Injury Prevention in Baseball: from Youth to the Pros
- 743 Downloads
Purpose of Review
This review examines recent literature on injury epidemiology and prevention in the sport of baseball from youth to professional levels.
Overuse is the predominant mechanism of injury in youth baseball players. Newer stretching and exercise protocols may help prevent these injuries. At the professional level, however, overuse has not been proven to correlate with increased injury incidence, but pitch counts are still monitored. There continues to be a rise in operations performed for baseball-related injuries, including ulnar collateral ligament (UCL) reconstruction, particularly in younger athletes. As the level of play increases, there is significant loss of participation due to injuries, such as the UCL in the upper extremity and the hamstrings in the lower extremity.
Baseball is a widely popular sport, which has led to a focus on injury epidemiology and prevention. While the majority of research regarding baseball injuries focuses on pitchers, fielders and catchers are also at risk. In an attempt to decrease non-contact injuries in the upper and lower extremities, stretching and strengthening exercises are vitally important. Because injury profiles demonstrate significant variability from youth to professional baseball, unique prevention strategies are likely necessary at each level. More research is needed to develop and validate appropriately targeted injury prevention programs.
KeywordsBaseball injuries Injury prevention Ulnar collateral ligament Overuse Professional Youth
Compliance with Ethical Standards
Conflict of Interest
All authors declare that they have no conflict of interest.
Human and Animal Rights and Informed Consent
This article does not contain any studies with human or animal subjects performed by any of the authors.
Papers of particular interest, published recently, have been highlighted as: • Of importance
- 1.Manager D. How many kids play baseball in the world? [Available from: https://www.dugoutmanager.com/how-many-kids-are-playing-baseball-in-the-world/.
- 2.Web HSB. Probability of playing college and professional baseball [Available from: http://www.hsbaseballweb.com/probability.htm.
- 3.Ozanian M. Forbes-MLB teams worth $36 billion as team values hit record $1.2 billion average [Available from: http://www.thesportsadvisorygroup.com/resource-library/business-of-sports/forbes-mlb-teams-worth-36-billion-as-team-values-hit-record-1-2-billion-average/.
- 4.• Conte S, Camp CL, Dines JS. Injury trends in Major League Baseball over 18 seasons: 1998–2015. Am J Orthop (Belle Mead NJ). 2016;45(3):116–23. This study represents the most recent examining injury trends in major league baseball. They examined injury incidence and amount of lost participation time between 1998–2015 using an MLB injury database. They found the incidence of injury to increase steadily during this period. Shoulder and elbow injuries were the cause of the most lost participation time. During the study period, MUCL injury incidence increased significantly and a significant number of pitchers had MUCL reconstruction surgery.Google Scholar
- 5.Position statement for adolescent baseball pitchers 2013 [Available from: http://www.asmi.org/research.php?page=research§ion=positionStatement.
- 6.• Makhni EC, Morrow ZS, Luchetti TJ, Mishra-Kalyani PS, Gualtieri AP, Lee RW, et al. Arm pain in youth baseball players: a survey of healthy players. Am J Sports Med. 2015;43(1):41–6. Though guidelines and recommendations are in place to prevent youth overuse injuries, adherence to them remains an issue for players and coaches. A recent study by Makhni et al. found that 46% of youth respondents said they were encouraged on at least one occasion to keep playing despite having arm pain. This is clearly a problem, as throwing-related arm pain is indicative of possible injury, and management involves cessation of throwing. It is imperative that adults, including coaches and parents, act in the interest of the athlete and not pressure them into continuation of potentially destructive activity. https://doi.org/10.1177/0363546514555506.
- 14.• Oliver GD, Plummer H, Henning L, Saper M, Glimer G, Brambeck A, et al. Effects of a simulated game on upper extremity pitching mechanics and muscle activations among various pitch types in youth baseball pitchers. J Pediatr Orthop. 2017. Whether or not young athletes should throw breaking balls prior to skeletal maturity has been a controversial topic over the years. This recent biomechanical study in youth athletes throwing various breaking and non-breaking pitches demonstrated no significant difference in arm slot position or muscle activation in the pelvis, torso, and upper extremity. This lends support to the argument that throwing a breaking ball is no more dangerous than throwing other pitches.Google Scholar
- 18.• Sakata J, Nakamura E, Suzuki T, Suzukawa M, Akaike A, Shimizu K, et al. Efficacy of a prevention program for medial elbow injuries in youth baseball players. Am J Sports Med. 2017:363546517738003. This prospective randomized trial of a unique stretching and strengthening protocol demonstrated a significant decrease in medial elbow injuries in adolescent baseball players. The exercises also improved dominant side total range of shoulder rotation, non-dominant side hip internal rotation, bilateral shoulder internal rotation deficit, dominant side lower trapezius muscle strength, and the thoracic kyphosis angle. This appears to be the first prospective study of its kind. The Yokohama Baseball-9, or similar exercises, could be incorporated into pre-game and pre-practice routines.Google Scholar
- 23.NFHS. National Federation of State High Schools Association Available from: www.nfhs.org.
