Low Back Pain in Growing Youth Baseball Players

With a wide range of injuries in youth baseball, and more than 12 million amateur baseball players in the United States, a comprehensive list of tests and measures may be helpful to assess strength, mobility, and motor control throughout the kinetic chain to reduce risk of injury in this population. Many studies have looked at youth baseball players using a single test or a small number of tests to determine the prevalence of specific injuries in youth baseball, but to this author's knowledge, there is no comprehensive musculoskeletal screen published at this time specific to youth baseball. The purpose of this article is to review literature published over the last year relative to injury in youth and adolescent baseball players in an effort to update the reader on current concepts, risk factors in this population, and to provide an updated systematic screening process that may be used in reducing injury rates.

Serious arm injuries in youth baseball players have been increasing. Though a breakage in the kinetic chain could affect arm injuries, an association between arm injuries and insufficient support of the trunk and lower extremities is not well understood. The purpose of this study was to investigate the association of low back and knee pain with elbow and/or shoulder complaints among youth baseball players. A self-administered questionnaire and document informed consent were mailed to youth athletes belonging to the Miyagi Amateur Sports Association. Multiple logistic regression analysis was used to examine the association of low back and knee pain with elbow and/or shoulder pain at the time of the questionnaire. Variables considered in the models were as follows: sex, age, BMI, years of athletic experience, position, team level, the amount of practice, participating day in team practice and game per week, frequency of participation in games, and practice intensity. The final study population was comprised 1582 youth baseball players (aged 6-15years old, male 95.6%) who had responded to the questionnaire. A total of 24.8% (n=381) had elbow and/or shoulder pain, whereas 8.5% (n=130) had low back pain and 13.1% (n=201) had knee pain. The prevalence of elbow and/or shoulder pain with concomitant low back and knee pain was 61.2% (n=82) and 51.9% (n=108) (p<0.001), respectively. The presence of low back and knee pain was significantly associated with the prevalence of elbow and/or shoulder pain among youth baseball players [adjusted odds ratio (ORs): 4.31, 95% confidence interval (95% CI): 2.86-6.51, p<0.001, and ORs: 2.92, 95% CI: 2.09-4.09, p<0.001, respectively]. For other variables, older age (10- and 11-year old: ORs: 1.73, 95% CI 1.10-2.73, p=0.018; 12-15 year old: ORs: 1.62, 95% CI: 1.18-2.58, p=0.006), pitcher (ORs: 1.46, 95% CI: 1.10-1.94, p=0.009), catcher (ORs: 1.69, 95% CI: 1.24-2.31, p=0.001,), and practice intensity (ORs: 1.58, 95% CI: 1.22-2.06, p=0.001) were significantly associated with elbow and/or shoulder pain. Both low back and knee pain were significantly associated with elbow and/or shoulder pain in youth baseball players. Clinicians should check the complaints of the trunk and lower extremities as well as those of the elbow and shoulder for preventing severe injuries in youth baseball players. Level of Evidence III.

Sport specialization is thought to be a primary contributor to the throwing-related injury risk in youth baseball players. To (1) establish arm-injury incidence in a cohort of male youth (9-12 years old) baseball players and (2) examine sport specialization and the frequency of arm injuries in the same cohort. Cohort study. Greenville, South Carolina, youth baseball programs and tournaments. A total of 159 asymptomatic youth baseball players (age = 11.1 ± 1.1 years) were physically assessed and then were prospectively followed for 6.7 ± 1.5 months. Athlete demographics and playing and injury histories were initially recorded. Athlete-exposures and presence of arm injury were prospectively tracked. All injuries were physically confirmed by a licensed physical therapist. Youth players demonstrated an arm-injury incidence rate of 2.22 per 1000 athlete-exposures. Parents and players underestimated sport-specialization status based on the standard research definition (self versus research based: 31% versus 83%, respectively; P = .001). The frequency of arm injuries was higher in specialized players (100%) than in nonspecialized players (80%, P = .03) but did not differ between pitchers and position players (13.2% each, P = 1.00). Sport specialization was associated with throwing-related arm injuries in a small cohort of youth baseball players. It is concerning that 57.9% of parents and specialized players were unaware of the athletes' status. Larger studies with longer follow-up periods are needed to further evaluate injury-risk profiles in physically developing youth populations.

