Health and Safety Resources

 Open vs. Closed Kinetic Chain Exercises

Open vs. Closed Kinetic Chain Exercises

Diamond Doc
By Dr. Marc Richard

Dr. Marc Richard, Orthopedic Surgeon at Duke University and USA Baseball Sport Development Contributor, discusses the kinetic chain and open vs. closed exercises.

Marc Richard, MD, is a contributor to the USA Baseball Sport Development Blog, and is an Associate Professor of Orthopaedic Surgery at Duke University, specializing in elbow, wrist and hand injuries. Dr. Richard’s research evaluates the clinical outcomes of fractures of the upper extremity, with a particular interest in wrist and elbow fractures and improving ways to treat elbow arthritis in young patients. He also has a clinical and research interest in adolescent elbow throwing injuries.

 Rehab Process from Tommy John Surgery

Rehab Process from Tommy John Surgery

Diamond Doc
By Dr. Marc Richard

Dr. Marc Richard, Orthopedic Surgeon at Duke University and USA Baseball Sport Development Contributor, discusses the rehabilitation process and what to expect after Tommy John Surgery.

Marc Richard, MD, is a contributor to the USA Baseball Sport Development Blog, and is an Associate Professor of Orthopaedic Surgery at Duke University, specializing in elbow, wrist and hand injuries. Dr. Richard’s research evaluates the clinical outcomes of fractures of the upper extremity, with a particular interest in wrist and elbow fractures and improving ways to treat elbow arthritis in young patients. He also has a clinical and research interest in adolescent elbow throwing injuries.

 Sports Nutrition Products

Sports Nutrition Products

A list of the best nutrition products for athletes


Athletes should take a “food first” approach to supply their nutrition and energy needs throughout the day. Sports nutrition products such as sports drinks, bars and gels have been designed to supplement an athlete’s nutritional program before, during and after athletic activity and not be a replacement or substitute for real food.


There are many sports nutrition products on the market, and it can be difficult to make good nutrition choices to meet an athlete’s physical development, training and performance goals. Below is a description of the three main sports nutrition products:

Sports Drinks

Sports drinks are flavored beverages that contain mostly carbohydrate and electrolytes and are typically consumed before, during and after training sessions. Sports drinks will help maintain hydration and carbohydrate replacement for optimal performance before, during and after training.

Energy Bars

Energy bars are designed to provide athletes a compact source of calories, carbohydrate and protein before, during or after training sessions. Although the size and composition of these energy bars varies, it is typically best to consume one that contains 30-100 grams of carbohydrate and 6-20 grams of protein.

Energy Gels

Energy gels are semi-solid forms of mostly carbohydrate that help to maintain blood sugar levels during training and competition. Most energy gels will contain at least 20 grams of carbohydrates, and some contain vitamins and minerals. If used during exercise, athletes should consume 1-2 gels per hour with 4-8 ounces of water.

Because the sports nutrition product industry is not subject to strict government regulations, some products may be mislabeled, or may be contaminated with banned substances or additives that are not listed as an ingredient on the label. The only sports nutrition products that athletes can use without the risk of contamination are those products that have been certified under the NSF Certified for Sport program. A current list of NSF Certified for Sport products is available at: should consult with a qualified sport dietitian for more information about choosing products and developing a nutrition protocol.

Courtesy of the United States Olympic Committee and Major League Baseball

 Written Risk Management Program

Written Risk Management Program

Elements of a Written Risk Management Program for Baseball Organizations

One of the best ways for baseball organizations to reduce the risk of injuries and related lawsuits is to formally adopt by board action, disseminate and implement a written risk management awareness program. The practice of risk management does not need to be complicated. It is often simply a matter of educating personnel on risk identification and training them on the appropriate response, whether that’s taking action or notifying management.

Below are the critical elements that must be addressed in a comprehensive risk management program for any local baseball organization:


A baseball organization should select a Risk Management Officer (RMO) and a Risk Management Committee to oversee the development, implementation and oversight of the program.


The proper insurance policies should be purchased from financially sound insurance carriers. They should contain high limits of protection with the proper customizations for the sports niche with the elimination of certain inappropriate exclusions. Most sports organizations will need to carry Excess Accident, General Liability, Directors and Officers Liability, Crime and Equipment. Other policies may also be needed.


