Avoiding Shoulder Injuries in Baseball

Shoulder and elbow injuries are common in baseball players of all ages, however, this is increasingly common as youth players become more specialized and more competitive at earlier ages. Additionally, players may not have access to the same level of training that they usually would due to the COVID-19 pandemic.

Shoulder and elbow injuries can occur at the beginning of a season due to inadequate preparation during pre-season training. More often, however, injuries occur later in the season simply due to too much throwing without enough rest. The most common throwing-related injuries are muscle strains,  biceps tendinopathies and labral tears of the shoulder, and ligament sprains or tears of the elbow (think Tommy John surgery).

Increased injury risk in baseball players is associated with increased throwing volume, not enough rest, increased pitching velocity, poor throwing mechanics, and poor conditioning.

You can reduce your injury risk by keeping these general guidelines in mind:

  • Participate in an off-season training regimen. This may include cardiovascular conditioning, mobility training, core strengthening, and weight/resistance training with a focus on the musculature involved in throwing.
  • Heavy weight-training should be avoided in the upper extremities, however, leaving the heavier weights for the legs.
  • Adequate time off from throwing between seasons is crucial to allow for the tendons, ligaments, and muscles of the arm to fully recover. A minimum of 4 months off from throwing per year is recommended for youth players, with 2-3 of those months being consecutive (MLB.com).
  • Monitor and limit pitch count. This becomes even more critical to a player’s health when they are playing for multiple teams as coaches may not always be on the same page. MLB.com is a great resource with detailed pitch count limits for each age group.
  • Allow for adequate warm-up prior to any bout of pitching or throwing. This may include, but is not limited to, a cardiovascular warm-up, dynamic mobility/stretching, and the use of light to moderate strength resistance bands to “prime” the musculature of the shoulder.

To summarize, the number one reason for injury is fatigue and overuse. This can be too many pitches in one game, not enough days off between throwing, or too many innings in one year.

Additionally, while much of the focus lies on the shoulder and elbow in baseball players, it is also critically important to address deficiencies throughout the rest of the body. In addition to assessing for weakness or inadequate range of motion of the shoulder, players should be assessed for adequate mobility and strength of the spine, trunk, hips, and ankles. If there are deficiencies in one or more areas of the body, they can contribute to pain, injury, and reduced performance of the throwing shoulder and arm. Working on sound throwing mechanics is essential as well, but one should use caution when attempting to drastically change a player’s throwing mechanics in-season.

Prior to the season, consulting with a physical therapist with knowledge of throwing mechanics may be beneficial. Additionally, if a player starts to feel any pain that does not go away with rest, a physical therapist may be able to help not only reduce the pain but also determine the root cause of the injury in order to prevent recurrence or a new injury in the future.

By Daniel Johnson, PT, DPT, Excel Physical Therapy Southampton

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