Little League® guidelines may not be strict enough to prevent injuries

According to a recent study investigating arm and shoulder injuries in Little League® baseball players, the current mandatory Little League guidelines, last modified in 2007, may not be sufficient to prevent injuries. New data suggests that the enforced guidelines, along with all-around compliance still results in a high number of arm and shoulder injuries in young pitchers.

The research evaluated 25 Little League players ages 10 to 13 of which 44 percent were pitchers and 56 percent were pitchers/catchers. Each athlete had an MRI before and after the season to examine the effect of one season on their shoulders and arms. MRI readings were labeled ‘abnormal’ if there was evidence of an injury. According to the researchers, the abnormalities were noted on the medial side of the elbow and included fragmentation of the epicondyle, edema and partial disruption of the ulnar collateral ligament. At the beginning of the season, 35 percent of the players had an abnormal MRI finding. At the end of the season, 48 percent of players had an abnormal MRI finding. Of the players with an abnormal MRI finding at the end of the season, 75 percent had new findings and/or a progression of an abnormal finding that was found before the start of the season.

Each player also had a physical examination at the beginning and the end of the season. Upon comparison, the researchers noted a loss of approximately 11.2 degrees of shoulder internal rotation per athlete, a loss of 10.8 degrees of the total arc of motion per athlete, and a development of an additional 1.4 degrees of elbow hyperextension per athlete. Researchers noted a positive correlation between the pre- and postseason findings and the effect they had on the loss of range of motion and the development of elbow hyperextension particularly since no other physical changes occurred during the season.

The authors of the study reported that players demonstrated “excellent” compliance with the mandatory Little League regulations, which consist of pitch count limits and mandatory rest days; however, players did not comply as well with the nonmandatory Little League regulations. These regulations include restrictions on throwing off-speed pitches such as curveballs and sliders, resting from baseball play for at least three months per year, and restrictions on how many teams an athlete may be on during one season. Of the 25 athletes in the study, 56 percent threw off-speed pitches, 68 percent did not rest for at least three months per year, and eight percent played on more than one team during the same season.

When the researchers examined the 12 players with an abnormality in their post-season MRI, 83 percent had not complied with at least one of the nonmandatory recommendations, compared to 62 percent of the players who did not have a post-season abnormality. Of the eight players who had a worsened and/or new abnormality at the end of the season, 88 percent had not followed at least one of the three nonmandatory recommendations, compared to 65 percent of the players who had no new and/or worsening abnormalities. Athletes who did not comply with the nonmandatory regulations had a greater likelihood of injuring their shoulder/arm.

According to the researchers, their findings underscore the importance of complying with both mandatory and nonmandatory Little League guidelines in order to optimize injury prevention. “These numbers are very high and call into question the overall effectiveness of the Little League pitching guidelines,” Dr. Steven Chudik said. “It also is a testament to the unnatural and damaging forces placed on the shoulders and elbows of our developing youth. We should focus more on instruction and free play and less on competitive organized sports,” he added.

For over 15 years, Dr. Steven Chudik treats patients at his Shoulder, Knee and Sports Medicine clinic in Westmont and Western Springs, Illinois. To schedule an appointment, call 630-324-0402, or schedule online.

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