Background: Despite the well-documented benefits of exercise and sports participation, young athletes are particularly vulnerable to musculoskeletal injuries. This is especially true during periods of rapid growth, sports specialisation, and high training loads. While injuries are an inevitable aspect of sports participation, the risk can be minimised by promoting the development of strong, resilient tissues through proper nutrition and injury prevention strategies. Moreover, targeted nutrition strategies can accelerate recovery and rehabilitation, allowing for a quicker return to sports participation. Methods: This narrative review synthesises scientific evidence with practical insights to offer comprehensive dietary recommendations aimed at strengthening tissues and supporting the healing process during recovery and rehabilitation. The selection of all sources cited and synthesised in this narrative review were agreed upon by contributing author consensus, experts in sports nutrition (R.A., H.V., B.D.) and exercise and sports medicine (M.H.). Results: Key topics include factors that contribute to injury susceptibility, general dietary recommendations for growth and development, sports nutrition guidelines, and nutrition considerations during injury and rehabilitation. This review also addresses external factors that may lead to suboptimal nutrition, such as food literacy and eating disorders. Conclusions: By highlighting these factors, this article aims to equip coaches, nutritionists, dietitians, athletic trainers, physical therapists, parents/guardians, sporting organisations, and schools with essential knowledge to implement effective nutritional strategies for injury prevention, recovery, and rehabilitation, ultimately enhancing long-term health and athletic performance.

Objectives:Serious arm injuries in youth baseball players have been increasing. Though a breakage in the kinetic chain could affect arm injuries, an association between arm injuries and insufficient support of the trunk and lower extremities have not been well understood. The purpose of this study was to investigate the association of low back and knee pain with elbow and/or shoulder complaints among youth baseball players.Methods:Study participants were mostly school-aged athletes belonging to Junior Sports Club Association of Miyagi prefecture (aged 6 to 15 years old). A self-administered questionnaire and informed consent document were mailed to25,469 registered athletes. Of those, 7,333 athletes replied both written informed consent and questionnaire (response rate was 28.8%). Those who did not play baseball (n = 5,577) and played both baseball and the other sports (n = 26) were excluded from this study. Missing data on variables (n = 192) were also excluded. The final study population was comprised of 1,535 players. We used multiple logistic regression analysis to examine the association of low back and knee pain with elbow and/or shoulder pain. Variables considered in the models were sex, age, BMI, years of athletic experience, position, team level, the amount of practice, participating day in team practice and game per week, frequency of participation in games, and practice intensity.Results:The frequency of elbow and/or shoulder pain was 24.8% (n= 393); that of elbow pain, 14.3% (n = 226); that of shoulder pain, 17.3 % (n = 273); that of both elbow and shoulder pain, 6.6% (n = 105); and that of low back and knee pain were 8.4% (n= 134) and 13.1% (n = 208), respectively. The frequency of elbow and/or shoulder pain who had low back and knee pain were 61.2% (n = 82) and 51.9% (n= 108) (p<0.001), respectively. The presence of low back and knee pain were strongly associated with elbow and/or shoulder pain (adjusted ORs (95%CI): 4.23 (2.83 - 6.34), p<0.001 and 3.11 (2.24 - 4.31), p<0.001, respectively), elbow (adjusted ORs (95%CI): 3.19 (1.74 - 5.83), p<0.001 and 2.45 (1.47 - 4.07), p=0.001, respectively), shoulder (adjusted ORs (95%CI): 4.25 (2.59 - 7.29), p<0.001 and 3.31 (2.17 - 5.05), p<0.001, respectively), and both elbow and shoulder pain (adjusted ORs (95%CI): 5.49 (3.08 - 9.79), p<0.001 and 3.52 (2.12 - 5.85), p<0.001, respectively).Conclusion:Both low back and knee pain were significantly associated with elbow and/or shoulder pain in youth baseball players. This result suggests that checking the trunk and lower extremities as well as elbows and shoulders are important for preventing sever injuries in youth baseball players.

