Preventing Pitching Injuries in Youth Baseball

Alarming injury statistics

If your child is a pitcher, he/she has about a fifty-fifty chance of experiencing pain in his/her elbow or shoulder during his/her baseball career.

A 2002 study in the American Journal of Sports Medicine found:

• roughly half of the 476 youth pitchers studied reported elbow or shoulder pain at least once during the season.

• For each additional 25 pitches thrown after reaching the 50 pitch count, the percentage of pitchers experiencing pain increased.

• The risk of shoulder pain was 2 and a half times greater for pitchers who threw more than 75 pitches per game

• The risk of elbow pain was 3 1/2 times greater for pitchers throwing more than 600 pitches per season

• For pitchers who self-reported pitching while tired, the risk of elbow pain was 6 times greater and the risk of shoulder pain increased four-fold.

• Youth baseball pitchers who threw curveballs or sliders were at an increased risk of elbow and shoulder pain [Note: while two recent studies suggest that throwing a curveball actually puts less stress on the elbow and shoulder than throwing fastballs, some experts, such as world-reknowned orthopedic surgeon Dr. James Andrews of the American Sports Medicine Institute (ASMI), still believe throwing curveballs at an early age can be dangerous; see #12 below].

A 2005 study in the same journal found that overuse was the overriding factor in the development of arm pain among pitchers in youth baseball. That study found that:

• Pitchers who averaged more than 80 pitches per appearance were nearly 4 times more likely to require arm surgery;

• Pitchers who pitched competitively more than 8 months per year were 5 times more likely to require surgery; and

• By age 20, those who pitched on a regular basis with a tired arm were an astounding 36 times more likely to have an elbow or shoulder injury requiring surgery.

Other studies have found that:

• 26% of youth players and 58% of high school pitchers experience elbow pain

• 29% of 9- to 19-year-old boys experience shoulder pain in one study and between 32% and 35% in two other studies (38% in a 2010 study of high school pitchers)

The epidemic of arm injuries suffered by youth baseball pitchers is reflected in the dramatic increase in the number of shoulder and so-called Tommy John elbow (ulnar) ligament-transplant operations performed by Dr. James Andrews at ASMI:

• 9 Tommy John elbow operations from 1995 to 1998
• 65 over the next four years
• 224 from 2003 to 2008
• 2001-2002: total of 13 shoulder operations on teens
• Over next 6 years, 241

Too many pitches, not enough rest

Research by the ASMI and others points to three principal risk factors for injury to youth baseball pitchers: overuse (number of pitches during a game, season, and a year), poor pitching mechanics, and poor physical fitness/physical conditioning.

1. Most baseball arm injuries are not the result of a single traumatic event. Instead, injuries are believe to be due to the cumulative effect of microscopic trauma from the repetitive act of pitching. Overuse occurs throughout the course of a single game, season, or year in the developing baseball player.

2. Poor pitching mechanics has been suggested as a possible risk factor for injury, but such a link has yet to be shown in bio-mechanical or clinical studies.

3. Poor physical fitness/physical conditioning.

Of the three, experts seem to agree that the number of pitches thrown coupled with the lack of appropriate rest periods are the greatest contributor to the increasing incidence of pitcher arm injuries.