Risk of injury still exists for 'safe' baseball, softball

Posted3/12/2012 6:00 AM

Comfortably college-bound, my patient was still looking forward to his final season of varsity spring baseball. The orthopedic specialist had cleared him to play but informed the young man that, come summer, he would need ligament repair for an old sports-related elbow injury.

The American Academy of Pediatrics recently published a policy statement addressing risk reduction and safe participation in my patient's favorite sport as well as in the field of girls softball.

The AAP's Council on Sports Medicine and Fitness considers these two springtime sports to be relatively safe. The group notes that in a study of nine high school sports, baseball had the lowest rate of concussions, and softball came in a low seventh on the list. Because of those safety records, the AAP recommends that pediatricians encourage baseball and softball participation among their patients who are 5 to 18 years old.

At the same time, the academy acknowledges that traumatic and overuse injuries do still occur in baseball and softball. Injuries tend to "cluster" in the middle of the age groups, with the highest number of baseball injuries occurring in 11- to 14-year-olds, and the greatest number of softball injuries seen in 13- to 16-year-olds.

Trauma in these two sports also tends to zero in on specific body zones, with approximately one-third of both youth baseball and youth softball injuries involving the upper extremities.

During sports activities, the shoulder joint is mainly stabilized by shoulder muscles as opposed to bones or ligaments. The AAP warns that pitchers who try to play through muscle fatigue are then actually pitching on an unstable joint, risking "serious and possibly permanent injury" to the shoulder.

Studies show that shoulder and elbow injuries increase "dramatically" when young pitchers pass the age-based maximum pitch limits over the course of a season or calendar year. Therefore, pitchers are advised to adhere to pitch count guidelines and to take three consecutive months of rest each year. All ballplayers are also encouraged to participate in preseason conditioning programs to improve muscle strength and help decrease the risk of injury.

The academy finds that catastrophic injuries such as major trauma from contact with a bat or ball, or "body system failure" such as cardiac collapse, are very low in baseball, with only one such injury sustained per 1 million participants annually.

A heart-stopping ball impact to the chest is a rare event in baseball and softball, but one which carries a 90 percent fatality rate. Players 14 and younger are thought to be at particular risk for this "commotio cordis" due to their elastic and more easily compressed chest walls. Though chest protectors do not appear to reliably prevent this rare cardiac crisis, catchers are still required to wear the gear to protect against the more typical game day contact with balls and ball players.

Baseball and softball coaches should always be prepared for life-threatening emergencies during practices and games by carrying a charged cellphone and having easy access to emergency medical phone numbers. Arrival of an automated external defibrillator on the field within the crucial first three minutes of a medical crisis is a potential life-saver.

Dr. Helen Minciotti is a mother of five and a pediatrician with a practice in Schaumburg. She formerly chaired the Department of Pediatrics at Northwest Community Hospital in Arlington Heights.

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