If you’re a baseball fan–whether that means following your favorite Major League team or taking your child to Little League games–you’ve probably noticed that arm injuries have become increasingly common. Generations ago, professional pitchers were generally allowed to keep throwing as long as they were effective on the mound; nobody even bothered tracking how many pitches they had thrown. Meanwhile, young developing players were often taught that “practice makes perfect,” leading some parents to encourage their kids to repetitively fire fastballs and curveballs, day after day, to improve their chances at success in the future.
All this has led us to a strange crossroads in baseball, where serious shoulder and elbow injuries are common and new research and safety protocols are being introduced to try stop the injuries. For some fans, this is confusing because it seems like precautions are actually causing more harm than good. A good example of this is when pro pitchers with limited pitch counts and specialized recovery programs still seem to wind up on the injured list far more often than players from decades past. Rather than looking at how pitchers are handled in the professional ranks, though, many of the answers we’re looking for can probably be found on the Little League fields.
Through most of the 20th century, it was common for young athletes to play multiple sports. It was also common for baseball players to jump between multiple positions on the field. This gave them a greater balance of different types of athletic disciplines and often prevented young pitchers (or quarterbacks in football) from spending too much time overworking their rotator cuffs or elbows. However, over the past couple decades, the idea of “specialization” has become more popular, with parents and coaches guiding a student athlete to embrace one sport (in order to excel at it) and one position (for the same reason). This focused type of training can certainly produce results in the short term, but studies suggest it doesn’t increase an athlete’s odds of making it to the pros. And in the case of baseball pitchers, it may do just the opposite.
According to a 2014 article published by the National Athletic Trainers Association, “There is ample evidence that suggests year-round young pitchers are likely to destroy their elbows,” with MRI scans already able to identify warning signs in many high school pitchers who throw more than 100 pitches per week. “That volume of throwing often leads to pain and swelling in the acromio-clavicular (AC) joint of the shoulder. With rest, the pain and swelling go away in three months. But ultimately, 86 percent of those pitchers who experienced AC pain & swelling ended up with incomplete development of one of the bones that make up the joint, specifically the acromion process of the scapula (shoulder blade).”
That same joint problem greatly increases the odds of a rotator cuff tear down the road, likely explaining why so many young pitchers, including many pitchers at the pro level, end up requiring shoulder surgery. Similar over-use of the ulnar collateral ligament in the elbow often leads to the same result; the elbow procedure famously known to baseball fans as “Tommy John Surgery.”
Another report from the NATA, in 2019, noted that “Youth pitchers are at two to five times greater risk of requiring shoulder or elbow surgery, or ending their baseball career, if they also played catcher, threw more than 80 pitches per game, threw more than 100 innings per year, or threw more than 8 months per year. The most perilous factor for these players, however, was regularly throwing with arm fatigue, which may place them 36 times more at risk of requiring surgery or ending their baseball career.”
As more research has been done, new regulations have been put in place to limit in-game pitch counts for hurlers at every level, including Little League, High School, and College. Managers in the Minors and Majors have put a greater emphasis on protecting their players, as well. The one thing that’s harder to control is how players are taught to train and practice. While it can always seem like working harder and longer will lead to the best results, it’s simply not the case when it comes to throwing a baseball. The intense, unnatural motion can do serious damage over time.
If you have a young ballplayer in your household, be sure you talk to them about managing their throwing time. They should also follow the guidance of trainers when it comes to rest, ice, stretching and other tips for being at their best. To learn more, contact your school trainer or schedule a visit with Dr. Robert Huff, Sports Medicine Director at Southeastern Med (Phone: 740.435.4022).