By William Heinz, MD
For many of us, playing baseball or softball is the first true sign of spring. Children and adults across the country anxiously anticipate the first chance to play catch, hit a few balls, or play pickle at the old ball field. While it may seem gentle when compared to some contact and collision sports, baseball can be a demanding sport on the body. Swinging bats, running the bases, and hurling balls at high speeds inevitably lead to some scrapes, bumps, and bruises along the way. Many of the accidental injuries that occur while playing baseball are just that, accidents — an errant pitch hitting a batter, turning an ankle on a base, or a grounder taking a bad hop.
These unfortunate events should be treated properly and immediately to minimize the players’ discomfort. (Think RICE: rest, ice, compression, and elevation.) There are, however, some injuries that can be avoided to keep you and your children in the game. These involve various muscle pulls, shoulder problems, and elbow sprains. The most common baseball injury involves the rotator cuff — a collection of four muscles surrounding the shoulder that functions to maintain correct biomechanics. Tendonitis (inflammation) of the rotator cuff occurs when the tendon is overused, often as a result of repetitive overhand throwing and underdeveloped muscular strength. Pitchers and catchers are most susceptible to rotator cuff injuries because of the amount of throwing involved in those positions, but outfielders and other players also can be affected.
Plan and Prepare
To prevent these injuries, all players are encouraged to develop a regimen of warm ups and stretching before throwing as well as proper throwing mechanics. Unfortunately, because children are often less aware of their physical limitations and sometimes put increased pressure on themselves, it is critical that parents and coaches pay close attention to their children’s play and be aware when their performance may have changed for the worse. For example, a pitcher who throws in control for the first few innings and then starts to throw wild pitches may actually be showing signs of fatigue or early injury to the rotator cuff. To avoid potential injury, this child should be removed from the game as performance begins to deteriorate.
During the game, players also are encouraged to look after themselves by observing the following habits:
• Stay warm: Keep a jacket on between innings.
• Stay loose: Jog out to your position on the field at the change of innings.
• Stay in the game: Keep moving between pitches.
If a shoulder, elbow, or hamstring begins to hurt, it is important to talk to your family doctor or sports medicine specialist to properly diagnose the problem. They will help develop a plan for resting and then strengthening the trouble spot. For easy reference, I have provided a few Web resources that describe some simple, effective strength exercises specifically targeting the rotator cuff and elbow. While lifting heavy weights will strengthen the large muscles in your body, the only way to strengthen the underlying tendons is through these very specific exercises that target the smaller muscles of the rotator cuff. Often, the only resistance needed is a piece of elastic tubing.
The USA Baseball Medical & Safety Advisory Committee recommends that the first pitch introduced to Little Leaguers should be the fast ball at 8 years old, followed by the change-up at 10, the curve at 14, the knuckle ball at 15, and the slider and fork ball at 16. Following these guidelines will allow the arm muscles to develop properly to meet the physical demands of each pitch and avoid “Little League Elbow,” a chronic inflammation of the growth plate in the elbow joint. It is also important to note that throwing fast or far is not purely a result of arm strength. Velocity comes from developing good mechanics and strengthening of the trunk, legs, and hips. The stronger you can make these parts of your body, the less stress you will put on your arm. Lastly, although it may seem like many of the players we see take the field at Hadlock or Fenway simply jump off the bus and hit the field ready to go, nothing could be further from the truth. Professional baseball players often reach the park four to five hours before game time and have done two hours of warm ups and stretching before even taking batting practice. Take a page out of their book and give yourself enough time to warm up.
William Heinz, MD, specializes in the diagnosis and treatment of sports-related musculoskeletal injuries. He received his undergraduate degree from Purdue University and graduated from Indiana University School of Medicine. He completed his residency in internal medicine and performed a fellowship in primary care sports medicine where he sub-specialized in shoulder injuries. He is the team physician for the Portland Sea Dogs and a team physician for U.S. Soccer. He is also the company physician for the Portland Ballet and the orthopedic consultant for Bridgton Academy, Gould Academy, and Deering High School.