Alabama-based surgeon to the stars pleads with parents to give young athletes a break

While I agree with everything in the article, it is sorta like Pandora's box. I'm not sure how to stop it or even slow it down. If you don't train year round, you will get passed by. That is simply facts. While 12 or 13 is younger than I am talking about, by 15 or 16 that is the way it is. My son was a casualty. His was not overuse. He played basketball and football up until 9 th grade. We always monitored his pitch count. He didn't throw a curve ball until around 14/15. So I don't have the answer. We were lucky that son didn't require surgery, rehab only. I don't have the answer and would be afraid to give advice.

Parents need to make a stand. But parents are often the ones at fault. 

Those in the medical field will always lean towards safety above development.

 

When the best players are the ones taking things easy we might see a change.

 

Risk and Reward!  Or should we say... No Risk = No Reward.

 

Those kids getting those big bonus payments in the draft didn't get there by taking it easy.  As long as those who have had TJ surgery are still getting drafted early, what are we suppose to think?

 

I am all for kids that want to play multiple sports.  I'm for kids that take time off. I'm totally against the abuse that takes place in baseball.  However, I also believe you have to deal with some risk in order to develop anywhere close to your full potential.  Those guys pitching in the Big Leagues aren't all the ones who pitched the least.  Though there is no doubt that there should be some reasonable guidelines and MLB and USA Bàseball is designing a good program that parents need to know about. We plan to follow their lead.

Imo, the issue isn't the fact that the players are working year round, but it is that they are working year round, taking no time off competitive baseball, and when they do decide to train, they don't do it the right way. Definitely agree with PGStaff on the idea that you won't get any better without taking some risks. Definitely need to make sure that they are smart, well researched risks.

 

Interesting article. Not specifically on the topic of taking time off, but it raises some relevant points.

 http://www.drivelinebaseball.c...arch-interpretation/

Sometimes it can be frustrating wanting to do the right thing, only to find out that you were 16-18 months behind what the new thinking is. I know a kid that would always take 3-4 months off in the fall to rest his arm. His sophomore year he never shut down and long tossed 3 times a week. He went from 86- 94mph in one year, and now his whole team is out long tossing in the snow. Growing spurt? hard work? or dangerously overworking the arm? who knows for sure, our current favorite that has had great results has been shut the arm down, and ease into weights and bands over the winter. Hopefully this method is doing more good than harm.

Do you (or anyone else) know the highest pick ever taken on a HS kid who's had TJ? College? I'm just curious how it impacts a kid's draft prospects. Thanks

So....who do we believe?  As a parent of a 12 year old who does have a year round commitment, which is the focus of this article....do we believe we are harming our child, or do we believe the coach who says baseball muscles are a learned thing that take near constant repetitive actions to acquire and keep?

 

In this doctor's opinion "For at least two months, preferably three to four months, they don’t need to do any kind of overhead throwing, any kind of overhead sport, and let the body recover in order to avoid overuse situations."

 

In our coaches opinion "November-February is about conditioning the body, speed and agility, combined with repetitive infield drills, combined with catching/pitching drills and conditioning the body to remember how to move to a baseball automatically."

 

We hear the word overuse from our coach often as in "for every inning you pitch you will sit out that many innings to give your arm a rest because we don't want to overuse your arm"...."We will only pitch once a week in practice because we don't want to overuse your arm".

 

Short of a kid saying something hurts, how do we as parents know if our kids arm is being overused? 

 

P.S. Neither my husband or I know anything about playing baseball, we certainly don't drill our kid, nor do we partake in private lessons for hitting or pitching...but a LOT of the 12 year old team does.

I know Jeff Hoffman was the 9th overall pick out of East Carolina this June.  He had TJ prior to the draft.  I know there was a second pitcher drafted in the first round this year that had TJ as well, I just can't remember his name.

CaCogirl, read, talk to others/coaches, learn.  At the end of the day, you are in charge and should have a plan for how often your son pitches/how much he pitches. You set his plan.   My son is a year older than yours.  I had the same thoughts as your post a year ago, confused by everything and all the advice.  Here are a few key things that can help:

 

-listen to Dr Andrews, specifically his pitch count rules.

