Little League Safety: How to Protect Our Future All-Stars on the Field

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Parsing the new policy statement released by the American Academy of Pediatrics for keeping kids safe while playing baseball.

Image: Heather Renee/Shutterstock

Every spring millions of American children ages five to 18 participate in baseball and softball programs throughout the country. To help prevent injuries, the American Academy of Pediatrics (AAP) has produced a policy statement aimed at increasing safe play.

Children understand and play the game differently and sustain different types of injuries at different ages and stages of cognitive and physical development. The new guidelines are meant to make coaches and parents aware of this so they can tailor rules, equipment, and expectations to the ages and stages of the children involved to make playing softball and baseball safer and more enjoyable. Here are some highlights.

OVERUSE AND REPETITIVE STRESS INJURIES

Overuse injuries in baseball and softball are common, particularly among pitchers. The AAP recommends that in addition to taking precautions to limit the number of throws, "Parents, coaches, and players should be educated about the early warning signs of elbow and shoulder overuse injuries.... [A]thletes should cease pitching immediately when signs of arm fatigue or pain occur...."

Little League shoulder and Little League elbow are both overuse injuries that result from the repetitive stress of throwing which can cause muscle fatigue, and damage muscles, tendons, and ligaments This, in turn, can lead to chronic pain, joint instability, and degenerative arthritis. Proper conditioning, proper throwing mechanics, enforced limits on daily, seasonal, and yearly pitches thrown, and enforced rest periods are all considered keys to prevention.

In 2006, the Medical and Safety Advisory Committee of USA Baseball set pitching limits for the season and calendar year based on the pitcher's age. Similarly, Little League has guidelines for the number of pitches to be thrown in a day and the number of rest days required between pitching assignments based on pitches thrown and the age of the pitcher. They also demand that each league designate a scorekeeper or official to track pitch counts as the official pitch-count recorder. A violation of the rules can result in a protest of the game in which it occurs.

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The Little League's own pitching guidelines state that a manager must remove the pitcher when a pitcher reaches the limit for his/her age group (they may remain to complete pitching to the batter at bat). The pitcher may remain in the game at another position. However, if a pitcher delivers 41 or more pitches in a game, he or she cannot play the position of catcher for the remainder of that day. When young pitchers are on multiple teams, it is important that the guidelines must be enforced across all teams, taking into account the sum of pitches among them, so that pitchers do not overstress their elbows and shoulders.

Rest Requirements for Young Shoulders, Backs, and Arms

Giving young bodies time to recover is as important to protecting pitchers' shoulders and arms -- and backs -- as limiting pitches. The Little League's rest requirements also take into account a pitcher's league age and the number of pitches thrown and stipulate that a player may not pitch in more than one game in a day.

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The AAP guidelines note that young pitchers should not pitch competitively for more than eight months in any 12-month period, and they recommend three consecutive months of complete rest from pitching each year. Additionally, it is recommended that pitchers not serve as catchers, since catchers throw even more often than pitchers.

The kinds of pitches being thrown make a difference, too. The curve ball and the slider are considered to be too stressful for the immature joints of young players. It is recommended that these pitches not be introduced until the pitcher has reached skeletal maturity, around age 14 to 16. Keep in mind that children mature at different rates, so some may still be growing at age 16 and beyond.

Special Softball Issues

Softball pitching has similar musculoskeletal challenges to baseball but softball pitchers throw underhand (windmill pitch) and the hips and legs are more involved in the supportive mechanics. Thus, weak gluteal muscles and poor pelvic stabilization may contribute to shoulder pain and overuse injury. Accordingly, injury rehabilitation and preseason conditioning for softball pitchers should include attention to the gluteal and pelvic muscles in addition to the shoulder.

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Esther Entin, M.D., is a pediatrician and clinical associate professor of Family Medicine at Brown University's Warren Alpert School of Medicine. She writes for TheDoctorWillSeeYouNow.com.

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