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Your Arm Hurts? Thank Your Little League, AAU, and Fall Ball Coaches.Written on April 26, 2011 at 8:06 am, by Eric Cressey I have a policy when it comes to my writing: If something is going to be controversial and potentially elicit a negative response from my readers, I “sit” on the topic for 24 hours. During that time, I weigh the decision of whether me publicly writing about something is for the better good – meaning that it’ll help people in the long-term even if it makes them recognize that they’ve been goofing up in the short-term. I did some thinking on that front last night (actually, for the past several nights), and decided to go through with this blog, as I feel like it’s something that every single baseball player, parent, and especially coach ought to read. So, if you’re in one of those categories – or are just a baseball fan who loves the game – please spread the word on what you’re about to read, whether it’s with a Facebook “recommend,” “Tweet,” or just a friendly email with the link to this article. If you’ve perused my Baseball Content page much in the past, you’ll know that I don’t try to hide the fact that throwing a baseball is an incredibly unnatural and flat-out dangerous motion. It’s the single-fastest motion in all of sports, and every day, physically unprepared athletes go out and essentially play with fire every single time they try to light up a radar gun – or even just play catch.
Not surprisingly, when you mix physically unprepared bodies with arguably the most dangerous sporting challenge on the planet (the folks in Pamplona, Spain might argue with me, but that’s a blog for another day), athletes get hurt. Arm injuries (like all youth sports injuries) are rising exponentially thanks to not “less athletic athletes” taking part in high-risk sports, but also this participation taking place at all-time high rates thanks to the proliferation of little league all-star teams, AAU teams, fall ball, private pitching instruction, and the baseball showcase industry. A fantastic study by Olsen et al. in 2006 (must-read for anyone involved in baseball development) clearly demonstrated strong associations between injuries requiring surgery and pitching “more months per year, games per year, innings per game, pitches per game, pitches per year, and warm-up pitches before a game” as well as showcase appearances during adolescence. The message was very clear: throw too much – especially at a young age – and you’re going to wind up hurt.
Unfortunately, though, many people glaze over numbers in studies (if they ever read them), and while they may walk away with the “overuse is bad” message, they don’t appreciate what true overuse really is – especially since it’s age-dependent. Fortunately, a February 2011 study from Fleisig et al. showed in no uncertain terms that, in ages 9-14, throwing more than 100 innings per year was associated with a 3.5 times higher risk of elbow or shoulder surgery – or retirement altogether. To put this into context, I’ll first ask you: do you realize how challenging it is to throw 100 innings in a little league season? Let’s say you start baseball the first week of April (little league) and even manage to play on a summer team that runs through the end of July. That’s a four month season: exactly what I was accustomed to growing up – at the absolute most. Conveniently right now, we are almost exactly through a month of the major league season – and Jon Lester leads my team of choice, the Boston Red Sox, with 31.1 innings pitched. In other words, at this point in time, a high-performance, skeletally mature pitcher (with no history of arm troubles) in the most elite baseball league in the world is on pace for roughly 130 innings pitched over the first four months of the year. However, there are parents and coaches out there that actually think it’s okay to send an 11-year old out there for a comparable number of innings? It’s especially troublesome when you realize that younger kids always throw more pitches per inning than their older counterparts, as they don’t have good command and insist on trying to strike everyone out instead of pitching to contact here and there.
Just think about how hard that is to do. Lester throws on a five-day rotation, and Little league games are, at most, twice a week. If a kid pitches once a week for four months, even if he throws complete games every time out (not something I’d advise, for the record), he’d still struggle to hit 100 innings (16 starts x 7 inning games =112 innings). Rats! It’s actually tough to overuse kids when the season is kept in check. So, instead, they add seasons. Join an AAU team (or seven of them). Play fall ball so that you can rack up another seven innings every weekend. Be sure to hit up a few college camps on Saturdays and throw as hard as you can so that your Sunday outing in 25-degree weather is extra miserable. Make sure you see your pitching coach for bullpens as soon as fall ball ends. Get your registration in early for that showcase that’s taking place the first week in January. Just do some band work and a couple of half-ass stretches and you’ll be fine. Riiiight….good thinking.
At risk of sounding arrogant, I’m good at what I do. I’ve devoted my life to keeping baseball players healthy. They comprise 85% of our clientele at Cressey Performance, and I work with millions of dollars of arms every off-season and see players from ages 9 to 50+. I do my best to surround myself with the smartest people in strength and conditioning, rehabilitation, and skill-specific training in and outside of the game. I managed the first subpectoral biceps tenodesis in major league history. I can talk mechanics with the best pitching coaches around, write strength and conditioning and throwing programs, manually stretch guys, you name it. I’ve got two fantastic therapists in my office to do massage, ART, Graston, chiropractic adjustments, and a host of other manual therapy approaches – not to mention a great physical therapist nearby who can handle all our complex cases. You know the only things I, we, or anybody on this planet can’t control? Poor judgment by athletes and their parents and coaches. And that – no doubt about it – is the primary reason that kids get hurt. We can do all the strength training, mobility work, and soft tissue treatments in the world and it won’t matter if they’re overused – because I’m just not smart enough to have figured out how to go back in time and change history. Worried about whether they’re throwing curveballs, or if their mechanics are perfect? It won’t matter if they’ve already accumulated too many innings. While athletes might be playing with fire each time they throw, the pain presentation pattern is different. You burn your hand, and you know instantly. Pitching injuries take time to come about. Maybe you do microscopic damage to your ulnar collateral ligament each time you throw – and then come back and pitch again before it’s had time to fully regenerate. Or, maybe you ignore the shoulder internal rotation deficit and scapular dyskinesis you’ve got and it gets worse and worse for years – until you’re finally on the surgeon’s table for a labral and/or rotator cuff repair. These issues might be managed conservatively if painful during the teenage years (or go undetected if no pain is present) – but once a kid hits age 18 or 19, it seems to automatically become “socially acceptable” to do an elbow or shoulder surgery.
