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Every Pitch Counts in Youth Baseball

An estimated 282,000 baseball-related injuries per year require treatment in hospitals, doctors’ offices or emergency rooms for players 18 years of age and younger.  Injuries are a part of all sports, however, many overuse injuries are preventable.

Little League Baseball and other youth baseball programs have made an effort to save young arms from overuse — but the rule may not protect pitchers when they participate on other travel teams, school teams and baseball leagues, in special show-case events or other throwing activities. The rule limits the number of pitches but only affects one specific team. While many baseball programs are governed, there may be different pitching rules and oversight is often lacking for pitchers who play on more than one team or in different leagues at the same time.  The term “Little League” is often used generically, but the official league doesn’t govern all leagues such as Babe Ruth, Pony or other school and local community specific leagues.

The key is to limit the amount of pitches thrown, rather than limiting the number of innings, in order to gain more control over how often kids throw in a game.  The ultimate goal is to prevent young, developing arms, elbows and shoulders from ending up on the operating table. 

Overuse is the Issue
Orthopedic surgeons are seeing more injuries due to overuse; young arms throwing too many pitches at a time when their bones are growing and more vulnerable.  An estimated 50 percent of youth sport injuries are due to overuse, and kids are getting injured at younger ages as they specialize in one year-round sport and/or position.  Research indicates that there has been a five to seven fold increase in throwing arm injuries since 2000.  Rest and recovery are essential for injury prevention, but may be overlooked.  This often leads to pain and injury that may go unrecognized.

Young bones are immature and have growth plates (the region of bones where growth and length occurs and where tendons attach) at their ends.  Growth plates are the weak link and are more vulnerable, especially when overused and not allowed proper healing with rest and recovery.

Exponential increased risk of injury is correlated directly with the amount of pitching.  Studies have shown that pitching greater than 80 pitches per game carries a 380 percent increased risk, pitching for greater than eight months per year leads to a 500 percent increased risk, and pitching with a fatigued arm leads to a 3,600 percent increased risk of injury.

Just Stop Throwing
When a baseball player experiences pain or injury to the shoulder or elbow, the solution is simple…just stop throwing.  The treatment for an overuse injury is underuse (rest). However, that’s easier said than done. It’s not always the kid you have to worry about; it may be the expectations from the coaches or parents.  Surgery is the extreme consequence for throwing too much and is avoidable if pain is recognized early and proactively treated with rest.  Modern techniques are very effective in rehabilitating these types of injuries for a safe return to throwing and to enable many years of baseball participation. 

Injuries can also be associated with:

  • An abrupt increase in pitching distance when a player advances to a new league or level
  • Inappropriate throwing mechanics
  • Unidentified muscle imbalance or weaknesses
  • A growth spurt, which could make the growth plate more susceptible to injury

The take home message is that not all baseball injuries can be prevented, but most can be significantly reduced.  Research confirms that if a young pitcher throws with a fatigued arm, he has a 36 to 1 times risk of injury.  By closely monitoring pitch counts, multi-team participation, year-round sport specialization and early recognition and treatment of pain, coaches and parents can be the difference between a young athlete’s long-term baseball participation and the inability to play due to a secondary to serious injury.

Dr. Mark Wood is an orthopaedic surgeon with Wake Orthopaedics.