UCL injuries on the rise among young baseball players, but many parents are unaware of pitching safety guidelines

Ulnar collateral ligament injuries and the need for Tommy John surgery have been on the rise for decades in youth baseball.

Although the exact number of injuries is unknown, orthopedic surgeon Dr James Andrews said There has been an increase in Tommy John surgeries of over 9% per year among players aged 15-19. Much research has shown that it is important to follow national guidelines for the number of throws and rest periods to reduce the risk of injury in these young athletes. So why does the increase continue?

A new survey suggests that part of the problem could be that many parents are still unaware of the risk that overuse poses to their young baseball pitchers.

In a survey of nearly 100 caregivers of young baseball pitchers in Florida, University of Florida health researchers found that 83% of them were unaware of safe pitching guidelines. This was true regardless of the player’s experience level.

Kevin Farmer, orthopedic surgeon at the University of Florida Health, points out that even young baseball players are vulnerable to arm overuse injuries that may require surgery. This is not just a problem in college and professional baseball.

the ulnar collateral ligament is located on the inner side of the elbow. It connects the upper arm to the forearm, helping to stabilize the arm. Daily activity doesn’t tend to overload the ligament, but research has shown that the repetitive forces of baseball throws can cause ligament tears.

Processing for ulnar collateral ligament injuries, usually begins with rest and physiotherapy. When that doesn’t work, however, reconstructive surgery to repair the tear – called Tommy John surgery after the first Major League pitcher to have it in 1974 – is needed.

“If you look at the ligament in the elbow, the ulnar collateral ligament, it by itself isn’t meant to withstand the stress it goes through when throwing a baseball,” Farmer said. noted.

It is why good throwing mechanics and the application of rest periods and the number of throws are so important, he explained.

It can be difficult, however, with so many young players throw all year round for several teams. In the survey, 44% of players participated in more than one league and 18% pitched nine months or more each year.

Another problem is that the number of slots is not always counted correctly. A 2018 study led by Dr Jason Zaremski, Co-Medical Director of the High School Outreach Program at UF Health, showed that many throws thrown by high school players, including those taken during warm-ups or in the reliever pen, were not included in the number of throws. despite the contribution to the risk of injury to pitchers.

“It’s really important that someone is watching the players closely to make sure they’re not throwing too much so that we can minimize the risk of injury,” Farmer said.

With children playing on multiple teams, parents and caregivers must keep up with their children’s throwing burden, Farmer and colleagues noted. Unfortunately, even among caregivers who are aware of the guidelines for safe pitching, the survey found that many were unsure of exactly what those guidelines were.

The survey also found that young people who played baseball for more than six months a year were more likely to experience throwing arm pain after a game or practice. Just over half of the caregivers who responded to the survey reported that their child suffered from pain in their throwing arm as a direct result of the pitching, with many missing a game because of the pain. Twenty-seven percent of the children had to seek medical evaluation for arm pain.

“We’ve shown time and time again that kids who play more and throw more are at higher risk of injury,” Farmer said. “I think coaches, for the most part, understand the importance of keeping track of the pitch. There is often no way for them to know how much someone is throwing somewhere else, out of sight. We all have to do it. a better job as specialists to spread the word. “

According to national guidelines for a safe pitch, young people aged 7 to 9 should not have a daily number of pitches greater than 50. For young people aged 9 to 10, the limit is 75.

The number of throws allowed in a game gradually increases as the player ages. It is recommended that players aged 13 to 16 have a daily throw count of no more than 95.

There are also recommendations for the number of days off and types of locations considered safe based on age. Learn more here.

The study was published in the International Journal of Sports Physiotherapy.

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