Most youth baseball organizations today limit pitch counts or require days of rest after a young pitcher’s stint on the mound — or both. And that’s a good thing. Medical research has shown that these rules are a safe way to protect the arms of these young players.

“Kids who start pitching who are not fully grown put tremendous stress on their shoulders and elbows,” says Gary Calabrese, PT, DPT, Senior Director of Rehabilitation and Sports Therapy. This can lead to a variety of physical problems, says Mr. Calabrese, who is a doctor of physical therapy and specializes in rehabilitation.

Common medical issues for young pitchers

Little League elbow and Little League shoulder are common problems among adolescent athletes. Other common injuries or issues that affect young pitchers include:

  • Growth-plate fractures — Widening of the important growth plate at the ends of bones in the arms.
  • Shoulder instability — An unstable shoulder bone can destabilize the shoulder and increase the risk of pain with a subluxed shoulder.
  • Rotator cuff problems — Repetitive overhead motion can cause inflammation of the cord-like tendons that enclose the shoulder (tendonitis) or the fluid-filled sacs that lubricate/protect the shoulder (bursitis). The swelling can cause painful shoulder impingement that frays and irritates the rotator cuff. A torn rotator cuff is often called pitcher’s shoulder, but is uncommon in youth pitchers.
  • Ulnar collateral ligament injury — A tear in the ligament on the inside of the elbow.

“Kids usually experience shoulder or elbow pain for one of three reasons,” Mr. Calabrese says. “Their pitch count is too high, they didn’t rest enough between pitching sessions, or their pitching mechanics are inadequate.”

Guidelines to safeguard young pitchers

Fortunately, Little League International, Pony Baseball, Babe Ruth/Ripken Baseball, Dixie Youth League, American Legion Baseball and other youth organizations have implemented rules that limit pitching to prevent these kind of overuse injuries. Many of these rules follow USA Baseball’s Pitch Smart guidelines and limit the number of pitches during a game or require several days of rest between appearances on the mound.

“Injuries to the growth-plate region of the bones in the shoulder and elbow can be prevented with proper adherence to pitching guidelines and review of proper pitch mechanics,” Mr. Calabrese says.

A pitch count controls the overuse stresses that accumulate over time in young pitchers, Mr. Calabrese says. Mandating rest periods between games allows the body an appropriate recovery period between pitching sessions.

“If a player wants to get better, the only way to improve, with regard to performance or training, is to have adequate recovery, and these guidelines allow that,” he says.

Other ways to prevent injury

There are other strategies a player can use to avoid injuries aside from limiting pitches and proper intervals between games.

Proper warm up before an outing is critical. A warm-up should begin with a light jog, followed by functional movements such as side shuffles or a high knee run, in addition to trunk rotation and upper extremity stretches.

Watch that windup

General soreness is not uncommon in young pitchers. However, “if an athlete experiences more pain than the usual muscle soreness, or if sharp pain occurs while throwing the ball hard, it’s time to see the doctor,” Mr. Calabrese says.

Reviewing the young pitcher’s throwing mechanics also is important, and while the coach can be a good source of advice, professional, medical-based help also is available to improve performance and keep the athlete injury-free.

A good sports performance program offers customized video analysis of pitching motion, with specific drills that address each athlete’s deficiencies, functional training and conditioning, and should offer injury prevention and rehabilitation for young pitchers in baseball and softball, Mr. Calabrese says.

Each injury is unique and should be treated as such by a sports medicine professional, he says.

“The key is addressing each injury individually,” he says. “No two injuries are the same.”


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