Of course, this isn’t just applicable to coaches in the 9-14 age group. You see “criminal” pitch counts in the high school and collegiate ranks as well, and while they may be more physically mature than the 9-14 year-olds, that doesn’t mean that they’re exempt from the short- and long-term consequences. This is why we need the best coaches at the youngest levels. It’s also why we need pitching coaches that understand “managing pitchers” as much as – if not more than – teaching pitching mechanics. And, it’s why coaches need to understand the big picture in terms of what different kids can do at different ages, at different times in the year. It’s also while parents need to be proactive with their young pitchers. If a coach isn’t going to track his innings – and a 9-year-old kid certainly can’t be expected to do so – the parent needs to step up and do so. I’ve met a lot of parents of kids who have been injured at ages 17-21, and most of them look back with a lot of anger toward coaches at younger levels for overusing their sons. Hindsight is always 20/20, but foresight is what saves an arm. Don’t be afraid to step up and say something, as you aren’t telling a coach how to do his job; you’re protecting your kid, just as you would be locking the door at night or making sure he brushes his teeth.
In terms of planning the competitive year, I have no problem with a 9-14 year-old kid playing baseball 4-5 months of the year, as the other 7-8 months per year should be devoted to at least two other sports. It’s basically the “rule of thirds” for long-term athletic development: three sports, four months apiece. Kids can strength-train year round. At ages 15-16, I’m fine with kids changing things up and going to only two sports. Baseball might occupy 7-8 months, but a big chunk of that should be focused on preparation. So, a kid might start playing catch in November, start his high school season in March, and then play summer ball through the end of July. August through November would be devoted to a fall sport and fall ball would be altogether omitted, as it was the only idea worse than making Rocky V. Kids would, of course, strength-train year-round. At ages 17 and up, it’s fine with me if you want to specialize in baseball, but that doesn’t mean you should play year-round. I actually advocate kids only throw for 8-9 months of the year (at most) – which is right on par with what most professional players do. The only thing that’d be different is that the season would be shifted up a bit in the year, as the high school season usually starts a few weeks before the professional season. Pro guys get half of October, then all November and December off from throwing. “Specialized” high school players get August, September, and October off (again, because fall ball is as useful as a trap door in a lifeboat). Strength training is year-round. You’ll notice that there isn’t a single penny spent on off-season baseball showcases. That wasn’t an accidental omission (read here why I don’t like them). If you insist on going to one, pick one between June and early August. I’m convinced that the next big thing in Major League Baseball’s “scouting revolution” is meticulously analyzing what players did when they were younger. If they are going to draft kids, they want to know that they haven’t been overworked for years prior to entering professional baseball. You’re already seeing this taking place in collegiate baseball based more on an assumption: pitchers from the North are getting more and more opportunities to play down South because coaches recruit them (beyond just talent) under the assumption that they’ve accumulated less wear and tear on their arms. This piece might have ruffled some feathers. Kids want to play year-round. Parents want to make kids happy – and they enjoy watching them play. You know what else? Kids love chocolate, and parents want to see kids happy – but that doesn’t mean that kids should get a limitless amount of chocolate to consume, right? You put away the Easter candy this week to stress moderation and look out for their long-term well-being. Coaches enjoy coaching and want to win – and they may take a commentary like this personally because they’re the ones who sent a 9-year-old out for 120 innings one year – and now he’s the one having the elbow surgery. Or, maybe it’s the college coach who let a kid throw 160 pitches in a game and killed his draft status because teams know he’ll have a shoulder surgery in three years. Admitting you’re wrong is hard enough, but admitting you’re wrong and learning from that mistake to help future kids is even harder – but all the more rewarding. This post wasn’t intended to make anyone feel bad, but bring to light an issue (throwing volume) that I think is the absolute most important consideration when taking care of arms. We can do everything right in terms of physical preparation, but if you throw too much – especially at vulnerable ages – none of it matters. Again, if you could help spread the word on this, I’d really appreciate it. And, feel free to comment below; I’m here to help. Sign-up Today for our FREE Baseball Newsletter and Receive a Copy of the Exact Stretches used by Cressey Performance Pitchers after they Throw! 90 Responses to “Your Arm Hurts? Thank Your Little League, AAU, and Fall Ball Coaches.”Leave a Reply |
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April 26th, 2011 at 8:17 am
Awesome article Eric,
I couldn’t agree with you more. I deal with a lot of parents who think that the best way to make their son into the next superstar is to have them play baseball all year around at a very young age, just like you mentioned.
Its very hard to explain to them that it is in the best interest of their son to play as many sports as possible when their young and to NOT specialize in baseball.
I think this is a much needed article in the baseball community, thank you EC!
April 26th, 2011 at 8:42 am
Well said Eric!
Once saw a 14 year old swimmer with a partial thickness rotator cuff tear.
The pressure some parents and coaches place on young athletes seems to approach abuse at times.
April 26th, 2011 at 8:49 am
Thanks, Eric. Keep speaking up–people need to know this!
April 26th, 2011 at 9:03 am
WOW! Who knew. Thank you so much for being brave enough to let this article out (even though you knew you would ruffle feathers)!
April 26th, 2011 at 9:03 am
Great article. I think you should add high school coaches to your list of suspects, because they are notorious for over-pitching and most do not have an effective system in place for managing the arm care of their pitchers in between starts.
April 26th, 2011 at 9:18 am
Was so pissed off at a coach recently I wrote a little article http://www.pfafit.com/expertadvice.html ,
He Pitched a 13 year old 4 times in meaningless games in one weekend at a 60.6 distance field. Total of 9 innings over two days for a kid who just turned 13!!!
that didnt make him very happy.
April 26th, 2011 at 9:24 am
Great article, Eric. The fact that its even necessary is a sad commentary on our fame/success obssesed culture. You’d think this would be common sense, though I am beginning to doubt there is such a thing!
April 26th, 2011 at 9:32 am
Nice piece. It reinforces the stat that most major league pitchers were position players during the bulk of their developmental years: learning whole the game AND saving their arms. Specialization is the death of all sports ameteur. I will be forwarding this on to the players I work with as it will be their generation that will have to change the culture of the game to save it.
