Now that school is out and summer is upon us, baseball is on the minds of many families while preventing injuries is always on my mind. Young pitchers are looking to gain an edge on their fellow competitors and some fall victim to injuries in their quest to be the next Nolan Ryan. Elbow pain is common in young pitchers with a recent study citing that nearly 26% of children ages 9-12 experience elbow pain during the season (1). “Little League Elbow” is used to describe pain along the medial (inside portion of the) elbow due to repetitive stress or overuse. Little League Elbow can ultimately result in avulsion fractures, Ulnar collateral ligament injuries (what Tommy John’s surgery repairs) or tendonitis. It is most common in pitchers 9 – 14 years old due to the non-closure of the growth plates in the arm and forearm bones. The growth plates along the medial elbow are closed on average around 15 years of age (2).
The most common cause of this injury is poor throwing mechanics, poor core and shoulder stability, muscle imbalances or just too many pitches. Little League Baseball Inc. and well know sports surgeon Dr. James Andrews have taken measures in an attempt to decrease the number of injuries by enforcing a pitch count. I have listed two charts describing what the new pitch count restrictions are based on age and the number of pitches thrown. These restrictions are only for Little League Baseball, Inc. and do not apply to USA Baseball leagues. USA Baseball is looking into having restrictions but currently is only making recommendations to their players, parents and coaches on pitch counts, rest days and types of pitches to be thrown.
Pitch count restrictions, based on age:
For pitchers 17-18: 105 pitches
For pitchers 13-16: 95 pitches
For pitchers 11-12: 85 pitches
For pitchers 10 and under: 75 pitches
Pitchers league ages 7 through 16 must adhere to the following rest requirements:
If a player pitches 61 or more pitches in a day, three (3) calendar days of rest must be observed.
If a player pitches 41-60 pitches in a day, two (2) calendar days of rest must be observed.
If a player pitches 21-40 pitches in a day, one (1) calendar day of rest must be observed.
If a player pitches 1-20 pitches in a day, no calendar day of rest is required before pitching again.
Pitchers league age 17-18 must adhere to the following rest requirements:
If a player pitches 76 or more pitches in a day, three (3) calendar days of rest must be observed.
If a player pitches 51-75 pitches in a day, two (2) calendar days of rest must be observed.
If a player pitches 26-50 pitches in a day, one (1) calendar day of rest must be observed.
If a player pitches 1-25 pitches in a day, no calendar day of rest is required before pitching again.
Our goal in managing sports injuries is to assess, diagnose, proper treatment and prevent future injuries. Pitching is a whole body activity so when assessing these injuries you have to look at ALL of the joints and muscles from the foot to the hand – this is commonly referred to as “Evaluation of the Kinetic Chain”. Just as in a chain, it is only as strong as its weakest link. Once you determine the weak link and make it stronger you make the entire chain stronger. Commonly in pitchers with “Little League Elbow”, they are over-compensating and too much stress is placed on their elbow, and that is why the injury occurs.
Hopefully this article sheds some light on what healthcare professionals and youth baseball organizations are doing to limit injuries in children. For more information please feel free to visit our website at www.imsjc.com or call 615-302-4747.
1.) Lyman, S., Fleisig, G., Andrews, J., et al; “Longitudinal study of elbow and shoulder pain in youth baseball pitchers”. Medicine & Science in Sports & Exercises, May 2001.
2.) Bradley, JP. Upper extremity: Elbow injuries in children and adolescents. Pediatric and Adolescent Sports Medicine. Vol.3. 1994: 242-61.