Kent Myer signed his letter of intent to play baseball for the Alabama Crimson Tide and, in the spring of his senior year, he was named player of the year and led his team to the 2008 Class 4A state championship. He was living the dream of many young, talented athletes, but after ignoring sharp pains in his right elbow for more than a year, he suddenly couldn’t continue to pitch.
“I felt something in my elbow give and my pitch went a mere 20 feet,” Myer said of his attempt at the first pitch in the fourth round of the playoffs. “It was as if all my strength in my elbow was suddenly taken away … this had never happened to me in my entire life.”
Two weeks after taking top honors, Myer discovered his ulnar collateral ligament, or UCL, was torn. He needed UCL reconstruction surgery — more commonly referred to as Tommy John surgery for the pitcher who was the first professional athlete to successfully undergo the procedure in 1974.
More than 3.5 million children under the age of 15 required sports-related medical treatment in 2003. Myer’s injury later in the decade was among the growing number of preventable youth sports overuse injuries that are dismantling children’s athletic hopes and dreams at an early age.
That’s the opinion of the STOP sports injuries campaign, which was started by the board of directors at American Orthopaedic Society for Sports Medicine, including co-campaign chair and renowned Birmingham orthopedic surgeon, Dr. James R. Andrews.
Many doctors, researchers and parents say culture has shifted to children playing sports at greater intensity beginning at a younger age. Today many young athletes concentrate on one sport and play it year-round, which causes underdeveloped muscles to “wear and tear,” which can ultimately affect their ability to pursue an athletic career.
Andrews claims there has been an epidemic of elbow injuries in baseball pitchers requiring UCL reconstruction. From 1994-2004, the number of youth and high school athletes with this injury rose dramatically.
In 1994, he saw no youth or high school patients at Andrews Sports Medicine clinic with the injury, but in 2004 he operated on 35 youth and high school patients, which accounted for 20 percent of his total number of patients with the injury. In 2010, he completed 41 UCL replacement surgeries on youth or high school patients, which was 31 percent of his patients with the injury.
Baseball is one of the most popular sports among young athletes across the nation, and like most other sports, has the potential for overuse injuries.
Dr. David Geier, orthopedic surgeon and director of the sports medicine program at the Medical University of South Carolina, said over time, the stress on a young pitcher’s elbow from repetitive pitches causes the ligament to fray.
“It’s like bending a paper clip,” Geier said, describing the ligament after multiple pitches. “If you keep bending it back and forth, eventually it breaks.”
Geier said the main problem with pitching is its repetitive nature as well as the overload stresses and forces put on the insufficiently developed muscle support in the elbow and shoulder.
Myer, who began playing baseball at age 6 and was a football quarterback when he wasn’t on the diamond, said throwing his whole life eventually caused the ligament in his arm to give out.
“I did not think much of it, and, being the competitor that I am, I played through the pain,” he said. “I would simply take 800 milligrams of Ibuprofen before I was scheduled to pitch and be fine.”
Andrews and his colleagues at American Sports Medicine Institute, including Executive Director Lanier Johnson, used their more than 20 years of research focused on youth baseball pitchers to help launch the STOP sports injuries campaign with a mission to improve the understanding, prevention and treatment of sports-related injuries through research and education.
“We want to keep the kids on the field and out of the operating room,” Johnson said, explaining that if a young athlete pitches with fatigue, he has a 36 percent chance of injuring himself to the point of needing surgery.
Johnson said pressure from coaches and parents to succeed at a young age as well as a lack of education on preventative measures is keeping young athletes from reaching the next level — college or professional sports. He said it is unfortunate that many scenarios could have been prevented if coaches, parents and athletes were fully educated about risk factors.
“The real challenge we face is educating them to know when the athlete is injured and teaching them how to identify risk factors,” Johnson said.
Andrews, who has operated on numerous professional athletes across the country, has recently seen young patients’ injuries similar to those seen in adults, which he said is problematic for many reasons. Not only are the young athletes still in the process of maturing, they don’t receive the proper training, medical care and nutrition that high-end professional athletes have access to.
Sports Illustrated writer Mark Hyman writes in his book, Until It Hurts, “injuries in youth sports are inherent, as inevitable as car pools and grass stains.”
Hyman said that each year as many as half of all youth sports injuries are the result of overuse, what he calls “a regimen of sports play and training so intense that a child’s body rebels.”
Hyman and numerous doctors suggest that by introducing variety, moderation and rest into the everyday sports routine, a child’s risk for overuse injuries can be cut to nearly zero. He writes that overuse injuries are infuriating because “unlike traumatic injuries — dislocations, hyperextensions and other mishaps — injuries caused by overuse are easily prevented.”
View from the diamond
Ty Gardner, assistant baseball coach at The Donoho School, said sometimes throwing is overdone and young athletes who pitch 80 games per year for a decade have an increased chance of getting an overuse injury.
“Kids don’t understand the damage they can do, and parents don’t know about the possibilities,” he said. “They can’t just do the throwing. … Once a kid gets hurt, then they realize that, and then it’s too late.”
