​Physiological Changes and Repetitive Throwing:
 
It is easy to understand how repetitive throwing can place an increased strain on the shoulder girdle and elbow joints of all athletes, and research suggests that these effects are often exacerbated in youth baseball players. Children and adolescents that participate in repetitive-throwing sports have an increased risk of becoming injured due to the immaturity of their musculoskeletal systems, and the rapid physiological changes that occur during growth spurts, puberty, etc.  Radiographic images indicate that 56% of youth baseball players displayed changes at the growth plate in their dominant throwing arm. This study also states that over half of these participants with boney changes never reported any symptoms like pain or arm fatigue. (Mair et al., 2008)  Another study suggests that after just one 12-week little league season, approximately 50% of players had elbow/shoulder abnormalities that were severe enough to be seen on MRI images. (Pytiak et al., 2017) Experienced medical professionals agree that although muscle soreness is normal and necessary in the development of a pitcher, complaints of joint pain is not. Therefore, shoulder and elbow pain should be considered a warning of the potential development of an overuse injury. (Manzi et al., 2022)


Proper Throwing Mechanics:
 
So, you’re asking yourself… what can we do about this?!? First things first, focus on proper throwing mechanics. This doesn’t just mean keep throwing that ball every day, over and over, until you can throw it faster and farther than anyone else on your team. Having an efficient and effective throw requires the engagement and strength of certain muscles, and proper flexibility and stability in others. Learning early on to engage your deeper core and abdominals to help stabilize your trunk, while also activating the larger muscles throughout your hips and legs for power, can help reduce the strain on your upper body and lead to less injury at your shoulder and elbow joints. Working with a local physical therapist or pitching coach can ensure that your kids maintain good all-around strength and global flexibility, in order to help minimize injury and reduce muscular strain or fatigue.

Pitch Count: Why it Matters


Pitch count is the number of throws performed by a pitcher within a certain amount of time. Numerous studies have been conducted that demonstrate the positive correlation between increased pitch counts and shoulder or elbow pain and injuries. Below you can find updated recommendations of these numbers based on a child’s age and pitching window:
 






It is important to understand that these players should not be allowed to exceed or bypass this “throwing max” by participating in more than one league/ team at a time, practicing with friends or parents, or even engaging in other sports that require a lot of throwing such as dodgeball or football. All organized throwing should be monitored closely by parents or coaches in order to ensure adherence to the suggested numbers. Not only does pitch count help reduce injuries, but it also can help players reduce the onset of developing fatigue. Sometimes it may be difficult for children or adolescents to explain what true muscular fatigue may feel like; this age group often described this as their arm feel “tired” or “off.” This can be a vital piece of information to further ensure their upper extremity health in years to come. Research states that a pitcher who regularly pitches despite feeling arm fatigue can be 36x more likely to develop a serious injury requiring shoulder or elbow surgery. Therefore, complaints of being tired should be taken seriously as they could indicate potential injuries in the future if ignored or played through.
 

In summary, children that engage in sports that involve a lot of over-head throwing and repetitive movements are more at risk for developing poor body mechanics and overuse injuries. Ignoring complaints of pain and fatigue places each child at an increased risk for developing serious injuries in the future, and potentially limiting their ability to participate in sports as they get older and enter into adolescence and adulthood. Ways to mitigate these risk factors include ensuring your child is using proper body mechanics while pitching and participating in sport, and paying close attention to the amount of throwing your child is doing overtime. For any further information or questions on this topic, please feel free to contact our office via our social media page or contact information below.
 
 
References:
1.     Mair, S. D., Uhl, T. L., Robbe, R. G., & Brindle, K. A. (2004). Physeal changes and range-of-motion differences in the dominant shoulders of skeletally immature baseball players. Journal of Shoulder and Elbow Surgery, 13(5), 487–491. https://doi.org/10.1016/j.jse.2004.02.008
2.     Pytiak, A. V., Stearns, P., Bastrom, T. P., Dwek, J., Kruk, P., Roocroft, J. H., & Pennock, A. T. (2017). Are the current Little League pitching guidelines adequate? A single-season prospective MRI study. Orthopaedic Journal of Sports Medicine, 5(5), 232596711770485. https://doi.org/10.1177/2325967117704851
3.     Manzi, J. E., Kunze, K. N., Estrada, J. A., Dowling, B., McElheny, K. D., Dines, J. S., & Carr, J. B. (2022). Variability in pitch count limits and rest day requirements by state: Implications of season-long pitch counts in high school baseball pitchers. The American Journal of Sports Medicine, 50(10), 2797–2804. https://doi.org/10.1177/03635465221111098
4.     Safety Tips for young baseball pitchers: HSS sports rehab. Hospital for Special Surgery. (n.d.). https://www.hss.edu/conditions_tips-for-young-baseball-pitchers.asp 

​Excited for another fun summer? So are we! We’ve put together a list of fun, easy, and enriching activities to do together with your child, all while incorporating physical therapy techniques and insights. Get creative with the below activities- and if you ever need any additional help — please reach out to our staff at Leaps and Bounds all summer long!

