Preventing Baseball/Softball Injuries

Jeremiah Clinton, MD
With spring nearly over the boys and girls of summer are heading to the mound for competitive and recreational baseball and softball. It may surprise you to know that in 2015, 265,000 Americans were treated for baseball related injuries and 10,000 of the injuries resulted in hospitalization. Even though we consider baseball a non-contact sport most serious injuries occur from direct contact with a bat, a ball, another player or the ground. Also of concern are overuse injuries to the shoulder and elbow from the repetitive nature of the game. Although we cannot prevent all injuries we can try and reduce them by making sure players have properly prepared before the season starts, that appropriate equipment is used, ensure the field is safe, and by focusing on the proper techniques of the game.

Preparation for the game is important for both coaches and players. For players warming up before you start the game is very important. You do not see the professionals running out cold and playing. They spend up to several hours before the game warming up, stretching, and practicing before the first at bat. It probably is not reasonable to think the average player can spend an hour or more warming up before the game but take 15-30 minutes and warm up with easy calisthenics like jumping jacks, pushups, and sit-ups. Run the bases at a light jog, not only to warm up but also to become familiar with the field and any danger it may pose. Stretching before the game can keep you playing without injury. It is especially important to stretch your shoulders, hamstrings, and back. In the big leagues, 22 pitchers that did a specific stretching routine for their shoulders did not miss an inning over the course of a 3 year period. In contrast, a different study followed 39 pitchers that had tight shoulders that were identified in spring training. These players did not do a specific stretching routine, and of the 39 players followed during the study, 23 of them or 60% had to stop playing because of shoulder injuries. Your coach or athletic trainer may be able to give you a simple stretching program that you can do before the game to avoid injury. From a coaches perspective ensuring players are warming up appropriately, using proper form and technique, that pitch counts and innings played are closely watched, and that the players have the right equipment can avoid games missed.

Like any sport the right equipment makes the game safer and more fun. Baseball shoes that fit properly and have the appropriate cleats for the surface can decrease the likelihood of foot and ankle injuries. The catcher requires position specific equipment to include: mitt, helmet, facemask, throat guard, chest protector, shin guards and a protective cup. Both the player at bat and the player on deck should have batting helmets on and they should be worn until the player has returned to the dugout. For additional safety a protective face mask can be added to the helmet to avoid facial injuries. In recent years batters have the option of using protective jackets to avoid injuries to the chest and back from wild pitches. Softer balls should be used in the youth leagues to avoid injury from pitches or balls that have been hit into play. Players should also be coached on how to avoid being hit by the ball verses taking the hit from wild pitches.

Many of the more serious injuries that occur during a game or practice are centered on base running. Specific instructions and coaching the appropriate technique can decrease the risk significantly. It is recommended that players under the age of 10 not be taught to slide and when initially learning to slide should do so without a base in place or use a specific "sliding bag." Fielders should be taught and should adhere to the "obstruction rule," and avoid blocking the runner or base when you are not in possession of the ball, as collisions on the field can lead to serious injury to both the runner and fielder. In contrast to the majors in little league and high school ball the runner is required to attempt to avoid contact with the defensive player, if they fail to do so this is considered "malicious contact" and the player can be thrown from the game. Players should attempt to slide into home and avoid smashing into the catcher as this can lead to very serious injuries and typically the runner gets the worst of it and unless the play is very close is usually still put out.

Pitching is another common source of injury to players, because of the enormous amount of force the throwing arm must generate and the stress this puts on the shoulder and elbow specifically. The American Baseball Medical and Safety Advisory committee has developed guidelines to limit both pitch counts per game and pitches per week. Additionally they have made recommendations when to teach young pitchers specific pitches. Pitchers should avoid playing for more than one team at a time, as it has been shown to increase the risk of shoulder and elbow injuries. In general young athletes should not participate in the same sport year round. Breaks are needed allow for young bodies to recover can decrease the risk of overuse injuries. Playing other sports also allows for the development of other skills that may cross over to their play on the diamond.

Finally, good communication between coaches and parents is important when an injury is suspected, since some players will try and hide an injury to avoid being removed from play. When injury does occur return to play should only happen when the player's symptoms have completely resolved. If a joint has been injured it should not be swollen or painful, have full range of motion and full strength. If a player has sustained a concussion they should not return to play until being cleared by a medical provider and are 100% asymptomatic both at rest and at play. For players with overuse injuries to the shoulder and elbow a gradual return to throwing should occur through a structured plan which progressively increases the number and distance of throws depending on the position of the player and the length of time away from the game.

With proper preparation, equipment, and coaching many injuries that occur in baseball and softball can be avoided allowing players to enjoy the great American past time.

Questions and or comments regarding this week's health column please contact Jeremiah Clinton, MD at Bitterroot Orthopedics and Sports Medicine, a service of Marcus Daly Memorial Hospital, 1200 Westwood Drive, Hamilton, MT 59840. Working together to build a healthier community!
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