-play other sports

-keep a log of when and how much your son pitches

-let the coaches know "when your son is available and for how many pitches"  (I haven't come across a paid youth coach yet that doesn't listen.  None want the reputation as an "abuser" of pitchers.  Bad for business.)

-get a reputable pitching coach (this can be the hardest, I got lucky w my son's coach)

 

PM if you want more specifics.  There is nothing that says what I am doing is right, but at least I have a plan.

Here are my thoughts. I have a senior in HS that is D1, and has signed to major school. He has been over used by his high school coach. We are talking almost 100 innings for his high school team last spring. He went into the most important summer of his life very exhausted because he had never eclipsed 100 innings before. His summer did not go as planned in part to arm fatigue. Really hurt his prospect status. His last pitch was Area Code in Cali and he then took off 3 full months this fall. He did not pitch in fall or go to Jupiter. This is risky because Jupiter is where the pro scouts start really evaluating you and he was not there. Will this work out for him? I have no idea. What I do know is he has trained in the weight room and on the track. He is rested and in the best shape of his life. Will the extra rest give him a fresh arm to get over the velocity hump? We recently started a 12 week throwing program that will go right up to first spring practice in late January. This program is hard and will ramp up as we go along. My hope and prayers for my son is that he is healthy, can lead his high school team to a championship and his velocity gets 2 ticks higher. He has been clocked by professional guys at 94 BUT sits high 80's and low 90's. He has always pitched in the fall/year around.Will this extended rest hurt or help? We shall see.I have another young son and I promise he will not pitch year around, mark that!!

Telling any kid to take 3-4 months off of any kind of overhand throwing, IMO, is basically an impossible task.  Especially if the kid is athletic and likes other sports.  That means, no pick-up football games, wiffle ball, home run derby or just playing around with their buddy's outside, just not realistic.  Back in HS I remember we were always playing something when we weren't playing baseball.  

 

I do think there can be some overuse at the youth level, but that is up to the parents to keep a watchful eye on.

 

Lots of opinions, lots of speculation and a whole lot of ????'s  Common sense is the main factor for me and my boys and any other kid that I coach.  What may be good for little johnny is not necessarily good for little billy.....IMO it is very much an individual thing

IMHO...

 

Your kid is exactly at the age when abuse begins.  Usually it's the result of an overzealous travel coach riding a couple of strong arms to try to win a plastic trophy every weekend.  Or it's the result of a kid playing for two teams at the same time and pitching for both.  Sounds like you're probably in a good situation with  your coach, and that your kid is not overextended.  But keep your eyes open. If you see your kid, or any kid, pitch in two games in one day, or pitch more than one or two innings on Saturday and come back Sunday, or pitch a full game and then play catcher, or stay in a game for multiple high-stress innings, then you have a problem.  If there's any doubt, keep a scorebook or buy a pitch counter for $5 and count your child's pitches.  If you Google Little League pitching rules you'll find numbers that are a good guideline for a 12yo.

Hopefully my kid's story will help.  He started "travel" ball at 10.  They started working out in November 3 days a week for an April 1 season start.  Each workout started with typical warm ups and then 10-20 min. of throwing.  Not hard, not far -- max distance was 60 feet or so limited by the indoor tunnel.  At first, I did the WTF -- they shouldn't be throwing that much, overuse, etc. (That's what I had "heard.")  The coach was an ex pitcher and had a pretty structured work routine.  So I trusted him.  Fast forward to spring and the kids start playing.  That year nobody had any arm issues.  Compared to his friends on other teams, they all had tired arms all season.  The difference, they didn't throw as much, or hardly at all, in the off season.  He has basically kept this routine up for 4 years, and has not had any significant arm issues.  He did have some tendonitis this fall and shut down for a few weeks.  Kids that didn't follow a similar program, have dealt with arm issues.  My experience is not scientific. 

