Arm Health and Injury Prevention in Youth Baseball

by Alexander Croog, M.D.

Arm Health and Injury Prevention in Youth Baseball

Whether it be making the youth travel team roster, starting for the varsity team, or hitting a home run, we all want our kids to achieve whatever dreams and goals they have athletically.

In fact, 50% of parents want their children to reach the highest levels of success in baseball by receiving a college scholarship and making it to the Major Leagues. Colleges are becoming more expensive. Admissions are becoming more competitive. And maybe your child’s athletic abilities on the diamond will help further their academic studies.

Yet, according to the NCAA, of all high school athletes, only 6% will go on to play college athletics, with only about one-third of that 6% playing at the Division 1 level. Within the Division 1 population, only 2-3% will play at a professional or Olympic level.

Injuries are just part of the game at the professional level, but the pros have what your children might not have access to.

Strength and conditioning coaches.

Trainers.

Physical therapists.

Nutritionists.

Sports psychologists.

Physicians.

Youth athletes' resources are often limited to their coach and their parents. And unfortunately, the risk for injury for youth athletes is higher than it is for the pros.

In the baseball community, the name Tommy John is renowned. He was a professional baseball player for the Los Angeles Dodgers, and was the first person to undergo a procedure where a tendon from his wrist was used to replace a torn ligament in his elbow. Tommy would go on to pitch another nine seasons in the Major Leagues.

Since that time, that procedure, now known as Tommy John surgery, has been performed to save countless professional baseball players’ careers. It was designed for pro athletes. To have to do Tommy John surgery on a teenager 20 years ago was unheard of. But unfortunately, the need for the procedure in today’s youth athletes is rising.

In 2004, the average age of someone receiving Tommy John surgery was 27. In 2014, the age was 17.

Jumping out of the baseball world for a moment, I recently treated a teenage diver. She competes nationally and has aspirations of reaching the Olympic level. And on a routine dive, she broke her elbow merely from the impact of the water.

How could that happen?

It turns out she actually had been experiencing elbow pain for months prior to the incident, but she did not want to inform her parents, fearing she would not be able to compete. Her surgery was successful, and I expect a full recovery.

But this scenario offers insight into the huge pressure our kids have to perform. They will play through pain and fatigue, and those factors can be tough to identify as a parent.

In a study of 13-year-old baseball players who pitched, 33% admitted to experiencing elbow pain when they throw.

What is specialization?

Specialization is a term that has become popular in recent years as kids are focusing more and more on a singular sport. But kids should be playing more than one sport per year.

A child who specializes in a singular sport is 81% more likely to sustain an injury due to overuse.

The number one risk factor for youth baseball athletes being injured is playing baseball year-round. A study conducted on youth baseball athletes who received Tommy John surgery found that the self-reported period of time-off pitching during a given year was an average of only one week, usually around the holiday season.

It is recommended that baseball players take at least 4 months off from throwing every year, with 2-3 of those months being in succession.

If you would like to read more about specialization, I highly recommend reading Is It Wise to Specialize? by John O’Sullivan.

How does fatigue affect injury risk?

In adolescent pitchers, for example, throwing while fatigued increases risk of injury a staggering 36 times.

Fatigue can be categorized into the following:

  • Event fatigue: playing too much within a particular game.
  • Seasonal fatigue: playing too much throughout a sports season.
  • Year-long fatigue: constant overuse throughout the entire year.

And 2021 is a year like no other. This season, athletes will not be as prepared since many youth sports leagues were cancelled, “real PE classes” weren’t held, and playground sessions were postponed.

The best way to avoid fatigue and fatigue-related injuries is to abide by throwing and pitch count recommendations. Some of them include the following.

  • Do not exceed 100 combined innings pitched in any 12-month period. Exceeding it increases injury risk 3.5 times.
  • A pitcher who delivers more than 40 pitches in a game cannot play the position of catcher for not only the remainder of the game but the entire day.
  • A player who has played the position of catcher for more than 4 innings cannot pitch on that day.
  • If a player has played catcher for 3 innings or less, they may throw 20 pitches but cannot return to the catcher position that day.  .
  • A proper warm up is needed before pitching. Shoulder flexibility and strength is key. Remember, amateur athletes do not possess professional bodies or have the same neuromuscular control.

A common response I hear about these pitch count guidelines is often along the lines of “don’t all kids’ bodies respond differently to fatigue?”

Yes, they do. But these guidelines are in place to protect the most vulnerable youth baseball athletes, and if they can protect that group, they can protect all groups.

Eventually for all youth athletes, fatigue will happen. How can we best monitor for signs of fatigue?

  • Your child complains in passing at home. These moments happen in the kitchen or living room, not on the field. Your kid may express their arm hurts casually in conversation when looking for a snack.
  • Your child needs Motrin or Tylenol to play. It’s really not acceptable to allow our kids to play in pain due to an injury.
  • Your child starts throwing fewer strikes; their throwing velocity decreases; they’re throwing balls in the dirt; or they’re throwing the ball above catcher’s head.

Frequently asked questions

Does icing an elbow have negative effects?

You can over-ice. Anything over 15-20 minutes is too much and will cause more harm than good.

Alternating between ice and heat in combination with anti-inflammatories is what I always recommend.

Does throwing side-arm reduce the risk of injury compared to overhand?

There are no studies or statistics that show any one way is more advantageous than another. Whatever your child’s throwing angle may be, proper pitch mechanics do matter, and a pitching coach will be able to offer greater insight on that front.

Is tendonitis the same thing as pitcher’s elbow/little league elbow?

Children don’t typically get tendonitis. Little league elbow is really a stress fracture in the elbow through the child’s growth plate.

The sign of a stress fracture in the elbow is usually tenderness on the inner side where the elbow pokes out a little. Other areas of the elbow can have tenderness, but that does not necessarily mean there is a stress fracture. Consistent pain on the outside of the elbow is something to keep an eye out for, especially in children aged 12-16.

Are there any breaking-style pitches that children this age can throw without increased risk of injury?

This topic is controversial.  Despite the paucity of evidence that curveballs and breaking pitches are the root cause of adolescent injuries, they certainly follow the “win now” mantra of so many parents and coaches.  Learning these types of pitches from one who truly understands pitching mechanics is key. 

That being said, one good mantra to follow for an adolescent male is “don’t throw a curveball until you can shave.”

When taking a break from baseball, are there other sports our children should avoid playing in order to properly rest their arms?

Anything that involves the same mechanics as a baseball throw is discouraged. For instance, if they want to play football, any position is fine other than quarterback. Serving in tennis has also been found to rely upon the same mechanics.