- 27.Saper MG, Pierpoint LA, Liu W, Comstock RD, Polousky JD, Andrews JR. Epidemiology of shoulder and elbow injuries among United States high school baseball players: school years 2005-2006 Through 2014-2015. Am J Sports Med. 2017:363546517734172.Google Scholar
- 34.Centers for Disease C. Prevention. Sliding-associated injuries in college and professional baseball—1990–1991. MMWR Morb Mortal Wkly Rep. 1993;42(12): 223, 229–30.Google Scholar
- 41.Ozanian M. Baseball team values 2017 https://www.forbes.com/sites/mikeozanian/2017/04/11/baseball-team-values-2017/#5d11a8332451.
- 46.Ahmad CS, Dick RW, Snell E, Kenney ND, Curriero FC, Pollack K, et al. Major and minor league baseball hamstring injuries: epidemiologic findings from the Major League Baseball Injury Surveillance System. Am J Sports Med. 2014;42(6):1464–70. https://doi.org/10.1177/0363546514529083.CrossRefPubMedGoogle Scholar
- 50.Camp CL, Conti MS, Sgroi T, Cammisa FP, Dines JS. Epidemiology, treatment, and prevention of lumbar spine injuries in major league baseball players. Am J Orthop (Belle Mead NJ). 2016;45(3):137–43.Google Scholar
- 52.Wilk KE, Macrina LC, Fleisig GS, Aune KT, Porterfield RA, Harker P, et al. Deficits in glenohumeral passive range of motion increase risk of elbow injury in professional baseball pitchers: a prospective study. Am J Sports Med. 2014;42(9):2075–81. https://doi.org/10.1177/0363546514538391.CrossRefPubMedGoogle Scholar
- 53.Wilk KE, Macrina LC, Fleisig GS, Aune KT, Porterfield RA, Harker P, et al. Deficits in glenohumeral passive range of motion increase risk of shoulder injury in professional baseball pitchers: a prospective study. Am J Sports Med. 2015;43(10):2379–85. https://doi.org/10.1177/0363546515594380.CrossRefPubMedGoogle Scholar
- 54.Camp CL, Zajac JM, Pearson DB, Sinatro AM, Spiker AM, Werner BC, et al. Decreased shoulder external rotation and flexion are greater predictors of injury than internal rotation deficits: analysis of 132 pitcher-seasons in professional baseball. Arthroscopy. 2017;33(9):1629–36. https://doi.org/10.1016/j.arthro.2017.03.025.CrossRefPubMedGoogle Scholar
- 56.About All These Velocity Spikes | FanGraphs Baseball [Available from: https://www.fangraphs.com/blogs/about-all-these-velocity-spikes/.
- 57.• Chalmers PN, Erickson BJ, Ball B, Romeo AA, Verma NN. Fastball pitch velocity helps predict ulnar collateral ligament reconstruction in major league baseball pitchers. Am J Sports Med. 2016;44(8):2130–5. In this analysis of major league baseball pitchers, it was shown that peak velocity was an independent predictor of UCL reconstruction status. They also found that increased mean velocity was a statistically significant secondary predictor. https://doi.org/10.1177/0363546516634305.CrossRefPubMedGoogle Scholar
- 61.Camp CL, Tubbs TG, Fleisig GS, Dines JS, Dines DM, Altchek DW, et al. The relationship of throwing arm mechanics and elbow varus torque: within-subject variation for professional baseball pitchers across 82,000 throws. Am J Sports Med. 2017;45(13):3030–5. https://doi.org/10.1177/0363546517719047.CrossRefPubMedGoogle Scholar
- 64.• Seagrave RA 3rd, Perez L, McQueeney S, Toby EB, Key V, Nelson JD. Preventive effects of eccentric training on acute hamstring muscle injury in professional baseball. Orthop J Sports Med. 2014;2(6):2325967114535351. This study demonstrated a decreased incidence of hamstring injuries in a single professional baseball franchise when eccentric or Nordic hamstring strengthening exercises were implemented. This led to decreased loss of participation time as well. https://doi.org/10.1177/2325967114535351.