Injuries in baseball players are on the rise, there is no arguing that. One of the more alarming things I’ve noticed, however, is that the injuries are now starting at a younger age. In fact, UCL reconstruction (‘Tommy John’ surgery) in athletes ages 15–19 has increased dramatically over the last decade. We are seeing an influx of injuries and surgeries in middle school and high school levels that used to only happen in the college and professional levels, and now at a higher rate. Why is this happening? Well, that’s the million dollar question. Every injury is unique to the individual athlete, and each athlete’s answer to “why” they got injured, is likely different based on the athlete. It is multifactorial, so to move towards an answer we need to consider a variety of issues.
The lowest hanging fruit for most of these injuries is overuse. A former MLB Physical Therapist, Mike Reinold, has even gone as far as saying we could stop calling it “overuse”, and instead call it “abuse”. The most important thing to understand when discussing overuse is that there’s numerous different ways a pitcher can be overused:
- Pitching too much in one game
- Pitching on back to back days
- Pitching year round without a rest period
- Playing on multiple teams at once
All of the above could fall under the umbrella of overuse, and all need to be addressed. And while one pitcher’s injury could be caused by doing too much (overuse), another pitcher’s injury may actually have been caused by doing not enough (no warmup, no recovery, etc.). This is why it’s critically important we look at each athlete’s injury as being unique to the athlete, and assess all factors that could be in play with youth pitching injuries.
To create discussion in regards to this, I want to offer 5 tips that should be considered to help keep the health of youth pitchers as our #1 goal. We will go in depth on tips 1-2 with this post, and will dive deeper into tips 3-5 in part 2 of this post.
1. Take 2-3 months off of pitching per year.
Multiple studies of MLB, NCAA, and youth pitchers show significantly higher rates of elbow and UCL injuries in warm-weather states compared to cold-weather states. Why do you think that is? It’s a lot easier to take time off of pitching in colder states due to the weather forcing you indoors in the winter, which doesn’t happen in the warmer states. Pitching year round occurs more in the warmer, southern states than it does in the colder, northern states. So I see 2 ways of approaching this- a) move up north so you can’t pitch all winter, or b) understand the concept that pitching all year increases you risk of injury and take time off from pitching in the off season regardless of where you live.
My advice: Take the 2-3 months off of pitching in the winter, with 1 of those months off of any throwing. What that looks like- light throwing in November without competitive pitching, take December off of any throwing, start throwing again in January, and then reintroduce pitching in February to get ready for the spring. This would be my minimum recommendation for someone who wants to take as minimal time off as possible. If you want to build in another month into the off season, by all means do it!
What should I be doing during my off season?Well since this is more geared towards youth athletes, my advice is use that time to be a kid. Play other sports. Have fun doing something other than baseball for some time. Since I love a good research article, let me throw this one at you too. Research also has shown that there are more arm injuries in youth pitchers who only play baseball. Early specialization can actually increase your chances of getting injured! So, you want to use your off season in a fun way that’s actually going to help you not be hurt? Go play basketball. Go play soccer. Go play tennis. Do something other than baseball and expose your body to a lot of different movements. This will help not only become a better athlete, but it will also make you a healthier athlete.
2. Follow pitch count guidelines.
Now that we know how to prevent overuse over the course of year, lets talk about preventing overuse over the course of a game, or a weekend, or a week. The best way to do this is to keep an pitch count. There are two main points I want to discuss in regards to this:
- Notice I emphasized ‘pitch’ count, as opposed to ‘inning’ count. An inning could be 3 pitches. An inning could be 40 pitches. Counting innings isn’t nearly reliable enough and can easily still cause overuse injuries. One study (yep, more research!) found pitchers who follow inning limits actually had higher injury rates than those who follow pitch counts, because an inning can vary dramatically in total workload. Count your pitches, not your innings.
- This should be ALL the pitches you throw across ALL your teams. I’ve worked with patients in the past who have been juggling up to 3 different teams at once between recreational, travel, and school teams. Playing for 3 different teams doesn’t mean you have 3 different pitch counts to follow. Pitch counts should be applied to the pitcher, not the team! To make this happen, communication is key! If you are a coach, you need to be aware if your pitchers have thrown on other teams in recent days and game plan accordingly. If you are a parent, you need to relay to the coach how much your child is safe to pitch based on how much they have thrown with other teams. It definitely can be a lot of work, but your pitchers arm will thank you!
USA baseball has done a lot of studying in regards to pitch counts for all ages and has great resources online. For more information on pitch counts, and to help you get a better feel for how much pitchers should be throwing, visit https://www.mlb.com/pitch-smart/pitching-guidelines
Pitching injuries aren’t fun. No pitcher wants to experience them. No parent wants their child to experience them. The only way to avoid them is through better education and to ensure we are doing everything we can on the front end to set every pitcher up for success. While avoiding overuse is the area we can make the biggest impact, we also need to be sure we are physically setting the body up success. We will discuss this in part 2, stay tuned!
Key Takeaways (Part 1)
- Pitchers should take 2–3 months per year off from pitching, with at least 1 month completely off from throwing.
- Early specialization increases injury risk — multi-sport participation improves durability and athleticism.
- Pitch counts are far more accurate than innings when managing workload.
