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Preventing Pitching Injuries in Youth Baseball

A dozen ways to reduce overuse and other arm injuries


6. Make sure your child is properly conditioned

  • "Most pitching injuries are caused by overuse, which may be the result of insufficient conditioning of certain muscles," says Dr. Gill.
  • All pitchers should incorporate conditioning and stretching exercises for the shoulder into an overall conditioning program. The muscles in the front of the arm are naturally stronger. Because many shoulder injuries result from weaker muscles in the back of the arm that are used to stop the pitching motion, the conditioning program should emphasize building up those muscles. "Exercise routines such as cross-body curls, using light dumbbell weights, and wall push-ups are useful for strengthening shoulder muscles," Dr. Gill says. 

The American Academy of Pediatrics' 2012 Position Statement on Baseball and Softball14 includes a recommendation that a preseason conditioning program that includes strengthening the core, the rotator cuff and the shoulder-stabilizing muscles (scapular stabilizers) may help reduce throwing injuries.

Many baseball coaches also believe strength and conditioning is important, not just of the arm, but the legs as well.

For an article on shoulder stretching and conditioning exercises, click here.

7. Make sure your child properly warms up and stretches.

  • Research shows that cold muscles are more injury prone. While a proper warm-up is important for all youth athletes, it is particularly critical during a growth spurt, when your child's muscles and tendons are tight. Experts, including the American Academy of Orthopedic Surgeons , recommend that your child warm up by: 
    • Dynamic stretching: Do jumping jacks, jogging or walking in place for 3 to 5 minutes to get the blood moving through the muscles and ligaments.
    • Static stretching: Then slowly and gently stretching, holding each stretch for 30 seconds. Pitchers should concentrate on stretching their arms, shoulders, neck and wrists, in addition to stretching their legs.
    • Soft tossing first. Your child shouldn't start throwing the ball hard right away, especially in cold weather. He should begin by "soft tossing" and then gradually increase the distance and velocity of his throws as his arm gets loose and warm.

8. Never allow your child to play through pain

The stories about youth baseball pitchers pitching in pain to the point of injury abound.  A 2014 study16 found that a third of youth pitchers reported arm pain, with 25% reporting that they "often" or "always" had pain the day after they threw. An alarming 46% of the players surveyed reported at least once being encouraged to keep playing despite having arm pain.

  • Any persistent pain is a sign of a chronic (i.e. overuse) or acute (e.g. traumatic) injury that should sideline a child from playing until it subsides.
  • Teach your child not to play through pain. If your child gets injured, see your doctor. Follow all the doctor's orders for recovery and get the doctor's (or physical therapist's ) okay before allowing your child to play again.
The key is to be able to distinguish between normal stiffness/soreness from throwing (which needs to be worked out by playing catch the day after) from pain which is the result of overuse, muscle or ligament strain, or serious injury, says youth baseball coach, author and MomsTeam contributor, Dan Clemens. 

"It's tough for kids to know the difference until they've been though it several times (maybe even into high school), " he says. "Coaches have a tough time knowing the difference because it's not their arm and they aren't feeling it.  Part of what we need to teach the kids is to know their own bodies,"  Clemens says. 

"As coaches we need to err on the side of caution. But I know that if kids only throw on the days they feel great, they'll only be doing it once or twice a week - and that's a "weekend warrior" strategy that's a surefire recipe for injury," Clemens says.

He recommends that kids throw 4 to 6 times a week (throw, not pitch) in order to build arm strength, which is what prevents a lot of injuries. To do this, they'll have stiffness they have to work through.  Just as the only way for runners to work out the pain and stiffness from the previous day's run is to go lace up the shoes, Clemens says. "I've tried this excuse and it only makes the run later in the week worse!"

9. Avoid using radar guns

Pitchers may be unable to resist the temptation to overthrow, subjecting them to increased risk of injury (see #5 above).

Some experts, including Ron Wolforth of Texas Baseball Ranch and Pitching Central,10 recommend the use of radar guns, not out of an obsession with velocity but because of their value to measure pitcher fatigue (see #1 above)(in other words, a drop off in velocity is a tell-tale sign that a pitcher is tired, regardless of competitive level, from youth baseball up to Major League Baseball).

10. Avoid showcases

Showcases (multi-day, high-level events in which athletes may play in multiple games in a short period of time) provide young players the opportunity to show off their skills to scouts at higher levels of baseball.

As USA Baseball notes,8 "Unfortunately, showcases often occur near the end of the player's season, when players are often fatigued and require rest and recovery. In other instances, players participate in a showcase after a prolonged period since the league ended and without adequate preparation for throwing hard again. It is without a doubt that young throwers will try to overthrow at these events in an effort to impress the scouts, which further increases the risk of serious arm injury."

