Youth Baseball Pitching Mechanics

Youth Baseball Pitching Mechanics:
A Systematic Review

As athletes continue to become younger and younger when they begin their athletic journeys, injuries remain increasingly common. Shoulder and elbow pain remain staple gripes in baseball and other throwing sports. Even with a decrease in youth baseball participation, throwing injuries are increasing in youth pitching. The causes of these injuries can be contributed to playing year round as well as ‘a lack of basic bio-mechanical understanding of the normal pitching motion. ‘ This study dissected 10 separate studies that related to bio-mechanical parameters of the normal youth pitching motion or compared mechanics of pitch type.

We must first recognize fundamental movements within the pitching motion to gain a full understanding of this review. ‘The windup and the stretch are the traditional starting positions used during the thrower’s ball release. The nuts and bolts of these positions collide when the lead hip and knee are flexed. The lead leg should then extend toward home plate, all the while the pitcher’s upper trunk rotates to face the target.’ The arm deceleration phase begins when the ball is released and ends with maximum shoulder internal rotation. Once the ball is released, the young pitchers had ‘challenges controlling throwing arm deceleration as a result of underdeveloped rotator cuff musculature; this showed to increase horizontal flexion across the torso in an attempt to decelerate the throwing arm.’

Little League Baseball recommends that breaking pitches not be thrown until 14 years old because of shoulder pain Youth pitchers showed that elbow valgus torque was a cause in several types of elbow injuries.

Joint torque was measured through out the throwing process of these 10 biomedical studies with athletes that ranged from 10-15 years old. The weight of the pitcher showed to be the bio-mechanical factor that paralleled with the significance of valgus torque and also connects with elbow injuries. Furthermore, several of the studies used showed that maximum elbow valgus torque occurs just prior to maximum shoulder external rotation. Forces on the elbow and shoulder are greater for the fastball than the curve. This article did bring up that there are not enough studies being done on the lower body of the adolescent pitcher since ‘the young pitcher will attempt to compensate lower body mechanics will subject the upper body to added stress and increased risk of injury.’ Further studies must be done on the lower body so that a complete understanding of adolescent pitchers so that a reduce in injury can truly be seen.

Sports Health A Multidisciplinary Approach
Youth Baseball Pitching Mechanics: A Systematic Review
Samuel F. Thompson, MD, Trent M. Guess PhD. , Andreas C Plackis, MD,
Seth L Sherman, MD, and Aaron D. Gray, MD
March-April 2018
Volume 10 Number 2

Shoulder Dislocations

Shoulder Dislocations

Shoulder dislocations are a relatively common injury in young athletes and occasionally weekend warriors. They most often occur due to a traumatic mechanism of injury where the shoulder is forcible pulled upward and outward (abducted and externally rotated). This disrupts the normal relationship between the ball and socket (glenohumeral joint) forcing the ball out of the socket. Contact sports including football, hockey, and wrestling are associated with shoulder dislocations.

Symptoms and signs include immediate shoulder pain, limited range of motion, and weakness. Shoulder deformity may be present as well. Occasionally the sensation of numbness and tingling occur in the shoulder or arm. Most often athletes complain that the shoulder feels out of place.

Initial management includes sling immobilization and documentation of the patient’s neurovascular status (pulses are checked and nerve function assessed). X-rays confirm a dislocation and any associated fractures about the shoulder. Subsequently, an attempt to reduce (put back in place) the glenohumeral joint is typically performed in the Emergency Room under sedation or local anesthetic, but can be performed on the athletic field by a Sports Medicine physician in certain circumstances. An x-ray is always taken to confirm that the shoulder is back in place after the reduction is performed.

Most injuries can be treated non-operatively with a brief period of immobilization in a sling. Once pain and swelling subside, a graduated physical therapy program is initiated focusing on range of motion and gentle strengthening. Many patients are able to return to sports without surgery, however, recurrent dislocations can occur and require further evaluation.

Recurrent shoulder dislocations or subluxations are best managed by an Orthopaedic Surgeon who can determine the reason for the continued symptoms and to formulate an appropriate treatment plan. Often times a magnetic resonance imaging (MRI) test is obtained to evaluate the anatomic structures injured. Bracing is an option that can be considered in appropriate patients. Surgery is also an option for some patients with good outcomes reported in most studies. However, patients considering surgery need to understand the risks of surgery, benefits, and alternative treatments prior to deciding their treatment course.

For more information on shoulder dislocations, please visit the AAOS website listed below.

Chris Pokabla, MD



My name is Shawn Matsunaga. As an athlete, wouldn’t you want to 1) Improve your reaction time 2) Reduce your injury rate and improve overall health 3) Prolong your playing career 4) Increase your accuracy and faster sprint times 5) Commit fewer mental errors? If your answer is yes, one of the first things to come to mind might be some sort of supplement or performance enhancing drugs (PED’s). If that crossed your mind, think again. It’s free and most of us don’t get enough of it. This wonder drug is SLEEP.

Sleep deprivation is known to reduce reaction time significantly. A single all-nighter can reduce reaction time greater than 300%! A study conducted at the University of California concluded that injury rates in youth athletes increased during games where athletes slept fewer than 6 hours. Lack of sleep impairs performance. Sleep is vital to restore your muscle and brain cells. Sleep loss impairs judgment, and has a negative effect on decision making, risk taking, moral reasoning and inhibitions.

In closing, sleep is needed not only for optimal performance, but optimal health. Contrary to popular belief, you can’t catch up on your sleep. Your best ergogenic aid is sleep. So, if you want to perform better and increase your overall health get your ZZZZZZZZ’s!

For details and references go to www.fatiguescience.com/5 ways sleep impacts peak athletic performance.

