The Real Reason Why There are so Many Youth Pitching Injuries

little-league-injuriesThis article that you are about to read is really disappointing.  Pitching injuries in young athletes continue to rise despite research and effort designed to reduce these injuries, this is a problem.

To quickly summarize what we have learned about youth pitching injuries, we know that approximately one third of youth baseball pitchers will experience shoulder or elbow pain during a season.  We also know that youth pitching injuries increased sixfold in the early 2000’s with Dr. James Andrews at his center in Alabama.  This number is probably even higher now.  (Photo by Edwin Martinez1)

After years of speculation regarding exactly why these injuries occur.  There is only one factor that continuosly correlates to these pitching injuries.  I’ve discussed the Little League curveball debate in the past.  It isn’t throwing a curveball, it isn’t pitching at an early age, and it isn’t long tossing.  The reason is simple:

Youth pitching injuries are due to overuse

But I think we are being polite be saying “overuse.”  I would imagine we can even say “abuse” or maybe even “neglect.”  Let me explain why.

After years of research showing that high pitch counts, pitching too frequently, throwing for multiple teams, pitching in showcases, and pitching while fatigued are significant factors in the rise of your pitching injuries, Little League Baseball and USA Baseball did the right thing  They consulted with many experts in the field of throwing injuries, including James Andrews, Glenn Fleisig, and the experts at the American Sports Medicine Institute, to develop pitch count rules to protect our youth from this overuse.

Kudos to them for stepping up and doing the right thing.  But here is the problem….

A recent study publish in Sports Health surveryed 95 youth baseball coaches about their knowledge of the saftey guidelines established by the USA Baseball Medical and Safety Advisory Committee.  The results are disapointing to say the least.

  • Overall, coaches answered 43% of questions correctly
  • 27% of coaches admitted to not following the safety guidelines, however only 53% of coaches felt that other coaches in the league followed the safety guidelines
  • 19% of coaches reported that they pitching a player while having a sore or fatigued shoulder or elbow

I’m sorry to say this, but…

Not understanding the safety guidelines is irresponsible and intentionally not following them is abuse.

The cause of youth pitching injuries are definitely multifactoral, however, overuse has been shown to be the most influential.  Sadly, overuse also seems to be the easiest to address.

So what can you do?  It probably starts with education.  Share this article to help spread that word that overuse needs to end and safety guidelines need to be followed.

You can go back and read my article on Little League pitch count rules.  USA Baseball also has some guidelines.  To summarize them, in addition to monitoring pitch counts, players should not pitch with pain, should limit their throws from other positions (especially catching), limit their participation in our leagues, limit their participation in showcases, and not progress to more demanding pitches until their bodies start to mature.

All coaches need to be aware of these recommendations.  Injury prevention begins with the understanding of how injuries occur and what the specific safety recommendations entail.

The next step is getting on a proper injury prevention program.  I’ve discussed some of these topics in my article on preventing Little League pitching injuries and have shared with you my Little League injury prevention exercises that I prepared for MGH several years ago.  I probably need to update these but it serves as a good basis to begin.

It really is a shame that all these youth pitching injuries are occurring, let’s do our best to spread this education and help reduce these Little League injuries as much as we can!

13 replies
  1. Rod Y PT (MN)
    Rod Y PT (MN) says:

    I 100% agree with pitch counts along with the other guidelines: no pain, no fatigue and not playing catcher in the same game. One thing that is not mentioned is WHEN should kids start pitching? It seems they are starting 1-2 years earlier then I did when I was growing up. What happend to the Pitching machine. I would like to see Youth Baseball extend the years of using the pitching machine. This could be the answer we all be waiting for??? Being a pitcher is a high level task and takes lots of control that we should not expect our 10-11 year olds to have. Thanks.

  2. Dan Swinscoe, MPT,CSCS
    Dan Swinscoe, MPT,CSCS says:

    Angie, I think you are spot on. We can’t expect a little league age kid to do that it needs to be a parent. I actually have an info sheet I give to the parents of players I see covering all that stuff. I remind them the only kids who get hurt are the ones who are good so its a double whammy. Coaches aren’t tempted to overuse kids who aren’t superior in ability

  3. Angie Shehorn, MS, OTR, CHT
    Angie Shehorn, MS, OTR, CHT says:

    I agree that the issue is the pitch/throw count. I also want to add that the parents also need to be educated and an advocate for their son or daughter. I see a lot of athletes who have shoulder to elbow issues and the parents seem to be pushing rather than helping some of these kiddos. Plus, we as clinicans also need to address proximal stability as most I see have instability in the shoulder thus creating a bad senario for the elbow! Thanks for sharing!

  4. Josh Bixler PT, DPT
    Josh Bixler PT, DPT says:

    Absolutely agree. Some of my former classmates and I presented a poster at CSM 2012 discussing this very topic, and the stats we found were alarming. One must also account for not only pitch volume, but TOTAL throw volume as well. It’s unnerving to see a kid pitch 3 innings and then play catcher for the next 3 innings. So many throws go unaccounted for with current guidelines.

  5. Bruce Kelly
    Bruce Kelly says:

    This is the overwhelming factor in youth pitching injuries and the most easily controlled. But parents, coaches and officials continue to ignore the obvious. It does border on abuse or for what? A local Little League or American Legion title? Ludicrous!

  6. Sue
    Sue says:

    Very sad that coaches overlook the safety of their pitchers. I played softball and I was the only varsity pitcher on the team for 3 years. That means I pitched every game no matter how sore or hurt I was. I’m upset that my coaches treated me that way and now I have laxity in my joint that is a constant source of grief.

  7. Kyle Boddy
    Kyle Boddy says:

    Great article, Mike. No matter how much I may disagree with some of the USA Baseball / LL suggestions, coaches should still be very well-educated and act on this knowledge.

  8. Dan Swinscoe, MPT, CSCS
    Dan Swinscoe, MPT, CSCS says:

    MIke, well done. I preach the same thing to the leagues I talk to. I especially remind them all the factors that will increase fatigue beyond just the pitch count. Like the saturday 9:00am game. Sleep over the night before. Pancakes syrup and OJ for breakfast. No sleep, no nutrition and dehydrate = recipe for injury, Plus up here in Seattle the kids fall apart faster in 80 degrees or more so they need to be watched closer on those rare days our sun shines. Great content as usual

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