Throwing Injuries in Youth Baseball Players: Can a Prevention Program Help? A Randomized Controlled Trial

Abstract

Background: Throwing injuries of the shoulder and elbow are common among youth baseball players. Hypothesis: A prevention program will reduce the incidence of throwing injuries of the shoulder and elbow by 50% among youth baseball players. Study Design: Randomized controlled trial; Level of evidence, 1. Methods: The authors block randomized 16 youth baseball teams consisting of 237 players aged 9 to 11 years into an intervention group (8 teams, 117 players) and a control group (8 teams, 120 players). The intervention program consisted of 5 stretching, 2 dynamic mobility, and 2 balance training exercises performed during warm-up. Both groups were followed up for 12 months, during which the incidence of shoulder and elbow injuries was recorded. In addition, ball speed during pitching as a performance-related factor and variables of physical function (passive range of motion of the elbow, shoulder and hip, dynamic balance, and thoracic kyphosis angle) were assessed during the pre- and postintervention periods. Results: The incidence of shoulder and elbow injuries in the intervention group (1.7 per 1000 athlete-exposures) was significantly lower than that in the control group (3.1 per 1000 athlete-exposures) (hazard ratio, 1.940; 95% CI, 1.175-3.205; P = .010). The factors related to pitching performance, as assessed by ball speed, tended to increase in the intervention group as compared with the control group ( P = .010). The program also improved shoulder horizontal adduction deficits on the dominant side, hip internal rotation on the nondominant side, and the thoracic kyphosis angle. Conclusion: A prevention program decreases throwing injuries of the shoulder and elbow and enhances the parameter of pitching performance in youth baseball players.

Regional Interdependence and the Role of the Lower Body in Elbow Injury in Baseball Players: A Systematic Review

“…Each study had unique limitations, but one of the most noteworthy is the fact that in several studies, ROM was assessed passively on an examination table. 6,8,14,15,26,28,29 While this is concordant with the literature, to best test the hypothesis that dynamic kinetic chain imbalances predict elbow injury, in future work athletes should be assessed functionally as well as passively. This review was also limited by discordant outcomes assessed in the reviewed literature; for example, outcomes ranged from objective UCL tears to subjective elbow pain, which limited interstudy reliability and meta-analysis.…”

“…(2) The high-compliance rate of 73.4% surpassed the 57.4% high-compliance rate reported for the original program used in the initial trial. (3) The intervention group also enhanced their throwing velocity by a mean 1.43 mph as compared with controls 29 (Table 2). This study represents extremely encouraging results by suggesting that not only can a brief warm-up program reduce the risk of medial elbow injury in youth baseball players, but it can also be done in a way that enhances throwing velocity.…”

“…The deficiencies shown to be independent risk factors for elbow injuries in specific subsets of baseball players included hip ROM, hip flexibility, balance, lower extremity injury, foot arch posture, and noncompliance with primary prevention programs. 6,8,9,[14][15][16]19,[26][27][28][29][30][31][32] Each reviewed study is detailed with results and corresponding comments in Table 2.…”

“…On the basis of these findings, the authors concluded that it is possible to reduce the medial elbow injury risk for novice players in an upcoming season by improving or modifying these specific physical risk factors. In a follow-up randomized controlled study, 29 the same group created an abbreviated program consisting of 9 exercises. This study demonstrated 3 key findings: (1) Over the same 12-month period, 24 players (22.0%) in the intervention group reported injuries of the throwing arm versus 42 players (38.2%) in the control group, representing a statistically significant reduction in the incidence of injury (hazard ratio, 1.940; P = .010) and an overall 48.5% lower injury risk.…”

The challenge of the sporting shoulder: From injury prevention through sport-specific rehabilitation toward return to play

“…Under the premise of ''as the twig is bent, the tree is inclined'', the focus leans more toward prevention programs in youth sports. There is growing evidence of possible risk factors for shoulder pain in adolescent athletes [1,36,37], and age-specific adaptations have been examined with clinical measurements [38,39] and imaging [37]. Recently, an injury prevention program was used in a randomized controlled trial of 237 baseball players aged 9 to 11 years [36].…”