Injury prevention guidelines for young baseball pitchers

What are the most common injuries in youth baseball pitchers?

Overuse injuries are by far the most common type of injury that affects young pitchers; up to 40 percent develop them. In a pitcher who is not finished growing, the growth plates of the elbow and shoulder are the anatomic structures most vulnerable to the stress of overuse. Growth plates are made of soft cartilage, and therefore are not as resistant to stress as ligaments, tendons, or mature bone. Repetitive stress due to overuse causes irritation and inflammation in these growth plates, resulting in injuries such as Little League elbow and Little League shoulder. Traumatic injuries are much less frequent than overuse injuries. The most common traumatic injury is an avulsion fracture of the medial elbow.

What causes injuries in young baseball pitchers?

Research has shown that the most important risk factor for injury is the number of pitches thrown. The more pitches thrown per game, per week and per season, the greater the risk for injury. Additional risk factors include lack of adequate rest between pitching appearances, throwing breaking pitches at a young age and pitching through fatigue. Young pitchers can reduce their risk for injury by following the pitch count guidelines published by the USA Baseball Medical and Safety Advisory Committee, and the injury prevention guidelines for youth pitchers.

What is a pitch count?

Pitch count refers to the number of maximum effort pitches thrown. All maximum effort pitches count toward the total number for the week, regardless if they were thrown in a game, in a practice or in your backyard. For more information on which pitches count, see the USA Baseball Medical and Safety Advisory Committee Guidelines.

Why is it important to count pitches?

Research has shown that the most important risk factor for injury is the number of pitches thrown. The higher the number of pitches thrown per game, per week, and per season, the greater the risk for injury.

How many pitches should youth baseball pitchers throw?

The USA Baseball Medical and Safety Advisory Committee has published guidelines for maximum pitch counts based on age.

Maximum number of pitches

Age	per game	per week
9-10	50	75
11-12	75	100
13-15	75	125

USA Baseball 2006

How much rest do youth pitchers need?

A certain amount of repetition is required to develop the strength and skills needed to be a successful pitcher. However, adequate rest is as important as repetition. If rest is insufficient, skill development suffers and the risk for injury increases. A pitcher's body muscles, tendons, and bone growth centers need sufficient time to cool down and re-charge for the next event. Pitchers should obtain at least 24 hours of rest after each pitching outing. Once removed from the pitching position, pitchers should not return to pitch in a later inning during the same game.

For pitchers age 7 to 16:

Pitches in a day	Rest time
61 or more	4 days
41-60	3 days
21-40	2 days
1-20	1 day

For pitchers age 17 to 18:

Pitches in a day	Rest time
76 or more	4 days
51-75	3 days
26-50	2 days
1-25	1 day

Little League International, 2006

Do specific pitch types lead more injuries?

There is some evidence to show that throwing breaking pitches before skeletal maturity may increase the risk for elbow and shoulder pain due to the excessive stress these pitch types place on the bone growth centers. The USA Baseball Medical and Safety Advisory Committee makes the following recommendations for earliest age at which pitchers should begin throwing each pitch type.

Pitch	Age
Fastball	8
Change-up	10
Curveball	14
Knuckleball	15
Slider	16
Screwball	17

Contemporary Pediatrics, 2004

Do certain pitching mechanics cause more injuries?

The answer to this question is currently unknown. There are many theories that implicate specific aspects of a pitcher's motion that could lead to injury, however there has yet to be any scientific evidence to prove or disprove these theories. The Institute for Sports Medicine and Motion Analysis Center at Children's Memorial Hospital are currently conducting a research study to investigate the influence of pitching biomechanics on injuries in youth pitchers. Pitchers can learn more about how their own pitching mechanics may be affecting their performance and/or injury risk by participating in Children's Memorial's Pitching Biomechanics Analysis, a state-of-the-art, three-dimensional (3-D) motion analysis technology that provides pitchers with personalized analysis and recommendations for stronger, safer pitching.

What else can youth pitchers do to prevent injury?

• Do not pitch through pain. Joint pain in the elbow or shoulder is one of the first signs of injury. Pitchers should be removed from pitching if they are feeling or showing signs of pain. Rest is required to allow time for the injured area to heal. If pain does not resolve after a 3-4 days of rest, consult your physician. The sooner an injury is identified, the sooner proper treatment can begin. The result is shorter healing time and faster return to pitching.

• Do not pitch through fatigue. Research shows that pitchers who pitch through fatigue may be a greater risk for injury. Decreased ball velocity, ball control and/or ball command are all signs of fatigue. Pitchers demonstrating these signs should be removed from pitching.

• Warm-up properly before all practices and games. Ten minutes of light jogging, cycling, or calisthenics before exercise will increase circulation to cold muscles, making them more pliable and less prone to injury. The Institute for Sports Medicine's TRAK program instructs young athletes how to perform age-appropriate warm-up exercises.

• Maintain appropriate body weight and general fitness throughout the year

• Learn and practice proper pitching mechanics

• Avoid playing on more than one baseball team during a single season

• Take at least 3 consecutive months off from pitching per year

• Avoid playing other overhead sports such as football (quarterback), volleyball, swimming during the baseball season. When combined with baseball pitching, these can put a large amount of repetitive stress on a young pitcher's arm and greatly increase the risk for injury.
• Find more on injury prevention guidelines.