 

My take then is that there is a difference between competitive throwing (ie; games and bullpens at 100%) vs. conditioning throwing (maybe 80%).  It's kind of like a marathon.  You work your way up.  Nothing wrong with taking a few weeks off, but 3-4 months I think would be difficult.  How do you keep your arm in shape before the season begins?  I would also encourage participation in other sports.  I think that helps tremendously.  I think the real issue is competitive throwing 365 days, which can be done in warmer climates.

 

 

One thing to add.... my 2017 used to pitch frequently in 14u and below, but he's had a serious shoulder issue and will not pitch again.  Early this  year, he saw a physical therapist and a pitching coach in order to basically relearn how to throw, and now he does a series of exercises  that are kind of a combination between the "throwers ten" and the standard Jaeger band routine (you can google either). Both the PT and coach told me that if baseball players did these exercises BEFORE they got hurt, not after, there would be far fewer injuries.  Something to think about.  My kid will be doing that routine daily, in  season and out, for as long as he plays baseball.

Since there are some posters of pre high parents. It's not important to be focused on baseball year round until high school. Even then my son still played a second sport just as many poster's kids have. Even then my son's November through January training was speed, strength and agility focused. He would swing a bat through that time. But he didn't throw.

With all due respect, because I see you have 10K+ posts...but how can you say not to be focused on baseball year round until high school? 

 

Here is what I know:

1. I live in GA, specifically in East Cobb territory where baseball competition is fierce.

2. My son will attend a 6A High School, they have a Varsity, JV, and Freshman team because once again competition is fierce they can have 3 teams and cut more than 100 players who try out.

3. While I have zero experience in the baseball world my kid has been saying since he was 5 that he wants baseball to be "his job" when he gets older.

 

Here is what I guess:

1. If my kid wasn't on a year round team he will not be able to compete at the same level as other children can to even make ANY of his high schools teams.

2. If he can't make his high school team he won't be able to make a decent College team or go further.

3. He will always be left wondering "what if"...what if I had trained more, what if I had taken more lessons, what if my parents had had me try out for a better team...could I have done anything?

 

Once again, with all due respect RJM I know you have the rare kid committing in 8th grade, but it's fairly common to have commitments in 10th grade, if you don't focus on baseball until 9th grade, meaning finally getting on a year round team, I'm thinking you are pretty much dooming the kid who wants to make it "his job".

 

While I know I will NEVER force my kid to play baseball, or want it more than him, if this is my kids dream as a parent aren't I obligated to get him to places/teams that can help him realize that dream in as safe a manner as possible?

From the article:

 

"but nobody was going in for Tommy John surgery to fix a frayed ligament that resulted from throwing a curveball all summer in elementary school."

 

Sigh. This author did no research. He apparently watched a 90 second segment on CBS Morning and wrote about it.

 

Two things:

#1) Why would he blame it all on curveballs in this sentence? There is no research to back this up and, in fact, Andrews own organization, ASMI, admits there appears to be no coorelation between curve balls thrown by youth pitchers and elbow injuries; and

 

#2) Of course no kids were getting TJ surgery back then. Parents didn't take their kids to ortho surgeons 20 years ago for elbow pain and general practitioners didn' refer their young patients to ortho. Even if they did, surgeons would have been unlikely to recomment the surgery for a lot of reasons.

Also from the article:

 

"'I started seeing a sharp increase in youth sports injuries, particularly baseball, beginning around 2000,” Andrews told The Cleveland Plain Dealer in an interview last year. “I started tracking and researching, and what we’ve seen is a five- to sevenfold increase in injury rates in youth sports across the board.”

 

Andrews makes a mistake in logic. What Andrews is saying is that he started seeing more referrals to his service. He can't make the logical leap to using this as proof that injury rates, themselves, actually increased. A sevenfold increase in TJ surgeries is strong evidence that TJ surgeries are on the increase, but provides no evidence of increases in actual injury rates. There has been a 1,000 fold increase in heart transplants and the use of artificial heartys in the past 40 years. Is this evidence to support an argument that heart disease is on the rise? No. It simply supports an argument that medical science has advanced and that we treat heart disease more often with transplants than in the past.

 

None of this means that there hasn't been an increase in injury rates. I am simply contending that using an increase in surgeies as proof of this contention is bad logic.