1) Animal walks - Bear crawls, penguin walks, kangaroo hops, crab walks, and flamingo stands are all fantastic, dynamic exercises that strengthen the full body and improve coordination in children.
• Bear crawls are great for strengthening the arms and legs in unison while improving coordinated movements of the extremities and promoting core stability. Bonus points for the scariest bear roar!
• Penguin walks, walking while keeping the toes pointed to the sky, are a great exercise to strengthen the lower legs and ankles. And this is especially great for kids who show any tendency to toe-walking.
• Kangaroo hops, standing on your tippy toes and jumping forward, are another great activity that challenge dynamic balance and promote leg strengthening, this is especially beneficial for kids who show a tendency to walk with their toes in or toes out.
• Crab walks, starting on your back followed by lifting yourself so that only your hands and feet are touching the ground is a great gross motor challenge that exposes children to using their muscles in a way they may not be used to. This activity improves coordination and strength of the full body.
• Flamingo stands, while standing up tall, lift one leg and balance it against the standing leg, now try to hold this position as long as possible. Notice if your child has any difficulty standing on one side compared to the other.

Now head to the zoo or aquarium to see how close your animal walks are to the real thing!

2) ​At the playground, your child can improve their coordination, strength, and core muscle endurance as they climb ladders and cargo nets and play on the monkey bars. Hop on the swings to increase proprioceptive input in all planes of motion. Climb UP the slide before making your way down to strengthen the upper extremities and core. Visiting a playground is a classic way to keep your child active, while promoting safe social interaction with other children!

3) In the water: swimming is an amazing activity that promotes sensory integration, motor planning, coordination, spatial awareness as well as cardiovascular health. Make swimming fun with your child by incorporating games such as tag, follow the leader, Marco Polo, mermaids, or make up your own games! If your child seems increasingly apprehensive about going in or out of water, reach out to one of our therapists as this could be a sensory processing disorder that needs a little extra support.

​4) Riding a bike is an essential summertime activity that also helps your child develop their leg muscles. Riding a bike just around the neighborhood or down the boardwalk will help elevate their exercise endurance and cardiovascular ability along with their coordination and balance. And if your little one is having any difficulty or fear with getting on a bike for the first time, reach out to our office as we offer bike learning classes!

5) Playing with a ball! This is a timeless and simple activity that will help improve hand to eye coordination. Some ideas are: throwing and catching, kicking, and bouncing, but feel free to freestyle and come up with fun new games that your child will love! Throw a football, kick a soccer ball, bounce a handball, and even embark on a new adventure together like juggling (pro tip: practice juggling with plastic bags first). 

6) Sidewalk Chalk: Playing with chalk promotes new sensory experiences while working on colors, shapes, letters, and numbers. Draw a hopscotch board (and other doodles) and work on single leg hops, draw a line and work on balancing, or draw an obstacle course and incorporate other elements, such as walking along a narrow line without losing balance and stomping feet on spots drawn on the ground. 

7) Kids yoga:  Yoga is a great way to wind down after any of the other summer activities you have planned. Find a nice spot (the beach, your backyard, or just the living room) and pull up a short YouTube video to follow or craft your own routine. The benefits of yoga are plentiful for kids and adults alike, including: improving focus, flexibility training, breathing practice, and muscle recovery.  And keep an eye out for one of the Leaps and Bounds Yoga classes happening this summer near you!

8) Building a fort: Spending more time outdoors during the summer is awesome, but it is also important to take a break indoors. Watching a movie or having story time inside a fort made with blankets and pillows can help reduce and integrate sensory input, spur creativity, and allow your kids to reset their minds and bodies alike. Bring puzzles or Legos inside the fort to have an equally cozy and stimulating activity. 

​BONUS!
Consider a scavenger hunt! This can be incorporated into most of the above activities and can help keep your child remain focused and eager throughout the exercises. Consider writing riddles to get your kids thinking or hide treats for a simpler approach. This can be both an outdoor and indoor activity (for those rainy summer days!)
 
Planting flowers is an enriching activity that you can work on together with your child. They can connect with their community and earth by sowing seeds and watching their creation grow over time. It’s great for the younger kids to develop motor skills in a fun and different way!
 
As always, if you have any concerns regarding your child’s development, please reach out to our office to speak with one of our licensed physical therapists.