Youth baseball has morphed into a year-round sport (particularly in warm weather climates), with some athletes playing on multiple teams in the same season. One result: an increasing number of pitchers sidelined with overuse injuries or needing surgery (e.g. Tommy John).

Guidelines on how many pitches young athletes should throw have been developed to stem the tide of injuries, but many coaches are not following the recommendations consistently, according to a study to be presented at the American Academy of Pediatrics (AAP) 2014 National Conference & Exhibition in San Diego.

"Our results show that youth baseball coaches are familiar with pitch counting but may not be using pitch counts all the time," said Sara Fraley, a fourth-year medical student at Case Western Reserve University School of Medicine in Cleveland.

Fraley and Allison Gilmore, MD, a pediatric orthopedic surgeon at Rainbow Babies & Children Hospital in Cleveland, surveyed 61 youth baseball coaches in Cincinnati and northeast Ohio to learn about their attitudes toward pitch counts, how they tracked and limited pitches, knowledge of injury risk factors and athlete demographics.

Results showed all of the coaches were familiar with pitch counts and were limiting pitches in some manner. In addition, 92 percent knew throwing with a fatigued arm put athletes at risk for injury. However, 44 percent admitted that they do not use pitch counts all of the time, and less than one in 10 coaches monitors and sets safe limits on how much athletes are pitching throughout the season or year, as recommended by the AAP.

Additionally, 41 percent of respondents coach athletes who are at an increased risk for overuse injury because they play on multiple baseball teams in the same season. More than one-third of coaches had at least one athlete benched with an overuse injury.

Coaches listed several reasons for not following pitch-count recommendations, including lack of knowledge, not having enough staff to keep track of pitches and lack of desire to perform the tedious task.

"It is important for athletes, parents, coaches and pediatricians to pay close attention to how much youth pitchers are throwing and to work together to keep youth baseball a healthy and fun activity," Fraley said.

Failure to follow pitch count rules: getting worse?

The new study reports an even higher percentage of coaches who fail to follow USA Baseball pitch count recommendations as those surveyed in a 2012 study. [1]

Depending on the age group with which the coaches worked, 27% of the coaches surveyed in that study, who coached youth baseball players between 9 and 15 years of age in a community league in the Midwest reported that they did not follow the pitching guidelines, with only about half (53%) saying they felt that other coaches generally followed the rules.  Neither percentage differed significantly by age group.

That study also reported that:

• 35% of coaches said their pitchers reported shoulder or elbow pain during the season, with the incidence of pain increasing as age group increased;
• 19% of coaches reported that one or more of their pitchers pitched a game with a sore or fatigued arm during the season;
• No coaches reported any pitching-related injuries among their players requiring surgery.
• Fewer than 10% of coaches reported that their players pitched in multiple leagues or participated in showcases.
• 91% reported that pitchers attended camps or received specific instruction to improve their pitching form.

The percentages of pitchers reporting pain or pitching with pain are "likely underestimates," said lead author, Joseph J. Fazalare, MD, of the United Hospital Center Orthopaedics in Bridgeport, West Virginia, "given that players themselves were not asked about pain."   The study took little solace in the finding that no injuries requiring surgery were reported, noting that such injuries "generally present at a later age than that of the patients in this study."

The low percentages of coaches answering the pitching guideline questions correctly "are concerning, as it is quite difficult for coaches to accurately follow guidelines with which they are not familiar," noted the study.

"In spite of significant efforts to educate coaches regarding youth baseball pitching injuries, knowledge of current recommendations for youth pitchers is poor," said Fazalare. "A better job must be done of educating players, coaches, and parents of the pitching guidelines and their importance."

Is better enforcement the answer?

Unlike Little League Baseball's pitch count limits, which are mandatory, with violations resulting in game forfeits, USA Baseball's recommendations are voluntary.

"Given the strong correlation that several authors have observed between elevated pitch counts, pitching while fatigued, catching in addition to pitching, and pitching in showcases, leagues should potentially take a more active role in enforcement of the [USA Baseball rules]", especially the rules regarding pitch counts and time spent catching and pitching, which are most likely easier to enforce than rules regarding fatigue and arm pain.

"Improved enforcement," said the study, "may also decrease the temptation of coaches to break the rules by improving their perception of the compliance of other coaches."

USA Baseball recommendations

To reduce the risk of arm injuries, USA Baseball recommends:

• Closely monitoring the number of pitches that are thrown in a game and throughout the season (see chart below)
• Avoidance of pitching in showcases, simultaneous leagues, or pitching more than nine months a year
• Not throwing breaking pitches until puberty
• Not catching in the same game as pitching
• Working on proper pitching mechanics.

For a comprehensive article on ways to prevent pitching injuries in youth baseball, click here.

Source: American Academy of Pediatrics 

1. Fazalare J, Magnussen R, Pedroza A, Kaeding C.  Knowledge of and Compliance With Pitch Count Recommendations: A Survey of Youth Baseball Coaches.  Sports Health: A Multidisciplinary Approach. published online February 6, 2012. DOI:10.1177/1941738111435632 (accessed February 7, 2012).

Posted October 10, 2014