What is “normal” youth sports participation?
The changes that the Covid-19 pandemic brought to our world have forced us to re-evaluate “normalcy.” This includes every facet of daily life: jobs, schools, and even youth sports. It is worth considering that a return to “normal” may not be in the best interest of the health of youth overhead athletes. In this series of articles, I will detail the effect of high-volume throwing programs, year-round overhead sports specialization, and how to prevent injuries and improve overall health of youth overhead athletes.
Last year, social distancing forced a reduction in the number of baseball and softball games played. While this is beneficial for overall musculoskeletal health, the return of a “normal summer ball” schedule brings with it the risk of arm and shoulder injuries. It is important to remember that athletes have not had “normal” training leading into this summer’s competitive season and overall activity levels have been reduced for over a year. This deserves special consideration as we resume “normal” participation following the Covid-19 pandemic.
Pediatric orthopedic surgeons have anecdotally advised considering children’s athletic and fitness abilities to be half of what they were before the pandemic. That means that a sudden return to pre-pandemic levels of sports participation can be dangerous. Imagine having an eight-year-old follow a sixteen-year-old’s competitive schedule: by the end of the season, there is no way that child would be healthy or enjoying their sport. Keep this in mind as game schedules are being made for 2021 and compare that to how much the athlete played and participated in 2020.
I recently attended a continuing education course with Dr. Angela Gordon, who is the former team physical therapist for the Washington Nationals. Even in the most ideal circumstances, she asserts that, “there are only so many throws in an arm.” “Normal” overhead range of motion for the shoulder is 180 degrees. That means if you put your hand overhead and reach towards the ceiling, your upper arm will be in line with your ear. The demands of overhead sports require that athletes routinely move their arms past this point. The tissues and bones of the joint adapt to these demands, but as with any athletic or physical activity, the body must be given adequate time and recovery to do this in a healthy manner.
When athletes are in peak condition, the American Sports Medicine Institute recommends the following throwing volumes based on athlete age:
7-10 years: 50/day
11-12 years: 85/day
13-16 years: 95/day
17-18 years: 105/day
Now remember, we are considering athletes’ tolerance for sports activities to be half of what they were in optimal conditions. To safely return to pre-pandemic levels of sports participation (the advisability of which will be covered in a subsequent article), the athlete has to be given a chance to be conditioned to the demands of their respective sport. How do we do this for overhead athletes?
Overall physical preparedness is the first line of defense against injury, particularly when ramping up participation in a sport. Physical preparedness can come from playing multiple sports, particularly those that complement the movements of another. For example, overhead athletes (baseball, softball, tennis, volleyball, and swimming) are complemented by participating in sports that have fewer overhead demands such as basketball, track, cross-country, or soccer. It is important to not participate in an overhead sport during these other seasons, as that defeats the purpose of allowing the arm and shoulder to recover while still developing athletically. Do not worry about “falling behind” during this off time. Coaches and scouts at the highest level preferentially recruit multi-sport athletes over specialized athletes, as they have repeatedly seen specialized athletes’ careers shortened by overuse injuries.
Physical preparedness and athleticism are further developed by participation in a strength and conditioning program. Powerful, overhead movements begin at the legs, hips, abdomen, and lower back, and a skilled strength coach can provide exercises strengthen these areas, which protects the arms and shoulders of throwing athletes. To generate a safe and healthy throwing motion, these muscle groups must operate in a specific sequence to support the arm and shoulder. This places less demand on the small muscle groups of the rotator cuff and upper back muscles and thus protects shoulder joint integrity. These smaller muscle groups are absolutely a part of the throwing chain of events, and they also must be conditioned and healthy, but they are not biologically meant to be the primary drivers of a powerful movement such as throwing or pitching. For this reason, most “arm care” programs alone are not adequate.
Though everyone is excited to a “normal” summer, we must remember to monitor the health of youth athletes. For those in overhead sports, that may mean a different kind of “normal,” as the high volume, specialized participation of years past is a detriment to athletic ability and, more importantly, mental and physical wellbeing. To keep your youth athlete healthy, encourage a variety of activities, insist on time off from sport, and find an experienced strength coach and physical therapist who can help to injury-proof vulnerable during overhead sports participation. In the next article of the series, I will cover the pathology of specific injuries that result from early specialization and inadequate recovery time in an overhead sport.
Dr. Claire Kopko, PT is a former collegiate softball player with extensive experience in strength & conditioning and pediatric sports medicine. Please reach out to her with concerns or questions regarding participation in overhead sports.
