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Are Baseball Players Facing an Epidemic of Earlier Onset Elbow Injuries and Surgeries?

The American Journal of Sports Medicine published a 2015 study that found athletes between ages 15-19 accounted for 56.8% of all Tommy John procedures. Many orthopedic surgeons have reported the fastest-growing segment of patients for these procedures continues to be 15-19 year olds.

As parents, we all want our children who want to play a sport to do their best and have the best opportunities. We drive them to practices that may not always be in our town (I drive 1.5 hours each day of practice) and we see how hard they work as athletes in practice and managing their overall time with homework and everything else in their schedules. If your baseball player could avoid surgery, especially a Tommy John Surgery which will cost $15,000-$50,000, and one year of rehabilitation, you would want to make sure you did what you could to prevent it. You might assume that the coaches do preventative strengthening while in practice, but usually, they do not have the time to cover this. I have gone to several sports teaching preventative exercise programs only to follow up and hear that the programs were not continued to be used. It is up to the athlete and parents to complete this on their own time. Even as a Physical Therapist, I have to squeeze in time to teach my child preventative strengthening programs.

Another part of this is that injuries like the Medial Ulnar Collateral Ligament (MUCL) are not only improper pitching mechanics but the focus on velocity training with a pitch clock not allowing enough recovery time and many other factors rushing the game. We all know with all sports that an athlete needs rest and recovery to prevent injuries. Young athletes need a gradual progression in sports and also should be doing strength training and sports-specific strength training as well. I have witnessed strength training being introduced mostly when they are high school level. They should be building a foundation of strength when they start sports in the first place. As a Physical Therapist, I have worked with many throwing athletes. Most all of them do not have proper shoulder complex and scapular stabilization, core stabilization, and leg strength which is all necessary in throwing sports.

Here are a few basics that a Sports Physical Therapist will focus on: Dynamic warm-up, appropriate glenohumeral (shoulder) and elbow mobility, maintenance of rotator cuff strength and scapular stabilization, appropriate workload management, recovery that promotes decreasing inflammation, and maintenance of flexibility and strength.

Some exercises that may be included are a progression of rotator cuff strength starting with external and internal rotation at 0 degrees abduction and progressing to 90 degrees of abduction, prone scapular stabilization exercises, wrist/elbow specific exercises, and shoulder external rotation with modified side plank. Exercises should change and be adjusted to the off-season and at different stages of the season. Adjusting the intensity of arm exercises should change according to pitch count, total throwing volume, subjective reports of fatigue, and objective tracking of measures like strength and range of motion (ROM). Constant re-assessment on a daily and weekly basis needs to be done by the Physical Therapist, Athletic trainers, other Medical team members, or staff to make the frequent adjustments necessary to prevent injury and surgery.

Each athlete must have a functional screen and evaluation to make an individualized program. You and your athlete could learn what you need to do in a few one-on-one visits and follow up as needed. It is important to choose a Physical Therapist like myself who is trained and experienced with sports. In a clinic, you would ask for a Sports Physical Therapist. Not all Physical Therapists are trained and experienced with athletes.

To schedule an appointment, please email me at or call 971-719-3162.

Karen Baltz Gibbs, PT, DPT, CSCS, CMP, LMT, Owner Garage Training & Rehab Gym

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