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How to Help Your Child Avoid The Throwing Injury Empidemic


Baseball has been played in some form since at least 1344, but the first recognized game was played on June 19, 1856 in Hoboken, NJ. Baseball has been played for 162 years, so why is it that all of a sudden there is an epidemic of kids with shoulder and elbow injuries from throwing a baseball?

Currently, 26% of Major League pitchers have had Tommy John Surgery (and an additional 15% of Minor League pitchers). There has been a rise of Tommy John Surgeries in kids as young as 13 years old. But Tommy John surgery is not the only throwing problem on the rise. Injuries such as little league shoulder, little league elbow, Ulnar neuritis, VEO (valgus extension overload, GIRD (Glenohumeral Internal Rotation Deficit) causing rotator cuff injuries and labral tears, and Capitellar Osteochondritis Dissecans to scratch the surface can all be caused by throwing.

I, like most men my age, played Baseball starting at 5 years old and all through High School, but don’t have any of these issues, nor did I deal with them during my playing career. (Was I a highly touted pitching prospect?...No, not even close…that’s why I’m not on the field, but help keep those prospects on the field). I played with some really hard throwers, who had loads of scouts at every game, and none of them had these issues. Cy Young pitched every third day (7356 innings pitched in the major leagues), in a time with barbaric orthopedic surgeries and no MRI’s. Nolan Ryan pitched in the Major Leagues for 27 years in which he struck out 5,714 batters… and no Tommy John surgery.

So, why all the injuries from throwing you ask? Young athletes are throwing harder, more often and without rest. Over the last 10 years, sport specialization has continuously risen. Ten years ago, it was not hard to find high school athletes who lettered in 3 sports…now, good luck finding more than 2 in a school. 30-40% of kids are told to specialize in their best sport by their coaches before high school. I bet that it would be easier to find an 8 year-old who only plays one sport than a 3 sport high school athlete. This specialization has allowed kids to throw harder and progress faster, but has caused more pitches to be thrown with less rest periods.

More pitches with more velocity dramatically increases the risk of throwing injuries. The research will tell you that the top two risks for throwing injuries are volume and velocity.

These injuries can be prevented. It will take a team approach to slow this epidemic. Here are some tips to keep your kids in the game and healthy:

  • Warm up properly by stretching, running and “playing catch”

  • Play other positions than just pitcher

  • Adhere to Little League Pitching guidelines. (see the tables below)

  • Avoid pitching on multiple teams (but if your kid does play on multiple teams, keep a journal of pitches and innings to coordinate between both teams)

  • Don’t pitch on consecutive days

  • NEVER use a radar gun

  • Don’t play year round

  • Develop skills and pitches that are age (and developmentally) appropriate. Master the fastball and changeup before even considering breaking pitches.

  • COMMUNICATE regularly with your child on how his/her arm is feeling and if there is pain

  • NEVER pitch through arm pain

  • Emphasize control, accuracy and (most importantly) GOOD MECHANICS.

  • Speak with a healthcare professional or Athletic Trainer if you have concerns about injuries or prevention strategies

  • See a Specialist in Shoulder and Elbow injuries in children sooner than later if your pitcher is complaining of pain. It is better to rule out an injury than to make it worse. Making it worse can lead to worsening injuries and longer periods not playing or worse.

Following these recommendations can decrease the risk of throwing injuries, but there are more things that you can do to keep your child healthy. There are various exercise and training programs that are being used to increase velocity, but as I said “velocity and volume” are the major cause of injury in throwers. I recommend a well rounded exercise program including core strengthening, leg strengthening, the “thrower’s 10” program. As well as, taking the time to go for a mechanical analysis by a qualified professional. With all these exercises, you still need to follow the pitch count and rest recommendations for your child’s age. See the below tables:

Little League Baseball’s Pitch Count Limits

Age Pitch Count/Game 7-8 years old 50 9-10 years old 75 11-12 years old 85 13-16 years old 95 17-18 years old 105

Little League Baseball’s Required Rest Periods

Ages 7-16 Ages 17-18 Require Rest Days 61+ pitches 76+ pitches 3 calendar days 41-60 pitches 51-75 pitches 2 calendar days 21-40 pitches 26-50 pitches 1 calendar day 1-20 pitches 1-25 pitches None

Remember, these are only guidelines, if your child complains of pain with throwing they need an evaluation, maybe some imaging and probably some treatment and rest. Talk to your child about the injury risks and all the steps that can be taken to combat these serious injuries and we can slow this epidemic and your child will not be part of these statistics.

For all the parents and coaches out there, I’m just scratching the surface of this huge topic. I recommend reading Dr. Christopher Ahmad’s book, following Mike Rienold on social media, subscribe to Elitebaseballperformance.com, and be your child’s advocate. If you are looking for more information, contact any of these people or call our office.

  1. Ahmad, Christopher, MD, Alexander, Frank, MS, ATC, Ahmad, Charles, Understanding Tommy John Surgery and How to Avoid It. Lead Player, LLC, New York, 2017.

  2. Andrews, James, MD, Ireland, Mary Lloyd, MD, and Fleisberg, Glenn S., MD, “Common Baseball Injuries and Prevention Tips” http://www.stopsportsinjuries.org/STOP/STOP/Prevent_Injuries/Baseball_Injury_Prevention.aspx

  3. Andrews, JA, Freisberg, GS, “Preventing Throwing Injuries”, Journal of Orthopedic and Sports Physical Therapy. Vol 23, No 3, March 1998: 187-188

  4. “Shoulder Injuries in the Throwing Athlete” https://orthoinfo.aaos.org/en/diseases--conditions/shoulder-injuries-in-the-throwing-athlete/

  5. “Elbow Injuries in the Throwing Athlete” https://orthoinfo.aaos.org/en/diseases--conditions/elbow-injuries-in-the-throwing-athlete/

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