BACKGROUNDDespite increased awareness of factors related to athletic performance and injury prevention, youth and adolescent baseball players continue to report injuries at alarming rates. Upper extremity muscle strength is an integral part of physical assessment and injury prevention in baseball players, however minimal data exists in youth populations. Changes in anthropometric measures, inherent in physically developing athletes, have been shown to impact strength measures, however normalization methodology is rarely reported.PURPOSEThe purposes of this study were to 1) compare the measurement properties of five potential methods for normalizing isometric shoulder strength in a cohort of 9-12 year old male baseball players and 2) examine the relationship between normalized isometric shoulder strength and ball velocity in a cohort of 9-12 year old male baseball players.STUDY DESIGNProspective cohort study (n=159)METHODSBaseline and follow up height, weight and bilateral ulnar length measurements were assessed followed by isometric strength in both the dominant and non-dominant shoulders. Strength measures included scapular plane abduction (scaption), external rotation (ER) at 0°, ER and internal rotation (IR) at 90°. Ball velocity was assessed as a measure of throwing performance. Intraclass correlation coefficients (ICC2,1), standard errors of measurement (SEM) and minimal detectable change (MDC95) were calculated for all strength measures. Repeated measures ANOVA were conducted comparing changes in normalized strength using five separate anthropometric measures: weight, height, body mass index, ulnar length and % of non-dominant shoulder strength. Linear regression models were used to examine the relationships between normalized isometric shoulder strength and ball velocity. Statistical significance was set a priori at α=0.05.RESULTSShoulder strength normalized using ulnar length was the only method that demonstrated excellent reliability (ICC2,1 0.98-0.99) and detected significant changes between strength in each of the four measures tested (SEM 0.39-0.69 Nm). Modest but significant correlations were observed between scaption and ball velocity (r2 = 0.27, p < 0.001) and ER at 0° and ball velocity (r2 = 0.23, p < 0.001).CONCLUSIONUlnar length was the most stable and reliable normalization method for assessing isometric shoulder strength in youth baseball players. In addition, normalized scaption strength was the most significant predictor of ball velocity, followed by ER at 0° strength in this population.LEVEL OF EVIDENCELevel 2b (etiology)

Background:Overthrowing injuries in youth baseball players have been linked with pitching behaviors such as as high pitch counts, inadequate rest, and participating in throwing activities throughout the year. Pitch Smart guidelines were developed as an initiative between Major League Baseball and USA Baseball to provide recommendations for youth baseball athletes to help decrease the risk of injuries from overthrowing.Purpose:The purpose of this study was to perform a quantitative analysis of pitch counts in youth baseball players and evaluate compliance with Pitch Smart guidelines.Methods:Local youth baseball teams competing in nine and under (9U) to fourteen and under (14U) age brackets were recruited to track pitches during the summer baseball season. A tablet with a pitch counting application was used to record pitches for each pitcher of the study team and their opponents. Days of rest between games was calculated for the study teams only and not opponents. Pitch counts and days of rest for each pitcher were compared to the recommended Pitch Smart guidelines. Continued prospective collection of data is ongoing through the 2019 summer.Results:Interim review of 23 youth baseball teams using a tablet allowed analysis of 181 pitchers of the 23 study teams using tablets and 285 pitchers of 98 opponent teams. Violation of Pitch Smart guidelines occurred in 14 (60.9%) study teams and 29 (16.0%) pitchers. Of these violations, 27 (93%) pitchers had insufficient rest between games while 2 (7%) pitchers exceeded daily maximum pitches. Further, 8 (35%) teams had more than one player violate guidelines. Pitch smart daily maximum pitch counts were violated in 2 of 98 (2.0%) opponent teams and 2 of 285 (0.7%) of opponent pitchersConclusion:A total of 61% of youth baseball teams and 16% of pitchers in this study violated Pitch Smart guidelines at interim analysis. The vast majority of guideline violations were due to inadequate rest between games. The high rate of Pitch Smart violations suggests that further education of coaches, parents, and athletes regarding these guidelines, with emphasis on rest recommendations, is necessary to prevent overthrowing injuries in youth baseball players.Table:.Age Group# Study Team Violations# Study Pitcher Violations (Rest)# Study Pitcher Violations (Daily Max)# Opponent Team Violations# Opponent Pitcher Violations (Daily Max)9U5 / 6 (83%)10 / 52 (19%)1 / 52 (2%)1 / 20 (5%)1 / 58 (2%)10U4 / 5 (80%)10 / 42 (24%)0 / 42 (0%)0 / 30 (0%)0 / 101 (0%)11U0 / 0 (0%)0 / 0 (0%)0 / 0 (0%)0 / 0 (0%)0 / 0 (0%)12U0 / 3 (0%)0 / 21 (0%)0 / 21 (0%)0 / 7 (0%)0 / 18 (0%)13U5 / 8 (63%)7 / 60 (12%)1 / 60 (2%)0 / 32 (0%)0 / 87 (0%)14U0 / 1 (0%)0 / 6 (0%)0 / 6 (0%)1 / 9 (11%)1 / 21 (5%)14 / 23 (60.9%)27 / 181 (14.9%)2 / 181 (1.1%)2 / 98 (2.0%)2 / 285 (0.7%)