April 26th, 2011 at 9:38 am
Eric, several years ago I wrote a similar article, it was picked up by several news organizations here on the west coast. It wasn’t a large article but it was too the point. I emphasized the problems of not only overuse injuries but also parents and coaches who have delusions of grandeur about their kids and teaching them to throw junk balls at such a young age. At one time within a 3 year period, I had 4 Tommy John post rehab clients with ages between 15-19. My findings were backed by the Orthos at the Curland-Jobe clinic. I submitted my article with findings to the USSSA and even with the backing of the orthos, they flat out rejected it.
April 26th, 2011 at 9:44 am
E-Great article. This isn’t just a baseball problem. We see this a lot in hockey too; it’s just a different list of injuries that manifests. We have some kids that play 8 games in any given week. They play for a club team, school team, and showcase team. Adductor/hip flexor “tweaks” turns into “nagging tweaks” turns into chronic strains, turns into surgeries. I think the underlying message in your article is that parents and coaches need to educate themselves on the long-term consequences of certain actions and have the foresight to make short-term decisions based on the best interest of the athlete (which isn’t always the best interest of the team). These decisions aren’t always popular, but that doesn’t make them wrong.
April 26th, 2011 at 9:48 am
AWESOME article Eric. Same thing going on with knee injuries in the population I serve which is soccer players. There is a reason youth injuries are called the Silent Injury – we don’t pay attention until we are forced to pay attention. It is sad we often treat our cars better (mainentence program) than we treat young athlete’s bodies.
I hope this opens up eyes and gets in front of the eyes who need it most – coaches and parents. Thanks for the honest article.
April 26th, 2011 at 10:29 am
It is not just the parents and the coaches. I see this also with the league organizations at the 7-12 yr old level for both baseball and softball.
With one LL I am familiar with there is an unwritten rule that kids must participate in league play, travel team play, fall ball, and seminars. Parents are not allowed to schedule vacations in the summer/fall months.
Parents and kids know that they have to commit (basically exclusively) if they want to play on the all star teams.
There is no GPP, little down time, or consideration given to other sports.
April 26th, 2011 at 10:39 am
Very well said, many neglect this issue because it is more of a selfish cause, whether it be the w or just the game. Overuse makes players also think they are impervious to injury and beleve they can perform at the same consistency.. They is a natural balance between overuse and recovery phase.. The fact our body actually has the ability to regenerate itself after exhaustion and overuse is amazing.. And this is an issue that may have to be acknowledged in the near future.. Not just for the athlete but the sport an the development of both
April 26th, 2011 at 10:47 am
Eric-Great post. Your preaching to the choir with me. I work with and I am around young baseball players all the time. My facility is in the same space as an indoor baseball facility. I wish more parents and coaches would read this. I see young kids playing more games in a shorter amount of time than pro players. Unfortunately, the kids do nothing else in terms of free play to help themselves get stronger and move better. It’s only baseball and video games, and then parents wonder why their kids get injuries. I also see many high school players who just pitch, which I can’t figure out. I’ve dealt with parents who tell me their kid is coming off an injury and ask if I can work with them. After an evaluation, I’ll tell the parents, have your kid learn to play another position. Problem is, a lot of kids now lack the athletic ability to play an other position. They can’t hit, or run. Again, great article
April 26th, 2011 at 11:11 am
Ditto Eric. Too many “coaches” in little league never consider pitch count unless its a league rule. “Aw he’s a kid he can play all day…we used to play all day every day”. As I have said leagues need to restrict a pitcher from moving to infield or catcher when he comes off the mound. Got to keep the best athletes on the field and win that special T-shirt. Bragging rights at the plant are more important at the time….
April 26th, 2011 at 11:42 am
Dave-Great point. One of the problems we see is that the kids we train that are multi-sport athletes are getting pushed by their coaches into “pseudo-mandatory” year-round playing in every sport. Every coach has their own tournament team/development camp/whatever, so no sport has a distinct, complete off-season. The result is year-round playing in multiple sports, and the cessation of both complete rest periods and pure preparation periods. No wonder every high school athlete that comes to us is either in pain, injured, or near-threshold.
April 26th, 2011 at 12:36 pm
Amen, amen, amen! While individual leagues have made great strides in recent years regarding limits on innings and pitch counts, it is up to the players and coaches to deal with multiple teams and leagues.
Playing AAU, Babe Ruth and Varsity baseball means you have three teams who want you to pitch, and three teams you ‘let down’ if you don’t because you pitched elsewhere. That’s pressure most teens can’t handle, and end up with a sore and eventually injured arm.
As for Little League? With the new pitch count rules in effect, it’s hard to overuse a kid, unless they are playing AAU. The real crime is the coach who insists on his pitcher throwing a curve ball over and over with horrible mechanics, just to win a game.
Little League now has a rule governing catchers pitching and vice versa. If you pitch more than 40 pitches, you can’t catch the remainder of the game. If you catch more than three innings, you can’t go pitch.
April 26th, 2011 at 12:49 pm
Very well said….. a lot of the concern was based on the unnatural motion of a baseball pitch. Do your concerns also pertain to fast-pitch softball motion?
April 26th, 2011 at 1:04 pm
Eric – Did either study mention anything about the mechanics of the players involved? Was video a component of either study in any way?
April 26th, 2011 at 2:03 pm
Eric,
Well done as usual. It would be great if you could post another as it relates to hockey. I would certainly forward it on. I”m sure today’s magnitude of hip/groin/abdominal issues are a direct result of year round hockey. The hockey world might be as crazy as the baseball world.
Jeff
April 26th, 2011 at 2:24 pm
Great article. It’s even worse in the world of fast-pitch softball. Coaches think nothing of having your 10 yr old daughter pitch 2 or more games in the same day. It’s crazy and no matter how many people say “softball pitching” is a natural arm movement… you throw your arm in that “natural movement” for 100s of times in a day and see what gives. Undoubtly it’s the girl’s shoulder. Parents need to be watch-dogs for their kids. Educate yourself and be prepared to stand-up for your kids well-being.
April 26th, 2011 at 2:31 pm
Good article but hope you can think about the following:
1. young ballplayers DON’T throw too much, they pitch too much. In fact they don’t throw enough. They throw 10+ pitches too many at max effort down a mound (increases stress loads) and then don’t really throw again until they go back top the mound 2-3 days later.
