Too much of a good thing? Mayo hosts summit on sports injuries

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On Saturday, Mayo Clinic Sports Medicine hosted its first-ever Baseball & Softball Summit. About 100 physicians, trainers, physical therapists and coaches attended in person or joined via webcast for a daylong discussion of a wide range of topics.

Dr. David B. Soma, a Mayo Clinic pediatrician who specializes in sports medicine, and Chad E. Cherney, a physical therapist for Mayo Clinic Sports Medicine, were two of the presenters.

On Friday, they gave the PB a sneak peak at the topics of Little League throwing injuries and the risks of early specialization in a single sport.

PB:How common are throwing-related injuries among youth baseball players?

Soma:Really, it's hard to get an exact number. What we do know is that among pitchers and catchers, probably the most common injuries that we encounter are shoulder and elbow pain. Some of the evidence seems to indicate that severe injuries, things that require surgery, seem to be on the rise. The reason for that is hard to know. Is it increasing pitch counts? Is it sports specialization? Is it that athletes are training harder? It's really hard to say.


PB:Is early specialization in baseball resulting in an increase in serious arm injuries?

Cherney:I don't know if there's a direct correlation established yet, but when you start looking at overuse injuries, what generally causes the injury is a change in the mechanics of the throw due to fatigue or discomfort. There is some interesting work being done, looking at what is the number of pitches that should be thrown per game and per season, and how much rest time is needed in a calendar year, looking at the risk of over-use and how the repetitive wear and tear on the shoulder, the elbow and the body in general can lead to increased risk of injury.

PB:When we think of baseball players developing shoulder and elbow problems, we think of pitchers, but are catchers at risk as well?

Soma:I've worked with quite a few catchers who have come in with injuries. They're kind of removed from the pitch counts and tracking. Sometimes they'll catch all five games of a weekend tournament, maybe more, so that's a really large volume of throws. Plus, their mechanics can be a problem. Some catchers don't even get off their knees to throw, so they're just using their arm to make the throw. So, while catchers probably aren't at as much risk as pitchers, it's still something to watch out for.

PB:You mentioned the pitch-count restrictions that are common throughout youth baseball now. Are they helping to protect young arms?

Soma:I think so, but it's not a perfect system. The problem is that a lot of times, kids go from fall ball, to winter ball, to spring ball to summer ball. Those pitch counts aren't being tracked from season to season, and sometimes kids are even playing in two leagues at the same time. So it's important as a baseball coach or an athletic trainer that you look for other signs that a pitcher should stop throwing, other than just looking at the pitch count. When a pitcher gets fatigued, they'll drop the elbow or show other changes in their mechanics. When there's a drop in velocity or a change in throwing mechanics, that's a sign that you need to get them a break, regardless of what the pitch count says.

PB:Why are kids playing so much more baseball today than they were 20 or 30 years ago?

Cherney:The trend is that athletes and families, and coaches to some extent, want specialization. They feel that by doing so, they'll acquire a skill set that is more beneficial down the road. Often, the thinking is "I'm going to earn a college scholarship, I'm going to make my way to the professional ranks." But only 1 to 2 percent of high school athletes will earn a college scholarship. And of those who are playing college sports on scholarship, it's a quarter- to a half-percent that will make it to the professional level.


PB:What, other than injury, is the biggest risk of early specialization in one sport?

Cherney:The burnout effect is probably the No. 1 cause of youth stopping participation. There are a number of papers that have looked at skill acquisition in elite-level players. Those who started a bit later, or did not become specialized as early, are more likely to stay with the sport longer. Those who specialize early do suffer a much higher burnout risk.

PB:So, if a young athlete -- say a pitcher or catcher -- has decided to focus exclusively on baseball, what steps can they take to reduce the risk of injury?

Soma:It's really important to build in the rest and recovery. There are some good position statements from sports medicine societies that recommend taking at least one day off per week from any sport. They also recommend taking at least two months off per year from doing that specific task, like throwing. And finally, young athletes shouldn't do more hours per week of a single sport than their age. So, if you're a 13-year-old baseball player, you shouldn't play more than 13 hours of baseball per week or you'll be potentially at risk for an overuse injury.

PB:There's a common belief that breaking pitches are harder on the shoulder and elbow than the fastball. Is that true?

Soma:One pitch isn't necessarily higher risk than another. Some studies have shown that a fastball puts the most torque across the elbow because it's thrown harder, but also, some studies seem to indicate that once a pitcher starts throwing curveballs, he's more susceptible to injury. But really, the most important thing is proper mechanics, regardless of what pitch you're throwing. If you aren't using proper mechanics to throw a fastball, then you shouldn't be learning new pitches.

PB:What role are coaches playing in the push for early specialization?

Cherney:There's high coaching pressure, even if it's not verbalized pressure. If you want to be the starting quarterback or the starting running back, and the coach says "I want you at these camps," then you're going to do what the coach wants you to do. When a coach has a very good athlete that will help them be successful as a coach, then there is some pressure on the athletes to specialize.


When athletes fill out surveys as to why they specialized, the top four influences are coaches, parents, peers and the media.

PB:Is there any push-back against the trend toward early specialization?

Cherney:Urban Meyer, the head football coach at Ohio State University, has said that he's looking for multi-sport athletes. He doesn't want players who specialized in football. And, if you look at the 2017 NFL Draft, 30 of the 32 athletes who were selected in the first round were multi-sport athletes.

We now know that football and baseball are late-acquisition sports. You can still become a very good baseball player even if you specialize in it relatively late. And today, college coaches want athletes. When they are looking for players, they've created a position for the athlete, the person who can be molded into whatever they need him or her to be as a player.

PB:If you coach youth baseball, or are the parent of a youth baseball player, what should you be doing right now to reduce the risk of a player suffering an injury?

Soma:Kids need to properly warm up and stretch out before they pitch -- but the problem is, after they pitch, these guys, who are often the best players on the team, go out to play shortstop or some other position where they'll make a lot of throws. Too often, people will rely on pain medications to push kids through to the next event, but coaches and parents need to be listening to the kids' bodies, rather than simply masking the pain with ibuprofen.

-- Eric Atherton

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