Impaired hip range of motion has been related to increased injury risk in baseball players. However, no hip rotation range of motion (ROM) reliability studies have been performed in youth, which cannot be assumed to be comparable to adults. This study aimed to: 1) assess the inter- and intra-rater reliability of hip rotation passive ROM in youth baseball players; 2) calculate the standard error of measurement (SEM) and minimum clinically important difference (MCID). Hip external (ER) and internal (IR) rotation were measured. Inter and intra-rater reliability were assessed through intraclass correlation coefficients (ICC) and 95% Confidence interval (95% CI), with SEM and MCID. Bland-Altman plots were used to assess overall measurement bias. Nineteen youth baseball players participated. Hip ER intra-rater ICC was excellent (tester one: 0.983 (0.965, 0.993); tester two: 0.952 (0.903, 0.980) and hip IR was excellent (tester one: 0.965 (0.927, 0.985); tester two: 0.965 (95%CI: 0.928, 0.985). Hip ER SEM was 3.2 degrees, and hip IR was 2.2 degrees. Hip ER MCID was 7.5 degrees, and hip IR was 5.1 degrees. Bland-Altman plots for hip ER and IR did not detect any bias. Hip ROM inter-rater and intra-rater reliability was excellent for use in youth baseball players, with no rater bias. Sports medicine professionals can reliably assess supine hip rotation ROM in youth baseball players. This ROM methodology can be easily administered within the clinic or pitch-side, and interpret the results, increasing its real-world applicability.

Risk factors for throwing elbow injuries during pitching analyzed by simulation using human musculoskeletal model in youth baseball pitchers

