeating: Major League teams spent $330 million dollars on pitching injuries”, reminds Coach Peterson. If one were to take Coach Peterson’s statements and apply them in the context of health in an area other than baseball, one would call this increase in injuries and the subsequent surgeries an epidemic. The National coverage of this epidemic would be leading the nightly news. While pitching injuries aren’t worthy of leading National news, within the industry, this epidemic is one that needs immediate attention. Because amateur baseball is more competitive than ever, children (beginning at 8 years old) are pitching more frequently. This increased use, without proper coaching, has led to the explosion of pitching related injuries. Fortunately, the amateur pitching market is about to get the benefit of 30 years of research from the acclaimed Dr. James Andrews and the on-field experience of Coach Peterson. Today, Coach Peterson explores the underlying causes of amateur pitching injuries, advancements made, and a look to the future.
Slow to React
As a whole, the amateur pitching arena (as well as the professional ranks) has been slow to react to the increasing number of pitching injuries. With such indisputable data, one cannot deny that there is a problem. It seems contradictory that youth baseball has not adapted to the problem considering the fact that amateur baseball has become much more organized, much more competitive, and much more specialized. Coach Peterson explains, “The problem is that nobody really knows what to do or where to go. There has never been a place or a program that can prevent pitching injuries. That is why it is so exciting to bring our program to the amateur pitching market. We can shift the focus from rehab to prehab.” Indeed that is the case. While there are some highly trained (and very well-intentioned) coaches involved with amateur players, few can bring the experience of Dr. Andrews’ research or Coach Peterson success in his 11 years as a Major League pitching coach and 30+ years in professional baseball. The expertise and advancements with pitching injury prevention have been limited to the professional ranks (furthermore, most teams don’t know what to do with the information—another group that is slow to react). With that lack of knowledge in the amateur baseball organizations coupled with increased intensity and playing time, youth pitching injuries have exploded. Additionally, as is usually the case with the medical field, it can often take far too long for doctors and scientists to get their full scientific validation in order to put a program into action. Luckily, because of Dr. Andrews’ research and Rick Peterson’s experience and work with Dr. Andrews and Major League pitchers, the tide seems to be changing.
The Root of Arm Injuries
Assuming that a pitcher is not genetically predisposed to arm injuries (meaning that he can, actually, pitch), there are three main causes of arm injuries.
1. Poor Delivery/Mechanics
The first cause is the classic “bad mechanics”. Coach Peterson (who prefers to refer to this as the delivery) doesn’t limit this one to just pitchers in the amateur market. Instead, he broadens it to poor throwing delivery or poor arm action. “Unfortunately, with amateur pitchers, this can be trained very early. One of the first problems is getting a young pitcher to grip the ball properly. How the heck can an 8 year old properly grip a baseball? His hands are too small.” This is most definitely the case. If one looks at training methods for other youth sports, most younger athletes are trained with a different set of equipment. In youth football, the ball is smaller. The same can be said for basketball. Coach Peterson jokes, “Can you imagine giving a ten year old an NFL football and saying ‘here kid, grip and throw the ball like Eli Manning’. It’s not realistic, yet we don’t have that option in baseball.”
The most important aspect of a poor delivery is the impact it has on a youth’s arm. The violence of a pitching delivery is very real. Coach Peterson explains, “Think about the pitching delivery as an upside down tornado. Hip rotation determines velocity. If the delivery is executed properly, the shoulder doesn’t do much work. But, in order for the shoulder not to feel the brunt of the workload, everything must be in sync, on-time, and in coordination with the rotational velocities, the lower body and the upper torso.” In other words, if a delivery is done correctly, the impact on the shoulder is minimal. The problem is that most amateur level coaches (I was a high school baseball coach for 10 years, so don’t take the following as a slight) do not have the pitching education to correct such deficiencies. Instead, most coaches will say to a pitcher something to the effect that the pitcher is “flying open”. But, as Coach Peterson explains, that merely means that the pitcher is out of sync which “puts a ton of pressure on the shoulder during the acceleration phase of the delivery.”
The acceleration phase of the delivery is significant in terms of impact on the shoulder. “After the cocking stage, the ball comes to a complete stop or almost a complete stop. This is right before the point where the pitcher’s arm is about to accelerate through the pitch. That stopping point to the completion of the acceleration phase lasts 0.3 seconds. So, if you think about it, in that 0.3 seconds the ball is accelerated from zero miles per hour to 90-plus miles per hour (for a Major league pitcher).”
