Posts Tagged ‘Baseball’

Commotio Cordis: Proposed NOCSAE Standard for Chest Protectors

“If we can stop a bullet, we can stop a ball”

Baseball is arguably one of the safest team sports. But it’s also where we see the most incidents of commotio cordis, a sudden cardiac arrhythmia caused by a direct blow to the chest. While instances of commotio cordis are rare, one death is too many.

Heart attacks among teen athletes are quite rare, and are most often a result of an underlying physical defect. Commotio cordis has no correlation to the physical health of the victim. According to lab tests at Tufts University Medical Center, it occurs when an object traveling approximately 40 mph makes impact directly over the heart in the milliseconds between heartbeats.

Who’s at risk and why

Catchers, pitchers and infielders are most at risk for blows by high-speed balls. Lacrosse and hockey players are also susceptible to being struck by rocketed balls and pucks. Boys under the age of 15 are most at risk of commotio cordis because their chest walls are still flexible as their bones continue developing into their early 20s.

The best chance victims have for surviving commotio cordis is resuscitation by a defibrillator, a device not housed at every ballfield. And if one is available, there needs to be someone in attendance who has been trained in its proper use.

Equipment manufacturers relying on science to help reduce the risk

But researchers are coming up with another solution. Statistics show that nearly one third of commotio cordis victims collapsed while wearing chest protection of some sort, which means that the protection athletes were given wasn’t good enough.

In January, the National Operating Committee on Standards for Athletic Equipment (NOCSAE) proposed the first standard for chest protectors used in baseball and lacrosse with the intention of reducing the risk of cardiac events. To meet the standard, manufacturers have to come up with a material that will distribute the force of the blow but not affect movements of the players.

Earlier this year, Mark Link, a Tufts University Medical Center heart specialist, published results of tests run on a model made of foam and a combination of polymers that appears promising. The company that developed the material, Unequal Technologies, plans to test it’s chest protectors and heart-covering shirts against the NOCSAE standard. Other manufacturers are visiting the NOCSAE laboratories to educate themselves on the testing process so they can modify their products to comply with the standard.

Source: Lauran Neergaard. “Performance standard proposed for chest protector in baseball, softball.” www. 30 May 2016.

Reducing Pitching Injuries in Youth Baseball

Biomechanics could be a game changer

More than two million youth put on their baseball gloves and caps each spring and head for the diamond to participate in America’s pastime. Sadly, a growing number of the pitchers among them will experience serious arm injuries.

There’s been a dramatic rise in surgical treatments since the 1990s that repair the ulnar collateral ligament (UCL) in the elbow, such as Tommy John surgery. What’s alarming about that is that the fastest growing category of UCL reconstruction patients are youth and high school pitchers.

Youth baseball injuries

What’s behind the rise in injuries

Youth baseball is increasingly being played as year-round sport or even the only sport for some players, so it’s all too easy to exceed 100 innings in a year. Parents, lured by the hope of college scholarships and even the possibility of a pro career, are encouraged to have their children play on travel teams, in year-round leagues,and participate in showcases.

Ironically, a great number of young pitchers suffer micro-tears of the UCL before they’re even drafted.

Pitch Smart was introduced in 2014 by Major League Baseball and USA Baseball and offers pitching guidelines for each age group and encourages pitch count limits and resting the arm for extended periods.

Taking steps toward reducing injuries

Making biomechanic analysis more accessible to non-professional players may be a way to reduce UCL injuries in young players. Biomechanics is the study of how the skeletal and muscular systems work under various conditions. For instance, rather than simply measure the  the acceleration of the elbow, a biomechanical equation calculates the force on the elbow.

The technology of biomechanical analysis enables the correction of certain mechanics that typically can’t been seen with the eye. Fleisig sits on the board of Motus Global, which is looking to commercialize this technology.

Motus Global, of which Fleisig is a board member, is looking to commercialize their biomechanical analyzation products to all levels of the sport – professional, collegiate, high school and youth leagues. Fleisig says there are two benefits in the mainstreaming the use of using biomechanics: avoiding injury and improving performance. That’s a win-win.