Ron Ingram, director of communications at the Alabama High School Athletic Association, said safety is of the utmost importance in sports.
“We have to look out for the best interest of the kid,” he said. “It doesn’t matter how good they are now … sometimes they don’t make it further if they wear out their arm now.”
Ingram, who works directly with the association’s medical advisory board, said all high school head coaches must complete a rules clinic that includes safety issues, such as heat index warnings, concussion laws and pitching rules. The association doesn’t oversee club teams, travel ball or elite leagues.
In high school, athletes can pitch no more than 14 innings in one week or seven innings in one day, followed by three days of rest. He said coaches are required to keep a pitching log for each game and if an athlete pitches too many innings, that team must forfeit the game.
Ingram also said it is imperative that coaches use common sense.
“If the passion is baseball, you want to make sure your passion doesn’t override the purpose,” he said.
Ingram, who played baseball and many sports growing up in Alabama, said a lot of damage isn’t done at the high school level — but rather “a lot of the damage is done at the youth level.”
Randy Wright, commissioner of Oxford Baseball for Youth, said the Dixie Youth league puts a lot of emphasis on teaching proper technique to 9- and 10-year-old pitchers when they reach the triple-A league. Triple-A is the first self-pitched level of play when children on the team pitch rather than a coach or a pitching machine.
He said youth baseball coaches go through background checks and an application process to become a coach. The league hosts a clinic with high school coaches to teach youth baseball coaches fundamentals and how they in turn can teach kids proper pitching technique.
Wright said a current county-wide trend for young baseball players is to train and learn the “right way” to pitch at elite training facilities, such as Excel.
“There are now serious efforts to do that,” he said. “Kids are getting much better and much more baseball savvy. … And they come back and share it with their teams.”
The founders of Excel Baseball Academy in Oxford are all former professional baseball players who specialize in one-on-one baseball and softball instruction for players of all ages and every skill level. Josh Beshears, Matthew Maniscalco and Steve Gendron bring their personal knowledge, experience and connections to help more than 300 yearly athletes achieve their goals.
Because the high school baseball season runs just three months, Excel has three traveling baseball teams during the summer, which Beshears says allows better exposure for players looking to play in college because those coaches are occupied with their teams in the spring.
Beshears said due to the basic principles of athletics and competition, it is natural to push an athlete, and Excel’s philosophy is to get its athletes to work harder than anyone else.
“There is a fine line between pushing the envelope and doing too much, but it basically comes down to really knowing what the athlete can handle,” he said.
Beshears said Excel does everything it can to prevent injuries by staying up-to-date with research studies related to baseball-specific injuries and incorporating arm-strengthening programs designed by certified physical therapists. He said pitchers can throw throughout the year if they train four areas equally: throwing arm, weight training, running and rehab exercises.
He agrees with the lowered pitch count in youth baseball, but sees problems with the implemented across-the-board pitch counts for athletes in high school. Beshears said lowered pitch count and rest can be good but may not be the best for older pitchers because sometimes injuries are just going to happen, regardless of whether the athlete does things properly.
Beshears said educating coaches is crucial and that it needs to start at the youth level because that is when pitchers “develop good and bad habits.”
To help spread the word about the importance of proper form and technique, among other topics in baseball, Excel has held a few free clinics with local youth baseball coaches and wants to organize more in the future.
Trey Pilkington, former Oxford High pitcher and upcoming junior at Alabama, started working out at Excel when he was about 8 years old. He trains at the facility in the off-season and when he is home on breaks.
“They’ve been around baseball a long time,” he said. “They know baseball-specific workouts … and I think that’s the reason I’ve been healthy, too.”
Ben Tootle, former baseball star at Oxford and Jacksonville State University, also played with Excel since its origin and is playing for the Minnesota Twins in the minor league while rehabbing his shoulder after rotator-cuff surgery last year. He started playing baseball when he was 5 years old and never had shoulder pain until he reached the professional league.
Throughout his baseball career, he has seen many injured players and thinks most are reluctant to speak up because of their competitive nature.
“No one wants to be stuck on the bench or in rehab,” he said.
Myer spent countless hours completing intense daily physical therapy to rehabilitate his arm for more than eight months following surgery. His injury hit at a disappointing time, causing him to red-shirt his freshman year at Alabama.
“It was difficult being injured,” he said. “To sit out and watch everyone else play was a hard thing to go through.”
He eventually gained full strength and was able to play summer ball in Ohio, but the following spring after only briefly playing for the Tide, Myer suffered another injury that mandated surgery. His experience illustrates how overuse injuries can prevent young athletes from reaching their full potential.
Though his dreams of baseball abruptly ended, Myer found another passion: physical therapy. He plans to go to PT school next year and has advice for young pitchers: “Do not get serious into pitching too early. It is OK to learn the proper mechanics of pitching but not OK to throw tons of pitches at an early age. … Overhand throwing is one of the worst things an arm can go through in sports, and to do that thousands of times a week can eventually lead to problems.”