What makes you assume that the data he refers to is just from his own practice?

Logical inference and the fact I've heard him use the same data before, but refer specifically to the increase in surgeries he's personally done. I guess he could be using data from a hundred orthos, but the logic problem is the same. He wouldn't have data on actual injury rates. Actually, no one would. They haven't been kept. The only data kept would involve those who have sought out treatment. Twenty years ago, thirty years ago, it would have been far more common for a young pitcher with elbow pain to simply stop pitching and rest. Today, it is quite common for parents to seek specialist advise immediately upon their young pitcher complaining of pain.

 

Now, don't get me wrong. I think this is a very good thing. We are much more aware of arm injuries and much more dilligent in seeking treatment. I'm not even making the argument that arm injuries have increased (although I suspect that if we did have the data, we'd find that they haven't), just that you can't use an increase in surgeries to prove it because surgery wasn't a realistic option in the past.

I just took a look at the ASMI site and it says that they've been around since 1987.  If you're interested in knowing what kind of data they're using to back up their positions, Dr. Fliesig seems to be very a  very communicative guy.

He is. And very knowledgable. The studies produced by ASMI are very well done and on the nose. Keep in mind, though, that the ASMI studies attempt to pinpoint the causes of injuries and the effect on injury likelihood of certain practices. However, the studies, themselves, do not claim an increase in injury rates. They may make reference to injury risks being a problem (who would argue that isn't true?), but the studies aren't based on any attempt to pinpoint a reason for any increase. Therefore, they don't use any data like that. The quotes from Dr. Andrews are his own experience and not based on any accumulated data.

 

Even ASMI recognizes that any assertion of increases in injury rates is non-quantifiable. Not the following form "Risk of Serious Injury for Young Baseball Pitchers," the 2010 research from Fleisig and Andrews, et al:

 

"For decades, the sports medicine community has reported

elbow and shoulder injuries resulting from youth baseball

pitching.

 

By the late 1990s, sports medicine physicians

perceived an increase in the number of adolescent

pitchers requiring elbow and shoulder surgery. The general

public became aware of this ‘‘epidemic’’ from

numerous television, print, and online stories featuring

young pitchers recovering from surgery. Many of these stories

focused on the rise in ‘‘Tommy John surgery’’ (ulnar

collateral ligament reconstruction) in youth baseball. No

national data for elbow and shoulder surgical rates were

documented, but increased rates at one prominent sports

medicine practice have been shown.

 

3,5,14 At that practice

in the late 1990s, few of the ulnar collateral ligament

reconstructions were for youth or high school pitchers;

however, rates in youth and high school–age pitchers

have risen to approximately one-fourth of these surgeries

in the 21st century. Whether this represents a referral

bias or a true epidemic remains a question. (emphasis added)

-

Again, I'm not saying that there hasn't been an increase, just that you can't use that particular data to prove it.

TCW, was this post a "hit and run"?

don't buy the "in my state" stuff. There are D1 baseball players from all over the country. There are high school multi sport athletes in your state who go on to play D1 baseball. I'll bet at least half of D1 baseball players played a second sport in high school. At my son's school I'd guess it's two-thirds.

 

It's one thing for a kid to want to play one sport. But a parent who believes their kid must go all in at age twelve has been sold a bill of goods. Those goods are labeled "keep up with the Jones." My son played four sports through middle school (three in school, two in travel, baseball was a repeat). He played three in high school freshman year. Then he played two the rest of the way. In high school he played fall ball three years while playing soccer for school.

       
       




Miscommunication RJM, the topic was giving kids a 4 month break from throwing overhand, any object/ball; not taking off for another sport.

Your duel sports I have no issue with, and have offered my son several sports alternatives including football, lacrosse and soccer he only wants to play baseball year round, he won't even ride his dirt bike in the spring...he's afraid to break an arm.

I thought you were saying dont bother being on a year round baseball team until 9th grade because they need a break for their bodies sake.

Sorry for the miscommunication.

One of the things never mentioned in the specialization and year around debates.

 

Per Capita more MLB players come from the Dominican Republic than any other place.  The large percentage of MLB players from Latin American countries is well documented.