Objectives: Repetitive throwing in youth baseball places athletes at risk for elbow injuries, and ulnar collateral ligament (UCL) subapophyseal avulsions are increasingly recognized (1). Ultrasound may be an effective technique to examine youth baseball elbows (2), particularly among the less-studied healthy population. The study aim was to evaluate asymptomatic elbows in youth baseball players for evidence of medial epicondylar avulsive changes at the origin of the UCL. Methods: After IRB approval, youth baseball players under 19 years without physician care in the prior six months were recruited during three club baseball ultrasound screening sessions. Basic demographics and sports participation history were obtained. Patient-reported outcomes included the Single Assessment Numeric Evaluation (SANE), The Hospital for Special Surgery Pediatric Functional Activity Brief Scale (Pedi-FABS), and the American Shoulder and Elbow Surgeons (ASES) score. Medial epicondyle avulsions, radiocapitellar osteochondral changes, and indirect humeral torsion angles (3) were assessed via ultrasound exam from one fellowship-trained physician using a 4-20 MHz High Frequency Linear transducer with a GE Venue Go portable ultrasound machine (Venue Go R4, GE HealthCare, Chicago, Illinois, USA). Descriptive statistics and Kruskal-Wallis comparisons were run between avulsive and non-avulsive groups (95% CI). Results: A total of 156 arms in 80 male athletes were evaluated (12.4±1.7 years). Athletes played baseball for 6.6±2.7 years with Pedi-FABS scores of 24.0±5.5. Dominant elbows were rated as 93.5±9.5 (out of 100; SANE) and dominant shoulders were rated 91.2±14.4. On the dominant medial epicondyle, 27/78 (34.6%) elbows showed evidence of a sub apophyseal avulsion: eleven active avulsions (14.1%) and sixteen united avulsion fragments (20.5%). No medial epicondyle changes were visible on the non-dominant elbow. One athlete demonstrated capitellar osteochondral changes (subchondral plate flattening) within the dominant arm, and another player demonstrated osteochondral changes in both arms (subchondral plate concavity in dominant, subchondral plate flattening in non-dominant). Those players with medial epicondyle avulsions demonstrated no differences in humeral retrotorsion or elbow pain on exam compared to those without elbow lesions. 11.1% of players who showed evidence of sub apophyseal avulsion reported playing pitcher, 44.4% reported playing infield, 3.7% reported playing outfield and25.9% reported playing pitcher. Conclusions: In a cohort of healthy, United States-based youth baseball players, one-third demonstrated an active or united avulsion of the medial epicondyle on their dominant elbow while capitellar osteochondral abnormalities were minimal. Ultrasound injury surveillance may provide a useful tool in youth baseball players to identify subclinical medial epicondyle subapophyseal injuries prompting earlier treatment and injury prevention strategies.

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.

Background:Youth baseball players who experience elbow pain during the season frequently exhibit radiographic elbow abnormalities. However, it is unknown whether asymptomatic elbow abnormalities are risk factors for in-season elbow injuries.Purpose:To determine whether the preseason presence of asymptomatic medial epicondyle apophysitis is a risk factor for in-season elbow injuries in youth baseball players.Study Design:Cohort study; Level of evidence, 2.Methods:Youth baseball players (N = 210; age range, 7-12 years) with no pain or history of injury in their throwing arms underwent preseason evaluations that included shoulder and elbow range of motion measurements, shoulder muscle strength testing, and ultrasound elbow scans with a multifrequency 13-MHz linear array transducer. Over 1 year of play, the players and their parents maintained daily elbow pain diaries. Elbow injuries were defined as medial elbow symptoms that prevented ball throwing for ≥8 days.Results:The preseason ultrasound evaluation revealed medial epicondyle apophysitis in 59 players. In the year following, elbow injuries occurred in 17 (28.8%) players with preseason medial epicondyle apophysitis and 18 (11.9%) players without apophysitis. Independent predictors of elbow injuries were preseason medial epicondyle apophysitis (odds ratio [OR], 2.488; 95% confidence interval [CI], 1.152-5.376; P = .02) and deficits of abduction (ABD) and external rotation of the dominant shoulder (OR, 0.963; 95% CI, 0.936-0.992; P = .012).Conclusion:Asymptomatic medial epicondyle apophysitis and ABD and external rotation deficits in the dominant shoulder were risk factors for elbow injuries in 7- to 12-year-old youth baseball players. These findings may aid in the design of programs to prevent elbow injuries in this population.