Source: Ben Berkon. “Biomechanics and the Youth Pitching Injury Epidemic,” 07 Apr 2016.

Protecting Against Risk of Commotio Cordis

Study shows new chest protector is effective and youth athletes most at risk.

Athletic chest protectors are critical to the safety of hockey and lacrosse goalies, baseball/softball catchers, and umpires. There is a wide assortment of chest protectors on the market, most of which have proven to be less than adequate against serious injury and can give a false sense of security.

But one manufacturer’s product apparently now offers better protection from potentially fatal blows to the chest.

The Unequal Technologies HART Chest Protector have proven 95 percent effective in the prevention of Commotio cordis,  according to a study published in The Clinical Journal of Sports Medicine. Commotio cordis is a sudden disruption of the cardiac rhythm caused by a forceful impact to the chest that often results in fatal cardiac arrest.

Unequal Technologies develops protective padding for a variety of athletic of headgear, including the popular Halo headband.

Youth athletes under the age of 16 are most at risk from such incidents. About 10 to 20 cases occur annually in the U.S. More than one-third of Commotio cordis incidents occur in athletes wearing chest protectors, according to a study published in 2013. Therefore, it’s paramount that appropriate padding is properly placed.

For more information on Commotio cordis, click here.

Source: “Study Finds Unequal Technologies’ Chest Protectors To Be First To Significantly Reduce Risk Cardiac Concussions For Youth Athletes,” 22 April, 2016.

Youth Baseball and Eye Injuries

Looking at preventative measures

As everyone know, baseball season is now in full swing. But what many probably don’t know is that youth athletes under the age of 14 incur more eye injuries in baseball and softball than any other sport. In rare instances, these injuries can result in permanent damage or even blindness.

Overall, there are more than 40,000 eye injuries reported each year, most occurring in baseball and basketball, followed by water and racquet sports. Balls, bats, pucks, racquets, and sticks are used in the sports that pose the highest risk for eye injuries. These sports also typically include body contact.

The leading cause of child blindness in the U.S. is injury, with most cases occurring in sports-related activities, according to the National Eye Institute. Penetration, blunt trauma and radiation are the most common causes of sports-related eye injuries. Exposure to the sun’s ultraviolet rays can result in radiation damage, which can be a particular risk when snow skiing, water skiing and participating in other water and snow sports.

Prevention measures

According to Jay Novetsky, 90% of sports-related eye injuries are preventable. Novetsky, an eye surgeon at the Vision Institute of Michigan, advocates for protective eyewear as part of every sports’ regulated safety equipment, such as safety shields, safety glasses, goggles and eye guards.

To specifically prevent injuries in baseball, batting helmets can be fitted with protective face guards and fielders can wear safety-certified sports goggles.

Many people don’t realize  that prescription glasses (and sunglasses) worn during play not only don’t offer protection, but they increase the risk of eye injury. Street eyeglasses and contacts can easily shatter upon impact and puncture the eye and surrounding areas.  Athletes who wear glasses or contacts can usually have their prescriptions matched in protective eyewear.

Return to Play

In order to return to play following an eye injury, the eye should be pain free, cause no discomfort and vision returned to normal. Release by an ophthalmologist should be required before an player with a serious eye injury returns to play. The team physician or athletic trainer should be able to determine if and when players with less serious eye injuries can return. Athletes returning to play following an eye injury should be required to wear eye protection to avoid a second injury.

Source: “Baseball Ranks #1 in Sports-related Eye Injuries for Kids.”. 14 April, 2016.

Accident Insurance and Baseball

Spectator injuries not covered by Little League policy

New Jersey’s Elizabeth Lloyd, is suing for more than $150,000 in damages after being hit in the face by a baseball. Although Matthew Migliaccio was only 11 years old at the time of the incident, the lawsuit filed in April claims that Migliaccio’s overthrow from the bullpen was deliberate and reckless.