The 2011 Little League pitching injury study reported that pitching in showcase events was associated with an increased risk of elbow and shoulder injury for those who also pitched in Little League Baseball and in high school pitchers.

11. Don't let pitchers be catchers too

The pitcher-catcher combination results in too many throws and may increase the risk of injury. Little League Baseball instituted a new rule for 2010 banning any pitcher who delivers 41 or more pitches in a game from going behind the plate to play catcher for the remainder of the day.

The results of the 2010 ASMI study5 appear to support such a ban.  While it found that playing catcher appeared to double or triple a pitcher's risk of injury, the small number of injured players in the study prevented a finding that the risk was statistically significant.  Nevertheless, the authors concluded that playing both pitcher and catcher in the same game or on the same day be "discouraged."

For its part, the National Athletic Trainers' Association 2011 position statement on overuse injuriess4 advises "caution when combining pitching with other demanding throwing positions (e.g. pitch 1 day and catch the next day) to ensure adequate time for recovery."

12. Consider delayed throwing of the curveball

As noted in the 2010 ASMI study,5 "the relationship between pitch types (particularly curveballs) and injuries in youth baseball pitchers is less clear [than between number of pitches thrown and injury risk] and more controversial." 

The 2002 ASMI study2 found associations between breaking pitches and arm pain, but found, unexpectedly, a relationship between throwing sliders and increased risk of elbow pain and an association between throwing curveballs and increased risk of shoulder pain.

Three biomechanical studies, one published in 20087 and two in 2009 9,11 all found a curveball less stressful to the elbows of youth and high school pitchers than the fastball.  The studies thus appear to pour cold water on earlier studies and the conventional wisdom that throwing curve balls at a young age leads to so-called "Little League elbow."

Ongoing debate

Glenn Fleisig, chairman of research at ASMI and co-author of one of the 2009 studies,9 told the New York Times12 in 2009 that he didn't "think throwing curveballs at any age is the factor that is going to lead to an injury."

Carl Nissen, the author of the other 2009 study,11 said in the sameTimes article that he could "comfortably stand up and say the curveball is not [part of the injury] problem."

Interviewed by the Times, however, Dr. James Andrews of ASMI, who had previously recommended against pitchers throwing curveballs before age 14, warned that the new findings "may do more harm than good" because he feared parents and coaches would interpret the findings improperly as a license to teach kids to throw too many curves or begin when they were too young.12

He also cautioned that the study9 he co-authored with Fleiseg, his longtime ASMI colleague, had limitations because it was conducted under laboratory, not game conditions and he continues to believe that, when young pitchers are tired, throwing curves could still be dangerous, citing the story of a 12-year-old on whom he operated the day of the interview who at age 12 had torn the ulnar collateral ligament in his elbow in two after throwing 30-something curveballs in a row, the last one snapping his elbow.

The 2010 ASMI study5 attempted to study the risk of serious injury from throwing curve balls before age 13 but, while it seems to show a slight increased risk associated with starting curve balls at a young age, the study had far too few participants to determine such an association. Thus, the true risk of serious injury from starting to throw curve balls at an early age is still unknown.

In its 2011 position statement on overuse injuries,4 the National Athletic Trainers' Association, largely comes down on Dr. Andrews's side of the debate.  The NATA points out potential flaws in the two biomechanical studies: "It is important to note that the participants in these studies were healthy, with no history of arm injury, and in the case of the [2009] study, perhaps slightly older than the players who are generally the target of the recommendations against throwing breaking balls." 

Thus the NATA recommends that parents and coaches restrict the use of breaking pitches in order to prevent pitching-related arm injuries.  If an individual pitcher can throw breaking pitches on a limited basis and remain symptom free, the NATA says, then it may be allowed.  If any throwing-related symptoms of overuse injury develop, however, the NATA says, throwing breaking pitches should be immediately terminated and medical attention sought.

More recently, a 2011 study by researchers at the University of North Carolina and commissioned by Little League Baseball stated that, while the "relationship between age, type of pitch, and injury is complex, ... there was no clear evidence that throwing breaking pitches at an an early age was an injury risk factor."