2. when they throw they most young players throw without a proper warmup. Pro players warmup to throw they don’t throw to warmup.
3. proper throwing mechanics are critical this is why youth coaches should focus on minutes 10-20 of their practices(after a 10 minute dynamic warmup not a slow jog around the field) on players throwing mechanics. This is the most important time in all of practice for the youth coach to be most focused.
Hope you can do a future article for the father/coach who is looking for guidance on how to run a healthy practice.
April 26th, 2011 at 2:35 pm
Thank you very much for this article. I plan to read the studies you cite and share with other coaches. As a coach, I aim to provide a fun environment and develop and guide young people, not expose them to greater risk of injury. A friend of mine who is still the best high school pitcher I have ever seen got hurt his senior year from being over pitched, had multiple surgeries and was never the same.
I agree that playing other sports is best–kids learn different things in each sport and it keeps things fun.
Question: Is pitching the only issue of concern with off-season baseball, or do we also need to worry about increased risk from batting and fielding practice? Is the short answer “just stop baseball altogether” or are there elements that are OK to do in the off-season?
Thanks so much!
April 26th, 2011 at 3:16 pm
The biggest issue with ALL shoulder and elbow injuries especially at any age and level of baseball is the lack of scapular control.
April 26th, 2011 at 4:43 pm
It’s even worst in Japan. Here it’s normal to have kids pitch everyday!! In High School, a pitcher pitches 9 innings… And it goes on and on if the game goes extra innings. Something has to go very wrong to change a pitcher during the game.
April 26th, 2011 at 5:05 pm
Good read Eric. Having the opportunity to work with both high school baseball players and softball players, I deal with guys and aching shoulders/elbows but I see more female fast-pitch players that come with shoulder/arm complaints once they start throwing inside, weeks before they get outside. Then, after a few weeks of this then they come in looking for some “lifting” program which is often mobility, movement training, strength training and flexibility. Surprising enough for them, how difficult the training seems to be before we even have a chance to focus on strength and stabilization training for the core and scapula complex.
April 26th, 2011 at 7:28 pm
Thank you so much for this! As my own kids come up into sports, this is an important subject. My 15-year old son plays high school baseball and this definitely hits home.
I also was a fast pitch softball pitcher for 7 years. I was rarely switched out of a game and pitched 2 games a week for 7-8 innings.
I spent my fair share of time in physical therapy and rehab for my shoulder.
April 26th, 2011 at 7:38 pm
can you provide citations to the two articles you cite Olsen2006 and Fleisig2011
thanks
April 26th, 2011 at 9:16 pm
Great article and there needs to be more written! I have a personal concern for more than just elbows & shoulders. TOS, Thoracic Outlet Syndrome. There are way too many surgeries for this! Repeative motion, so it is also in other sports as well. However, pitchers are high risk. The bad thing is there are no physicals or testings done for something so very serious. I know it can be life threatening, my son survived, and is currently pitching for college ball. I never let him play fall ball or year round. Just no way of knowing. I am hoping parents realize THEY are in charge. Coaches use to tell me I was ruining my sons future, lol. Now I am so happy I listened to my own common sense.
April 26th, 2011 at 9:36 pm
Good writing Eric.
There are several research studies out there now that show that there are only two things that injure youth pitchers, and they are not the curveball or slider.
Two words: NEGLECT and ABUSE
That is right, pitch selection has so far not been shown to increase injuries, but pitch counts do. Perhaps the kids that can throw a curveball in little league are better and thus pitch more, but regardless, its pure quantity.
April 26th, 2011 at 10:05 pm
Great article…. I would also like to point out (and please correct me if needed be) that this is very much like any other sport. It has become a habit/culture to do the same within any other sport. It’s important to allow an athlete to get active rest after post season and then to rebuild them as each unique individual.
April 26th, 2011 at 10:07 pm
Great article Eric! This information should be provided to all parents with children playing junior sport in any country. Unfortunately there is a huge culture of “more is better” but when it comes to sports specific training for any sport, baseball, tennis, hockey, track etc but too much can cause injury. Moderation in junior athletes gives them far greater potential to be champions than just another burned out kid with talent.
April 26th, 2011 at 10:58 pm
Our middle school coach had a dispute/run-in with a travel ball team coach who insisted it wasn’t important that he knew how much his player pitched for our team (where we managed his pitch count closely) because he was going to pitch him as much as he wanted, when he needed him. We got upset when we found out he had thrown between 150-170 pitches over 3 games in a Saturday-Sunday tournament. Of course, that didn’t include warm-up pitches, either. Unbelievable.
Fortunately my sons go to the same pitching coach, and I told him what had happened. Our pitching coach was horrified, and had a nice, long talk with the player’s parents to straighten them out on overuse. He, too, is a big believer in taking time off during the year from throwing at all.
April 27th, 2011 at 12:07 am
First time reader, couldnt agree more. I am currently in my junior season in college and have to say that this is the first season of my college career that I haven’t been injured. My senior year of highschool I started 12 games out of 26 usually going on 3 or 4 days rest. In those games I most always went 7 innings with a pitch count upwards of 110. I threw 84 innings my senior year and went straight into summerball with my AAU team where we played another 50 or so games. Needless to say I was overworked and it hurt my once I got to college. I threw only 34 innings my freshman year because it was cut short with rotator cuff issues. My sophomore year was also cut short with a 3 week stint on the dl with soreness in my elbow. I then went and played summerball in the GLL until I was sent home with a frayed UCL and torn flexor mass in my elbow. All of this I believe was due to the work I put in back in high school. Thank God my coach realized the problem and I was shutdown before I needed surgery. I was given the entire fall of and eased back in the winter. I have felt fresh all spring due to this REST as well as stregthening efforts and rehabilitation. You can’t say enough about rest and the ill effects of overuse. Take care of your arms when you are young.
On a side note, all those complaining about slowpitch softball, I think that is an invalid arguement because it is a much more natural motion to throw underhand. This is why you see college pitchers at elite programs throwing back to back games and pitching the majority of games during the season. I think this is a much more relevant article to those playing baseball than softball.
