3. Pitch Counts Pitch Counts Shoulder/Elbow Anatomy Shoulder/Elbow Anatomy Risks for Injury Risks for Injury Medical Care Medical Care Injury Prevention Injury Prevention Rehabilitation Rehabilitation Return to Sport Return to Sport Training Training

7. 9 Months 9 Months 3 months of NO throwing 3 months of NO throwing REST, Conditioning, Rehab, Preparation

8. Two Major Studies Two Major Studies 1996 USA Baseball Medical & Advisory Committee 1996 USA Baseball Medical & Advisory Committee Expert Survey Expert Survey 2002 American Journal of Sports Medicine Study 2002 American Journal of Sports Medicine Study Epidemiological Study Epidemiological Study

9. 2002 Study; American Journal of Sports Medicine 2002 Study; American Journal of Sports Medicine 476 baseball pitchers ages 9- 14 followed x1 season 476 baseball pitchers ages 9- 14 followed x1 season Pre-season and Post-season Questionaires Pre-season and Post-season Questionaires Types of pitches Types of pitches Stiffness and pain in elbow and shoulder Stiffness and pain in elbow and shoulder Injury and Performance interviews following each game Injury and Performance interviews following each game Pitch count logs Pitch count logs Video analysis of pitching mechanics Video analysis of pitching mechanics

10. 50% reports elbow or shoulder pain at least once during the season 50% reports elbow or shoulder pain at least once during the season Pitchers who threw sliders were 86% more likely to experience elbow pain during the season Pitchers who threw sliders were 86% more likely to experience elbow pain during the season Pitchers who threw curve balls were 56% more likely to experience shoulder pain during season Pitchers who threw curve balls were 56% more likely to experience shoulder pain during season Pitchers who threw change-ups were 12% less likely to experience elbow pain and 29% less likely to experience shoulder pain during season Pitchers who threw change-ups were 12% less likely to experience elbow pain and 29% less likely to experience shoulder pain during season

11. As pitch counts increased, the number of shoulder and elbow pain cases increased As pitch counts increased, the number of shoulder and elbow pain cases increased The incidence of elbow and shoulder pain increased with the number of pitches thrown in a season The incidence of elbow and shoulder pain increased with the number of pitches thrown in a season

13. LISTEN and REACT to complaints of arm pain LISTEN and REACT to complaints of arm pain A pitcher who complains or shows arm pain during a game should be removed immediately A pitcher who complains or shows arm pain during a game should be removed immediately Medical Attention: Medical Attention: Pain not relieved in 4 days Pain not relieved in 4 days Recurs immediately upon return to throwing Recurs immediately upon return to throwing

15. GAME: 50 GAME: 50 WEEK: 75 WEEK: 75 SEASON: 1000 SEASON: 1000 YEAR: 2000 YEAR: 2000

16. GAME: 75 GAME: 75 WEEK: 100 WEEK: 100 SEASON: 1000 SEASON: 1000 YEAR: 3000 YEAR: 3000

17. GAME: 75 GAME: 75 WEEK: 125 WEEK: 125 SEASON: 1000 SEASON: 1000 YEAR: 3000 YEAR: 3000

19. GAME Pitch Count GAME Pitch Count Warm up pitches Warm up pitches No breaking pitches until bones mature No breaking pitches until bones mature 13 years old 13 years old FOCUS: Good Mechanics and Control FOCUS: Good Mechanics and Control NO MORE than 9 Months of Competition NO MORE than 9 Months of Competition

24. Pitch Count, Pitch Count, PITCH COUNT Pitch Count, Pitch Count, PITCH COUNT OVERUSE OVERUSE Showcases Showcases Playing year round Playing year round Improper Activity to Rest Ratio Improper Activity to Rest Ratio Poor Shoulder ROM/Flexibility Poor Shoulder ROM/Flexibility Poor Elbow ROM/Flexibility Poor Elbow ROM/Flexibility

