By Thomas Scar, Interim Physiotherapist 

Baseball season is upon us and as the weather gets better, young athletes are going to be starting to get out onto local baseball fields to “play ball”. With a new season, comes situations where we want players to be focused on having fun and on the field playing – not on the sidelines injured. 

This article covers: 

• Common reasons for shoulder and elbow injuries in young baseball athletes
• Recommended guidelines from a leading sports medicine doctor in baseball
• A throwing program I have created that gradually progresses, so players can go into their seasons with a base level of throwing capacity

Too Much Pitching, Especially Too Early in The Year

It is always great to get on the mound and start throwing fastballs to your friends and family! The thing is, sometimes individuals are not prepared for the demands of throwing and pitching. Further, when it comes to arm injuries, the risk factor with the strongest correlation to injury is the amount of pitching one does (Fleisig & Andrews, 2012). Makes sense, right?!

In a study by Olsen et. al (2006), the authors demonstrated in a retrospective study of 140 adolescent baseball pitchers (14 to 20 years old) that:

• More than 80 pitches per game almost quadrupled the chance of surgery. 
• Pitching competitively more than 8 months per year increased the odds of surgery by fivefold.
• Most importantly – a pitcher who regularly pitched with their arm fatigued was 36 times as likely to be put into the eventual surgery group. 

None of this is rocket science – all of the concepts above have a common theme: if kids are pitching too much, it may result in injury. 

If you take one thing away from this article, it is that you, your son or daughter needs to be cautious with how often they are pitching and throwing. It can’t be a situation where they are pitching too much, especially when they have arm soreness/fatigue.

The rise in elbow injuries in young pitchers looks to be related to the “extra baseball” era we are in, where more kids want to throw harder and play at higher levels. They are playing year round and not taking time off. I think that it is great that kids want to be the best player possible, it is just at times, we may forget that they can be at risk if they are throwing too much and too often. A lot of the time, more is not always better!

Recommended Guidelines from Dr. James Andrews – the leading surgeon for Ulnar Collateral Ligament injuries.

• “Watch and respond to signs of fatigue (e.g. decreased ball velocity, decreased accuracy, upright trunk during pitching, dropped elbow during pitching, or increased time between pitches). If a youth pitcher complains of fatigue or looks fatigued, rest is recommended.”

• “No overhead throwing of any kind for at least 2 to 3 months per year (4 months is preferred). No competitive baseball pitching for at least 4 months per year.”
  My current considerations for youth athletes is consider taking October to February off of throwing, for example. 

• “Do not pitch more than 100 innings in games in any calendar year.” 

• “Discuss with coaches and athletes regarding pitch counts and having specific days rest after pitching.”
  Below is Baseball Canada’s current recommendations for pitch counts. 

• “Avoid pitching on multiple teams with overlapping seasons.” 

• “Learn good throwing mechanics as soon as possible. The first steps should be (1) basic throwing, (2) fastball pitching, (3) changeup pitching.”
  There are several great instructors and coaches here in the Vancouver area if you feel that you, your son, or daughter needs help with specific throwing mechanics. See the link here to get some help from coaches at UBC: https://recreation.ubc.ca/baseball/youth/spring-summer/

• “Avoid using radar guns.”
   While I think radar guns are a great tool to use at times, I wouldn’t be “married” to velocity in the early teens. At this time, the focus should primarily be on getting the mechanics down and having fun. 

• “A pitcher should not also be a catcher for his team. The pitcher-catcher combination results in many throws and may increase the risk of injury.”

• “If a pitcher complains of pain in his elbow or shoulder, discontinue pitching until evaluated by a sports medicine physician and/or a physical therapist/medical practitioner.”

• “Inspire youth pitchers to have fun playing baseball and other sports. Participation and enjoyment of various physical activities will increase the youth’s athleticism and interest in sports.” 

So it looks like:

A Basic 4 Week Throwing Program:

*Principle guidelines

• If anything hurts, do not continue throwing. Go and see a medical professional!
• If you or your child is already throwing with your/their team a few times a week, consider if you even need to do more throwing (maybe you need less!?).
• This is meant for before a younger player gets onto a mound. So, if someone hasn’t started throwing yet this year, this might be a nice start.

You’re probably wondering about strengthening the arm and shoulder.

This article is not directly about that. I think individuals are all different and often require individualized programs. However, for a general “arm care (shoulder and elbow pre-hab) program” there are great free programs available such as the The Throwers 10. Which you can find here: https://www.ortho.ufl.edu/sites/ortho.ufl.edu/files/handouts/Throwers-Ten.pdf

Wrap Up:

I hope this article was helpful and that you learned something!

I would love feedback, so if you found something that you would like to share with me, please send me an email: tscarrphysio@gmail.com.

Thanks for reading. 

About the writer, Thomas Scarr: I am an Interim physiotherapist and strength and conditioning specialist working at Allan McGavin Sports Medicine in Downtown Vancouver. I help people achieve their goals through exercise prescription, education, manual therapy, and working together as a team! I am the current therapist for UBC Baseball. I also played collegiate baseball, but now I just enjoy exercising and helping people play sports and be active!

References:

Baseball Canada (2018). Official Rules of Baseball Canada Content [Photograph]. Baseball Canada. Retrieved from, https://www.baseball.ca/uploads/files/2018%20Arm%20Smart%20(Pitch%20Count)%20(Eng).pdf

Fleisig, G. & Andrews, J. (2012). Prevention of Elbow Injuries in Youth Baseball Pitchers. Sports Health. Volume 4 , 5. pp. 419-424.

Toulgeout, Dan. (2018). Nat Bailey Stadium named one of the best minor league ballparks [Photograph]. Vancouver Is Awesome.Retrieved from, https://www.vancouverisawesome.com/amp/sports/nat-bailey-stadium-vancouver-best-minor-league-ballparks-1939679

Olsen SJ, Fleisig GS, Dun S, Loftice J, Andrews JR. (2006). Risk factors for shoulder and elbow injuries in adolescent baseball pitchers. Am J Sports Med. 34:905-912.

Pinterest.com. (2021). Baseball Tips [photograph]. Pinterest. Retrieved from, https://www.pinterest.ca/pin/60517188727146004/

Yankees Entertainment and Sports Network (2014, December 19). Dr. James Andrews on the rise of Tommy John surgery [Video]. Youtube. Retrieved from, https://www.youtube.com/watch?v=utqT9EgRUtw