April 27th, 2011 at 12:40 am
I had a conversation about this with a hitting and pitching coach a little more than a month ago as I came to see one of my guys hit and unfortunately I didn’t get through too much (I promise I was respectable and not a smart ass) as they seemed to think specialization is key and that’s the determining factor…I agree, its the determining factor for injury.
I have sent them the link to this article respectfully and even if they don’t reply I hope they read it.
Great article and I will spread it to every person I know involved in baseball.
Luka
April 27th, 2011 at 5:08 am
Thanks, Jason! Honestly, the prevalence of partial thickness cuff (undersurface/articular side) tears is probably very high in that population regardless of whether they participate year-round or not. I believe it’s 91% of MLB pitchers that have partial thickness cuff tears nowadays. So, beyond diagnostic imaging, my concern would be how he moves and feels.
April 27th, 2011 at 5:10 am
Sean,
One thing that is tough about implementing these changes is that you really can’t see the true benefits for 5-6 years, as that’s when overused kids often reach “threshold.” Right now, in high school, college, and pro ball, we’re seeing the “fallout” of the years that all these high-volume/high-frequency pitching opportunities were in place without true pitch count guidelines like we’re seeing today. Combining these guidelines with better strength and conditioning and mechanics coaching makes me feel more confident about the healthy future of today’s young pitchers!
April 27th, 2011 at 5:11 am
Jack,
Yes, to some degree, although pitching a softball is considerably different than throwing a baseball, as there isn’t a point of extreme external rotation (peel-back mechanism). That said, I think girls can still learn a lot from this discussion, as the ones that get hurt are usually the ones who are the most physically unprepared.
April 27th, 2011 at 5:13 am
Bobby,
The crazy thing is that the Olsen et al. study actually accounted for private pitching instruction and found that it didn’t have any association with “saving” kids. Of course, not all private pitching instruction is created equal.
No video, as the study design wouldn’t allow for it.
April 27th, 2011 at 5:14 am
Absolutely! Wouldn’t be surprised if we have the youth hockey generation to thank for the “epidemic” of femoroacetabular impingement. They created a diagnosis!
April 27th, 2011 at 5:16 am
Bill,
I agree with you on #2 and #3, but only partially on #1. Kids definitely need to spend more time on throwing programs and less on pitching. However, to just suggest that they throw more is a slippery slope because you and I both know that most people will simply add it on top of what they’re already doing.
April 27th, 2011 at 5:17 am
Brian,
I don’t think that off-season hitting/fielding is as much of an issue because they aren’t throwing downhill, but I do think it’s important to have breaks factored in. Or, if a kid is going to take BP and ground balls year-round, he better be doing something else to “cancel” it out.
April 27th, 2011 at 5:17 am
Definitely a player – and I’d add nasty tissue quality from accumulated eccentric stress as a tie for first place.
April 27th, 2011 at 5:19 am
Marc,
I link directly to the abstracts for both articles in the post, but here they are again:
http://www.ncbi.nlm.nih.gov/pubmed/11689728
http://www.ncbi.nlm.nih.gov/pubmed/21098816
April 27th, 2011 at 5:20 am
Very true!
April 27th, 2011 at 7:17 am
One of the best and most important post I have read in a long time. Great work Eric. I will pass it along via Facebook and get it out in my newsletter this week. People need to read this.
Even with the growth and awareness of a proper strength and conditioning programs the proper preparation still seems to take a back seat to the actual playing of the sport itself. S&C is seen as the “off season” thing to do; when in fact MORE time should be devoted to it beginning at a young age and progressing carefully, slowly and consistently.
This should be the case especially at the younger levels where they are developing their pitching skills as well.
Could talk all day about it.
Great job once again!
April 27th, 2011 at 7:58 am
I like this article and I have been fortunate not to have any players or students who have had surgery. May I also point out that one of the flaws of most coaches is that they do not develop or give opportunities to enough kids. They pick the two or three kids who throw the hardest and give them all of the innings. Most of the teams I’ve coached from 13u to High School have had more pitching talent than I can overwork. If they would develop and teach as many kids who show an interest, have some talent and can throw strikes in the PRE-SEASON, they will have so many choices that they can’t possibly overwork them. Plus, you might discover a diamond in the rough and give opportunities to kids who might develop later in their adolescence. It’s ok to be competitive but you don’t need to throw your ace against every team.
April 27th, 2011 at 8:25 am
Dante,
That is a FANTASTIC point. Thanks for your contribution!
April 27th, 2011 at 9:15 am
Great post Eric. Maybe this is beyond the scope of a comments section, but what do you think are the primary differences between kids who play year-round in the US compared to the kids who play year-round in Latin America?
April 27th, 2011 at 9:29 am
Eric,
I’ve been getting the same info through the ASMI and putting the same message forward on my own site for years. The problem: those of us who known this and gets this – including several who replied above – are preaching to the choir. The real challenge is how do we reach the ill-informed. How do we make the casual, volunteer coach and the parents who don;t know this stuff to read it, hear it, and care. As part of my Insider series this week I’m getting into the whole coach-parent dynamic and in my view we blame the parents far too often when we need coaches to step up and be the guardians of young arms. As you point out, those who might be aware are focused on other desires (like winning) and those who are clueless will remain so. I believe that none of the national youth baseball associations – even those who pay lip service to coach training – are really willing to impose stricter training/certification on their coaches …for fear of losing volunteers. We need AAU and LL and Pony and the rest to get tough on this. Pitch count is only one small part of the larger issue of poor conditioning habits and player mismanagement.
April 27th, 2011 at 9:34 am
Eric- Fantastic article. I shared it with the CheckSwing.com community and you received many great compliments from coaches and MLB level guys. Please keep the info flowing. You are helping a great deal of coaches with this info.
You can see the feedback here: http://www.checkswing.com/profiles/blogs/your-arm-hurts-thank-your
April 27th, 2011 at 10:45 am
I’m embarassed for our society that this article is necessary. You are so dead on right!
