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Health & Exercise Forum

Health and Safety Tips for Youth Baseball Coaches - Part 2 of 2

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May 11, 2015

Dr. Mackarey's Health & Exercise ForumPrevent Overuse Injuries in Youth Sports. Part 2 of 2 on Health and Safety Tips for Youth Baseball Coaches.

Recently, much attention has been given to the drastic increase in the incidence of serious injuries in youth sports, like baseball, from overuse. In my practiced as an orthopedic and sports physical therapist, I have seen more overuse injuries in youth sports leading to surgery in the past 5 years than in previous 20 combined. Some examples are: little league elbow, ulna collateral ligament strain of the elbow (often requiring Tommy John surgery) and Dead Arm Syndrome at the shoulder. While these injuries can sometimes be related to poor mechanics, overuse is almost always the true culprit. Statistics clearly show that more children are participating in more competitive organized sports year round at an earlier age than in previous generations. Not coincidentally, a significant increase in the number of injuries has occurred and more than 50% of sports injuries in children and teens are due to overuse.


When a bone, muscle, tendon or ligament is subjected to repetitive stress without adequate healing or recovery time, tissue damage occurs. Examples include:

Little league elbow: The muscles, tendons and immature elbow bone where the tendon attaches at the elbow become inflamed due to overuse.

Ulna collateral ligament strain: The ligament on the inside of the elbow becomes inflamed, partially or completely torn from excessive stress and overuse. It can often require surgery called Tommy John surgery, named after the all-star baseball pitcher who resurrected his career following the surgery to repair his ulna collateral ligament.

Dead Arm Syndrome at the shoulder: The posterior capsule of the shoulder (back of the shoulder where the rotator cuff attaches) is overused and stressed. Overtime, the tissues react, scar and tighten, creating an imbalance and abnormal forces on the shoulder joint and surrounding tissues. Eventually, an athlete cannot throw without pain, must compensate resulting in loss of velocity and effectiveness.

Overuse injuries are manifested in the form of pain, swelling, and inflammation, loss of range of motion, strength and function. Tennis elbow in tennis players, little league elbow in baseball players and shin splints in runners are a common example of an overuse injuries.

4 Stages of an Overuse Injury

  1. Pain in the site of injury after the physical activity
  2. Pain in the site of injury during the physical activity without restriction on performance
  3. Pain in the site of the injury during the physical activity with restriction on performance
  4. Constant pain in the site of the injury, even at rest


Children Are Not Small Adults! Therefore, they should not be treated the same way. Their bodies CANNOT take the same amount of stress as an adult because they are still growing and immature soft tissues and bones are less resilient to stress. Little league elbow and dead arm at the shoulder are two of the best examples.


  • Preseason Physical Evaluation: In addition to a physical examination from a family or sports medicine physician, a musculoskeletal screening by an orthopedic or sports physical therapist is valuable. Then, recommendations can be made to work on deficits, such as tight hamstrings and weak core muscles, during the offseason.
  • Avoid Specializing in One Sport: Sometimes the best advice is to keep it simple…athletes should not specialize in one sport before puberty as most are too young to know your interests and strengths. Also, your body is too immature to handle the physical stress of using the same muscle, tendons and ligaments all year long. Moreover, not concentrating on one sport will help avoid “burn-out” before high school or college. This winter, play indoor soccer instead of baseball to develop lower body strength, endurance and agility. MIX IT UP AND HAVE FUN!
  • Proper Preparation and Training: As discussed in last week’s column, warm up, stretching, protective gear and clothing will go a long way to prevent injury.
    • A warm-up routine is essential prior to stretching. As a total body   warm-up, take a short jog, two to three laps around the field. Then, move the muscles of the shoulder, elbow and wrist 20 – 25 times to warm up muscles and tendons prior to throwing. Lastly, throw in short to long toss, start at 10 feet and increase by 10 feet every 10 tosses.
    • Following a warm up, stretching is essential to protect against injury. Upper body: hands behind head, hands behind back, elbow across chest. Lower body: Indian sit, hurdle stretch, hamstring stretch lying on back, calf stretch.
  • Watch for Signs of Injury - Pain/Swelling. Coaches and parents should not encourage youngsters to play through pain. Pain and swelling are usually warning signs of injury or a minor problem that can lead to a serious injury. Remember children have growth plates at the ends of their bones that are not fully fused.
  • Treatment: The most important treatment for most sprains and strains in children and teens is rest. It is also the best way to prevent overuse injuries such as little league elbow and throwing shoulder tendonitis. Treatment includes
    • Rest- stop throwing
    • Ice – ice packs 15-20 minutes 3-5 times per day
    • Compression – compression bandage or sleeve
    • Minor Problem - if discovered early, the above treatment may be sufficient.
    • Physician Visit – if pain persists for more than a few days, a visit to your family physician is important to determine the extent of the injury.


REMEMBER: Kids are not small adults! Keep it light and have FUN!

SOURCE: The American Academy of Pediatrics

Visit your doctor regularly and listen to your body.

NEXT MONDAY – Read Dr. Paul J. Mackarey “Health & Exercise Forum” in the Scranton Times-Tribune.

This article is not intended as a substitute for medical treatment. If you have questions related to your medical condition, please contact your family physician. For further inquires related to this topic email:

Paul J. Mackarey PT, DHSc, OCS is a Doctor in Health Sciences specializing in orthopaedic and sports physical therapy. Dr. Mackarey is in private practice and is an associate professor of clinical medicine at The Commonwealth Medical College.