Memphis Orthopaedic Group’s Bartlett Office Open for Business – 3.12.18

MOG Bartlett Officer 3.12.18

Memphis Orthopaedic Group is pleased to announce a new office opening in Bartlett March 12, 2018.  The new office is located at 3045 Kate Bond Road, Bartlett, TN 38133.  Not only will patients be able to see one of MOG’s ten doctors, patients will also be able to have an MRI and physical therapy at the new Bartlett location.

All ten board certified physicians at Memphis Orthopaedic Group practice at their 3 locations, allowing patients to see their preferred physician, regardless of which office they visit.  Patients can now choose from the practice’s East, Germantown and Bartlett locations.

Patients can call the appointment line at (901) 381-4MOG or visit memphisorthogroup.com and specify their preferred location.


In the past few years, we have seen the media bring the subject of concussions into the spotlight. One movie in particular, “Concussion” starring Will Smith highlighted the potential long-term effects of repetitive brain trauma in NFL players. The Center for Disease Control estimates that 1.6 to 3.8 million people in the United States will suffer a sports-related mild traumatic brain injury this year, which we can all agree is a significant number. This raises several questions with athletes, parents, coaches, and athletic trainers. How do we know if an athlete has sustained a concussion? How should they be treated? When can they return to their daily activities, school, and sports? How are they prevented?

Concussions have several different definitions ranging from “complete loss of consciousness” to “getting your bell rung”. In the 2016 Journal of the American Academy of Orthopaedic Surgeons article Concussions in Sports: What Orthopaedic Surgeons Need to Know? it was stated “The Concussion in Sport Group formally defined concussion as a complex pathophysiological process affecting the brain, induced by biomechanical forces.” What does this mean? Essentially, after the brain sustains an injury whether direct or indirect, the chemicals produced in the brain go into overdrive leading to symptoms such as confusion, headaches, irritability, nausea, vomiting, depression, or dizziness. Why don’t we just order a CT or MRI to determine if a concussion is present? A great question! The answer is that these tests are typically normal in a concussed patient and do not help us with diagnosis. This is why it is important for players, parents, coaches, and athletic trainers to know the symptoms. The severity of the symptoms can range from person to person. This in turn can make it difficult to determine if an athlete has sustained a concussion, but once the symptoms are recognized it is essential for them to be removed from the sport until cleared by a medical provider.  Your family physician, a sports medicine physician, or a neurologist are doctors that can treat patients with concussions. If a player returns to sports too soon or before being cleared by a doctor, it may prolong or even worsen their symptoms.

Once we have determined an athlete is concussed, how should they be treated? The answer always incorporates REST in the treatment plan! Both mental and physical rest may be necessary until patients are symptom free. We all know what physical rest is, but what is meant by mental rest? This includes limiting television, video games, and occasionally reading until symptoms resolve. Both players and parents of young athletes must be educated on the importance of being symptom free prior to return to play. While concussions may not be 100% avoidable, prevention is still an important factor. Making sure players have proper equipment and understand safe techniques for their sport can potentially aid in the prevention of concussions.

The following is a link to more information about concussions through the American Academy of Orthopaedic Surgeons: http://orthoinfo.aaos.org/topic.cfm?topic=A00574

-Christopher Pokabla, M.D.

-Lacy D. Johnson, P.A.

Dr. Harold Knight Retires

It is with mixed emotions that we announce the retirement of Dr. Harold Knight.  He has provided Memphis Orthopaedic Group with 34 years of service, sacrifice, and dedication.  Things around here won’t be the same!

Dr. Knight you will be sorely missed and impossible to replace!  However, we know you have plans to travel and OU games to attend.  Thank you for your 34 years with Memphis Orthopaedic Group!  We wish you nothing but the best!


Treatment Options for Rotator Cuff Tears

What are the treatment options for rotator cuff tears?  First and foremost, what is the rotator cuff?  It’s a group of four tendons all of which come from muscles that originate on the scapula or shoulder blade.  The tendons then attach to the “ball” of the shoulder joint forming about 1/2 of a shirt sleeve cuff from the front to the back of the “ball”.  The two middle tendons on the top of the ball are the one’s usually torn.  If you’re under forty years of age you probably don’t have a rotator cuff tear, i.e., the older you are the more likely the diagnosis. The under forty crowd most likely has rotator cuff tendinitis or, if injured, a shoulder separation, dislocation, or labral tear.   Middle-aged patients(forty to sixty years old roughly) tend to tear the rotator cuff after injuries whereas degenerative tears are more likely the older one gets. On the job rotator cuff tears are quite common.  

 Treatment options are conservative or nonsurgical, and surgical.  I treat most of my younger very active patients with surgery simply because they rarely respond to injections and physical therapy.  Surgery has a high success rate generally especially in healthy nonsmoking patients and many of these patients can resume normal activities and work several months after the repair. Rotator cuff surgery is easier and more likely to be successful if I can do the repair less than six months after symptoms begin.   Repeat surgery is required in less than 10% of patients. 

 Older patients have a much better chance of responding to injections, physical therapy, home exercises, activity modification, and “wait and see” treatment.  

 Hope this helps.  Thanks for your time.

Mark Harriman, M.D. 

Low Impact Exercise

As we age past 40, our bodies lose muscle mass and bone density. So it is certainly wise to exercise in order to maintain as much muscle mass and bone density as possible.

That being said it’s important to listen to your body. In our 20’s and 30’s, the mantra for exercise is “no pain, no gain.”

I would suggest that after 40 you should listen to your body. If a certain exercise hurts, you may want to modify, decrease reps or even discontinue it altogether.

Safe low impact exercises include biking, ellipticals, rowing machines, yoga, Pilates and pretty much anything in a pool.

So try to implement some of these into your regular routine!

-Kenneth Grinspun, M.D