April 27th, 2011 at 12:13 pm
Eric,
Good information! I haven’t read all of the comments, so I’m not sure if this was already mentioned or answered, but why were you hesitant to post? From your last post about blogging, you noted that good information was what makes good blog sites. Obviously, you’ve earned your audience, and you’ve established yourself as a credible resource, especially on subject matter concerning your sport. Now, just speak/write from the heart. We’re on your side. It’s a BIG time for change in the business of injury prevention and performance, and you’re not alone in trying to overcome this inertia for the mass movement.
April 27th, 2011 at 1:39 pm
Eric-great article as usual. As echoed by someone earlier, this issue travels to all sports. Most of my clients are basketball players who play basketball year-round with school and AAU. The amount of overuse injuries is staggering. Then you add the fact that many coaches and players in the basketball realm believe that “basketball players don’t need strength training” because they think it will mess up their shot. Oh the stupidity. 9 out of 10 players that I work with have little ankle mobility (or they just wear ankle braces), incredibly weak hips, and almost all complain of knee pain and shin splints. This is true from my youth clients to the athletes I have that are preparing for the draft. Someday they’ll learn.
April 27th, 2011 at 1:47 pm
(In Mexico pitchers starting from7 year old till 12 years old are allow to pitch only fast and change ups, curves are allow starting at 13 years old and above.
I really like this rules. Why in the US kids are allow to pitch curves starting at 11???? Someone need to make a suggestion of changing the little league rules to not allow kids under 13 years old to pitch curves, only fast and change up….that will reduce the amount of little league injuries.)
April 27th, 2011 at 2:46 pm
I have a question in response to your article, which by the way I enjoyed. How does lengthening a season (6 months rather than 4) for a 12 year old impact shoulder and elbow issues if the innings limit is respected. (under 100 innings over course of season). Of course this question is assuming a perfect world, mechanics are perfect and warm up is proper.
April 27th, 2011 at 3:41 pm
Great article Eric! An important insight in the motion of throwing related to the age of a thrower. The big challenge is to create the change on the grass root level but that is why we need to send this article to everyone and their mother. Thank you for sharing!
April 27th, 2011 at 4:12 pm
Eric,
Thank you for writing abouth this. I have been a collegiate coach for the last 9 years and I can’t tell you how many times I have seen this exact thing happen to a young player that has some athletic ability. Too many times does a coach (who a lot of times is his father) let his player(son/daughter) throw too many innings and the kid can’t even pick up his/her arm to shoot a basketball or throw a football. It’s amazing how I have heard of 12-year-old kids getting Tommy John surgery when they don’t even have enough muscles and tendons and ligaments to hurt.
Overuse hurts draft status for sure, as well as collegiate recruiting.
Thank you for taking the time to write this because if you didn’t, the ball would have started rolling after watching the little league world series this year and hearing about how a kid has hurt arm from throwing too many curve balls in a summer.
I appreciate this and I hope that parents and coaches take a close look at this situation this year so that when their son gets to me in a few years, he will still have his arm and his shoulder without a zipper on it!
Thanks,
Coach Pla’
April 27th, 2011 at 7:26 pm
Articles like this, and analysis of why pitchers get hurt is always interesting to me. I’m a 32 year old who has pitched my whole life, and had a shoulder surgery resulting from a labral tear while back squatting. I also did a lot of pitching and throwing throughout my life. I know a LOT of guys my age who pitched a lot in college, then pitched in summer leagues, then broke down by the time they were seniors. My dad pitched, too, and used to throw for hours every day against the barn as a kid. He pitched for two separate teams in the summers while in high school, and once in H.S. threw seven innings on a Monday, Wednesday, and a Friday. My uncle did the same sort of stuff, and so did a lot of other guys they played with. Most of them never had arm problems. These guys threw hard, too. My dad was mid 80′s, my uncle could touch 90. I topped at 88. I’ve never understood why they didn’t get hurt. One thing they didn’t do, though. We’re from northern Iowa, and they never threw from basically October until April, because there was no place to do it indoors. Maybe that’s it. I just know that I don’t want my boys to end up wrecking their arms, because I know they’re going to be able to throw hard, and if they want to pitch, I want to help them do it-and stay healthy. Thanks for all your work, Eric. I’ll keep reading your stuff, and putting it to good use.
April 27th, 2011 at 8:20 pm
Eric, thanks so much for bringing this much needed subject into the limelight again. It is important that someone with a reputation such as yourself, is willing to tell everyone something many coaches and parents just do not want to hear or accept. Your efforts may just save a few kids arms, and future in the sport!
April 27th, 2011 at 8:58 pm
Eric;
I thoroughly enjoyed this article. If I were you , I wouldn’t be too worried about ruffling anyones feathers. The problem isnt what you wrote, but rather the parents that want to watch their kids destroy their arms while they chase their failed childhood dreams. You see this in every sport unfortunately. Keep up the great posts, and maybe one day the parents will finally get the message.
April 28th, 2011 at 11:08 am
Eric,
Completely agree. The story of my life and many of my friends. I was wondering if there are any statistics on children/players from the Dominican? Everyone down there is playing year round, I would assume then that injury rates would be that much higher in arms of dominican players?
April 28th, 2011 at 4:27 pm
Eric, great article. Im seeing things on the surgery side of the house and it is really sad what these young pitchers are going through. by the time the kids get to our office its too late, their arm are shot. im planning on being proactive and speaking to some of the youth leauges around my area. THANKS YOU for all your diligent work, pat E.
April 29th, 2011 at 3:06 am
Not real clear about what you’re really saying. Anyone who engages in strenuous excercise stands the risk of getting hurt. Proper conditioning is vital in preparing anyone, serious athlete or novis, in any strenuous activity. Proper warm-up is also key to injury prevention as well as a common sense approach as to not over exsert oneself.
Statistically, I’m not sure that 3.5 times more likely to injure yourself pitching is significant. I pitched countless innings over almost 20 years without arm injury. I started when I was three…but I threw everything…especially rocks and tennis balls for hours and hours daily during the summer (and most other days throughout the year as well). By the time I was Little League age I was quite proficient in the act of throwing.
