Youth baseball throwing injuries are on the rise across the country. Increases in participation coupled with the popularity of year round travel teams and player showcases (play multiple games in a weekend without strict standards for pitch counts or numbers of innings pitched) has orthopedic specialists treating overuse injuries (typically seen in the professional ranks) at the youth league to high school levels.
Two main areas injured in throwers are the rotator cuff muscles in the shoulder and the ulnar collateral ligament found on the inside of the elbow (popularly known as it is the ligament repaired in the “Tommy John” procedure). The impact of youth injury is more substantial as not only muscles or ligaments may be injured but also the non-fused bone (growth plates) found both in the shoulder and inside of the elbow. Growth plate injuries can cause abnormal development of the elbow and shoulder possibly leading to future inability to throw and post-traumatic arthritis.
The number one statistical cause of youth arm injury in baseball is overuse and throwing with arm fatigue. Arm fatigue is caused by excessive throwing but can be compounded by sports training in general. Parents are investing hundreds of dollars per month with the hopes of making their 9-17 year-old stronger and faster than the competition. Sports training facilities are more popular now than ever before and are more than willing to take parents’ money without considering the long term impact of overtraining a young athlete. Training programs designed to improve performance may be overstressing young joints and contributing to muscle fatigue. Experts feel the unrealistic performance standards of parents, performance trainers and coaches put the child at risk and don’t consider their health first.
What to be aware of
●High velocity throwing: Pitchers enjoy the success of overpowering the competition. As velocity increases, stress on the shoulder and elbow joints also increases. The growing body may not be equipped to tolerate this stress so players with above average throwing velocity should be closely monitored for arm pain.
●Overtraining: Participating in similar activities requiring an overhead motion (baseball and swimming or tennis), year round participation or over training/practicing does not allow the young player’s muscles and tendons to recover properly. Young athletes need time-off from organized sports participation.
●Throwing too much too soon: in the early weeks of the season, young arms are adapting to the increase in training and stress from throwing. To minimize soreness and fatigue players should start throwing gradually and increase as the body acclimates.
●Restricted or painful joint movement: If your child complains of pain during or the days after throwing and have pain with movement or limited motion with comparison to the other arm, seek attention from a medical professional familiar with sports injury.
What parents can do:
●Parents are the youth players advocate. Communicate and be proactive when it comes to your player’s league rules and with coaches in regard to training and pitch counts. Does the team use pitch counts even if the league doesn’t require it? What are the Coach’s expectations and limits?
●Keep track of how much your player is throwing in practice and at home. Rest is necessary for the young arm and body in general to recover from practice and games. Pitching practice in the backyard with mom or dad that the Coach may not know about contributes as much to arm fatigue as team practice and games.
●Don‘t let your child pitch with elbow or shoulder pain. If pain persists, seek medical attention.
●Avoid pitching/throwing on multiple teams and/or year round: The USA Medical and Safety Board Advisory Committee recommends at least 3-4 full months of complete rest from throwing every year.
●Communicate with your child about how their arm feels. Is there any pain when throwing? How about after?
What Coaches can do:
●Warm-up players up properly
- Don’t pitch or use a player at catcher that complains of arm pain. Ask the parents if the player complains of arm pain at home.
●Report complaints of arm pain to parents and ask that they follow-up with a qualified medical professional.
●Emphasize proper throwing mechanics; if you aren’t familiar with proper mechanics seek outside education or assistance for your players.
●Avoid pitching a player on consecutive days.
●Avoid teaching breaking pitches until age 14. Master the fastball and change-up first.
●Adhere to pitch counts and required rest limits.
●Minimize throwing in practice for players who recently pitched; maximum effort throwing from the infield or catcher position is stressful to the throwing arm and the number of throws are not counted. Be aware that rest days mean just that, rest.
With youth baseball leagues utilizing varying standards (see tables below) for pitch count and rest periods the responsibility falls on parents and coaches to closely monitor players for overuse and complaints of arm pain. Beyond verbal complaints, watch for subtle signs of arm pain or injury such as: decreased arm strength (decreased pitch velocity), unwillingness to attend practice or games, a change in throwing mechanics (dropping the elbow and pushing the ball vs. throwing with the elbow up), decreased throwing accuracy, and pain that persists even after a period of rest from throwing.
The most important thing to remember as a parent or coach, listen to your player when they complain of arm pain. Only they can feel their pain and the “throw through the pain” mentality puts young players at risk for a serious injury that could have long term effects.
This information was composed and reviewed by:
Dr. Andrew Vertson, PT,DPT, ATC (owner of Intecore Physical Therapy in Orange, Aliso Viejo, and Foothill Ranch). and Eric Welker MA, ATC, PTA. For more information or a free 30 minute arm injury assessment of your youth baseball player, please call:
(844) 468-7800 or visit