How To Prevent Arm Injuries in Youth Baseball Pitchers | A Parent’s Ultimate Guide

Are you a baseball parent concerned about your child's arm health? 

You're not alone.

These days, there’s increased pressure placed on competitive youth pitchers to consistently perform well – sometimes year-round.  

And as you’ll see below, young ballplayers are developing shoulder and elbow injuries at an increasing rate.

In many cases, these injuries might require months of rest or even surgery to recover.

Parents deserve to have all the facts. 

So this ultimate guide covers everything you need to know about how to prevent arm injuries in youth baseball pitchers, including: 

• The most common injuries they face
• The biomechanics of a pitching motion 
• Official recommendations for avoiding injuries 
• Proven injury-prevention techniques 

#Injuries are Prevalent in Youth Baseball Pitchers

Many institutions, such as the American Sports Medicine Institute (ASMI), Little League Baseball & Softball, and the USA Baseball Medical & Safety Advisory Committee, as well as independent researchers have documented the growing number of injuries among young baseball players for years. 

To start, it’s good to know that every year, about three million children in the U.S. play baseball, and about 25,000 athletes compete at the NCAA level. 

Overall baseball injuries across age ranges can be placed into two major categories: 

• Non-overuse
• Overuse.

Contact injuries accounted for 110,000 children ages 5-14 being treated in hospital emergency rooms for baseball-related injuries in 2009. 

However, many baseball injuries – as is our concern for this guide – are due to overuse.

Pitchers are at particular risk for shoulder and elbow injury because of fatigue, overuse, and improper mechanics. 

The number of Tommy John surgeries – a surgery that reconstructs a torn elbow ligament – among athletes aged 15-19 has risen by over 50 percent since 1974 when the surgery was first performed. 

Here are a few more alarming statistics about the state of youth baseball pitching injuries:

• Up to 74% of youth baseball players (ages 8-18) admit they have some pain when throwing
• 25% - 50% of amateur players, parents, and coaches believe that pitchers should get Tommy John surgery as soon as possible because they’ll throw harder afterward (this is false)
• 5% of youth pitchers will suffer a serious elbow or shoulder injury within 10 years; a strong predictor of such injury is pitching volume
• Pitchers ages 9-18 years old admitted to pitching habits that go against ASMI recommendations: 43% said they pitched on consecutive days, 31% pitched on multiple teams with overlapping seasons, and 19% pitched multiple games per day
• In a 2015 survey of 203 healthy baseball players, 46% of youth pitchers said they were encouraged at least once to keep playing despite having arm pain
• In a 2015 survey of 98 baseball players aged 9 to 16, 63% disagreed with the idea that they were more likely to get an injury the more they threw
• In the same 2015 survey, 64% of respondents said they would keep playing if they were injured, and 61% said they would keep playing if they had a sore arm during a game 

Countless surveys, research, and epidemiological surveys have shown one fact to be true – overuse puts youth baseball pitchers at a greater risk for injury. 

Next, let’s look at the forces that go into throwing a baseball.

#The Biomechanics of Throwing a Baseball

A baseball pitch is a complicated biomechanical process that requires precision and the use of several muscle groups. 

Sports scientists have broken down the windup into six phases:

1. Wind-up
2. Stride
3. Arm cocking
   
4. Arm acceleration
   
5. Arm deceleration
   
6. Follow-through
   

During which of these phases do experts tend to see the most injuries?

• Arm-cocking
• Arm acceleration
• Arm deceleration 

During the arm-cocking phase, the arm is so externally rotated that the muscles of the shoulder are pushing back against it. The excessive external rotation of the arm and internal rotation of the shoulder creates torque that can, with overuse, lead to injury. 

During arm acceleration, the shoulder internal rotation can get up to 7000 degrees per second for a professional athlete. This velocity can lead to injury of the labrum – which is a piece of fibrous cartilage attached to the rim of the shoulder socket. 

