Baseball is our American pastime and it has always been expected to be a safe and healthy sport. However since 2000, there has been a five- to seven-fold increase in youth baseball injuries. Injuries now have approached epidemic proportions. Moreover, many of the arm injuries of professional baseball pitchers have been documented to have had their origins at the youth level.
One of the missions of the USA Baseball Medical Safety & Advisory Committee has been to provide scientifically based information to its youth baseball members to reduce the risk of injury and maximize younger players’ abilities to perform at advanced to higher levels. Because of this support of USA Baseball, we at the American Sports Medicine Institute (ASMI) began to research the epidemic.
Fatigue and joint pain
A major risk factor associated with injuries in youth baseball is excessive pitch counts. Research from ASMI indicates that if a youth baseball player pitches with fatigue, then there is a 36 to 1 times (3,600% increase) chance that he or she will injure their throwing shoulder and/or elbow. Pitching with fatigue means “event fatigue,” which is too many pitches in a game; “seasonal fatigue,” which is too many innings in a season; and “year-round fatigue,” which is too many innings year-round without rest. We have always recommended that a young thrower have at least 2 months, preferably 3 to 4 months, off each year where he or she is not participating in an overhead throwing sport.
A survey conducted by the USA Baseball Medical & Safety Advisory Committee and published in USA Baseball News in 1996 showed that most experts believed pitch counts should be kept for youth pitchers, as well as collegiate and professional pitchers. In response, the committee sponsored an epidemiological study by ASMI to look at the issue. The findings, which were 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 players. Therefore, it was 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 were recommended for youth baseball.
Pitch counts and pitch types
The Little League International, whose primary interest always has been the health and well-being of young baseball players, adopted pitch counts for all of their youth leagues. There has been a significant decrease in the number of throwing arm injuries in the league because of this action. A number of the other youth organizations have since adopted pitch counts to prevent shoulder and elbow injuries in youth baseball.
The risk factors as recently published by Safe Kids International include the following:
- 45% of youth baseball pitchers pitched in a league with no pitch counts;
- 43.5% of youth baseball pitchers pitched on consecutive days;
- 30.4% of youth baseball pitchers pitched with multiple teams;
- 19% of youth baseball pitchers pitched multiple games in one day; and
- 13.2% of youth baseball pitchers pitched year-round.
These risk factors are accumulative and almost guarantee an early injury to the young athlete’s throwing arm.
The pitch counts adopted by USA Baseball, Little League International and Major League Baseball’s Pitch Smart Program are as follows:
- 7- to 8-year-old pitchers – 50 pitches
- 9- to 10-year-old pitchers – 75 pitches
- 11- to 12-year-old pitchers – 85 pitches
- 13- to 16-year-old pitchers – 95 pitches
- 17- to 18-year-old pitchers – 105 pitches
The 2000 study by ASMI also showed that youth baseball pitchers who throw curve balls and sliders have an increased risk of elbow and shoulder pain. Therefore, youth pitchers should avoid throwing breaking pitches until after puberty to reduce the risk of future overuse injuries.
Pitching mechanics and physical conditioning are also very important.
Showcases and multiple leagues
Showcases are another risk factor we must consider. Showcases are established to give young players the opportunity to display their skills to scouts for advancement to higher levels of baseball. Unfortunately, showcases often occur near the end of a player’s season when the player is often fatigued and requires rest and recovery. In other instances, players are at-risk when they participate in showcases after prolonged periods since their league ended and they do not have without adequate preparation to throw hard again. Young throwers will try to overthrow at these events in an effort to impress scouts and coaches, which further increases the risk of serious arm injury.
Obviously, playing in multiple leagues at the same time is also a problem. In these situations, there is no way one coach vs. another coach can keep up with the total number of innings pitched or pitch counts as related to fatigue.
Specialization and professionalism
Two things that best characterize the epidemic of youth baseball pitching injuries are specialization and professionalism. Specialization means the players concentrate on youth baseball as a primary sport for 12 months of the year, without having any cross-training opportunities. Professionalism means the players are training as if they are professional athletes with high-intensity and heavy workloads. Their young bodies are more vulnerable to injury and certainly not ready to take the heavy workload.
As orthopedic surgeons, the time is right to get involved with prevention of injuries in youth baseball. The above risk factors must be remembered. If risk factors are recognized, then common sense will prevent about 60% of these overuse injuries.
James R. Andrews, MD, is a founding partner and medical director of the Andrews Institute for Orthopaedics & Sports Medicine in Gulf Breeze, Fla. He also is a co-founder of the American Sports Medicine Institute in Birmingham, Ala. He can be reached at the Andrews Institute for Orthopaedics & Sports Medicine, 1040 Gulf Breeze Pkwy., Suite 203, Gulf Breeze, FL 32561; email: firstname.lastname@example.org.