Danger Zone

Danger Zone

6/20/2019

By Greg Bach

It’s become an all-too-common – and alarming – sight in the office of renowned orthopaedic surgeon Dr. Jeffrey Dugas of the famed Andrews Sports Medicine & Orthopaedic Center in Birmingham, Ala: talented teen baseball pitchers facing surgery from overuse.

“I see this a lot,” says Dugas, a sports medicine specialist. “I had two 14-year-olds in my office last week who could throw it 80-plus miles an hour. If you can throw like that when you’re 14 you’re probably pretty successful, but the problem is that 14-year-olds still have open growth plates. If your body can generate enough force to throw a ball 80 miles an hour at 14 that doesn’t necessarily imply that your body can tolerate it.”

Yes, hard-throwing teens with unhittable fastballs are coveted by coaches, loved by teammates, and proudly watched by parents.

But as these kids pile up wins, strikeouts and accolades – logging heavy innings – that can fast-track them to the operating table.

“The last thing on earth that you want your kid to be is the stud 13- or 14-year-old pitcher, because that means they’re pitching a lot,” Dugas says. “You want him to pitch a little bit, practice and get better, don’t throw with maximum effort and really work on the finer points of pitching to become a better pitcher. But you don’t want them out there maxing out their pitch count every time they can and pitching twice a week, because that’s a recipe for disaster.”

Check out what else one of the most respected orthopaedic surgeons in the country shared to help keep your young athletes safe:

SPORTINGKID LIVE: What should coaches be on the lookout for during games that indicate a problem?

DUGAS: As pitches start to rise and go up that’s usually a sign that their legs are getting tired and their arms are doing more of the work. Also not having enough rest between pitching opportunities. You throw a certain number of pitches you should have a certain number of days off. I think the numbers that are out there in terms of pitch counts and rest periods are very reasonable and should be followed. (Visit the American Sports Medicine Institute for more information.) If Major League pitchers use rest when they need it and aren’t available to pitch on certain days because of the innings they threw the last game, why wouldn’t we do the same thing for the more vulnerable adolescent kids?

SPORTINGKID LIVE: Do kids have a responsibility to speak up when pain strikes, or are there generally not any warning signs?

DUGAS: I often don’t think that they have a lot of pain. It’s not common for a 12-year-old to say his elbow was hurting for two weeks before he felt a pop. But we have to know when there is fatigue going on, and it’s not just elbow fatigue. If his shoulder is fatigued it will transmit that stress to his elbow. So we know that shoulder fatigue is bad for elbows and if kids are throwing a lot and their shoulders are getting fatigued, that’s not good. So it’s important to have rules in place to keep that from happening, because a lot of times there isn’t an early warning.

SPORTINGKID LIVE: What’s something you would really like adults and young athletes to be aware of to help minimize injury risk?

DUGAS: One of the things that we need to really push is the idea of not throwing with a fatigued arm. What that really gets to is these kids do not need to be lifting upper body weights and throwing at the same time – that’s a bad idea because you are going to fatigue your shoulder. So kids who are two-way athletes – they’re working out for football and they’re going out and throwing – that’s a real recipe for a problem.

If you look at baseball players at the highest level you don’t see a lot of guys who look like they bench press and military press. They’re not big-chested, gym rat looking guys. That doesn’t mean they’re not great athletes, because they are. But they have to be long and loose to throw, not big and bulky in their chest and shoulders. So I caution kids against trying to be muscled up, or doing things that are going to build bulk in their chest and shoulders, and then trying to throw. Those two things are exactly the opposite forces that you are looking for. We want shoulders to be loose and their chest to be loose in order to throw a ball well. If you are tight you are going to create a problem. If you are lifting heavy weights in the fall for football that’s not a good time to be throwing. It’s so important to be a baseball player during baseball season and a football player during football season.

SPORTINGKID LIVE: Do you get a sense that high school and youth baseball coaches understand this and are steering kids away from lifting heavy weights, or is it still a big area of concern?

DUGAS: I think that’s something that unfortunately has not trickled down to the high school and junior high school level. At the pro level they get that. You don’t see pitchers lifting heavy weights at the Major League Baseball level. They don’t do a lot of heavy, upper body stuff during the season. In fact, some teams don’t do anything besides bands, and you don’t see a lot of shoulder injuries in Major League Baseball from pitchers anymore because they quit doing that. We don’t see the labrum and rotator cuff injuries as often as we did 10 years ago, and we attribute it to them getting away from those types of strengthening regimens and letting them be looser and less muscular. It doesn’t make them throw it any less hard. In fact, people are throwing it harder and harder, but not because they have been bench pressing.  

SPORTINGKID LIVE: You have developed a Tommy John surgery alternative for UCL repairs using internal brace construction. How did you come up with this?

DUGAS: The idea of the internal brace was first used in the ankle by a surgeon in Scotland who used it to reconstruct ankle ligaments, which is about the same size and dimension as a UCL. So I had this idea that maybe for some of these people where their tissue quality was OK and their tissue quantity was ok – they just tore it – maybe we could repair it and augment it and that would be better than reconstructing it.

SPORTINGKID LIVE: How successful has it been so far?

DUGAS: This is not something that is going to replace Tommy John surgery for every injury, but it certainly is good for people with lower level injuries like partial tears. This internal brace is not a ligament replacement, it is a ligament repair and augmentation. A lot of the times it’s these kids who feel good one moment and the next moment their ligament is torn, and it’s torn on one end or the other, so we’re just putting it back to the way it was before they tore it. In April we published our two-year outcomes on the first 125 we have done, and it ended up being in the 92 to 93 percent return rate, which is really good. So we were really pleased with how this is going. But again, it’s not for every Tommy John surgery. It’s for the ones where the tissue quality dictates that this is ok.

Dr. Jeffrey Dugas Pitching Baseball Overuse Safety Health Andrews Sports Medicine

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