Youth baseball injuries are increasing at an alarming rate despite a growing knowledge of how injuries occur. Several reasons for this increased injury rate have been postulated (i.e. throwing curveballs too young, inadequate and/or incorrect instruction, sport specialization, etc.), but when you dig into the data, there seems to be a simple, overwhelming reason why youth pitchers are getting injured – OVERUSE.
Recent generations of youth baseball players have migrated from pitching occasionally on a recreational level to participating in more competitive and frequent situations on “elite” or “select” baseball teams and leagues. Those pitchers who display an aptitude for pitching are often “thrown” into high-volume pitching programs in an effort to develop the young athlete into the next Nolan Ryan. The issue is not that sport specialization occurs, but rather that specialization yields more repetitive stress on the shoulder without the relative rest that comes with participation in other forms of recreation. Reports have shown that over 50% of youth sports injuries are from overuse and can be prevented, or at the very least, the incidence can be decreased.
To gain a better understanding of the scope of injuries sustained by pitchers and the risk factors, Little League Baseball and Softball, in collaboration with USA Baseball, the governing body of amateur baseball in the United States, and the Department of Exercise and Sport Science at the University of North Carolina in Chapel Hill, conducted a study of pitching arm injuries in youth baseball. Let’s examine the findings:
- A previous history of injury predisposes young athletes to over 5x greater risk of incidental injury at both the elbow and shoulder joints.
- The average number of innings pitched per game is a risk factor for shoulder injury in youth baseball pitchers.
- Pitch count programs reduce the risk of shoulder injury in Little League Baseball by 50%.
- Many pitchers in the study pitched in two leagues at the same time. Local Little League programs have no mechanism for monitoring such cross-league play.
- Pitching in travel ball “elite” and “select” programs and pitching in “showcase” events were associated with an increased risk of elbow and shoulder injury for those who also pitched in Little League Baseball, and high school pitchers.
- The relationship between age, type of pitch, and injury risk is complex, but there was no clear evidence that throwing breaking pitches at an early age was an injury risk factor.
So, again…it is not necessarily the type of pitches being thrown, but rather the number of pitches being thrown that appears to be the most important consideration. That is not to say that we should not be monitoring the types of pitches thrown, but we certainly need to more closely monitor overall pitch counts. So how much is too much for a given age? The current Little League Baseball pitching guidelines are as follows:
- The manager must remove the pitcher when said pitcher reaches the limit for his/her age group as noted below, but the pitcher may remain in the game at another position:
|League Age (years)
||Pitches Per Day
- Exception: If a pitcher reaches the limit for his/her league age while facing a batter, the pitcher may continue to pitch until any one of the following conditions occurs:
- That batter reaches base.
- That batter is put out.
- The third out is made to complete the half-inning.
- A pitcher who delivers 41 or more pitches in a game cannot play the position of catcher for the remainder of that day.
- Pitchers of league age 14 years and under must adhere to the following rest requirements:
- If a player pitches 66 or more pitches in a day, four (4) calendar days of rest must be observed.
- If a player pitches 51-65 pitches in a day, three (3) calendar days of rest must be observed.
- If a player pitches 36-50 pitches in a day, two (2) calendar days of rest must be observed.
- If a player pitches 21-35 pitches in a day, one (1) calendar day of rest must be observed.
- If a player pitches 1-20 pitches in a day, no (0) calendar day of rest is required.
- Pitchers of league age 15-18 years must adhere to the following rest requirements:
- If a player pitches 76 or more pitches in a day, four (4) calendar days of rest must be observed.
- If a player pitches 61-75 pitches in a day, three (3) calendar days of rest must be observed.
- If a player pitches 46-60 pitches in a day, two (2) calendar days of rest must be observed.
- If a player pitches 31-45 pitches in a day, one (1) calendar day of rest must be observed.
- If a player pitches 1-30 pitches in a day, no (0) calendar day of rest is required.
All coaches (and parents) should understand these guidelines, and more importantly, should adhere to them. Despite all of the recent literature about pitch counts and overuse in baseball pitchers, a recent survey showed that a large percentage of youth baseball players are still putting themselves at risk:
- 40% pitched in a league without pitch counts or limits
- 13% of pitchers pitched competitively for more than 8 months of the year
- 57% pitched back-to-back days
- 19% pitched more than one game in the same day
- Nearly 33% of the pitchers pitched for more than one team during the same season
- 10% also played catcher on the same team
Primary prevention of injury and correct rehabilitation from injury is very important, and injury prevention begins with awareness. Understanding the factors that have been scientifically proven to increase the risk of injury is the first step in avoiding overuse dysfunctions. Mandatory pitch counts are an important injury prevention program in Little League Baseball, and consideration should be given to adoption of pitch count programs in other youth baseball leagues and in high schools. There should be more education for coaches, parents, and athletes about the risks associated with travel ball and showcases. Good coaching on correct pitching technique, and parent and athlete education of the importance of correct technique, are important means of injury prevention for pitching arm injuries. So let kids be kids and allow them to explore their recreational horizons to help limit sport specialization and allow them to be more well-rounded athletes…which may in turn help them to be healthier
athletes, thereby improving their overall performance.