For a pitcher, an arm injury can be devastating. That's why it's worrisome that the elbow condition known as ulnar collateral ligament (UCL) injury is on the rise for pitchers of all ages.
"There's been a pretty steady increase in the number of UCL injuries diagnosed and treated over the last 10 years or so. We're seeing this as more and more of a problem, for both younger pitchers and professionals," said Robert Najarian, MD, a Washington Nationals team physician and a member of the Inova Sports Medicine Team.
Inova Sports Medicine is responsible for the medical care of all the Nationals players in conjunction with the Nationals medical staff -- a perfect match due to both organizations' comprehensive care and focus on injury prevention.
Bigger and Faster
Why are UCL injuries on the rise? "The nature of the game has changed. Players have gotten bigger and stronger. They're pitching with more velocity, and putting more stress on the elbow," Najarian said.
On top of that, pitchers are starting at younger ages, and are more likely to pitch year-round, he added. "Perhaps we are now seeing the cumulative effects of all this excessive pitching from youth and high school baseball players," he said.
And excessive pitching puts the ulnar collateral ligament at risk. The ligament stretches from bone to bone across the inner part of the elbow joint. The act of throwing strains the ligament, Najarian said.
For pitchers hurling ball after ball, day after day, that strain can be significant. "That side of the elbow never sees excessive force in day-to-day use," he said. "During pitching, there are tremendous forces that this ligament is not used to."
If a player has poor pitching mechanics, or doesn't give the arm adequate rest, the ligament can become stretched or even torn over time. 
Tommy John Surgery
Wear-and-tear to the UCL can improve with time and rest. But many pitchers -- especially at the elite level -- find themselves facing UCL reconstruction, commonly called Tommy John surgery.
Recovery from this surgery can take at least a year or more. The good news is that the majority of players can return to the same level of play after recovering from a first-time Tommy John surgery, Najarian said. "Some studies show that greater than 90 percent can return to throwing at the same level, assuming they take enough time and follow the appropriate rehab protocols."
Preventing UCL Injury
Given the high stakes, preventing UCL injuries is key. Najarian recommends taking these precautions to minimize the risk:

• Good Conditioning: Pitchers put their whole bodies into a throw, from their legs through their core and into their arm and shoulder - a sequence of muscles known as the "kinetic chain." To stay healthy, it's important to keep that whole chain in good condition, from head to toe, Najarian said.
   
• Proper Mechanics: Youth players should focus on learning the mechanics of good pitching before worrying about speed. And all players should listen to their bodies to keep the pitching process running smoothly, Najarian said. "Injuries anywhere in the kinetic chain can cause you to overstress your arm. Don't pitch through injury - you can change mechanics and put your elbow at risk."
   
• Rest and Recover: Pro players have a clear regimen of rest days and offseasons. But youth players often push too hard, putting themselves at risk of an overuse injury. To minimize the risk, younger players should avoid pitching multiple days in a row, and should rotate positions so they're not pitching all the time, Najarian said. And they shouldn't be playing year-round, he said. "When the season is over, you need 3 or 4 months when you're not throwing."