 

Why are so many of those players in the Big Leagues?  The majority of them actually specialized in baseball and played it year around. And many of them still do!   Is there risk involved? Yes, of course!  Is the potential reward worth that risk?  IMO That is something each individual and their parents need to decide.

 

That said, I'm all for as much information as possible and very much against abusing young players.  I just know that if I were a doctor I'd be most interested in my patients health and safety.  If I am a coach I'd still be interested in my players health and safety, but at the same time I would place a lot of importance on development.

 

Bottom line... I think it is great if young kids play every sport and take time off.  At the same time, I've seen too many year around specialists make it to the Big Leagues to think that is such a bad thing.  And if you were responsible for Major League Baseball, wouldn't it be great if every good athlete specialized in baseball?  In fact, that would help solve some problems involving losing great athletes to other sports. How many in the NBA specialized in basketball? Still, I like seeing kids play more than one sport. Or we can truly play it safe and stay away from all sports and stay away from all sports injuries.

 

 

Awhile back Julie made me an administrator on this site.  I really have never done anything, deleted anything, etc.  however every once in awhile I accidentally hit some button that ends up creating an email that I imagine goes to moderators. 

 

Then I get this email....

We're sending you this email because you are following moderated content. The following content is not live. The following reply was sent to the moderation approval queue by PGStaff.

 

because I don't know how to deal with this, thought I would simply say it was a mistake rather than any complaint about someone's post. Maybe someone will know what I'm talking about here.

As a strength and conditioning coach in the private sector I believe I offer a different perspective. I am currently training high school baseball players who fall into the category of "specialized athletes." Baseball is the only sport they play and they play it year round. 

 

Here I want to focus on the physical development side. When your son is playing competitive baseball year round and playing in tournaments every weekend, where is there time to develop physically? I'm not saying pitchers should take 4-5 months off but I do believe these high school and youth pitchers need some time away from the mound. During the course of a season shoulder range of motion changes. Most commonly seen is an increase in external rotation and decrease in internal rotation in the throwing shoulder. I've also seen decreases in abduction on the throwing side. A structured off-season strength and conditioning program can be implemented to help correct these imbalances and keep the athlete healthy. 

 

Also, a vast majority of baseball players that I work with REALLLLY need to develop physically. They would benefit greatly by spending 3-4 days a week in the weight room building strength, power, and appropriate mobility/stability using an detailed off-season program. When they're playing in tournaments every weekend in the fall they simply can't dedicate enough time to training and developing themselves as better athletes. 

 

Properly designed strength and conditioning programs can vastly improve performance while decreasing the risk of injury. There's a reason professional baseball players have an off-season.

I would agree with Austin regarding S&C for HS players. it certainly was the biggest weakness in my son at the time. He has gone from a under developed twig in HS 6'4" 170-180 to now 6'4" 215-220 and I am convinced that he would have been throwing a lot harder had he been more physically developed at the time. Obviously there is the natural growth cycles that contributed his development but when you see the physicality of the top college players and compare that to HS players there is a huge gap, which can't be completely closed, but an aggressive S&C program should be part of a top HS players program and you can't get this done "in season". Not discussed by Dr Andrews is also the mental side and getting away from the game for a period of time. Personally I think a player would be ahead of the game with an aggressive S&C program for 3 months than playing for an additional 3 months. JMO

I agree with Austin and thanks for coming on the board.  My sons have always had time away from pitching.  We workout year round and throw some long toss and play catch.  But not competitive pitching year round, that's insane. 

 

We go fishing, camping and end up talking about pitching.

I would agree with the statements above regarding Strength and Conditioning. I definitely agree with BOF regarding time off for mental reasons.  All of that makes sense.

 

The one thing that is still confusing is why is there such a large percentage of the best players on earth coming from the DR and other Latin American countries where they play baseball year around. Are they bigger and better athletes?  Sure they have academies there now, but it wasn't like that years ago.  Do they have more money, better equipment, better instructors, better trainers, etc?   They sure don't dominate internationally at the very highest level in other sports.  So why baseball?  I can only come up with a few reasons and one of them is because the game is a way out of poverty so many of the kids there specialize and play year around.  They simply play more there! Maybe some might say they take on more risk.  Would that have anything to do with producing many of the best arms, best defensive players and best hitters in the world? The average high school SS in the USA might be a million ground balls and throws behind the same age Dominican SS. Which one is more likely to suffer an injury?  Which one is most likely the better SS? Seems like the answer would be the same for both those questions.