I just want folks to be careful not to jump to the wrong conclusions here. I think that pitching injury is more caused by improper conditioning or warm up than over-use. I can see it now…nobody is going to let a kid throw more than a couple of innings per week…period.
Like anything else thats challenging physically…a good common sense approach to proper conditioning over time, technique and warm-up is essential to build bodies for long term activity. But even that offers no iron-clad guarantees.
April 29th, 2011 at 9:09 am
Hi Eric. Very interesting article. I am a youth baseball coach (in neighboring NP Twp!) for 10-11 yr olds and was wondering about my players use of breaking pitches. Is there a rule of thumb for how many breaking balls (if any) a youth player should pitch per, say 20 pitches. In my intermural regular season, I typically pitch a player 1-2 innings per game, and no more than 3 per week, but I wonder about the boys who are starting to work in breaking pitches and how it could relate to arm trouble. Any advice is ppreciated. Thanks!
April 30th, 2011 at 6:17 am
Michael,
I think there are a quite a few considerations:
1. My hunch is that fields aren’t quite as good in Latin America, and the mounds are generally lower, which would decrease arm stress. Subtle difference, but worth considering.
2. I think that they do a lot MORE THROWING and considerably LESS PITCHING. No AAU scene means that kids have to round up 18 players if they want to have a game. Their lack of organization probably protects them.
3. There’s a greater focus on PLAY than just competition. I don’t get the impression that there are crazy parents fighting over little league trophies.
4. I think that there are more “live” arms, so one player is less likely to get overused. In the U.S., there is a lot more disbursement of talent among several sports, so you wind up with only 1-2 good arms on each team – and they get abused.
5. Diagnostic imaging and quality medical care isn’t as accessible or affordable in Latin America, so you could make the argument that their injury rates are actually very high – but many kids go undiagnosed and either quit or play through pain. Additionally, most of the best players wind up playing in the U.S. – and their injury rates are just as high as American players when they get to pro ball. They may just be finally reaching threshold when they get a bit older – even though their youth experiences were still very stressful on the body.
April 30th, 2011 at 6:17 am
Thanks, Bill!
April 30th, 2011 at 6:18 am
Nick,
You’d be surprised how many readers of this blog are likely totally guilty of a lot of the stuff I’m covering. Many coaches try to get better with strength and conditioning because they think it’ll make up for the fact that they abuse their pitchers. Not cool at all…but it’s happening.
April 30th, 2011 at 6:19 am
Agreed 100%, Coach Ward! Basketball guys are pretty bad, too – and they were actually the motivation for me in Writing The Ultimate Off-Season Training Manual.
April 30th, 2011 at 6:21 am
Francisco,
Look at the research (and Mike Reinold’s comment above): pitch type really has little to no predictive/associative value to injuries. A kid can learn a curveball whenever he masters his FB and CU – but the problem is that the kids who are good enough to learn curveballs are the ones who get abused. The pitching volume gets them, not the pitch type.
April 30th, 2011 at 6:23 am
The longer the break between outings, the more time a young athlete will have to recovery from eccentric stress. You can see heightened markers of eccentric activity in the blood for several days after a pitching outing – and it’s this stress that works to reduce ROM in pitchers. Wait until they recover, then throw again…no need for a little kid to be pitching at 75% effort when there are 15 other kids on his team who are ready to throw with their healthy bodies.
April 30th, 2011 at 6:24 am
Thanks, Coach Pla! Need more college coaches picking up on this!
April 30th, 2011 at 6:25 am
Great points! We’re comparing apples and oranges in looking at players in years past’s ability to throw a ton of innings.
April 30th, 2011 at 6:25 am
Derek, check out my comment RE: Latin American players from earlier. Thanks!
April 30th, 2011 at 6:27 am
Jim,
Thanks for the addition – and I’ll be the first to tell you that improper conditioning, warm-up, and faulty mechanics are a big problem. However, no matter how well you train, warm-up, and throw, overuse will always get you. I see it every year. We can send the most perfect bodied guy out there with pristine mechanics and an ideal warm-up, and he’ll still break down if he throws 150 pitches every game.
April 30th, 2011 at 6:29 am
Larry,
The only one I’d be very careful with right now is the slider, as there is some research showing an 86% increased risk of elbow injury in those who throw it. Most kids that age are just throwing curveballs, though, so it shouldn’t be an issue.
As long as they can command the fastball and change-up, you can start working in the curveball. I don’t know of specific guidelines, but I would ease it in slowly and do more of the practice on it by spinning some in flat-ground sessions as opposed to on the mound.
May 2nd, 2011 at 10:06 am
I totally agree with little league and the coaching tier. We have the best coaches at levels where the players are most advanced, and MOST of the time, the worst coaches where the kids need to be coached the most.
However, there is the trend that I still don’t understand in the major leagues. How is it that pitchers could go from throwing 300-400+ innings in a season to where now it’s a major feat to hit 200-250? There were pitchers back then throwing just as hard as some of the guys today; granted, not as many, but they were still around. The ball was a little heavier and the mound was even higher! According to physics, that should make the stress even more so on the arm of the pitcher, but these guys still threw 300+ innings! In shorter seasons even!
You look at guys like Christy Mathewson, Cy Young, Walter Johnson and even Nolan Ryan hit 300+ a few times. Again the seasons were shorter then on top of that (no when Nolan Pitched, but for the others). Now I get that in the modern game there are more role specific pitchers now like the setup man and closer, but something else has had to change between then and now.
Have mechanics changed that much? If they have, have they changed for the better? Has throwing curveballs and other offspeed pitches changed since then? Because a lot of those guys did have offspeed pitches as well; they weren’t just throwing all fastballs back then. It’s just interesting to me that this has changed over the years and I still cannot pinpoint what exactly has led to the change.
Great article! I hope this isn’t taken as being a knock on the article because as I said earlier, I totally agree with the problems in little league with too many innings. I also totally agree that kids should be multi-sport athletes. It just helps them to become more balanced as an athlete and to learn their body in space (proprioception) much better. I hope this article gets published elsewhere where it will really ruffle some feathers.
