Risk Factors for Shoulder and Elbow Injuries in Adolescent Baseball Pitchers

Risk Factors for Shoulder and Elbow Injuries in Adolescent Baseball Pitchers

(Andrews et al.; The American Journal of Sports Medicine; 2006)

• Ninety-five adolescent pitchers who had shoulder or elbow surgery and 45 adolescent pitchers who never had a significant pitching-related injury completed a survey. Responses were compared between the 2 groups using t tests and ?2 analyses. Multivariable logistic regression models were developed to identify the risk factors.
• The injured group pitched significantly more months per year, games per year, innings per game, pitches per game, pitches per year, and warm-up pitches before a game. These pitchers were more frequently starting pitchers, pitched in more showcases, pitched with higher velocity, and pitched more often with arm pain and fatigue. They also used anti-inflammatory drugs and ice more frequently to prevent an injury. Although the groups were age matched, the injured group was taller and heavier.
• There were no significant differences regarding private pitching instruction, coach's chief concern, pitcher's self-rating, exercise programs, stretching practices, relieving frequency, pitch type frequency, or age at which pitch types were first thrown.
• Pitchers who competed more than 8 months per year were at about 5 times increased risk for injury requiring surgery. The current recommendation is to discourage year-round pitching and to have at least 3 months of active rest per year. Here, active rest is defined as rest from throwing but not from other sports or activities. On the basis of the data from the current study, pitchers may need more than 3 months of active rest.
• The injured pitchers pitched on average 6 innings per appearance, compared with 4 innings in the control group. They also pitched approximately 88 pitches per game, compared with 66 pitches per game in the control group. Pitchers who throw more than 80 pitches per game are at nearly 4 times increased risk of injury requiring surgery compared with those pitchers who throw fewer than 80 pitches per game. The current USA Baseball recommendation for a 14-year-old pitcher is to throw fewer than 75 pitches per game and fewer than 3000 pitches per year. These recommendations may be too liberal.