Sports Medicine: Just the Facts

CHAPTER 76 • BASEBALL 463

on reducing pain and swelling and improving strength.

During the recovery phase treatment is focused on

pain-free range of motion, strength, and improved sta-

bility and function. The maintenance phase of rehabili-

tation includes increases in power, endurance, strength,

and activity specific function.

• Interval throwing programs(ITPs) are structured to
  increase a pitcher’s strength and endurance before
  returning to competitive pitching. ITPs are prescribed
  after an injury or at the start of preseason training.
  Programs are designed for players to reach specific
  goals, often over a period of 3 to 4 weeks. A typical
  week might comprise 4 days of throwing and 3 days of
  rest. Throwing days start with warm-ups and stretching
  and are followed by throwing. Throwing distances are
  gradually increased throughout the program.

PREVENTION

• Prevention of injuries is directed at proper condition-
  ing, proper mechanics, proper equipment, and avoid-
  ing overuse.


• Pitchers throwing more frequent change-ups have a
  decreased risk of elbow pain compared to pitchers
  throwing more sinkers (Marshall et al, 2003; Lyman
  et al, 2001).


• Implementing use of safer equipment including
  break-away bases, batting helmets with face guards,
  and lighter mass baseballs in youth play (Janda,
  2003).

LITTLE LEAGUE BASEBALL

•For information on Little League Baseball, including
policies and rules on such things as restrictions for
pitchers, visit their web site at http://www.littleleague.org.

THE AMERICAN ACADEMY OF PEDIATRICS
RECOMMENDATIONS (Washington, 2001)

• Baseball and softball for children 5 through 14 years
  of age should be acknowledged as relatively safe
  sports. Catastrophic and chronically disabling injuries
  are rare; the frequency of injuries does not seem to
  have increased during the past two decades.


• Preventive measures should be used to protect young
  baseball pitchers from throwing injuries. These meas-
  ures include a restriction on the number of pitches
  thrown in organized and informal settings and instruc-
  tion in proper training, conditioning and throwing

mechanics. Parents, coaches, and players should be

educated about the early warning signs of an overuse

injury and encouraged to seek timely and appropriate

treatment if evidence of an injury develops.

• Serious and potentially catastrophic baseball injuries
  can be minimized by the proper use of available
  safety equipment. This includes the use of approved
  batting helmets; helmets, masks, and chest and neck
  protectors for all catchers; and rubber spikes.
  Protective fencing of dugouts and benches, and the
  use of break-away bases also are recommended, as is
  the elimination of the on-deck circle. Protective
  equipment should always be properly fitted and well
  maintained. These preventive measures should be
  used in games and practices and in organized and
  informal participation.


• Baseball and softball players should be encouraged to
  wear polycarbonate eye protectors on the batting hel-
  mets to reduce the risk of eye injury. These eye pro-
  tectors should be required for functionally one-eyed
  athletes (best corrected vision in the worst eye of less
  than 20/50) and for athletes who have undergone eye
  surgery or experienced severe eye injuries if the oph-
  thalmologists judge them to be at an increased risk for
  eye injuries. These athletes also should protect their
  eyes when fielding by using polycarbonate sports
  goggles.


• Consideration should be given to using low-impact
  baseballs and softballs for children 5 to 14 years of age.
  Particularly, children younger than 10 years should be
  encouraged to use the lowest impact balls.
  •Developmentally appropriate rule modifications, such
  as avoidance of headfirst sliding, should be imple-
  mented for children younger than 10 years.


• Because current data are limited, the routine use of
  chest protectors is not recommended for baseball
  players other than catchers.


• Surveillance of baseball and softball injuries should
  be continued. Studies should continue to determine
  the effectiveness of low-impact balls for reducing
  serious impact injuries. Research should be continued
  to develop other new, improved, and efficacious safety
  equipment.

REFERENCES

Curfman GD: Fatal impact—concussion of the heart. N Engl J

Med 338(25):1841–1843, 1998.

De Maeseneer M, Jaovisidha S, Jacobson JA et al: The bennett

lesion of the shoulder. J Comput Assist Tomogr 22(1):31–34,

1998.