Hinge...Pronate: On Throwing Arm Pain from 4 Perspectives: Player, Dad, Coach, & Shoulder/Elbow Surgeon

Hinge...Pronate: On Throwing Arm Pain from 4 Perspectives: Player, Dad, Coach, & Shoulder/Elbow Surgeon

Most of the 11.5 million athletes playing baseball in the United States compete at the high school or club level. In 2022 we are seeing increasing numbers of youth and professional baseball players develop shoulder and elbow injuries. The numbers of players undergoing surgical intervention for arm injuries, particularly at young ages, has risen at an alarming rate. It is unclear as to why. Nearly two decades after experiencing arm pain from throwing baseballs, the author became a practicing orthopaedic surgeon that specializes in shoulder and elbow surgery in an academic medical center. He was tasked with caring for many patients with complex shoulder and elbow disorders and failed prior surgery while teaching medical students and orthopaedic surgery residents how to diagnose and treat simple and complex shoulder and elbow disorders. Some of the patients he was seeing were those with arm pain related to throwing baseballs. Convinced, along with many of his colleagues, that baseball throwing volume was the culprit for arm pain, he counseled many athletes to decrease throwing volume significantly as a source of pain relief and overuse injury prevention. 10 years into his orthopaedic surgery practice and into his early 40’s, the author’s son developed a love for baseball, and the author became the pitching coach for his son’s club team. Pitch counts and reduced throwing volume remained the author’s pat professional answer for his son and his son’s teammates. Yet, the author knew the problem was more complex than overuse. In their team’s second season his son developed excruciating shoulder pain while pitching exactly as the author taught him and his teammates at the direction of a former collegiate pitcher. Now the author had conflicts while wearing three hats (dad, coach, & orthopaedic surgeon) while reminiscing about the arm pain he experienced decades earlier. With normal x-rays and an ultrasound of his son’s shoulder, he had to balance his son’s arm pain and expectations, help manage a group of pitchers and a team without a good strike-thrower and maintain professional integrity! In search of an answer while respecting all perspectives, the author sought help from those outside the orthopedic community. In coaches, physical therapists, and trainers he found facts and solutions that spoke to truth across multiple disciplines. The findings astounded him because they were in plain sight all along. The truth is that the etiology of arm pain and injury is multi-factorial and THE answer to pain and injury reduction is different for each player because of infinite human variability. But there are many options between the two extremes of rest and surgery.