During arm deceleration, the arm slows down so much that the posterior shoulder joint contracts with forces equal to one’s body weight, which can result in an injury of the rotator cuff or physis.

These injuries are only the most common ones found in baseball pitchers. And they can occur even with a proper pitching motion. 

When the kinetic chain is compromised or a pitcher’s mechanics are off at all, injuries can happen at any phase.

#Factors impacting baseball pitching biomechanics

Several factors affect the biomechanics of the pitching motion. 

Some of these factors are more likely to lead to injury than others: 

• Pelvic rotation: forces and torques on the throwing arm decrease as the pelvis opens
• Time of ball release: the greatest shoulder force happens near the time the pitcher releases the ball
• Volume of pitches thrown: there’s a significant relationship between an increased number of game pitches and the risk of shoulder pain. Lyman et al found that 75 or more pitches thrown by one pitcher more than doubled the odds for shoulder injury. And Olsen et al found that pitchers who threw consistently with a fatigued arm were 36 times more likely to develop an injury that required surgery
• Innings pitched: a 10-year retrospective study showed that pitchers who pitched more than 100 innings in a year were 3.5 times more likely to be injured
• Pitch type: Lyman et al. also saw shoulder and elbow pain increase in youth pitchers, ages 9-14, when they threw sliders and curveballs. However, conflicting studies have shown that throwing a fastball produced greater arm torque than a change-up or curveball in all age groups 

The ASMI’s position on pitch type is that curveballs aren’t inherently more risky than other types of pitches, but they can lead to injury without the proper mechanics. 

Young pitchers are more at risk for shoulder injury from volume of pitches thrown, overall innings pitched, and poor biomechanics than they are for any given pitch type. 

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#Common Myths in Baseball Player Arm Care

The increased need for Tommy John surgery has given rise to several misconceptions about the surgery and its recovery afterward. 

ASMI addressed some of these myths in its 2016 position statement on Tommy John injuries in baseball pitchers. 

#Myth #1: Tommy John surgery improves your arm

One myth that has convinced many people is that pitchers should get Tommy John surgery as soon as possible because it will help them throw harder and better. 

It’s true that MLB pitchers have come back after the surgery throwing better than they did before, but it’s not only because of the surgery itself. 

After the surgery, these pitchers spend time in physical therapy, working with top-tier therapists, trainers, and strength coaches to rebuild the strength in their arms and fix longstanding imbalances across their entire body. 

They also have a much longer break from throwing a baseball than would usually be afforded in their line of work, and that extended rest along, coupled with everything we detailed above, helps them recover and return looking better than ever. 

However, their performance will decrease over the long-term, according to ASMI. 

#Myth #2: Throwing curveballs are bad for young pitchers

For many years, coaches and parents have encouraged young pitchers not to start learning to throw a curveball too soon, because the motion supposedly carries a greater risk for elbow injuries. 

Amid still-raging debates on this issue, a 2008 study of pitch type and injury risk for pitchers around age 12 was one of the first biomechanical studies looking at the curveball in youth pitchers. 

The authors found that, in general, elbow and shoulder loads were the greatest in the fastball and least in the change-up – with curveballs somewhere in-between.

ASMI suggests that the more likely the cause of injury in young pitchers is the lack of neuromuscular control – which comes with physical maturity – to throw a curveball with the right mechanics.

#Myth #3: Lowering the mound height will fix the problem

Even though we’re calling this last one a myth, in reality, researchers still disagree on whether pitching from a raised mount or flat ground is better for elbow torque safety.

However, a recent study by Dowling et al. suggests that the mound doesn’t make a significant difference when it comes to stress on the elbow.

It offers that the problem may not lie with the height of the mound but instead with maximum-effort throwing. 

Regardless, most experts agree that it’s best not to limit or pigeonhole young baseball players too early into only identifying and operating as pitchers. 

Such overspecialization has consequences on growing bodies.

Instead, playing other positions and especially playing other sports can help develop an athlete’s arm and entire body in a healthier way.

