Monday, November 30, 2015

What you need to know to avoid youth pitching injuries

The pitching motion is the most dynamic motion in sports, and can cause injury even under the best circumstances. Here are some tips to avoid "high-risk"situations for youth pitchers.

What you need to know to avoid youth pitching injuries


Youth pitching injuries have risen dramatically since the early 2000s. The pitching motion is the most dynamic motion in sports. Arm speed (internal rotation) has been recorded at 6900 degrees per second in youth pitchers and higher in older pitchers. That’s the equivalent of spinning your arm in a circle over 19 times in one second.

According to Dr. James Andrews, world renowned orthopedic surgeon, major shoulder and elbow surgeries (including Tommy John surgery) have escalated in 12,13, and 14-year old pitchers. These surgeries previously only occurred in elite college and professional pitchers. Parents, athletes, coaches, and medical providers are looking for ways to protect pitchers and prevent long term injuries. USA baseball, Little League baseball and ASMI have regulated pitches and innings per game, week, and season ( These guidelines, however, still have not reduced injuries and here are a few reasons why.

First, the guidelines need to be understood and followed by youth leagues, coaches, and most importantly parents. Parents need to assure that their child is only pitching for one team at a time. Otherwise, well-meaning coaches will allow a pitcher to pitch without knowing their true work load from both teams. If a pitcher has reached their maximum level of pitches or innings for the day, week, season, the pitcher must be removed from the game. Although many parents do not want to interfere with a coach during a game, insisting that your child be removed is necessary to protect them. If they fractured their arm, parents would not hesitate to act. The cumulative effect of over-pitching is as significant as a fracture, and often takes considerably more time to heal.  

As pitchers age, pitch count recommendations also increase, however most high schools and colleges are not obligated to follow recommendations. Allowing a pitcher to throw 120, 130 and in some cases up to 150 pitches is extremely irresponsible. In my opinion, coaches allowing excessive numbers of pitches during one game or with minimal rest between games are not concerned with that pitcher’s future well-being. Regardless of the desire to win, youth pitchers need to be protected and removed from the game at every level.

Secondly, faulty pitching mechanics leads to injuries. Many injuries can be predicted simply by watching a pitcher throw. When we evaluate an injured pitcher in the clinic, their mechanics are often poor, which significantly increases the stress on the shoulder and elbow. Correcting faulty mechanics often requires changing the pitching motion to a shorter, more compact motion.  Unfortunately, many pitchers do not address their throwing mechanics until after they are injured and some still throw with poor mechanics after they recover.

This occurs from little league to major league baseball (i.e. Steven Strasburg, Mark Prior, etc). Poor motion sometimes create more ball movement or the perception that the ball is being thrown harder; however don’t be deceived by these short term gains, they are not a substitute for long term health. Poor pitching mechanics cause injuries!

Thirdly, throwing curve balls, sliders, etc. at a young age is often a leading factor in injury.  Young pitchers are rarely able to throw curve balls with proper mechanics. The poor mechanics will lead to injury. Pitchers should not throw curveballs/ sliders until they are in high school and should only than throw them if they have excellent fastball and change-up mechanics.

Lastly, year-round sports specialization has led to excessive training for one sport. When that sport is baseball, pitchers are often pitching from March through October and then continue to throw bullpens during the off-season. Experts have recommended that youth pitchers not throw more than 100 innings per season. It is imperative that young athletes take time off to physically and mentally heal and recuperate. Play a different sport, start an off season training program, but do not throw for at least three months.

Pitching is an unnatural movement and under the best circumstances can lead to injury. Taking steps to protect young pitchers from overuse injuries is imperative. Following guidelines, using proper mechanics, and taking time off from pitching will help keep young pitchers healthy and on the mound.

Brian Cammarota is the former Rehabilitation and Minor League Athletic Training Coordinator for the Phillies and has over 15 years of experience working with pitchers for injury prevention and rehabilitation. He is currently a partner at Symetrix Sports Performance and athletic trainer at OAA orthopedics in Allentown.


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Whether you are a weekend warrior, an aging baby boomer, a student athlete or just someone who wants to stay active, this blog is for you. Read about our growing list of expert contributors here.

Tracey Romero Sports Medicine Editor,
J. Ryan Bair, PT, DPT, SCS Founder and Owner of FLASH Sports Physical Therapy, Board Certified in Sports Physical Therapy
Brian Cammarota, ATC, PT, DPT, CSCS Partner at Symetrix Sports Performance
Ellen Casey, MD Physician with Drexel University Sports Medicine
Desirea D. Caucci, PT, DPT, OCS Co-owner of Conshohocken Physical Therapy, Board Certified Orthopedic Clinical Specialist
Michael G. Ciccotti, M.D. Head Team Physician for Phillies & St. Joe's; Rothman Institute
Julie Coté, PT, MPT, OCS, COMT Magee Rehabilitation Hospital
Peter F. DeLuca, M.D. Head Team Physician for Eagles, Head Orthopedic Surgeon for Flyers; Rothman Institute
Joel H. Fish, Ph.D. Director of The Center For Sport Psychology; Sports Psychology Consultant for 76ers & Flyers
R. Robert Franks, D.O. Team Physician for USA Wrestling, Consultant for Phillies; Rothman Institute
Ashley B. Greenblatt, ACE-CPT Certified Personal Trainer, The Sporting Club at The Bellevue
Eugene Hong, MD, CAQSM, FAAFP Team Physician for Drexel, Philadelphia Univ., Saint Joe’s, & U.S. Lacrosse
Brian Maher, BS, CSCS Owner, Philly Personal Training
Julia Mayberry, M.D. Attending Hand & Upper Extremity Surgeon, Main Line Hand Surgery P.C.
Gavin McKay, NASM-CPT Founder/Franchisor, Unite Fitness
Heather Moore, PT, DPT, CKTP Owner of Total Performance Physical Therapy, North Wales and Hatfield, PA
Justin Shaginaw, MPT, ATC Athletic Trainer for US Soccer Federation; Aria 3B Orthopaedic Institute
Thomas Trojian MD, CAQSM, FACSM Chief of the Division of Sports Medicine at Drexel University
Robyn Weisman, ACE-CPT Certified Personal Trainer
Sarah Whitman, MD Sports Psychiatrist in Philadelphia
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