BackgroudBaseball players are subjected to repeated loads on the supraspinatus and long head biceps tendon from youth, and repetitive pitching motions can cause shoulder injuries. The purpose of this study was to evaluate the immediate changes caused by pitching in the supraspinatus muscle-tendon, long head of the bicep tendon (LHBT), and shoulder range of motion (ROM) and to verify their recovery over time in youth baseball players.MethodsFifteen youth baseball players (mean age, 11.5 ± 1.3 years) were enrolled. The thicknesses of the supraspinatus tendon and LHBT and the strain ratios (SRs) of supraspinatus muscle and tendon were measured by sonoelastography. ROMs of shoulder joints (abduction, external rotation at 90° of abduction [ABER], and internal rotations at 90° of abduction [ABIR]) and horizontal adduction (HA) were measured using a goniometer. All measurements were performed on the throwing shoulders before and immediately after pitching (mean pitch count, 78.3 ± 13.3) and at 30 minutes, 24 hours, and 72 hours after pitching.ResultsThe thickness of supraspinatus tendon (6.64–6.27 mm, p = 0.026) and that of LHBT (2.56–2.26 mm, p = 0.021) significantly decreased immediately after pitching. The SRs of supraspinatus muscle tended to decrease, whereas SRs of supraspinatus tendon tended to increase immediately after pitching. ABER increased (119.7°–127.3°, p = 0.001) and HA decreased (34.7°–29.3°, p = 0.023) immediately after pitching. All immediate changes recovered 72 hours after pitching.ConclusionsThe immediate effects of pitching on the supraspinatus muscle-tendon, LHBT, and shoulder ROM in youth baseball players were confirmed in the current study. These changes were recovered to pre-pitch levels 72 hours after pitching. Therefore, we recommend that youth baseball players should rest for three days after pitching to minimize the risk of shoulder injury.

Basketball is a major sport worldwide among different age groups that leads to a high frequency of injuries at multiple body sites. Upper and lower extremities and lower back are common pain sites in basketball players; however, there is little information about the relationship between upper or lower extremity pain and lower back pain. This study elucidated the associations between upper extremity (shoulder and elbow) pain and lower back pain (LBP) among young basketball players. We conducted a cross-sectional study using self-reported questionnaires mailed to 25,669 young athletes; the final study population comprised 590 basketball players, and their median age was 13 years (range: 6-15 years). The point prevalence rates of lower back, shoulder, elbow, and upper extremity pain among young basketball players were 12.9% (76/590), 4.6% (27/590), 2.7% (16/590), and 7.1% (42/590), respectively. Multivariate logistic regression analyses revealed that upper extremity pain was significantly associated with LBP (adjusted odds ratio [OR]: 7.86; 95% confidential interval [CI], 3.93-15.72). Shoulder pain was significantly associated with training per week (> 4 days) (adjusted OR: 4.15; 95% CI: 1.29-13.40) and LBP (adjusted OR: 13.77; 95% CI: 5.70-33.24). This study indicates that upper extremity and shoulder pain is associated with LBP among young basketball players. Assessing for lower back pain, as well as elbow and/or shoulder pain, may help prevent severe injuries in young basketball players. In conclusion, parents and coaches should be properly re-educated to help improve lower back, upper extremity, and shoulder pain among young basketball players.

To assess genetic and environmental influences on low back and neck pain in a classic twin design and to examine the extent to which these are explained by structural changes seen on magnetic resonance imaging (MRI) and psychological and lifestyle variables. The subjects comprised 1,064 unselected women (181 monozygotic [MZ] and 351 dizygotic [DZ] twin pairs) recruited from a national registry of twin volunteers. Outcome measures included lifetime history of low back and neck pain (using a range of increasingly stringent definitions), MRI scores of disc degeneration in the lumbar and cervical spine, psychological distress as assessed by the General Health Questionnaire (GHQ), and lifestyle variables assessed by questionnaire. For all definitions of pain, there was a consistent excess concordance in MZ when compared with DZ twins, equating to a heritability for low back pain in the range of 52-68% and for neck pain in the range of 35-58%. The strongest associations were between low back pain and MRI change (odds ratio [OR] 3.6, 95% confidence interval [95% CI] 1.8-7.3]) and between neck pain and response on the GHQ (OR 3.3, 95% CI 2.1-5.0). These associations were mediated genetically. Genetic factors have an important influence on back and neck pain reporting in women. These factors include the genetic determinants of structural disc degeneration and an individual's inherited tendency toward psychological distress. MRI changes are the strongest predictor of low back pain.