Common Baseball/Softball Injuries and How to Prevent Them

With longer days and warmer weather creeping in, another baseball and softball season is underway for many young athletes.

As spring training gets rolling, one thing most young athletes are NOT thinking about is injuries – and how best to avoid them. Edward D. Re, MD, a pediatric sports medicine specialist at Children’s Hospital of Philadelphia and previous team doctor for West Chester University and Penn Charter High School in Philadelphia, shares his insight on ways players can stay healthy throughout the season and what to do if an injury occurs.

Common baseball/softball injuries

Baseball and softball are generally not considered contact sports – unlike football and rugby, for example – yet injuries still happen. The most common injuries include:

• Sprains and strains. Because of the repetitive nature of these sports, ball players are susceptible to sprains and muscle strains in their arms, shoulders, elbows and ankles. Pitchers are at particularly high risk due to high pitch counts and insufficient rest time.
• Overuse injuries. Most injuries are due to repetition rather than a single traumatic event. Common overuse injuries of the elbow include medial epicondyle apophysitis (also known as Little League elbow), lateral epicondylitis (also known as tennis elbow), ulnar collateral ligament (UCL) injuries and medial epicondyleavulsion fractures. In some cases, these injuries will require surgery. Overuse injuries of the shoulder include humeral epiphysitis (Little League shoulder) and rotator cuff tendonitis.
• Fractures. Swinging bats and throwing at high velocity, as well as collisions with other players, can cause stress fractures. The most common fractures among youth ball players affect fingers, hands and wrists and require immobilization with a cast or splint.
• Concussion and head injuries. Accidentally getting hit in the head with a ball or bat can cause serious brain injury. While any player can be affected, concussions are most common among catchers because of their unique position on the field.
• Bumps, bruises and dehydration are also frequent as young athletes focus on their goal, rather than what their body needs to retain peak performance.

Common causes of overuse injuries in young athletes

There are three primary causes of overuse injuries in youth ball players:

• Absence of a proper warm-up before playing
• Failure to participate in conditioning programs that help athletes build strength and endurance
• Not giving the body enough time to rest and recover between strenuous workouts

“Fatigue is a major cause of injuries among youth athletes,” Dr. Re says. “It can be caused by many factors – extended play time, playing year-round, playing on multiple teams, extended stress situations, and even things like not getting enough sleep or having a poor diet.”

While most youth players are reluctant to slow down even when their bodies need it, parents and coaches can step in if they see a player is fatigued and are at greater risk of injury. Some signs of player fatigue include slower reaction time, complaints of soreness or stiffness, decreased performance, and loss of interest.

Pitchers are at particularly high risk of injury from fatigue. Most youth sports leagues have pitch limits in place to restrict the number of pitches thrown in a game. But it’s equally important to track pitch counts over multiple days, in practice and game situations, and to insist that players take rest periods.

Signs of fatigue pitchers often demonstrate include:

• Taking extra time between pitches and/or changes in their breathing
• Decreased velocity and/or accuracy of pitches
• Changes in control over the type of pitch thrown (i.e., fast ball vs. curve ball)
• Dropping their arm-slot and releasing the pitch from a lower angle

Reducing the risk of injury

To help reduce your child’s risk of injury while playing baseball or softball:

• Warms up before playing. Simple exercises like lunges, jumps and jogging can elevate your child’s heart rate and break a sweat.
• Ensure adequate food, energy and hydration to properly fuel their practice and competition requirements.
• Know the difference between pain and soreness, and when to halt activity if needed.
• Cross-train. Encourage your child to diversify their workout, to use different skills and muscles than those used for their primary sport. By using different muscles, the body is strengthened rather than overstressed.

Treat injuries that do occur

No matter how hard your child tries to prevent injuries, sometimes they do still occur. It is important for all injured youth athletes to be evaluated and treated by pediatric experts who understand the injury involved and can determine the best treatment approach for a still-growing youth with open growth plates.

To speed recovery, Dr. Re suggests families utilize these non-invasive treatments:

• Rest, Ice, Compress and Elevate (RICE). Rest gives the body time to heal, ice can reduce inflammation and pain, and compression supports the joint. Elevating the joint above the heart can also help.
• Taping and strapping to better support the injured area and reduce stress on nearby muscles, joints and soft tissues.
• Non-steroid, anti-inflammatory medications. Over-the-counter pain medications like Motrin^® and Advil^® can reduce pain and decrease inflammation.
• Physical therapy can help warm up and loosen muscles, helping your child become more limber and less prone to future injuries.

In rare cases, youth with baseball or softball injuries will require surgery. The most common procedures performed by pediatric orthopaedic surgeons at CHOP related to youth baseball/softball injuries include:

• Ulnar collateral ligament reconstruction surgery, commonly called “Tommy John surgery”
• Superior labrum anterior posterior (SLAP) repair, generally performed arthroscopically
• Rotator cuff surgery, which is more common among softball players due to the distinctive “windmill” pitch style
• Knee surgery to repair tears in the meniscus, the anterior cruciate ligament (ACL), or lateral, posterior or medial cruciate ligaments

Edward D. Re, MD, is a pediatric sports medicine specialist in the Division of Orthopaedics and the Sports Medicine and Performance Center at Children’s Hospital of Philadelphia and has served as team doctor for West Chester University and Penn Charter High School in Philadelphia.