Ryan J. Faer

This piece was originally written for one of my science writing courses. I enjoy writing and sharing, so I figured why not share this one. I have made some minor edits before posting here. Enjoy!

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For those working in the game of baseball (at every level), these should be exciting times: youth participation rates in the sport are on the rise, and the entire amateur sports industry is now valued at over $7 billion. Meanwhile, billion-dollar baseball complexes are being built all across the country to meet the burgeoning demands of travel baseball.

But sadly, these are not the only numbers on the rise in baseball. Tommy John surgery, a major procedure repairing a pitcher’s failed Ulnar Collateral Ligament (UCL), has increased in prevalence over the past two decades. So much so, in fact, that many have gone as far as to call it an epidemic.

A study by the American Journal of Sports Medicine found that, in 2011, nearly 60% of all Tommy John surgeries could be attributed to patients between the ages of 15 and 19, a staggering jump of almost 6% from five years prior. All the while, the professional ranks have also seen an increase in the procedure; 80 players reportedly went under the knife for UCL repairs in 2015, as compared to just 65 in 2012. While Tommy John surgery receives a bulk of the attention in the media, it is not the only arm injury occurring in the sport. Overall, upper extremity injuries were found to account for over 51% of all injuries in Major League Baseball from 2002 to 2008.

It is no coincidence, though, that both the increase in popularity of youth baseball and the increase in arm injuries at both the amateur and professional levels are both on the rise. That is because the act of throwing a baseball is a great paradox. What can help give rise to a young pitcher’s stock is also the very same that can lead to his breakdown: early sport specialization, youth baseball’s epidemic.

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Characterizing today’s amateur baseball climate as competitive would be an understatement. Due to pressures imposed by society, friends, parents and/or coaches, kids are not only playing the game more often, they are now playing the game at the exclusion of other sports more frequently. In other words, they are falling victim to what is known as early sport specialization, a wide-spreading trend seen in all of amateur athletes, not just baseball.

Early sport specialization possesses a very alluring upside to parents, players, and coaches alike: it allows a child to focus all of his or her attention on one sport, and by doing so, a young athlete and their parents can allot more of their resources to that sport. This means more time to practice those particular skills, and more money to spend on lessons, camps, and tournaments. Predictably, highly specialized baseball players have the potential to improve very quickly in the sport. So, why shouldn’t parents and coaches steer their children away from other sports to focus on the one sport in which they possess the most talent?

Unfortunately, like most things in life, more isn’t always better. While playing one sport at the exclusion of others can lead to early improvements in skill, it can also lead to psychological and physiological repercussions if taken too far.

In terms of the former, a loss of enjoyment in the game – as some informally call it “burnout” – can occur, and at a time when fun and enjoyment should be the driving forces behind participation. What is left without enjoyment is simply obligation; do we really want our kids feeling obligated to play a game?

Early sport specialization in baseball can also lead to physiological changes within the body as a response to training and practice. In other words, it is the violent nature of the swing and throw that can cause physiological adaptions in the body with voluminous repetition. For example, Internal rotation of the shoulder joint – the motion occurring as a pitcher delivers the ball to home plate – can occur at nearly 7,000 degrees/second, a speed in which no other joint in the body can match. That means that the motion required to pitch a baseball is the single fastest movement that the human body can make. The ability to accelerate and produce these speeds (and then decelerate them) places incredible demands on the muscles, bones, and ligaments of both the elbow and shoulder. These extreme forces that occur during the pitch typically cause significant changes to these tissues over time, especially for youth and adolescent players whose bodies are still developing and maturing.

At first, a young ballplayers body will positively adapt to these imposed demands; the changes experienced in the bones, ligaments, and muscles will initially help them to perform baseball skills more effectively and efficiently. But, over time these adaptations can also set an athlete up for future breakdown and degeneration, especially if the athlete experiences overuse.

Overuse is such a prevalent concern in baseball given both the nature of the sport and the climate of its youth levels: regardless of the position played, the ballplayer must rotate violently in one direction (e.g. throwing, swinging, pitching) hundreds of time each day during practice and games. And, in many parts of the United States, it is commonly accepted that baseball is a year-round sport, one in which players often play competitively for multiple teams in a single season. So, what sets baseball apart isn’t just the violent movements, but also the sheer volume accrued at the youth levels today.

It is this very process that can lead to overuse injuries, also known as chronic injuries,  which are a result of repetitive micro-trauma to the body’s tissues and joints. For comparison, there are acute injuries, which occur quickly, such as that of an ACL tear during a football game. In baseball, though, most injuries manifest much more slowly. The act of throwing and hitting leads to micro-trauma; micro-trauma builds with overuse; overuse, when left unchecked, can lead to chronic injury.

The timeline of chronic injury, however, can vary. Some athletes might experience a more early arrival of symptoms (e.g. tendonitis of the arm, or more commonly known as “Little Leaguer’s Elbow”), while others might see a more insidious onset of symptoms (e.g. the slow degeneration of the shoulder capsule that lies asymptomatic for years). Thus, early sport specialization could very well attribute to both chronic arm injuries at the amateur level and in the professional ranks of the sport.

While some might argue that opting out of year-round baseball would hurt a young player’s chances of success in the game, it can be contested that this is about more than just baseball. The NCAA has estimated that only 7.1% of high school baseball players will go on to play at a collegiate institution, while only 9.1% of those collegiate players will potentially reach the professional ranks. It isn’t just about baseball.

For the overwhelming majority of players, we should not even be considering their arm health in relation to their potential to play beyond high school, but rather we should ask ourselves what we are really risking. The kids that we are encouraging, condoning, or allowing to be overused – they aren’t professional baseball candidates, nor should they be viewed in this light; they are kids, with bright futures that more than likely happen to lie outside of the game of baseball. Thus, that 14 year-old elbow with stress fractures from throwing, that 17 year-old shoulder that will one day need replacement parts, and that arm that becomes arthritic down the road, they most likely belong to a future lawyer, doctor, emergency service worker, or father – not a future professional athlete.

While early sport specialization may be at the heart of baseball’s arm-injury epidemic, it also poses ramifications that are even greater when we look beyond the game.