#The Most Common Shoulder Injuries in Youth Baseball

In a 2012 article for PM&R, the journal of the American Academy of Physical Medicine and Rehabilitation, Zaremski and Krabak looked at common shoulder injuries in skeletally immature baseball pitchers. 

Each of these injuries is quite a mouthful to say out loud:

• Proximal humeral epiphysiolysis
• Rotator cuff dysfunction
• Superior labrum anteroposterior (SLAP) lesions.

But let’s take them one at a time. 

#Proximal humeral epiphysiolysis in young baseball players

Proximal humeral epiphysiolysis, also known as Little League Shoulder, is a common injury amongst baseball players ages 11 to early teens. 

The “humeral” in “proximal humeral epiphysiolysis” refers to the humerus bone. 

When this bone is fractured, it’s either a proximal humerus fracture or a humerus shaft fracture.

The proximal humerus is essentially the “top” of the humerus bone, near the shoulder. 

And children have a cartilage-like disc in their humerus called a physis. 

The physis is also called a growth plate because it helps long bones, such as the humerus and the femur, to grow. 

Young baseball pitchers who overuse their arms are at risk of Little League Shoulder because repetitive throwing can put stress on the physis. 

This common injury occurs because the proximal humerus is overloaded, likely at the time the shoulder is at its greatest external rotation – which is the arm-cocking phase.

#Treatment for Little League shoulder

Baseball players with this injury usually have pain in their upper arms, and it resembles a stress fracture. 

According to Zaremski and Krabak, the best treatment is implementing the proper pitching mechanics and completing a preseason strengthening program.

Wasserlauf and Paletta suggest the player stops throwing for six weeks after the initial diagnosis, then advise another six weeks of no throwing during the strengthening phase of the player’s recovery.

#Glenohumeral instability and rotator cuff dysfunction in youth baseball throwers

Compared to adult throwers, young baseball players who are skeletally immature are more predisposed to instability in their shoulder joint (also called the glenohumeral joint). 

Young athletes also tend to have weaker rotator cuff muscles.

Most rotator cuff tears occur in adults, but they can happen with adolescent throwing athletes as well. 

The specific dysfunction of the rotator cuff in young baseball players comes from repetitive eccentric stress on three of the rotator cuff muscles and on the muscles that surround the shoulder blade (known as the scapular stabilizers). 

Stress on these particular muscles leads to fatigue and eventually to injury.

The pain associated with rotator cuff dysfunction tends to come during the arm deceleration phase of the throw. 

Trakis et al suggest that rotator cuff injuries in youth throwers come specifically from underdeveloped rear shoulder muscles combined with a decelerating arm – which is being propelled by overdeveloped front shoulder muscles. 

Once again, such imbalances are more common when athletes specialize in a sport and a position in that sport (pitcher) too early on in their athletic careers. 

Other than pain in the upper arm during throwing, other signs of a rotator cuff injury might be decreased velocity and precision. 

#Treatment for rotator cuff injuries

Once an athlete has been diagnosed with a rotator cuff injury, they should stop all throwing until they no longer show symptoms. 

A 1-3 month throwing program that strengthens the rotator cuff and shoulder blade muscles, along with restoring proper mechanics, should start once the athlete is pain-free. 

Once the throwing program is complete and the athlete shows no more evidence of symptoms, they can return to competition. 

Alternatively, If a player complains of pain during the arm cocking and arm acceleration phases of pitching, it might be a sign of secondary shoulder impingement. 

Rehabilitation from a shoulder impingement involves a strengthening program aimed at shoulder blade muscles.

#Superior labrum anteroposterior lesions in pitchers

The labrum is a piece of fibrous cartilage around the socket of the shoulder joint, which helps keep the ball at the top of the humerus bone in place.

Throwers ages 10-15 have a much lower risk of SLAP lesions than older players, but if one of the muscle stabilizers of the shoulder (in this case, the biceps tendon) becomes compromised in a skeletally immature thrower, the risk of SLAP lesions increases.

