The most effective way to address injuries is to address them before they begin. A sport such as baseball involves repetitive, powerful, and precise movements, replicated many times throughout a season. When thinking about which parts of the body are involved in the movements when playing baseball, the wrist, elbow, and shoulder joints probably are the first to come to mind. Some general principles can be applied when it comes to injury prevention. Baseball players should always respect pain when it comes to throwing. Pain in the shoulder or elbow could be an indication of a problem that can worsen if left unaddressed.
Proper conditioning for running and agility can reduce the risk of injuries while running the bases or playing the field. Extreme forces are applied to the body with throwing and hitting in particular. Overuse injuries to tendons such as impingement and tendonitis can occur in the elbows and shoulders from repetitive use, weakness, or poor body mechanics. A common injury suffered by baseball players at all levels, is medial epicondylitis, or little league elbow. This injury is incurred by repetitive stress on the inner side of the elbow, where the muscles that bend the wrist connect to the elbow. These muscles are susceptible to overuse strains, and even resulting stress fractures in adolescent players given the amount that they perform this motion with hitting and throwing. Proper conditioning, warm up, and throwing programs can reduce the risk of such injuries occurring.
Any weak link in the chain can lead to poor performance or injury. Strengthening programs should include 1-3 sets of 6-15 repetitions of exercises addressing these muscle groups, while replicating movements that are most similar to those used in baseball. One program that addresses upper body strengthening, specific to baseball is the Throwers Ten program. This program consists of strengthening exercises for the shoulder blades, elbows, and wrists, which are mainly performed using elastic tubing. These types of exercises can be appropriate for baseball players over the age of 7-8 years old. While the upper body joints play an integral role in baseball activities, the core, trunk and hips, as well as the lower body all are essential as they work together as a chain to prevent injury as well as promote maximal performance. Additionally, exercises including rotating the trunk while throwing a medicine ball, lunges, squats, step ups, chopping, and planks are all appropriate to address the core and lower body to prepare for hitting and pitching activities. Given that most players only throw or hit from one side, muscles and joints may be imbalanced from rotating in one direction. It is beneficial that players can train by performing rotational activities from both sides to attempt to balance the muscle and joint forces. Even swinging from both sides as part of a warm up may help. Performing the rotational exercises discussed earlier in both directions will also address this.
Monitoring the amount of time an athlete plays is important in reducing the risk of injuries. Adhering to pitch counts, allotting for proper rest, as well as paying attention to body mechanics and types of pitches a pitcher throws can all contribute to the risk of injury. The USA Medical and Safety Advisor Committee recommends that pitchers should not attempt to throw curveballs before the age of 14 years old, while knuckleballs and sliders should not be attempted until the ages of 15 and 16 years old, respectively. At any rate, it is recommended to seek proper coaching regarding pitching mechanics from a qualified individual. Regarding pitch counts, it is recommended that pitchers age 7-8 not throw more than 50 pitches per day, those 9-10 years old no more than 75, those 11-12 no more than 85, and those 13-16, no more than 95. For those ages 7-14 years old, it is recommended that players throwing from 21-35 pitches be given 1 day of rest, those throwing 36-50 pitches be given 2 days rest, 51-65 pitches 3 days rest, and over 66 pitches be given 4 days rest from pitching. It is recommended that pitchers ages 15-18 years old throwing 31-45 pitches be given one day of rest, those throwing 46-60 pitches be given 2 days rest, those throwing 61-75 pitches 3 days rest, and those over 76 pitches be given 4 days rest between pitching.
A proper warm up is essential to raise core body temperatures, resulting in increased ability for muscles to lengthen and contract, producing greater strength as well as reducing the risk of muscle strain. Warm up exercises can begin with general movements such as jumping rope, or skipping, as these types of activities are more similar to baseball skills than jogging. They can be followed by dynamic stretching and static stretching of elbows, wrists, and shoulders, since these joints are often required to reach extreme ranges of motion during throwing. Following a warm up, players may participate in interval throwing programs, which consist of structured progressions of throwing from seated and kneeling positions. Players will then transition to stationary positions, then finally throws while striding, before throwing with a crop hop. Throws should consist of multiple throws at a shorter distance, gradually increasing to build up arm strength.
Finally, some general advice can also be helpful to protect baseball players from injury. Icing the throwing arm following pitching or extensive throwing can help to reduce soreness or inflammation. Applying ice for 20 minutes, then alternating for two cycles of 10 minutes on and off has been shown to be beneficial to accomplish these goals.