To explain the significance of the trauma that can cause with an improper delivery, Coach Peterson tells a story of an encounter with a doctor after a he gave a presentation on this very topic. “I did a presentation for a group of coaches one year and afterwards a doctor of physics came to me. He asked me if I knew what that type of acceleration meant in terms of g-forces. Of course, I had no idea so I asked him to explain. He said, ‘If your entire body was accelerated at that same rate of speed for over sixty seconds you would die. Your body could not handle that acceleration, the G forces of that type of acceleration’.”
2. Poor Conditioning
Quite simply, amateur athletes are not conditioned to pitch as much as they do. Coach Peterson wonders about the following, “How many amateur pitchers are made to do shoulder strengthening exercises as a part of their youth programs? The answer is probably none.” Additionally, conditioning comes into play during the deceleration phase of the delivery. Based on ASMI (American Sports Medicine Institute) research, most amateur pitchers are not old enough (or developed enough) to properly drive through a pitching delivery. Coach Peterson gives a car analogy, “You wouldn’t give a kid the keys to a sports car without brakes, would you? Well, that’s similar to what’s happening to young pitchers. They are not conditioned enough to properly execute a delivery.”
The hard throwers are the group that is most at risk for injury, especially if they are poorly conditioned. Why? Well, to start, on the amateur level, the pitchers who are used the most are the hardest throwers. Having a hard thrower on the mound is the easiest way for an amateur team to win a game. It can be assumed that if a pitcher is throwing harder, the acceleration within that aforementioned 0.3 seconds is much quicker and much more violent. Poorly conditioned, young pitchers will break down as a result.
There are many different variations of the term overuse when it comes to pitching injuries. In this case, Coach Peterson is not talking about in a particular season or a particular game (although that can also be a small factor). Instead, he speaks of overuse in the context of entire year. “The days of the three letter athlete are over. Today, amateur baseball is played year-round. Amateur pitchers will play in travel leagues all winter and continue to throw. Quite simply, there is not enough time for a player to rest. The winter should be a time for the body, the muscles, to rest and recover.”
In the age of increased specialization, this issue is not likely to resolve itself soon. As amateur baseball continues to be played all year round and become even more competitive, pitchers are put at risk. Couple the fact of a lack of conditioning with overuse and one as a recipe for disaster, or in this case, the epidemic of pitching related injuries.
The Winds of Change
Now, the medical field seems to be moving quickly to the side of injury prevention instead of reacting to an injury. Not surprisingly, Dr. Andrews has been on the forefront of this movement. For the past 27 years, Dr. Andrews has conducted The Baseball Course. The Baseball Course is attended by doctors, physical therapists, scientists, coaches, and players. As stated on the official website, “The purpose of the course is to exchange information regarding all aspects of baseball healthcare including mechanisms of injury, conservative and surgical treatment of injuries, rehabilitation, conditioning, nutrition, mental, skill, and injury prevention.”
Coach Peterson is happy to report that during the most recent Baseball Course (January 23-25, 2009), there was “the highest level major call to action to bring the research and findings to the field. The focus finally seems to be moving more towards pre-hab rather than rehab.”
As a result, a new focus of the Baseball Course (in addition to the continued research into the cutting edge methods of treatment) is to improve deliveries, improve conditioning, and increase awareness of overuse. With that, Coach Peterson brings up a key concept known as periodization. “Periodization is the cycling of high intensity activity and a period of rest/recovery.” The result of all of this research and knowledge has led Rick Peterson to devise a program incorporating this research combined with his professional experience.
The Peak Performance Pitching Triangle
The subtitle of the Peak Performance Pitching Triangle is “Preparation equals Performance”. The triangle incorporates the three areas necessary for the makeup of a successful pitcher. First on the triangle is skills and competencies which are the technical components of a pitcher. Obviously, a pitcher will need the proper delivery in order to achieve a high level of success. The triangle also incorporates physical behaviors such as the necessary conditioning. Lastly, performance based behaviors rounds out the list. That is the physiological side of successful pitching, an area even more ignored than the aforementioned rise of injuries.
The Peak Performance Triangle is the basis of Coach Peterson’s new business venture into the amateur pitching market. In the near future, Coach Peterson will launch a new company that will, in his words, “give amateur pitchers access to the same technology, research, and conditioning programs that I and Dr. Andrews have used with major leaguers.” Look for a future FCP article regarding the new company as well as an in-depth look at the Peak Performance Triangle.
Coming Soon in our Amateur Pitching Series
Besides the aforementioned articles on the new company and the Peak Performance Triangle, Coach Peterson will share his thoughts on a study conducted by Doctor Michael Axe. Dr. Axe completed a study on the correlation between velocity and distance. In his study he surveyed amateur pitchers, ages 8-14, and asked two simple questions:
- How fast do you throw and are you special?
- How far do you throw and are you special?
His findings are fascinating and have quite an impact on the development of young pitchers. The discussion of results are worthy of a separate article.