25. Kids who required surgery TWICE as many pitches as those who did not….

26. After ONE game pitchers loose some shoulder and elbow range of motion

28. Number of pitches Number of pitches History of previous injury to area History of previous injury to area

29. Games Games In-season In-season Painful Painful Off Season Off Season

30. Warm Up: Full Body and Shoulder Warm Up: Full Body and Shoulder NOT all throwing NOT all throwing Pitch Counts Pitch Counts COUNT full speed, warm up pitches/throws COUNT full speed, warm up pitches/throws Limit between inning warm up throws Limit between inning warm up throws Post Game Stretching: Elbow and Shoulder Post Game Stretching: Elbow and Shoulder

31. Flexibility post throwing (ALL Positions) Flexibility post throwing (ALL Positions) Light shoulder exercises Light shoulder exercises Mix Up Demands, Practice, and Training Mix Up Demands, Practice, and Training

35. Consequences: Devastating Elbow Pain Elbow Pain Torn UCL = Tommy John Surgery Torn UCL = Tommy John Surgery Shoulder Pain, Little Leaguers Shoulder Shoulder Pain, Little Leaguers Shoulder Fracture of Humerus Fracture of Humerus

36. Pain greater 3-4 days Pain greater 3-4 days Pain immediately returns Pain immediately returns Unable to walk (weight bear) >3-4 steps Unable to walk (weight bear) >3-4 steps Pain is getting significantly worse Pain is getting significantly worse Not improved with rest Not improved with rest

37. REFER THEM OUT

38. Less often, less weight in season Less often, less weight in season Make a part of practice at least in pre-season Make a part of practice at least in pre-season NOT TO FATIGUE NOT TO FATIGUE 3 sets of 8-12 3 sets of 8-12 Slow, good control, EXCELLENT form Slow, good control, EXCELLENT form http://www.mikereinold.com/2010/05/little-league-injury-prevention-program.html

45. Lower Body Strength, Power, Control & Balance Lower Body Strength, Power, Control & Balance Single Leg Balance Single Leg Balance Lunge Lunge Squats Squats Core Strength & Control Core Strength & Control Lower Body Flexibility Lower Body Flexibility Higher Level Shoulder Exercises Higher Level Shoulder Exercises

46. RELATIVE REST > NO THROWING RELATIVE REST > NO THROWING Strengthen small stabilizers of shoulder and shoulder blade Strengthen small stabilizers of shoulder and shoulder blade Total Body conditioning including strength and resistance Total Body conditioning including strength and resistance Baseball Players CAN and SHOULD lift weights

47. http://www.mikereinold.com/2009/04/little- league-pitching-injuries.html

48. Curveballs: http://www.mikereinold.com/2009/08/is- throwing-curveball-dangerous-to-our.html http://www.mikereinold.com/2009/08/is- throwing-curveball-dangerous-to-our.html http://www.mikereinold.com/2009/08/is- throwing-curveball-dangerous-to-our.html Youth Injuries:http://www.mikereinold.com/2012/02/ the-real-reason-why-there-are-so-many- youth-pitching-injuries.html http://www.mikereinold.com/2012/02/ the-real-reason-why-there-are-so-many- youth-pitching-injuries.htmlhttp://www.mikereinold.com/2012/02/ the-real-reason-why-there-are-so-many- youth-pitching-injuries.html

49. http://www.ericcressey.com/baseball-content http://www.ericcressey.com/baseball-content

50. http://www.asmi.org/asmiweb/usabaseball.ht m http://www.asmi.org/asmiweb/usabaseball.ht m http://www.asmi.org/asmiweb/usabaseball.ht m http://www.asmi.org/asmiweb/usabaseball.ht m Effect of pitch type, pitch count, and pitching mechanics on risk of elbow and shoulder pain in youth baseball pitchers. Am J Sports Med. 2002 Jul-Aug;30(4):463-8. Lyman S, Fleisig GS, Andrews JR, Osinski ED. Effect of pitch type, pitch count, and pitching mechanics on risk of elbow and shoulder pain in youth baseball pitchers. Am J Sports Med. 2002 Jul-Aug;30(4):463-8. Lyman S, Fleisig GS, Andrews JR, Osinski ED. Am J Sports Med. Lyman SFleisig GSAndrews JROsinski ED Am J Sports Med. Lyman SFleisig GSAndrews JROsinski ED