Lloyd is filing suit to cover for medical costs and pain and suffering, while her husband is suing for the loss of “services, society and consortium.”

The count alleging Migliaccio’s negligence is covered by the family’s Homeowner’s policy, but the other counts are not. Little League has denied any coverage, due to their accident policy only covering staff or players; spectators are not included.

In my opinion:

Little League is correct that spectator injuries are not covered by an Accident policy. However, “Accident like” benefits for spectator injuries up to a limit of $5,000 can be covered if the General Liability policy includes premises medical payments. Otherwise, if damages are greater than $5,000, the only recourse for an injured spectator is to sue. Such lawsuits would be covered under a General Liability policy under the Each Occurrence section. This case is similar to one that one of our league clients had about ten years ago when a spectator was hit in the jaw by an overthrow ball during pre game warm-ups. It was alleged that the league and coaches were negligent in allowing the players to form two lines for warm-ups where one line was too close to an unfenced spectator area. The carrier settled the case for around $300,000 but the damages were extensive.

-John Sadler

Source: Insurance Journal, June 26, 2012

Improper Pitching Mechanics

Posted | Filed under Baseball, Injury

Over use and technique result in Tommy John surgery

It’s been 18 months since the Nationals star pitcher Stephen Strasburg, 22,  underwent Tommy John surgery,, or reconstruction of the ulnar collateral ligament (UCL). Strasburg spent aa year on the disabled list, but now appears to be pitching as well as he diStrasburg debutd before the elbow injury.

Orthopedic surgeon Frank Jobe performed the first UCL reconstruction 37 years ago on Dodgers pitcher Tommy John, whose name become synonymous with the procedure. Johns, Strasburg and many others who have undergone UCL reconstruction have one thing in common: a mechanical flaw in the timing of their deliveries. The improper technique causes the arm to lag behind the rest of the body, which puts extra stress on the shoulder and elbow.

“The timing is subtle,” says the Glenn Fleisig of the American Sports Medicine Institute. Fleisig has analyzed more than 2,000 pitchers and is on of the world’s foremost authorities on the biomechanics of pitching.

The top risk factor for UCL injuries is poor mechanics, according to Fleisig, followed by overuse.  Overuse and poor mechanics makes for big trouble.

“Force of Habit” is an excellent article on the exact pitching motion flaws that lead to this injury.  And pitchers interested in having their mechanics evaluated should contact Fleisig at ASMI.

New Studies on Curveballs in Youth Baseball

Posted | Filed under Baseball, Injury

Research results fuel new debate

Parents and coaches of young baseball players know the drill: no curveballs. The edict is based on the potential for injuries in young pitchers due to the mechanics involved in delivering the pitch. But recent studies have fueled the debate as to whether risk of injury from throwing curveballs actually exists.

“For years, we told people that curveballs were bad. Then we set out to prove it. We did not prove curveballs are safe, but we could not prove they were dangerous,” said Glenn Fleisig, the research director of the American Sports Medicine Institute, who has conducted studies on breaking balls and young arms since 1996.

The force of throwing a curveball is no greater than for a fastball when the proper mechanics are employed. But many kids either don’t have proper mechanics, enough neuromuscular control, or are fatigued when throwing curveballs, according to James Andrews, an orthopedic surgeon and a founder of ASMI.

A study by the University of North Carolina was conducted on more than 1,300 pitchers aged 8 to college age. The study was commissioned by the Little League and USA Baseball leagues. The pitchers were observed over a five year period, annually assessing the number of innings pitched, types of pitches thrown, number of teams played for and any arm pain or injuries experienced.

“There was no association betwamateur baseball insuranceeen throwing curveballs and injuries or even arm pain,” said Johna Mihalik, author of the study.

Dr. Timothy Kremchek, an orthopedic surgeon and Cincinnati Reds’ physician, thinks Little League’s position is irresponsible.  It’s his opinion that Little League has an obligation to protect the young players but are instead are saying, “There’s no scientific evidence curveballs cause damage, so go ahead, kids, just keep throwing them.” Medical professionals who have to treat those players a few years later are pretty sure there is a cause and effect, according to Kremchek.