Athletes with SLAP lesions will feel a dull aching sensation within the shoulder, pain, and a catching feeling when throwing. They might also have trouble sleeping due to shoulder discomfort. 

Pain for this injury usually happens in the arm cocking phase and is also associated with a decrease in velocity.

An athlete usually needs a physical examination or diagnostic imaging to detect a SLAP lesion, although these methods are meant to be more for adults than children. 

#Treatment for SLAP lesions

For adults with SLAP lesions, how soon they return to competition depends on the severity of the injury. 

For youth players, Zaremski and Krabak recommend a period of serious rest after a SLAP lesion diagnosis, before surgery is even considered. 

Physical therapy and rest can help resolve these symptoms. 

#GIRD problems in baseball hurlers

Glenohumeral internal rotation deficit (aka, “GIRD”) is a common shoulder problem among all throwing athletes, including baseball pitchers. 

Most studies on GIRD and its treatment do not reference youth pitchers, although it does occur in young baseball athletes. 

So, the researchers behind Nakamizo et al wanted to look at GIRD in Little League players to see how prevalent the problem really is among youth pitchers. 

Examining a small sample of 25 Little Leaguers, they found 10  of them to have reduced internal rotation in the shoulders of their dominant arms, compared with their non-dominant arms. 

More research should be done on GIRD in youth baseball players specifically to determine what the most appropriate method for treatment would be. 

However, such work has been done on slightly older pitchers. 

A 2020 study by Hwai-Ting Lin, et al., set out to see if a mixture of collegiate and high school senior baseball pitchers with GIRD showed detrimental differences in their pitching mechanics. 

The researchers came to the following conclusion:

And this feels pretty definitive to us. 

The authors went on to suggest “that pitchers with GIRD need stretch training to enlarge joint range of motion, and to improve trunk strength and flexibility to alleviate potential problems.”

#The Top Causes of Shoulder Injuries in Youth Baseball Pitchers

Several risk factors for shoulder and elbow injuries in youth pitchers have been proposed over the years, and evidence supports some of these causes more than others. 

Below is a list of risk factors for arm injury in youth throwers – again, some with more supporting evidence than others. 

#1. Fatigue

Playing through pain and fatigue is unfortunately common for young pitchers, and doing so increases the risk for injury in pitchers of ages. 

Olsen et al. surveyed 95 pitchers who’d had shoulder or elbow surgery and 45 pitchers who hadn’t, in order to find out what their pitching habits were. 

Not too surprisingly, the results showed that the injured group pitched more months, pitches, games per year, innings per game, pitches per game, and more warm-up pitches per game. 

The injured pitchers were also in showcases more frequently, were usually starting pitchers as opposed to relievers, pitched with a higher average velocity, and pitched more often through pain and fatigue. 

The two groups matched in age, but the injured group was on average taller and heavier, and reported more use of anti-inflammatory drugs and ice to prevent injury.

How many times the word “more” appeared in the above paragraphs says everything that’s needed about how overuse can cause fatigue and fatigue can cause injury in developing ballplayers. 

Fatigue and overuse are inextricably linked.

#2. Overuse

Overuse is a top factor linked to arm injuries in young baseball pitchers – and the literature on the risks of pitching too often is vast.

Yen and Metzl even suggest that young throwing athletes develop “microinjuries” in their youth that develop into more serious problems in high school, college, or in professional leagues. 

These recurrent, small injuries might not require surgery or major intervention while the athlete is pre-pubescent, but they lay the groundwork for worse injuries later. 

This unfortunate reality is that the consequences of overuse in youth competition can hide, waiting to emerge just as the ballplayer – who's devoted so much time and effort to get to this point – is trying to get seen and recruited to play at the next level. 

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#Biomechanics

Many studies have looked at pitching biomechanics and noted a link between poor mechanics and arm pain.

Davis et al. conducted a study of 169 baseball pitchers aged 9-18 to determine if improper mechanics was an indicator of pain.

