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A Pitch for Preventing Kids' Baseball Injuries

Children can suffer elbow and shoulder injuries if they throw too many pitches

SUNDAY, May 26, 2002 (HealthDayNews) -- If you're the coach of a kids' baseball team and lucky enough to have a talented pitcher who throws a whole lot of smoke, it may be tempting to put him on the mound as much as possible.

However, where there's smoke, there's the danger of igniting injury. Allowing a young pitcher to toss too many pitches could lead to elbow and shoulder damage that may require anything from a few weeks' rest to major surgery, experts say.

"What a coach or parent has to ask themselves when they have a kid who's a good baseball pitcher is, 'Do I want this kid to be the best pitcher he can be this year, or do I want him to be the best pitcher he can be for the span of whatever his career is going to be? Do I want to use him up right now and get the most out of him?' That's the choice they're making," says Glenn Fleisig, Smith+Nephew chair of research for the American Sports Medicine Institute (ASMI), and a member of USA Baseball's medical and safety advisory committee.

ASMI recommends these per-game pitch limits for youngsters pitching two games a week: ages 9 to 10, 50 pitches; ages 11 to 12, 70 pitches; ages 13 to 14, 75 pitches.

Little League Baseball, the largest national youth baseball organization in the world with about 2.4 million players, limits pitchers to six innings -- one full Little League game -- per week.

There are different rules or suggested limits, depending on the league or organization, but many coaches and parents don't recognize how important they are or adhere to them, says Mike Muffenbier, a physical therapist with the Institute for Athletic Medicine (IAM) in Edina, Minn.

"For the most part, kids throw until they don't look good throwing anymore and then their coaches take them out of the game. Coaches mostly go by what they see, versus by any sort of standard," says Muffenbier, who developed a thrower's-injury program at IAM.

"Some kids look great for a long period of time [in a game], and they might be putting undue stress on their elbow or their shoulder," he says.

The danger to young pitchers centers on their growth plates. These are areas of the bone, located near the joint, where bone growth takes place. Growth plates aren't as strong as the bone itself or the surrounding ligaments and tendons. That makes the growth plates susceptible to damage from the stress placed on a pitcher's throwing arm, Muffenbier says.

Pain in a young pitcher's arm can indicate growth plate damage. The arm needs to be rested until the pitcher can throw again without suffering pain. That may take as long as six to eight weeks.

Muffenbier stresses that any young pitcher who complains of arm pain should be pulled from the game immediately.

Ignoring the pain can lead to more growth plate damage, in which a small piece of bone breaks off at the point where the tendons attach.

"So when a kid blows out an arm, what's happened to him is he's actually ripped off a chip of his bone or an end of his bone off the rest of the bone," Fleisig says.

That kind of injury may require extended periods of rest or even surgery to remove the loose pieces of bone. And a youngster's arm will never be the same after that kind of surgery, Fleisig says.

"It's not like you just shake it off and come back. It's not like a muscle sprain or something like that. You're not going to be able to recover back to normal," he says.

So, coaches or parents who push their young pitchers too hard, resulting in arm injuries, may be denying those kids any chance at making it to the big leagues.

"As far as we know, there's not one pitcher in Major League Baseball who ever had that [type of injury as a youngster]. So basically your career after that is going to be very limited," Fleisig says.

The type of pitch used by a youngster can be a problem, too. Curve balls can exert great pressure on the arm and shouldn't be used until a player is old enough to shave.

"Basically, if the kid has facial hair, it's about the time his growth plates have closed up," Fleisig says.

A change-up pitch will serve a young player as well as a curve ball, he says.

Muffenbier urges coaches and parents to understand these are children playing a game and a win-at-all-costs attitude is wrong.

"I think you need to have realistic expectations. There's never been a kid that's won a World Series when he's 13 years old," he says. "You need to be respectful of the fact that these are children playing in summer league baseball games. This isn't the World Series and it's not the big leagues."

What To Do: For more about shoulder and elbow problems in young pitchers, visit Johns Hopkins University. To learn more about growth plates, check the National Institute of Arthritis and Musculoskeletal and Skin Diseases.

SOURCES: Glenn Fleisig, Ph.D., Smith+Nephew chair, research, American Sports Medicine Institute, Birmingham, Ala., and member, USA Baseball medical and safety advisory committee; Mike Muffenbier, MPT, SCS, physical therapist, Institute for Athletic Medicine, Edina, Minn.
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