Others wonder if asking whether the curveball is safe is the wrong question and whether overdoing it is the problem. It’s been proven scientifically that too much throwing leads to injury, and sometimes serious injury.

In my opinion:

I’m on the USA Baseball Medical and Safety Committee with Glenn Fleisig. Based on the studies that I’ve seen, the quantity of pitches in a season is the number one predictor of elbow/shoulder pain in youth baseball.  As for curveballs, it’s important to give more weight to scientific research than anecdotal observations.  However, I additional studies should be performed on the impact of proper techniques vs. improper technique when throwing curveballs.

The USA Baseball Medical and Safety Committee has a number of excellent articles on youth baseball safety.

John Sadler

Source: Bill Pennington, “Young Arms and Curveballs: A Scientific Twist,” 11 Mar. 2012

ASMI on Safety for Youth Baseball Pitchers

Posted | Filed under Baseball, Injury

Official statement released

The American Sports Medicine Institute (ASMI) has released its position statement on best practices for youth pitchers in avoiding injuries.

Of particular interest is the statement that throwing curve balls is not a risk factor in youth shoulder and elbow injuries. However, this does not mean that youth pitchers don’t need to take precautions before doing so.

The position statement addresses how to avoid overuse, mandatory 4 month rest periods, and pitch counts.


Source: ASMI

Recession Impacts Youth Baseball Participation

A recent news release by ABC News indicates that many youth baseball leagues are reporting smaller registrations as the recession impacts family spending. In addition, it is reported that team sponsors are becoming more difficult to recruit and league concession sales declining.

Some leagues have responded by lowering registration fees and providing scholarships. Others are asking sponsors to contribute less in order to sponsor a team.

Do these anecdotal stories reflect isolated pockets or do they reflect a national trend?

Steve Keener, president and CEO of Little League, indicated that national registrations are in line with past years but that the trend will need to be watched closely.

Could it be that fundraising will become popular again? In past years, fundraising was on the decline as many parents preferred raising the registration fees in lieu of fundraising.

Safety Balls in Youth Baseball

Debating the use of reduced-impact ball

The following is an excerpt from the USA Baseball Medical and Safety Committee  report:

Based on the research performed by USA Baseball and other investigators demonstrating that a reduced-impact ball can decrease the incidence and severity of ball impact injuries to less skilled players aged 5-12, the USA Baseball Medical and Safety Advisory Committee recommends:

That youth baseball organizations adopt for their Tee-Ball and other “minor league” programs that are focused on skill development, reduced-impact baseballs that meet NOCSAE standards levels 1 and 2.

  1. This recommendation does not diminish the importance of teaching fundamental baseball skills and ball avoidance skills and techniques for batters.

  2. Current scientific literature on the prevention of commotio cordis by chest protectors is not adequate and therefore the effect of any equipment on the risk of chest impact death remains unsubstantiated at this time.

In my opinion…

I know from the ongoing injury study that I perform for Dixie Youth Baseball (ages 12 and under) that three of the leading causes of injury are being struck by batted balls, thrown balls, and pitched balls. The vast majority of injuries that occur in T-ball and coach pitch are from being struck by batted balls and thrown balls. These injuries in the lower age groups are primarily caused by lack of skills.

Baseball injuries

Based on my personal observation in working with youth baseball players ages 5-8, players learn skills better when some of the fear factor is removed. I would say that softer baseballs definitely remove some of the fear factor, which can result in more quality practice sessions in terms of repetitions and the development of skills. As players move up from T-ball and coach pitch, the skill levels are usually such that the types of injuries that could theoretically be prevented or reduced by reduced-impact balls don’t come into play as often.

From an injury analysis point of view, it is almost impossible to determine if a reduced-impact ball could have prevented or reduced an accident insurance claim. It is much easier to predict the outcome of using other safety equipment such as batter’s face guards or catcher’s throat protectors as they about 99% effective in preventing injury.