Arm pain in young baseball players is common, preventable

November 06, 2014

NEW YORK, NY (November 6, 2014) --The most in-depth survey of its kind found that arm pain is common among supposedly healthy young baseball players and nearly half have been encouraged to keep playing despite arm pain. The findings suggest that more detailed and individualized screening is needed to prevent overuse injury in young ballplayers. The study, led by Columbia University Medical Center (CUMC) researchers, was published this week in the online edition of the American Journal of Sports Medicine.

"Both nationally and internationally, we're witnessing a troubling increase of elbow and shoulder injuries in young baseball players," said study leader Christopher S. Ahmad, MD, chief of sports medicine and professor of orthopedic surgery at NewYork-Presbyterian/Columbia and head team physician for the New York Yankees. "The likely explanation is that they're throwing too much, too early, putting increasing demands on their bodies that their bodies are not ready for. Despite current guidelines and precautions--for example, limiting pitch counts and emphasizing off-season rest--many players are still sustaining overuse injury to their throwing arm. Thus, it's vital that we develop better ways for coaches, parents, and clinicians to identify players at risk so we can prevent irreversible injury and season-ending surgery."

As a first step toward this goal, Dr. Ahmad and his colleagues designed a questionnaire to learn more about the frequency, severity, and psychosocial effects of arm pain among active adolescent baseball payers. The questionnaire was completed by 203 players from New York and New Jersey between the ages of 8 and 18. All of the surveys were completed without input from parents or coaches.

Among the survey's findings was that 74 percent of players reported having arm pain while throwing (answering that they "always," "often," "sometimes," or "rarely" experienced arm pain). Just 26 percent said they "never" had arm pain while throwing.

The study also found that: Pitchers, compared with infielders and outfielders, were especially likely to have played with pain. One-quarter of pitchers reported that they "often" or "always" had pain the day after throwing. "These pitchers likely represent one of the higher-risk groups for incurring a future overuse injury and thus warrant particularly high monitoring," said Dr. Ahmad.

Almost half (47 percent) of players reported that they had been encouraged to continue playing in a practice or game even though they were having pain. One in eight players aged 17 to 18 reported that they "always" felt encouraged to continue playing despite having arm pain. A majority of players reported that arm pain caused them to experience less enjoyment while playing and that it was responsible for holding them back from being a better player.

"It's alarming that so many young baseball players are encouraged to play with pain," said Dr. Ahmad. "Years ago, prior to concussion protocols, we observed something similar in football, where players who suffered a concussion were routinely sent back into the game after 'recovering' for a few minutes. The initial concussion lowered the threshold for another concussion, and the repeated concussions put the player at risk for permanent damage. I think we're seeing a similar problem in baseball, where playing with arm pain is setting the stage for more serious injury."

Dr. Ahmad suspects that this phenomenon has contributed to the recent rise in "Tommy John" surgeries among college and professional baseball players. ("Tommy John" surgery is the colloquial name for reconstruction of the elbow's ulnar collateral ligament. The procedure was named after the former Los Angeles Dodgers pitcher, who was the first to undergo this repair in 1974.)

According to Dr. Ahmad, current precautions and guidelines are inadequate for preventing injury. "It's not enough to set pitch counts based on a player's age," he said. "While some 14 year olds are already quite mature, in terms of their skeletal structure, others haven't even started their growth spurt yet. We need to come up with more individualized throwing programs and better ways to detect which players are at risk for injury." Dr. Ahmad is currently investigating the use of ultrasound for correlating arm pain with tissue damage.
The article is titled, "Arm Pain in Youth Baseball Players: a Survey of 'Healthy' Players." The other contributors, all from CUMC, are Eric C. Makhni, Zachary S. Morrow, Timothy J. Luchetti, Pallavi S. Mishra-Kalyani, Anthony P. Gualtieri, and Randall W. Lee. Dr. Ahmad has disclosed the following potential conflicts of interest or source of funding: Acumed (consultant), Arthrex (consultant, research support), Stryker (research support), Major League Baseball (research support). Dr. Makhni receives non-monetary research support from Arthrex and is a non-salaried partial owner of a wellness company (Physalife).

Columbia University Medical Center provides international leadership in basic, preclinical, and clinical research; medical and health sciences education; and patient care. The medical center trains future leaders and includes the dedicated work of many physicians, scientists, public health professionals, dentists, and nurses at the College of Physicians and Surgeons, the Mailman School of Public Health, the College of Dental Medicine, the School of Nursing, the biomedical departments of the Graduate School of Arts and Sciences, and allied research centers and institutions. Columbia University Medical Center is home to the largest medical research enterprise in New York City and State and one of the largest faculty medical practices in the Northeast. For more information, visit or

Media Contact: Karin Eskenazi, 212-342-0508,

Columbia University Medical Center

Related Concussion Articles from Brightsurf:

Diagnosing sports-related concussion in teens
Researchers investigated the effectiveness of using measurements of how pupils react to light as physiologic biomarker to help diagnose sports-related concussion in adolescents.

Should you really be behind the wheel after concussion?
Even after all of their symptoms are gone, people who have had a concussion take longer to regain complex reaction times, the kind you need in most real-life driving situations on the road, according to a preliminary study released today that will be presented at the American Academy of Neurology's Sports Concussion Virtual Conference from July 31 to August 1, 2020.

Biomarkers may help us understand recovery time after concussion
A blood test may help researchers understand which people may take years to recover from concussion, according to a study published in the May 27, 2020, online issue of Neurology®, the medical journal of the American Academy of Neurology.

Concussion alters how information is transmitted within the brain
Damage from concussion alters the way information is transmitted between the 2 halves of the brain, according to a new study.

Concussion recovery not clear cut for children
Sleep problems, fatigue and attention difficulties in the weeks after a child's concussion injury could be a sign of reduced brain function and decreased grey matter.

A concussion can cost your job -- especially if you are young and well educated
A seemingly harmless concussion can cause the loss of a job -- especially for patients who are in their thirties and for those with a higher education.

After concussion, biomarkers in the blood may help predict recovery time
A study of high school and college football players suggests that biomarkers in the blood may have potential use in identifying which players are more likely to need a longer recovery time after concussion, according to a study published in the July 3, 2019, online issue of Neurology, the medical journal of the American Academy of Neurology.

Concussion is a leading cause of injury for children in recreational sports
In a two-year study of children between ages 5-11 who play recreational sports, more suffered concussions than most any other sports-related injury.

Concussion symptoms reversed by magnetic therapy
Concussion symptoms -- such as loss of balance and ability to walk straight -- can be reversed by a new type of magnetic stimulation

Study paves way for better treatment of lingering concussion symptoms
The results of the study, released in Neuroscience journal, show that significant levels of fatigue and poorer brain function can persist for months, or even years, following concussion.

Read More: Concussion News and Concussion Current Events is a participant in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising fees by advertising and linking to