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Shoulder and Elbow Pain in Youth Baseball Pitchers

Shoulder and Elbow Pain in Youth Baseball Pitchers

It’s that time of year again! The sun is shining, the birds are chirping, and you can hear the sound of the baseball hitting the catcher’s mitt. Teams are getting ready as America’s pastime is starting its season. For young pitchers, this means trying to stay healthy and pain-free throughout the season. With injuries leading to Tommy John’s surgery and Little League Shoulder on the rise, there has been much research into what may be causing shoulder and elbow pain.

Elbow pain has been related to increased age, decreased height, increased body mass index (BMI), number of pitches thrown during a season, arm fatigue, decreased satisfaction of performance, concurrent participation in a weightlifting program, and participation in additional baseball leagues. Shoulder pain is associated with number of pitches thrown in games, number of pitches thrown in a season, pitching with a tired arm, and decreased performance satisfaction.

Overall, about 15% of all pitching appearances result in elbow or shoulder pain, with approximately half of youth baseball pitchers reporting shoulder or elbow pain during a season. Overuse seems to be the overriding factor in the development of joint pain among pitchers in youth baseball. Most baseball arm injuries are not a result of a single traumatic event, but instead are believed to be due to the cumulative effect of microscopic trauma from the repetitive act of pitching. Youth baseball pitchers who pitch more than 8 months out of the year are five times more at risk for injury. Pitchers should not pitch in more than one game per day and should be given the recommended rest days between appearances. Another way to avoid shoulder and elbow pain is to stay away from throwing breaking pitches until an appropriate age.

The slider was found to have the most significant relationship with elbow pain, especially with 13- to 14-year-old pitchers. There is an overall 86% increased risk of elbow pain among slider users. Use of the curveball accounts for 52% increased risk with shoulder pain regardless of age. The dangers of the loads created by these breaking pitches is magnified for the prepubescent athlete because the growth plates in the elbow and shoulder joints are still open and are therefore more susceptible to stress-related injuries. The change-up in its variety of forms has been demonstrated to be a safe pitch for 9- to 14-year-old baseball pitchers and is recommended for this age group instead of the curveball and slider.

To minimize complaints of shoulder and elbow pain, it is recommended that pitchers between 9 and 14 years old do not throw the curveball or slider. These pitchers should use the fastball and change-up exclusively. Baseball organizations may consider limiting pitchers in this age group to 75 pitches in a game and 600 in a season. Baseball pitchers should not be allowed to manipulate pitch limits by participating in more than one league at a time. The recommended pitching limits refer to only full effort, competitive game pitches and do not include warm-up pitches, practice pitches, throwing from other positions, and throwing drills, all of which are vital for a pitcher’s development. Although muscle soreness is normal and necessary in the development of a pitcher, joint pain is not.

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