Baseball organizations should avoid certain high-risk activities such as group and individual transportation of participants, use of 12- and 15-passenger vans, overnight sleepover social events, serving of alcoholic beverages, swimming events and certain high-risk fundraisers. If such high-risk events are undertaken, specific risk management controls must be put in place.


Contractual risk transfer techniques must be used to transfer the risk of loss to the other party whenever feasible and generally accepted in the industry. Participant registration forms should be used to protect against certain liabilities arising from bodily injury or invasion of privacy of participants. Examples of such participant registration forms include waiver/release, emergency information and medical consent and image release. Other situations arise when the sports organization will need to impose insurance requirements and indemnification/hold harmless provisions on parties with which it enters into contracts, such as facility users, visiting teams and service providers and vendors. On the other hand, when other parties impose insurance requirements and indemnification/hold harmless provisions on the baseball organization, such contractual agreements should be reviewed by insurance agents and legal counsel. Examples of parties imposing such contractual requirements include facility owners and tournament hosts.


The basic elements of any sex abuse and molestation risk management program include the implementation of a system to run criminal background checks on all staff with access to youth, written policies and procedures to make an incident less likely to occur (ex: use of a “buddy system” and prohibition of overnight sleepovers) and a written allegation response plan that includes the requirement to notify law enforcement. The improper running of criminal background checks can result in liability and steps must be taken to safeguard the confidentiality of results and to protect the rights of others under federal and state law before any adverse action is taken. In addition, written disqualification criteria should be established prior to running criminal background checks.


Lack of adequate supervision is the No. 1 allegation in sports litigation. The baseball organization as an entity and its board of directors are responsible for exerting proper general supervision over all aspects of the program. A written risk management program is an excellent way to satisfy this responsibility. On the other hand, individual staff members are responsible for exerting specific supervisory control over individual participants or small groups of participants. Examples of such responsibility include the duty to stop rowdiness, the location of the supervisor and proper selection and the proper grouping of the size, age and skill of participants.


Proper instruction involves a qualified coach who has been formally trained through some type of coach training program, such as can be provided through a governing body or other recognized source. Many leagues provide in-house training of coaches as part of a pre-season seminar. Coaches are required to instruct participants on baseball-specific safety rules and procedures and to stress the more hazardous aspects of baseball where a mistake could lead to a serious injury (ex: how to avoid a wild pitch).


Sports injury care involves prevention as well as pre-injury planning and post-injury response. Prevention includes pre-participation screening, which may include pre-season physicals or the completion of a medical clearance form, as well as a program for flexibility, conditioning and strength training. Pre-injury planning includes an emergency medical service plan, first aid stations, first aid training and the use of athletic trainers. Post-injury planning includes assessment, administration of first aid, decision on 911 vs. other transport, availability of emergency information and medical consent form, notification of parents and risk management officer and return-to-play protocol. Sports injury care also includes policies on emergency weather response, the lightning safety 30/30 rule, heat illness avoidance and concussion/brain injury protocols.


Problems with facilities arising from playing areas, spectator areas, concession areas, parking areas and paths between are another major cause of injuries and litigation. Most of the classes of facility-related lawsuits arise from: improper design and layout; inadequate or inappropriate physical features for sport or age group; lack of controlled access; improper inspection, maintenance or repair on pre-season, weekly or pre-event basis; and failure to document maintenance or repair. An inspection checklist should be customized for each facility.


The most common equipment-related classes of lawsuits arise from the purchase of inadequate equipment, modification, inspection, fitting, maintenance and repair, reconditioning, replacement and record-keeping. An inventory of all equipment should be maintained with documentation of all maintenance, repair and reconditioning.


An auto policy should outline permissible group transportation, individual transportation and position on the use of 12- and 15-passenger vans, including any motor vehicle registration driver requirements.


The written risk management plan should be distributed to all administrators and staff on an annual basis with the collection and retention of a signed and dated statement that the plan has been reviewed and that it will be followed.

Courtesy of John M. Sadler, JD, CIC; Member of the USA Baseball Medical & Safety Advisory Committee; President Sadler Sports & Recreation Insurance

 Athleticism Before Skills

Athleticism Before Skills

Athleticism is achieved through consistent conditioning

By Jim Ronai MS, PT, ATC, CSCS, Member, USA Baseball Medical/Safety Advisory Committee

It is well documented that baseball maintains enormous popularity in the United States. The fundamentals of how the game is played remain relatively constant. However, the methods and practices whereby players are coached and developed continue to evolve. The definition of successful participation has taken on new meaning to many of the 9 million participants between the ages of 9-17.