Specifically, they were looking for signs of a lower humeral internal rotation torque and elbow valgus load.

And high internal rotation and elbow valgus loads have been known to increase the risk of injury significantly.

#4. Immaturity

Epidemiological studies have noted that throwing with an immature skeleton poses different risks than throwing with a mature skeleton. 

Specifically, children between ages 2 and 11 develop six ossification centers at the elbow, which don’t fuse until they hit puberty, between 13 and 17 years old. 

These open ossification centers, or physes, are common sites for injury. 

After the physis closes, however, the more likely injury is on the ulnar collateral ligament – leads to Tommy John injury.

This is why we tend to see this sort of injury, and subsequent surgery, in older ballplayers. 

#5. Velocity

Throwing at a high velocity has been linked to injury risk in the major leagues, and it’s also a risk factor for adolescent pitchers as well. 

In a study of 27 former high school baseball players who had undergone ulnar collateral ligament reconstruction, Petty et al. saw that 74% returned to baseball after the surgery. 

The pitchers who had gotten the surgery averaged a self-reported fastball velocity of 83 mph.

The study concluded that special attention should be paid to elite teenage baseball pitchers who throw with high velocity. 

Young pitchers are very literally playing with fire when a propensity for high velocity is coupled with any of the other risk factors detailed on this list.

#6. Pitch count

Several recent studies have found links between the number of pitches thrown in one session and shoulder and elbow injuries. 

Previously, we mentioned the Lyman et al. study, which found that any more than 75 pitches thrown more than doubled the odds for shoulder injury. 

But another study, Fleisig et al. followed youth pitchers aged 9-14 for 10 years to investigate long-term risks for injury. 

#How Pitching Biomechanics Change as Youth Pitchers Mature

As pitchers’ bodies develop, their pitching mechanics inevitably change. 

Understanding these evolving biological differences and how to adapt to them could help players, parents, and coaches avoid injury. 

In a seven-year study of youth pitchers, starting with their first season pitching, Fleisig et al. noticed a few key differences in pitchers’ motions as they aged:

• Stride length increased from 73% of the pitcher’s height to 83%
• Lead foot placement to the closed side increased from -2cm to 18cm
• Trunk separation increased from 23 degrees to 42 degrees
• Shoulder external rotation at foot contact decreased from 92 degrees to 66 degrees
• Maximum shoulder external rotation increased from 164 degrees to 177 degrees
• Shoulder and elbow forces and torques increased significantly with age 

This way, adolescent pitchers have a solid foundation from which to build more strength and power. This additional strength and power leads to more stabilization and resilience, and less injuries.

#Official Recommendations for Pitcher’s Youth Arm Care

All of this information about injuries and risk factors wouldn’t be beneficial without recommendations for prevention. 

The prevention and rehabilitation techniques covered here are taken from the sources we’ve cited throughout this article thus far. 

But we’ll also include official recommendations from recognized associations, such as ASMI and USA Baseball. 

#American Sports Medicine Institute

The ASMI’s recommendations for avoiding Tommy John surgery in youth pitchers are similar to the Pitch Smart and Little League Baseball guidelines, but go a bit further. 

ASMI encourages coaches to have a biomechanical analysis done to gain insights about the pitcher’s motion.

The institute also promotes throwing more off-speed pitches as a pitching strategy, rather than throwing as hard as you can most of the time. 

ASMI stresses the importance of players communicating with their coaches and trainers, and keeping them up to date on any stiffness, soreness, and pain. 

Similarly, pitching coaches need to watch their players for signs of fatigue on the mound and intervene when they think the pitcher is too tired. 

Another ASMI recommendation that’s found in other official guidelines is to not always throw at maximum capacity. At a young age, pitchers should play other positions. 

Doing so will help them develop good throwing mechanics without putting too much stress on the ulnar collateral ligament. 

ASMI suggests at least two months off from throwing each year; other experts suggest three.

During this period, athletes can continue exercising and training in other ways, to stay in shape but give their arm a needed rest.