The last word, to this point, on the subject of curve balls is contained in the American Academy of Pediatrics' 2012 Position Statement,14 While acknowledging the recent studies challenging the theory that the curveball and slider were stressful to the young elbow, the AAP continues to endorse the recommendation, based on studies that show increased injury among those who throw curve balls and sliders at early ages, that introduction of the curve ball be delayed until after age 14 or when pubertal development has advanced to the stage when the athlete has started to shave, and that sliders should be delayed until age 16. (Update: The AAP has since been joined in this recommendation by USA Baseball and MLB, who recommend in their Pitch Smart program that players younger than 14 avoid throwing pitches other than fastballs and changeups, and that older pitchers only begin using breaking pitches after developing a consistent fastball and changeup. 

Updated and most recently revised October 2, 2015

1. Lyman S, Fleisig GS, Waterbor JW, et al. Longitudinal study of elbow and shoulder pain in youth baseball pitchers. Med Sci Sports Exerc.2001;33(11):1803-1810.

2. Lyman S, Fleisig GS, Andrews JR, Osinski ED. Effect of pitch type, pitch count, and pitching mechanics on risk of elbow and shoulder pain in youth baseball pitchers. Am J. Sports Med 2002;30(4):463-468.

3. Olsen SJ 2nd, Fleisig GS, Dun S, Loftice J, Andrews JR. Risk factors for shoulder and elbow injuries in adolescent baseball pitchers. Am. J Sports Med. 2006;34(6):905-912.

4. Valovich McLeod TC, Decoster LC, Loud KJ, Micheli LJ, Parker JT, SandreyMA, White C.  National Athletic Trainers' Association Position Statement: Prevention of Pediatric Overuse Injuries.  J Ath. Tr. 2011;46(2):206-220.

5. Fleisig G, Andrews J, Cutter G, Weber A, Loftice J, McMichael C, Hassel N, Lyman S. Risk of Serious Injury for Young Baseball Pitchers: A 10-Year Prospective Study. Am. J. Sports Med. 2010;20(10): 1-5.

6. Kaplan KM, Jobe FW, Morrey BF, Kaufman KR, Hurd WJ. Comparison of Shoulder Range of Motion, Strength, and Playing Time in Uninjured High School Baseball Pitchers Who Reside in Warm- and Cold-Weather Climates.Am.J Sports Med. 2011; 39(2): 320-328.

7. Dun S, et. al., A Biomechanical Comparison of Youth Baseball Pitches: Is the Curveball Potentially Harmful? Am.J. Sports Med. 2008;36(4):686-692.

8.  ASMI Position Statement for Youth Baseball Pitchers, August 2009

9. Fortenbaugh D, Fleiseg G, Andrews J. Baseball Pitching Biomechanics in Relation to Injury Risk and Performance. Sports Health: A Multidisciplinary Approach 2009;1:314-320.

10. Wolforth, Ron, Observational Fatigue & New Guidelines (accessed May 27, 2010)

11. Davis, J.T., et. al. The Effect of Pitching Biomechanics on the Upper Extremity in Youth and Adolescent Baseball Pitchers. Am. J. Sports Med. 2009;37(8):1484-1491.

12. Hyman, Mark, "StudiesShow That the Curveball Isn't Too Stressful for Young Arms," NewYork Times (July 26, 2009).

13. 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).

14. American Academy of Pediatrics Council on Sports Medicine and Fitness, Baseball and Softball Policy Statement (doi 10.1542/peds 2011-3593)(www.pediatrics.org/cgi/doi/10.1542/peds2011-3593 (accessed February 27, 2012).

15.  Hurd W, Jazayeri R, Mohr K, Limpisvasti O, El Attrache N, Kaufman K. Pitch Velocity Is A Predictor of Medial Elbow Distraction Forces in the Uninjured High-School Aged Baseball Pitcher. Sports Health: A Multidisciplinary Approach. 2012; DOI:10.1177/1941738112439695 (accessed March 22, 2012)(published online ahead of print).

16. Makhni E, Morrow Z, Luchetti T, Mishra-Kalyani P, Gualtieri A, Lee R, Ahmad C. Arm Pain in Youth Baseball Players: A Survey of Healthy Players. Am J Sports Med. 2014;20(10). DOI: 10.1177/03636546514555506 (published online Nov. 3, 2014). 

Additional sources:

Berler, Ron "Arm-Control Breakdown", New York Times (August 9, 2009)

Krajnik, et. al. Shoulder Injuries in US High School Baseball and Softball Athletes, 2005-2008. Pediatrics 2010;125(3):497-501.

The Learning Curve: Little League Seeks to Address Concerns, Answer Questions about Curveballs and Overuse (Little League International 2011).

Berra L. "Force of Habit" ESPN The Magazine, April 2, 2012 (accessed March 30, 2012)

Guidelines for Youth and Adolescent Pitchers (accessed October 2, 2015)