In many instances, the goal of learning and perfecting the fundamentals of baseball, while having fun, has been replaced by an emphasis on outcome and performance statistics. Opportunities for participation and exposure to baseball continue to increase. The youth baseball season is now longer and consists of 2 parts: the regular season and the all-star season.

Participation on multiple teams, year-round participation and the evolution of scouting showcases are just a few of the many well documented factors identified as contributors to a rise in the incidence of shoulder and elbow injuries to young baseball players.

The majority of injuries in youth baseball are of the overuse variety and typically affect the athletes whom are involved most in games and practices. Specifically, overuse injuries to the pitcher are in all likelihood related to increases in intensity and volume of pitching along with increased frequency and duration of play.

Another major contributor to the rise in injury rates to youth baseball pitchers is the lack of age appropriate, year-round formal conditioning.

In the absence of developmentally appropriate flexibility, core balance, neuromuscular coordination, agility, strength and endurance, players are unable to meet the progressive physical and skill specific demands of the game as they graduate through the various levels of youth baseball.

Time Constraints

Most coaches will agree that the most limiting factor associated with their ability to teach and coach is a lack of practice time. Consequently, the emphasis of most practices is on batting practice and position specific fielding and throwing. The goal of the practice is to raise the level of fundamental execution of the players, whether in the batter’s box, on the mound or in the field.

Unfortunately, coaches ignore the fact that without the basic elements of athleticism achieved through consistent conditioning, most players do not possess the physical skills necessary for them to assimilate a coach’s instruction and master a given baseball specific skill.

Most people would agree, a stable, well-built home cannot be constructed without some form of solid foundation or footing. Nor can an athlete properly and efficiently execute a complex athletic movement without a foundation of athletic skills. To that end, it is not reasonable for coaches and parents to expect 10 and 11-year-old physically immature kids to throw a ball with velocity, accuracy and consistency without a foundation of core strength, balance coordination, strength, agility or endurance.

Without taking away from the intent of baseball practices and games, efficient and effective methods of team athletic conditioning need to be implemented by trained strength and conditioning professionals and adopted by leagues.

Food for Thought

Baseball is a game that involves bursts of energy expenditure followed by periods of recovery and relative inactivity. The game requires balance, coordination, core strength, agility, endurance, speed and general upper and lower body strength. The challenge for most coaches is to implement a pre-practice or pre-game conditioning routine that effectively addresses these areas while allowing for most remaining time to be spent on baseball skills.

Preparation for sport

Substituting sport specific movement based dynamic flexibility in place of traditional static stretching exercises is an efficient way of preparing a player for the demands of their sport. After all, baseball is a sport that is played in an upright, weight-bearing position. From a performance enhancement perspective, there is very little carry over from static; ground-based stretching routines performed in a seated or laying position.

Ideas for successful programming

Organizing a team into several equally distributed lines and having them perform a series of weight bearing, multiplane and rotational movements while stabilizing their abdominal muscles is an excellent method of gaining flexibility, balance, coordination and core strength. Repeating the routine before each game or practice in the same order facilitates motor learning and skill acquisition that equates to consistent improvement over the course of the entire season, thus positively influencing overall athleticism. As participants gain proficiency in their routines, the time required to execute, the routine diminishes thus leaving more time for other activities.

Coaches and parents interested in developing movement based athletic development routines can do so by contacting a local strength and conditioning certified coach in their area or by researching programs documented in books and journal publications. The National Strength and Conditioning Association is an excellent source of information in the area of age and sport specific athletic skill enhancement. ( Additional, current sources of information and programming in the area of athletic skill development are current texts by Strength and Conditioning coaches Mark Verstegen and Mike Boyle. Verstegen’s Core Performance and Boyle’s Functional Training for Sport are excellent references for parents and coaches. Coaches, athletes and parents can also direct questions to the USA Baseball Medical and Safety Advisory Committee: Jim Ronai is a Physical Therapist, Certified Athletic Trainer and Certified Strength and Conditioning Specialist. He is the Director of Physical Therapy and Sports Medicine at Rehabilitation Associates, Inc. in Milford, Connecticut and is the Director of Jim Ronai’s Competitive Edge,LLC, Speed, Conditioning and Strength training in Connecticut.