Don’t kill the messenger travel ball coaches. 

ASMI also emphasizes how especially important it is for pitchers who throw at a high velocity to follow pitching guidelines and rest day recommendations.

#USA Baseball – Pitch Smart Program

The Pitch Smart initiative is a joint program with MLB and USA Baseball to provide pitching guidelines to amateur players to help them avoid injuries. 

They post official recommendations for rest days for each age level and compile resources about healthy throwing arms, available on their website.

The most a pitcher should throw in any game, according to these guidelines, is 120 pitches for the 19-22 year old age group. 

At the opposite end of the spectrum are pitchers 7-8 years old, who shouldn’t exceed 50 pitches in one game. 

Here are a few more highlights from the Pitch Smart recommendations:

• Pitchers 14 and under who throw 66+ pitches in one day should take at least four days rest
• Pitchers 14 and under who throw more than 20 pitches in one game should take at least one day of rest
• Pitchers between the ages of 15-22 should take at least one day of rest after throwing 30 or more pitches in one game 

#Little League Baseball

Little League Baseball has pitching rules that apply to all regular-season games. Some of the highlights include:

• For age groups below Little League’s Junior, Senior, and 50-70 leagues, the pitcher cannot return to the mound after being taken out in a single game
• Any player who has played catcher for four innings or more isn’t eligible to pitch on the same day
• 13-16 year-olds can throw 95 pitches per day, 11-12 year-olds can throw 85 pitchers per day, 9-10 year-olds can throw 75 pitches per day, and 7-8 year-olds can throw 50 pitches per day 

Pitch count limits and rest days for Little League baseball resemble the Pitch Smart program. 

#How to Prevent Arm Injuries in Youth Baseball Pitchers

In addition to the associations listed above, independent researchers and experts have formulated recommendations for injury prevention in young baseball pitchers, based on their studies.

#Recommendations for pitching injury prevention

• Learn proper fastball mechanics and mechanical consistency first
• Pitching competitively shouldn’t exceed eight months per year
• Limit the use of radar guns in games and practice, as this can encourage young players to give maximal effort too often
• Players should complete stretching and strengthening programs that aim to improve posture and range of motion of the elbow, shoulder, and hip 

#Recommendations for youth pitchers ages 8-18 who experience pain while throwing

• Periods of avoidance of throwing activities should be coupled with ice, anti-inflammatory drugs, and stretching
• Players experiencing pain should have regular evaluations by sports medicine physicians
• When taking a break from throwing activities, players should perform general conditioning and core strengthening exercises

#Baseball Parents Should Be Aware of Risks and Injury Prevention Strategies

One of the biggest injury prevention techniques for youth baseball players is parents staying informed. 

Some parents who have kids participating in baseball may have never played the sport themselves or simply put other priorities ahead of maintaining a healthy pitching arm.

Such parents should seek out resources about young baseball pitchers and arm injuries. Understanding recommended guidelines – and actually following them – can be the difference between a Tommy John surgery before age 20 or not. 

Short term success in the game should never be traded for long term risk – especially at the youth levels of play. 

Zabawa and Alland surveyed 853 baseball parents, to see if they understood the MLB’s and USA Baseball’s Pitch Smart guidelines, and whether their lack of knowledge resulted in the likelihood of an injury for their child. 

The percentage of correct answers to Pitch Smart guidelines from parents who reported having players with a preexisting injury history was 55%. 

When the parents of ballplayers without an injury history were polled, 62% answered correctly. 

The same survey results also showed that showcase participation was a prime predictor of player injury.

The results of the parent Pitch Smart survey conducted by Zabawa and Alland reinforces the important role of parents in preventing injury in their kids. 

The guidelines are out there, as are qualified pitching coaches, trainers, and pediatric medical professionals.

Parents should always seek help when they need it and gather as much info as they can from reputable sources. 

By following the advice of experts, you can prevent your young pitcher from getting injured and allow them to continue playing the game we all love as long as possible.

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