Preventing Throwing Injuries

By Barry Werries, MD
Board Certified Orthopedic Surgeon

????????????????????????????????????????????????????????????????????Of all the athletic activities studied, throwing a ball creates one of the greatest forces across the elbow and shoulder. These repetitive forces make the shoulder and elbow susceptible to both acute and chronic overuse trauma. The incidence of baseball pitchers having shoulder or elbow pain is becoming an epidemic.

Even though the most common symptom is pain, there are other subtle signs and symptoms of an arm injury, such loss of strength and range of motion. The elbow or shoulder can have catching or locking or the player may have numbness in the arm. The player may have ball control problems or decrease in ball velocity. There may be changes in the mechanics which may actually cause damage somewhere else in the body. Other signs of fatigue may be an upright trunk or dropped elbow during pitching or increased time between pitches.

Risk factors for these injuries are the amount of pitching and pitching while fatigued. Other risk factors include pitching on multiple teams, pitching year round, playing catcher when not pitching, poor pitching mechanics, increased ball velocity, and poor physical conditioning. Injuries to the back or legs or loss of flexibility can alter the chain of events that contribute to the act of throwing and put more stress on the arm.

When a child who is not skeletally mature is exposed to throwing, the body will make some anatomic adaptations at the shoulder that may be protective. Although it is apparent that there should be a limit to the number of pitches to decrease injury, there may be an increased likelihood of injury in athletes who start pitching in high school than those who have been throwing in early childhood.


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Click to enlarge.

The USA Baseball Medical/Safety Advisory Committee has made recommendations on the limits of the number of pitches. Some organizations such as Little League Baseball have instituted these limits into their rules. These limits should also include pitches in practice, and coaches should be aware of pitch counts with players who play on other teams. Just as important as the number of pitches, the same committee has also made recommendations on days of rest after pitching. I am a firm believer that the body needs time to recover from the stresses of pitching, and I do not advocate throwing every day. Despite the emphasis on pitch count in a game, there is also evidence that the accumulation of pitches within a season is just as important to the health of the throwing arm. It is recommended to avoid any overhead throwing for 2-3 months per year and no competitive pitching for at least 4 months per year.

Unfortunately, little leaguers are throwing breaking balls at the age of 11 or 12. There has been a higher incidence of shoulder pain with curveballs and elbow pain with sliders. With proper mechanics, the curveball may not put increased stress on the elbow. Many young pitchers, however, have difficulty with the proper technique to throw a curveball, so there should be more emphasis on throwing a changeup at a young age. A safe approach is to wait until the age of 14 to start throwing curveballs and the age of 16 for sliders.

Proper throwing mechanics are very important to preventing arm injuries. Even though a pitcher is successful in games, throwing with improper pitching technique is like an engine leaking oil; the arm will eventually break down. If a pitcher does not correct his mechanic flaws, then his injuries will recur despite even surgical repair. Thus, it is advisable to have a coach who is knowledgeable of the proper throwing mechanics to work with a pitcher.

A majority of the throwing injuries occur in the beginning of the season because the players have not built up their strength. An excellent program for strengthening the arm is the Thrower’s Ten Program which focuses on the rotator cuff, scapular stabilizers, and forearm muscles. Many of the throwers who have arm problems have scapular dyskinesia. Scapular dyskinesia is when the scapula or shoulder blade is moving abnormally which creates shoulder/arm dysfunction and injury.

Many athletes focus on arm strengthening but they ignore the core/trunk and lower body strength which accounts for more than 50 percent of the kinetic energy to throw a ball. Core trunk stabilization focuses on strengthening the spinal and pelvic stabilizers and abdominal musculature. Weakness of lower body muscles, especially the hip abductors and hamstrings, have been identified in athletes with shoulder and elbow injuries. It is also important to build up the endurance of the lower body, and I prefer an interval sprinting program over jogging for baseball players.

The loss of flexibility of particular joints in the throwing athlete will predispose them to arm injuries. In the shoulder, throwing athletes have the loss of internal or forward rotation which is addressed by stretching the posterior, or back, of the shoulder. Care should be taken when stretching the front of the shoulder because most overhead athletes have stretched out their anterior capsule, which is in the front of the shoulder. In the lower body and trunk, the lumbar (low back) inflexibility, hip rotation deficit and hamstring tightness can also increase the risk of arm injury. It is also recommended to stretch for 5 minutes after playing.

In summary, a pitcher should focus on proper throwing technique, good physical conditioning and flexibility, avoid excessive stress on the arm and allow the arm to recover from the stress of throwing will help decrease the chances of an arm injury.

This article was published in the October-December 2014 edition of ”FYI from OCI”, a quarterly publication created by the Orthopedic Center of Illinois. To see the full publication, click HERE.

