Baseball throwing injuries: Are We Putting Our Kids at Risk?

By Dr. John R. Mishock, PT, DPT, DC
Approximately, 2.2 million children between the ages of 4 and 16 will begin participating in organized baseball this season throughout the country. Many of these young athletes who participate in baseball may develop a painful condition of the elbow and/or shoulder.
Youth baseball throwing injuries continue to escalate. In most cases, youth throwing injuries are not increasing because of throwing more curveballs, pitching with poor mechanics, performing an aggressive long toss programs, or other proposed claims. Although these factors may be involved, the main cause of injury is due to “abuse”, not “over use”.

Overuse implies that the athlete is simply throwing too much, which is often accurate. The American Sports Medicine Institute has shown that many of the primary factors that correlate to injury in youth baseball are related to overuse.
Specifically, the more you pitch, the more you raise your chances of getting hurt. This includes factors such as:

• Pitching competitively for more than 8 months of the year
• Pitching on back-to-back days
• Pitching for more than one game in the same day.
• Pitching for more than one team during the same season.
• Pitching and also playing catcher on the same day.

To combat this, both Little League Baseball and USA Baseball have provided pitch count rules and guidelines to follow.
However, in my experience I have seen the abuse first hand where parents and coaches simply neglect the stated pitch count guidelines and youth safety information that has been provided by league organizations.

There was a study sponsored by AOSSM that included 700 pitchers around the country between the ages of 9 and 18 years old. One-third of the pitchers reported a pitching-related injury in the past 12 months, 70% reported significant arm tiredness in the past 12 months, and nearly 40% percent reported significant arm pain within the past 12 months.

More importantly, the study was able to quantify the percentage of youth baseball pitchers that were performing activities that have been correlated to increase injury risk:

• 40% pitched in a league without pitch counts or limits
• 23% of pitchers pitched competitively for more than 8 months of the year
• 57% pitched on back-to-back days
• 20% pitched more than one game in the same day.
• 34% of these pitchers pitched for more than one team during the same season
• 10% also played catcher on the same team

The results of the study demonstrate that quite a large percentage of youth baseball players are being put at risk by their parents and coaches. The first step in injury prevention is awareness. We now know several factors that correlate to injury. We have rules and guidelines that have been designed with this information in mind. We know how many players are putting themselves at risk. Now it is time to start using this information to help protect our kids and reduce baseball arm injuries.

Dr. Mishock’s book, “The Rubber Arm: Using science to increase pitch control, improve velocity and prevent elbow and shoulder Injuries.” Can be obtained at

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