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Arm injuries a concern regarding youth baseball players, too

J.D. Campbell is the Assistant Athletic Director for Media Relations at Indiana University. He was an All-American baseball player at Newman University in 1985 and was the 1982 Nevada American Legion Baseball Player of the Year. He also played two seasons at Taft (Calif.) Community College.

Baseball has given me everything I have. Had it not been for baseball, I would never have had the opportunity to go to college and now do what I do.

As I raised two sons who both enjoyed the game, I became more involved in our youth organization in Bowling Green, Ohio, serving as Commissioner of the Travel League, which sponsored teams in the 11- to 14-year-old age divisions. These teams played an average of 45 to 60 games per year and each team generally had 12 players on the roster. In any given season, it was not uncommon for us to have as many as 10 members of the team who pitched 15 innings or more during the season.

Through the years, I saw a number of coaches who brought different philosophies on how to handle pitchers. Most leagues and tournaments have rules regarding innings pitched, but a recent trend is to look at the number of pitches a youngster throws. In addition, sports medicine professionals also are looking at the type of pitches (fastball, curveball, changeup) and the relationship that pitch selection can have in determining the risk of arm injuries.

Below is information provided by the American Sports Medicine Institute (ASMI) about arm injuries in young players.

USA Baseball Medical & Safety Advisory Committee Guidelines

  • Position Statement: Baseball is one of the safest sports available for today's youth. However, many of the serious injuries suffered by adult baseball pitchers may have begun to develop at the youth level. One of the missions of the USA Baseball Medical & Safety Advisory Committee is to provide scientifically based information to its youth baseball members to reduce the risk of injury and maximize the younger player's ability to perform and advance to higher levels.
  • Pitch Counts: Pitches are counted and monitored for professional, collegiate and high school pitchers in order for them to reduce the risk of injury. A 1996 survey conducted by the USA Baseball Medical & Safety Advisory Committee (USA Baseball News, 1996) showed that most experts believed pitch counts should be kept for youth pitchers as well. In response to this charge, the committee sponsored an epidemiological study by the ASMI to look at this issue. This study -- published in The American Journal of Sports Medicine in 2002 -- showed a significant relationship between the number of pitches thrown and the risk of shoulder and elbow pain in youth baseball. It is the opinion of ASMI and the USA Baseball Medical & Safety Advisory Committee that joint pain indicates the early development of a potentially serious joint injury. Thus, pitch count limits are recommended for youth baseball. If -- for some valid reason -- a league is unable or unwilling to enact pitch count limits, the league should limit the number of batters faced. Because 9- to 12 year-old baseball pitchers average about 5 pitches per batter, pitch count recommendations can be converted into batter limitations by dividing by 5. However, pitch limitations are a better choice than batter limitations for accurately monitoring and controlling risk of overuse.
  • Pitch Types: The 2002 study by the ASMI also showed that youth baseball pitchers who throw curveballs or sliders have an increased risk of elbow and shoulder pain. Therefore, youth pitchers should avoid throwing breaking pitches in order to reduce the risk of future overuse injuries.
  • Multiple Appearances: Because a youth pitcher usually stays in the game at another position after pitching, the player is eligible to return to the mound later in the game, according to the rules of baseball. While it may be good strategy to have a starting pitcher come back in and finish a game, it is not a good idea from a health and safety perspective. Muscles, tendons and ligaments need time to "cool down" after physical activity, just like they need to "warm up" before activity.
  • Multiple Leagues: In order to get more opportunity to develop skills, many young players play in multiple leagues. Although the amount of pitching in a league is often limited by league rules or the judgment of its coaches, individual pitchers sometimes exceed such limitations by pitching in more than one league at a time. The strength and skills needed to be a successful pitcher are developed by repetition; however, a pitcher must also give his body time to rest and recover in order to optimize his development.
  • Year-Round Baseball: In certain parts of warm-weather states (Florida, Texas, California, etc.) baseball leagues are available in all seasons. However, the principle of periodization states that an athlete should have different periods and activities in his annual conditioning schedule. Specifically, baseball pitchers need a period of "active rest" after their season ends and before the next preseason begins. During active rest a pitcher is encouraged to participate in physical activities that do not include a great amount of overhand throwing.

Recommendations in the report

Based upon its expertise and review of existing studies, the USA Baseball Medical & Safety Advisory Committee makes the following recommendations for minimizing a pitcher's risk of future serious arm injury and maximizing his chance of success:

  • Coaches and parents should listen and react appropriately to a youth pitcher when he/she complains about arm pain. A pitcher who complains or shows signs of arm pain during a game should be removed immediately from pitching. Parents should seek medical attention if pain is not relieved within four days or if the pain recurs immediately the next time the player pitches. League officials should inform parents about this consideration.
  • Pitch counts should be monitored and regulated in youth baseball.
  • Recommended limits for 9-10 year old pitchers: 50 pitches per game, 75 pitches per week, 1000 pitches per season, 2000 pitches per year
  • Recommended limits for 11-12 year old pitchers: 75 pitches per game, 100 pitches per week, 1000 pitches per season, 3000 pitches per year
  • Recommended limits for 13-14 year old pitchers: 75 pitches per game, 125 pitches per week, 1000 pitches per season, 3000 pitches per year.

Note: Pitch count limits pertain to pitches thrown in games only. These limits do not include throws from other positions, instructional pitching during practice sessions and throwing drills, which are important for the development of technique and strength. Backyard pitching practice after a pitched game is strongly discouraged.

  • The risk of throwing breaking pitches until physical maturity requires further research but throwing curves and sliders, particularly with poor mechanics appears to increase the risk of injury.
  • Pitchers should develop proper mechanics as early as possible and include more year-round physical conditioning as their body develops.
  • A pitcher should be prohibited from returning to the mound in a game once he/she has been removed as the pitcher.
  • Baseball pitchers are discouraged from pitching for more than one team in a given season.
  • Baseball pitchers should compete in baseball no more than nine months in any given year, as periodization is needed to give the pitcher's body time to rest and recover. For at least three months a year, a baseball pitcher should not play any baseball, participate in throwing drills, or participate in other stressful overhead activities (javelin throwing, football quarterback, softball, competitive swimming, etc.).

Additional publications and research findings available at

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