A new narrative review, “Sport Specialization and Overuse Injuries in Adolescent Throwing Athletes: A Narrative Review,” recently published in The Journal of Athletic Training’s special thematic issue on sport specialization highlights the role sport specialization plays in overuse injuries and the importance of conditioning and rehabilitation programs. The Journal of Athletic Training is the scientific publication of the National Athletic Trainers’ Association.
According to the studies reviewed by the authors, youth baseball players experience throwing-arm pain more than 50% the time and shoulder and elbow injury rates among high school baseball players over 10 years was 1.39 per 10,000 athlete-exposure (AEs) and 0.86 per 10,000 AEs, respectively.
Pitchers are the hardest hit with 39.6% of all the shoulder and 56.9% of all the elbow injuries. The number of baseball players needing ulnar collateral ligament (UCL) reconstruction has also been on the rise in the last 20 years.
In short, say the study authors, “Early sport specialization (ESS) is a theoretical external risk factor for throwing-related overuse injuries of the shoulder and elbow. Understanding the association between ESS and throwing volume is critical to reducing injury risks and rates.”
They explained that sport specialization in baseball regardless of fatigue, age, and workload increases the risk of overuse injury and just injury in general. They added that pitchers 9 to 14 years old who pitched more than 8 months per year had a 5 times greater risk for surgery than those who pitched for less than 8 months.
The crux of the issue seems to be throwing workload and volume, and throwing while fatigued or in pain. Here are some important statistics from the review:
- Pitchers were at 4 to 36 times greater risk of sustaining an injury due to overuse and fatigue when pitching with pain or fatigue.
- Pitchers were at 3 to 7 times greater risk of developing shoulder or elbow pain, or injury if they regularly threw with arm fatigue, threw more than 75 pitches per game, played catcher when not pitching, or threw more than 600 pitches per year.
- Adolescent pitchers were at 2 to 5 times greater risk of requiring shoulder or elbow surgery or ending their baseball career if they also played catcher, threw more than 80 pitches per game, threw more than 100 innings per year, or threw more than 8 months per year.
- Regularly throwing with arm fatigue also increases chance of needing surgery.
Besides following recommendations and guidelines about overuse injuries and sport specialization, the authors recommend that sports medicine team caregivers “develop a comprehensive understanding of each thrower’s competition level, ability, throwing volume, and (if possible) pitching velocity during practices and games”.
This will help with the development of rehabilitation or conditioning programs that center on neuromuscular control, strength, muscular balance and endurance among throwing athletes.
The authors offered the following recommendations, “When designing strength and conditioning programs for this population, the clinician should take the athlete’s chronological age, training experience and skill level into account.”
They also called for more research to be done on the concept of workload and the acute-to-chronic workload ratio (ACWR).
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