Gregor Wenig, SPT
Spring is here and warmer temperatures are on the way, which means baseball season is almost here! Youth baseball, commonly known as Little League, is an excellent way for kids to get outside and be active during the spring and summer months. Baseball is a great sport for kids to participate in as it allows them to be physically active, engage with their peers, and learn the importance of teamwork. One of the few downsides to participation in baseball is the risk for throwing injuries, especially in kids that decide to pitch. However, as more statistics and information have become available, more measures have been taken in an attempt to prevent these injuries.
Overuse injuries of the shoulder and elbow are not uncommon, especially in youth and adolescent baseball pitchers. One of the most common throwing injuries at the elbow is medial epicondylitis, which is often referred to as little leaguer’s elbow. When somebody has medial epicondylitis, they will typically feel pain or soreness at the inside of the elbow that increases with wrist movement and gripping. These symptoms will increase with throwing or pitching as well.
Also associated with little leaguer’s elbow, is damage to the ulnar collateral ligament (UCL). The UCL is a ligament located at the inner elbow that helps connect the upper arm to the forearm. If the UCL is damaged, the athlete will notice localized pain at the inner aspect of the elbow, especially with throwing or pitching.
Another common throwing injury is little leaguer's shoulder, which is damage to the upper arm bone (humerus) at the growth plate near the shoulder joint. Stress placed on the growth plate during excessive throwing and pitching, especially in adolescent athletes who are still growing, makes this a more common injury in Little Leaguers. With this injury, athletes will complain of pain at the shoulder joint that can be present at rest, but increases significantly with throwing. Athletes will typically notice a significant drop off in throwing velocity with this condition.
For each of these injuries, if signs and symptoms are recognized early; athletes will typically feel better with rest and some time away from competitive pitching. Some athletes may benefit from a rehabilitation program guided by an appropriate health care professional such as an Athletic Trainer or Physical Therapist. If athletes attempt to push through the pain, they may cause further damage to their injury that might need to ultimately be repaired with surgical intervention.
Research has shown that adolescent baseball players who sustain pitching injuries throw more months per year, games per year, innings per game, pitches per game, pitches per year, and warm-up pitches before a game, compared to players without pitching injuries. Due to this, Little League has implemented specific pitch counts and rest requirements for pitchers. Below are the most up to date pitch count and rest requirement guidelines implemented by Little League. These are guidelines that should be followed by all youth baseball leagues across the country.
| Age | Max # of pitches per day |
|---|---|
| 13-16 | 95 pitches |
| 11-12 | 85 pitches |
| 9-10 | 75 pitches |
| 7-8 | 50 pitches |
Rest Requirements:
Pitchers age 14 and under must adhere to the following rest requirements:
- If a player pitches 66 or more pitches in a day, 4 calendar days of rest must be observed
- If a player pitches 51-65 or more pitches in a day, 3 calendar days of rest must be observed
- If a player pitches 36-50 or more pitches in a day, 2 calendar days of rest must be observed
- If a player pitches 21-35 or more pitches in a day, 1 calendar days of rest must be observed
- If a player pitches 1-20 or more pitches in a day, 0 calendar days of rest must be observed
Pitchers age 15-16 must adhere to the following rest requirements:
- If a player pitches 76 or more pitches in a day, 4 calendar days of rest must be observed
- If a player pitches 61-75 or more pitches in a day, 3 calendar days of rest must be observed
- If a player pitches 46-60 or more pitches in a day, 2 calendar days of rest must be observed
- If a player pitches 31-45 or more pitches in a day, 1 calendar days of rest must be observed
- If a player pitches 1-30 or more pitches in a day, 0 calendar days of rest must be observed
Now one may ask, what exactly do you mean by rest? Can Braiden still play catch with mom or dad in the backyard? What if Austin plays in multiple leagues? What if Addy wants to play a pickup game with her friends? The answer to these questions can be complicated, but here are some guidelines that might help. During these rest periods, a pitcher should avoid any high intensity, game-like pitching. This means that they may still do some light throwing between games. Actually, light throwing between games is encouraged, but it must be done in moderation! Young athletes should still be allowed to play catch with mom, dad, or their friends but need to understand that it is important they are able to do so pain free. If the athlete plays in multiple leagues, they should still follow these guidelines. If a pitcher pitches one day, they should not pitch in a game the next day, even if it is a different league. It is important for these young athletes to understand that resting will help prevent injuries that could sideline them in the future!
Outside of pitch counts and rest requirements there are a few other factors to consider that should help reduce the likelihood of injury. The following tips may not be as measurable as pitch counts and rest requirements, but are important things to consider:
1. Look for signs of fatigue – Just because a child has not thrown the maximum number of pitches allowed by the pitch count, they should not keep throwing if they are fatigued. Common signs of fatigue include throwing with less velocity, consistently missing high in the strike zone and relying less on the lower body and more on the upper body to throw.
2. Do NOT pitch through pain – If a child is reporting any type of pain or discomfort while pitching, use common sense and remove the player from the mound. Many kids may try and pitch through pain, because they think it is normal. Therefore, be sure there is a strong line of communication with the young athletes about how they are feeling during the course of a game or practice.
3. Teach young pitchers how to throw – Poor throwing mechanics might increase the likelihood of shoulder and elbow injuries. Be sure that young athletes understand how to use their trunk and lower body during pitching. If a pitcher does not use their entire body to pitch, they will likely put too much stress on the shoulder and elbow.
4. Avoid pitching and catching – Try to avoid letting an athlete play the pitcher and catcher positions. As a catcher, you are required to throw, just as much as the pitcher. For a player that pitches and catches, it is difficult to get the appropriate amount of rest required following a game or practice of pitching.
Resources
Olsen, Samuel J., et al. "Risk factors for shoulder and elbow injuries in adolescent baseball pitchers." The American Journal of Sports Medicine 34.6 (2006): 905-912.
http://www.littleleague.org/learn/rules/pitch-count.htm