Risk-Prone Pitching Activities and Injuries in
Youth Baseball: Findings From a National Sample

Jingzhen Yang, Barton J. Mann, Joseph H. Guettler,
Jeffrey R. Dugas, James J. Irrgang, Glenn S. Fleisig and John P. Albright. Am J
Sports Med 2014 42:1456.

Take Home
Message:  Young pitchers who engage in
“risk-prone” pitching activities are more likely to report arm tiredness and
pain, which is related to shoulder and elbow injuries.

Millions of children play youth baseball each year
and many players adopt early sport specialization, which means they are playing long competitive seasons, training year round, and
play in multiple leagues. Unfortunately, many young
baseball players suffer elbow and shoulder injuries. To optimize pitching
recommendations and prevention programs it is important for us to understand
the pitching activities of youth players and how these activities relate to
injuries.  Therefore, Yang and colleagues
surveyed youth pitchers (9 to 18 years of age) to describe 1) “risk-prone” baseball-related activities that do not meet
the American Sports Medicine Institute (ASMI) recommendations, 2) age differences
in reported pitching-related arm problems and injuries, 3) the relationship
between “risk-prone” activities and pitching-related arm problems, and 4) how reported
arm problems relate to pitching-related injuries. In this study, 754 young male
baseball pitchers (along with their parents in some cases) completed questionnaires
provided by their physicians that encompassed multiple pitching facets
including: pitching frequency, pitching volume, pitch type thrown, rest and
recovery, shoulder/elbow problems, treatments, and preventative/protective
care.  The authors identified pitching-related
arm pain as experiencing arm pain while pitching at any point during the
previous 12 months.  The majority of
pitchers (69%) reported experiencing arm tiredness while pitching, 38% experienced
pain within the past 12 months while pitching, and 31% reported having a
pitching-related elbow or shoulder injury in the prior year. The authors
identified the following 7 “risk-prone” activities: 1) > 8 months of
competitive pitching (13% of pitchers), 2) participating in leagues with no
pitch count or innings pitched limits (44% of pitchers), 3) pitching on
multiple teams with season overlap (30% of pitchers), 4) pitching on back-to-back
days (44% of pitchers), 5) pitching in more than 1 game/day (19% of pitchers),
6) playing catcher when not pitching (10% of pitchers), and 7) playing baseball
12 months/year at the exclusion of other sports (31% of pitchers).  Pitchers who pitched on back-to-back days
were more than 4 times as likely to experience arm tiredness and more than 2.5
times as likely to experience pain while throwing.  The pitchers who played and pitched on
multiple teams during the same season were also more than 3 times as likely to
experience arm tiredness and had 85% greater odds to experience
pitching-related arm pain.  Pitchers who
threw curve balls were 66% more likely to experience arm pain than pitchers who
did not throw curveballs; however, the authors found no relationship between
arm pain and throwing sliders or sinkers. When compared to pitchers that never
experience arm tiredness or pain, pitchers who often pitched with arm tiredness
or arm pain were almost 7.5 to 8 times more likely to report a recent shoulder
or elbow injury. 

While the findings in this study might seem relatively
straightforward because arm fatigue, pain, and injury seem to go together, the
simple fact is that more studies like this are going to be warranted in the
future.  It is important to note that
this study was a survey that captured activities, injuries, and symptoms over
the past year. Therefore, we are unable to verify that fatigue and pain caused
the injuries or if the injuries led to pitching with fatigue and pain. This
study is an important advancement in our knowledge because most previous
studies have relied upon biomechanical analysis. Having a handle on a child’s
pitching volume is going to be crucial to understanding injury patterns and
prevention.  It is beneficial for us to
have this data regarding risky baseball activities because it can help us
educate our players and coaches as well as help us develop injury prevention
programs.  Furthermore, it appears that
there is a lot of work that will need to be done in terms of educating parents about the pitfalls and perils of early sport specialization, and that taking a long-term approach to athletic development is not only the best route for athletic prowess, but,
more importantly, a better approach for the child’s physical health. 

for Discussion: Were you surprised by any of the findings in this study?  Are you surprised at the number of athletes
participating in the “risk-prone” activities, if so which ones?  Do you believe the odds simply confirm what
many clinicians have known anecdotally all along?  What advice do you give your young throwers
and their parents about keeping their arm healthy throughout the year?

Written By: Mark Rice
Reviewed By: Jeffrey Driban

Related Posts:

Yang, J., Mann, B., Guettler, J., Dugas, J., Irrgang, J., Fleisig, G., & Albright, J. (2014). Risk-Prone Pitching Activities and Injuries in Youth Baseball: Findings From a National Sample The American Journal of Sports Medicine, 42 (6), 1456-1463 DOI: 10.1177/0363546514524699