 

I'm not arguing whether this is good or bad, but it is right there in front of everyone, yet seldom brought up when discussing specialization or playing year around baseball.  Also keep in mind, that to this day there still are MLB players that play all season and also play a Winter season, finishing up shortly before Spring Training.

 

Guess I would be for getting everything on the table, rather than just using the numbers that relate to one side of the debate (Injury). Then maybe we could discuss risk and reward together rather than just considering the risk alone. We all know that it is impossible to get anywhere near your physical potential without some risk.  You ll never even have an idea what you are capable of without some risk.  

 

At the same time, it would be ignorant to ignore the risk involved In certain things.  Pitching being the main topic.  

 

 

 Plus one for me BOF

 

PG - interesting take on the Latin players. I would really like to know the yearly schedule routine of these Latin players.Maybe somebody on this site has a close connection to a program there.

 

Since they have been playing year round for decades.

We may find out they have had a higher rate of injuries than we have had for a longer period of time. And we're just catching up.

Would be interesting to add that comparison to the topic.

 

I think I would have to list my kids, at least the two oldest ones as "specializing" in baseball.  They have dabbled in other sports in middle school, and one played youth football for 1 season.  But I don't look at it as being bad.  Most seem to think that just because they don't play another sport "officially" like a scholastic sport or other sanctioned "league", that they "only" play baseball.  I can say, without a doubt, that Lefthook could have easily played V football.  He constantly was out with the his soccer buddies playing soccer.  Out playing Ultimate frisbee.  Out playing tennis and any other thing that they could turn in to some type of "competition".   

 

With that said, I have watched the development of his arm.  Was careful not make sure he did not feel the need to keep up with the Jones' so to speak.  He has had no arm issues(fingers crossed now...lol).  Righthook the same way, just not as dominantly athletic.

 

S&C definitely has it's place, and that is what righthook is concentrating on now....getting stronger and physically prepared for the upcoming season

PG brings up an interesting point that there is probably not an easily obtained answer. 

 

 

There are approx 9.5M people in the DR and the number of MLB players I counted were 133. If you look at the link below the most Latin American players come from the DR and Venezuela which has approx 29M people. The DR is the outlier data point so let's focus on them. 

 

Logically this would be due to 1) Genetics (Actually there is a lot of controversy in this area which I don't want to get into but put a link to for ref) ) 2) Focus on one particular sport (ie the population only plays one sport) (Maybe) 3) Training methods (Maybe) 4) Age that they start in their sport (Maybe) 5) Fertility rate ie number of youth's per population (I don't know could not find )

 

To really figure it out someone would have to look at the average age a participant stars in a sport, the number of participants, the length of time they practice/play that sport, and their training methods. Clearly length of time and specialization is probably relevant but if you compare them to the US, for example, many of the top athletes are not going into baseball, they are going into Football, Basketball, and other sports. According to the WSJ article there were 5.6M kids playing baseball in 2012. To really understand the answer to the question we would need to know how many kids are playing baseball in the DR, compare that to how many are in the MLB and see what the ratios look like compared to the US/MLB numbers. If you look at the wikipedia link there is some discussion on fast twitch muscle development with players from West African decent. Could this be a factor in the DR? Probably not but I really have no idea. Their training methods are probably below US standards, but time and hours are probably well beyond. 

 

I basically have no more time and have to get back to work, but In summary after looking at this for an hour today I think the answer IS not possible without someone doing a graduate level study on the subject. 

 

http://en.wikipedia.org/wiki/L...y#Dominican_Republic

 

http://online.wsj.com/articles...04579350892629229918

 

http://cotni.org/where-we-serve/dominican-republic

 

http://en.wikipedia.org/wiki/Race_and_sports