Assistance for Illinois Senior Athletes, 11th Annual Chip in Fore Charity

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Dr. Romanelli presents the $20,000 check to Jennifer Phillips, director of the Illinois Senior Olympics.

Springfield area business leaders and the physicians at OCI joined together to fund a $20,000 community impact grant through the 11th Annual Chip in Fore Charity. The weather compromised the original date, but everyone rallied two weeks later on Sept. 29th to benefit athletes 50 years and older through the Illinois Senior Olympics. The OCI Foundation proudly presented the $20,000 check to foster lifelong fitness and wellness for athletes in our community and across the state. Thank you to our generous sponsors for making this event possible year after year! In 11 years, this event alone has funded more than $200,000 in community grants.

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Second place team: Adam Springer, Jason Loftus, Ben Call, Dr. Idusuyi

Presenting Sponsors:
Memorial SportsCare
St. John’s Hospital

Corporate Sponsors:
DePuy Spine
Hanger Clinic
Isringhausen Imports
Levi, Ray & Shoup
US Bank


Education Sponsors:
B&B Electric
Harold O’Shea Builders

Lunch Sponsors:
Comprehensive Prosthetics + Orthotics
United Community Bank

Beverage Sponsors:
Entre Solutions II
Innotek Medical Products

Driving Range Sponsors:
A-1 Corporate Hardware
Bank of Springfield
Jason Loftus
Joe & Missy Mizera

Putting Green Sponsors:
American Central Insurance
Joe Iacono, AXA
Prairie State Bank and Trust

Hole Sponsors:
DJO Global
Gallagher Healthcare
Game Ready
Green Family Stores
Hurwitz Enterprises
Randy and Barb O’Brien, CES
Smith & Nephew

Patron Sponsors:
A&B Printing
Entec Services, Inc.

Gifts and Raffle Sponsors:
Anytime Fitness
BJ Grand Salon & Spa
Country Market
Denney Jewelers
Isringhausen Imports
Jim Herron Menswear
Norb Andy’s Tabarin
Robert’s Seafood Market

Thank you to our official media sponsors, WICS NewsChannel 20 and the State Journal-Register, and our printing sponsor, Solution Printing.

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Enjoy the Great Outdoors Pain Free

By Joe Williams, Physical Therapist, Midwest Rehab at OCI

As the days begin to shorten and the air begins to cool,
Raking Exercisethe fall season also brings to mind the beauty of the changing leaves.  But, the leaves that are so pretty on the trees are not so beautiful on the ground.  Getting them off your lawn and out of your landscaping is a seasonal challenge that can be a challenge to your body as well.  We want you to protect your body.

Before heading out to work in the cool air, we have some suggestions to help protect you from injury.  It is always a good idea to do some type of warm up before jumping to a task in the yard.  The body needs some time to get going, the blood to start pumping, and the joints to loosen.  A 5-10 minute walk can be just the activity that can help get you going.

Now that the body is going, it is important to choose the right equipment.  Many hardware stores will sell you broad rakes that pick up a lot of leaves with one pass.  While this might seem desirable at first, the larger the rake, the larger the load you are lifting.  Consider how much force it might take you to lift those leaves to bag them.  Wet leaves will be heavier than dry ones, which will also increase the load you lift.  Rake heads may vary from 8″ to 30″ or more.

As you start to use the rake you have chosen, it is very important to watch your posture.  Raking is by nature an activity in which we flex the spine often.  This can create quite a strain on the back.  Try to keep the back upright and use your legs to step forward and back with the raking motion.  After 15 minutes of raking, it is also a good idea to stop and stretch.  After repeated flexing, it is good to extend the spine arching the back in the opposite direction.

Most of us prefer raking leaves on one side or the other.  But, that can produce uneven stresses on the back and other structures.  You would be wise to switch your grip on the handle often, switching the lead hand as you rake.

Many people live where they must bag their leaves.  Be sure to lift with your legs, keeping the back straight, when you are picking up the leaves.  Your legs can do the lifting when you keep the chest up.  Tightening the abdominals as you lift can help support the spine as well.  This can be a good time to practice good body mechanics, so it will be good habit with any other lifting you may do around your home or work.

Above all, be safe as you prepare your house and yard for the winter ahead.  Autumn is a great season, and we want you to enjoy it.  If you have questions about information in this article or would like to discuss how to prevent injuries with a physical therapist, we can help. Call Midwest Rehab today to set up a consultation: (217) 547-9108.

Jow Williams 4x6Joe received his bachelor’s degree from St. Louis University. He practiced in a wide range of settings before focusing on orthopedics. He is especially interested in treating lower back and lower extremity pain and other orthopedic conditions.

This article was published in the October-December 2014 edition of ”FYI from OCI”, a quarterly publication created by the Orthopedic Center of Illinois. To see the full publication, click HERE.