May 2nd, 2011 at 10:17 am
Eric
Great post as always. I definitely agree that quantity is an issue with our pitchers. I have read your posts on pitch type as it relates to injury. My question may pertain more to higher levels versus little league. What are your thoughts on the role of split-fingers and changeups in medial elbow issues. To me these are “grip-type” pitches, whereas as the fastball and to a lesser extent curveball are a more relaxed grip. The split and change-up seem to be more significant now than they were years ago. Everyone used to be FB, CB, and straight change. Pitches seem to have evolved more to FB, C/U, and then either curve or split. Assuming scap control is where it needs to be, do you feel that this change has any role in the increased rate of elbow injuries/TJ surgery in higher level pitchers?
Eric
May 2nd, 2011 at 10:19 am
Eric
To clarify what I mean by “grip-type” pithces, I simply mean the flexor mass is much more involved in these pitches than in the other. Thanks again for your work
Eric
May 2nd, 2011 at 1:54 pm
i agree in general but see no need to push other sports on a kid who only has interest in one. one sport/baseball is fine..just use common sense.
May 3rd, 2011 at 9:19 am
Super article, Eric…I’ll definitely continue spread the word!!
May 3rd, 2011 at 4:43 pm
Great article Eric. I have one question, you menton at least 3 times that these young athletes should strength train year round. At what age do you think kids are old enough to begin strength traing, and then weight taining? Obviously teaching them proper form before hand is key but after that process. Cheers.
May 8th, 2011 at 9:52 am
Great article but I have to wonder if it’s also the type of pitch these kids are being told to throw, only to be “ahead” of other pitchers. My husband, a former pitcher, will only allow our 13 yr old son (a lefty pitcher) to throw his fastball and change up until he is 14-15. Our son is a force on the mound and there is pressure from coaches for him to throw U’s and curve’s. Ironically I can name atleast 5 travel teams in oujr area that are down pitchersdue to elbow problems …. all were throwing major league pitches.
May 9th, 2011 at 11:34 am
Excellent job with the cold hard truth. I am a father of an 11 year old and my first move was to take him to a good pitching coach before he had the opportunity to pitch in a game. He’s had 4 lessons in the past 2 years and has no joint pain from pitching. He threw 75 pitches in 4 innings a few weeks ago and the next morning he said his muscles were a little tight. The arrogant coaches and parents will never see this article, but, for me, it is MY job to present my son with opportunities and protect him. That’s why I’m studying everything I can put my eyes on…
May 12th, 2011 at 6:50 am
Thanks Eric,
Right on, as usual! As a father of a 7 year old boy – experiencing baseball for the first time – your concern; injury prevention and education for our youngest athletes and coaches is shared. I sent your article to several Youth Little League coaches in Natick. Thank you!
Mike Kozul
September 22nd, 2011 at 1:44 am
I was the pitching coach for the 13/14 in Savannah,Ga for 7 years prior to moving to Mississippi. I was pretty burned out and didn’t really want to coach any longer, but as fate would have it, the 11/12 team needed one more coach mid season, so I agreed to help out. During my very first game I noted our “Starting Pitcher” seemed to me to have thrown a lot of pitches through 3 innings. I asked the “Pitching Coach…??” what the pitch count was on the 11 year old pitcher. The pitching coach informed me that he didn’t count pitches, he just let the boy’s throw until they began to struggle and then he would pull them! Needless to say, I was dumbfounded! I insisted to the Head Coach that I take over as pitching coach, which he agreed. The former pitching got angry and quit…(thankfully).
I said all this to say that your blog is dead on right. Stupid coach’s can seriously hurt young players!
Thanks for shooting from the hip!
NB
December 17th, 2011 at 2:49 pm
Not a single person disagrees? hmmm….? either everyone here is a frontrunner without doing their own studies or else these are fake posts to make the article seem more appealing. I am a HS coach, own a private baseball “club”, run a private baseball exposure operation, and scout part time for the Braves and I can only agree that overuse is rampant.
Otherwise, the idea that “fall ball” is a as useful as a trap door in a submarine is VERY well misinformed and unfair to kids that don’t play a fall sport especially since fall usually has better weather than spring seasons. Additionally, almost every GREAT exposure event from the east coast (Jupiter Florida) to the west coast (Peoria AZ) is in the fall. More kids are recognized and pay for college and or get drafted from fall exposure than any other season.
I think that if you could keep from generalizing the fact that there should be a rest period and that it should come between “certain” months, then I would tend to agree more. As for the number of innings used, I can’t agree more. We use a formula to eliminate overuse in a single outing and usually limits the innings a kid would throw in a season. If we have a kid that throws more than 25 in an inning we count each over 25 as 3. We limit those kids to 75 in an outing. this ensures we use every possible arm but never overuse a single one of them.
In your words, I know this will ruffle feathers on what is obviously a bandwagon blog but I can’t go without addressing what I believe to be an article that is based on poorly trained athletes but never give credit to the ones that are trained properly, are rested, and do perform to a high level well into the pro game regardless whether they play AAU, Fall Ball, and/or HS baseball. It would be more appropriate to give some of us credit for doing our jobs carefully and well.
December 29th, 2011 at 12:53 pm
Seeing my grandson enjoying and dominating the game is the best thing for a grandfather could ask. Teaching this kids with proper techniques in a younger age can really make a big different on their life. I really hope to see my grandchild as a professional athlete.
January 21st, 2012 at 4:40 pm
Eric, my names Davin and im 17, im a starting shortstop for my highschool. I’ve been looking online for articles to tell me what is wrong with my arm, because it hurts when i throw at my hardest on the opposite side of my elbow. From reading this article, i realize that it was from previous overuse. Which makes since, because from the age of 10-15 i played baseball year-round on traveling teams and middle school teams. I read on your article that “it is too late” . Does this mean that there is NO WAY that i can fix my arm problem at all? Please respond. Baseball is my life, and i’d hate for it to be my past.
January 22nd, 2012 at 1:32 pm
Davin,
I would suggest you see a qualified elbow specialist in your area. You simply aren’t going to get healthy reading on the internet and guessing as to what the issue is. Get it checked out!