Pitch Smart Risk Factors

In 2014, USA Baseball and MLB teamed up to establish Pitch Smart, a series of practical, age-appropriate guidelines to help parents, players and coaches avoid overuse injuries and foster long, healthy careers for pitchers.

A primary goal of the Pitch Smart program was to help young players reduce arm injuries by providing a comprehensive resource for safe pitching practices. While baseball is a relatively safe game to play at all ages, research has shown that pitching too much, particularly at a young age, can increase a pitcher’s risk of injury. To limit the likelihood of injuries caused by pitching with fatigue, the Pitch Smart guidelines included age-specific pitching limits and required rest recommendations for pitchers ages seven to 22.

In 2017, USA Baseball and MLB updated the original guidelines. The updated guidelines took effect in the 2018 season. The new guidelines included new thresholds for required rest periods for the 17-18 and 19-22-year-old age groups. Pitchers in the 17-18-year-old age group, for example, are now required to rest for a minimum of three days after throwing between 61 and 80 pitches (previously between 61 and 75) and rest a minimum of four days after throwing 81 or more pitches (previously 76 or more). Pitchers in the 19-22-year-old age group are now required to rest for a minimum of three days after throwing between 61 and 80 pitches (previously between 61 and 75), a minimum of four days after throwing between 81 and 105 (previously 76 or more) and a minimum of five days after throwing 106 pitches or more (previously a minimum of four days’ rest was required after throwing 76 pitches or more). An additional stipulation added for all age groups was that no pitcher should appear in a game as a pitcher for three consecutive days, regardless of pitch counts. Previously, there was no limit on consecutive days in which a pitcher could appear.

The purpose of this post is to outline the risk factors that the Pitch Smart Program as identified as being associated with arm injuries in pitchers. Specific age-appropriate Pitch Smart guidelines will be presented in a following post.

Risk Factors for Injury

Through decades of research, experts have gained insight into the behaviors that put amateurs at an increased risk of injury. In the most recent nationwide study of youth pitchers, research found that youth pitchers were still exhibiting many of these risky behaviors, all of which were associated with increased likelihood of pitching with arm tiredness and arm pain¹.  These risk factors included:

• 45% pitched in a league without pitch counts or limits

• 43.5% pitched on consecutive days

• 30.4% pitched on multiple teams with overlapping schedules

• 19% pitched in multiple games on the same day

• 13.2% pitched competitive baseball for more than 8 months per year

More Risk Factors

Other factors that were found to be associated with an increased risk of injury included:

1. Pitching while fatigued. Coaches and parents should watch for signs of fatigue during a game, during a season and over the whole year. The American Sports Medicine Institute (ASMI) found that adolescent pitchers who undergo elbow or shoulder surgery are 36 times more likely to have routinely pitched with arm fatigue.

2. Throwing too many innings over the course of the year. ASMI found that players who pitched more than 100 innings in at least one year were 3.5 times more likely to be injured than those who did not exceed 100 innings pitched. Every inning, whether during a game or showcase event, should count toward that threshold.

3. Not taking enough time off from baseball every year. ASMI also found that pitchers who competed more than 8 months per year were 5 times as likely to suffer an injury requiring surgery. Pitchers should refrain from throwing for at least 2-3 months per year and avoid competitive pitching for at least 4 months per year.

4. Throwing too many pitches and not getting enough rest. Daily, weekly and annual overuse is the greatest risk to a youth pitcher’s health. Numerous studies have shown that pitchers who throw more pitches per game and those who do not rest adequately between appearances are at an elevated risk of injury. While medical research does not identify optimal pitch counts, pitch count programs have been shown to reduce the risk of shoulder injury in Little League Baseball, for example, by as much as 50%. The most important thing is to set limits for a pitcher and stick with them throughout the season.

5. Pitching on consecutive days. Pitchers should avoid pitching on consecutive days, if possible, irrespective of pitch count. According to Yang, et. al., pitchers who pitched on consecutive days had more than 2.5 times greater risk of experiencing arm pain, compared with pitchers who did not pitch on consecutive days¹.

6. Excessive throwing when not pitching. A pitcher should not also be a catcher for his team as it is the next most throwing-intensive position and results in far more throws than players at other positions. ASMI found that amateurs who played catcher while not pitching were 2.7 times more likely to suffer a major arm injury.

7. Playing for multiple teams at the same time. Players who participate on multiple teams at the same time are at an increased risk of injury as it makes it more difficult to monitor pitcher limits and results in reduced rest.

8. Pitching with injuries to other body regions. Players should be cautious about returning to play after an injury. A sprained ankle or oblique strain can imperceptibly affect the player’s biomechanics, change the way he throws and put more stress on his arm.

9. Not following proper strength and conditioning routines. While often overlooked any strength and conditioning program should include a shoulder and elbow component. Numerous studies have shown that deficits in upper extremity strength and mobility are strongly correlated to serious arm injuries.

10. Not following safe practices while at showcases. A showcase can be a terrific opportunity for young players to demonstrate their skills for college coaches and professional scouts. However, pitching in a showcase during the offseason can be particularly hazardous, as it is difficult to get back to healthy game condition and it also makes it difficult to get sufficient off-season rest. Pitchers should treat these appearances as they would any other game for purposes of daily, weekly and annual pitch count limits. Furthermore, they should avoid the temptation to overthrow in an attempt to make a favorable impression.

11. Throwing curveballs and sliders at a young age. While existing research has not consistently shown a strong connection between the curveball and injuries, Yang, et. al., found that amateur pitchers who threw curveballs were 1.6 times more likely to experience arm pain while pitching and Lyman, et. al., found that youth pitchers who threw sliders are 86% more likely to experience elbow pain than those who do not².

12. Radar gun use. While radar guns do not directly cause harm to a young pitcher, they can inspire pitchers to throw harder, oftentimes beyond their normal comfort level, in an attempt to impress others. This may create additional strain on the arm.

 After reviewing years of sports medicine research and consulting with several of the top sports medicine specialists, the following age-appropriate guidelines were adopted by the Pitch Smart program:

Guidelines for Youth and Adolescent Pitchers

Ages 9-12 (typically 46-60’ pitching distance)

• Focus on athleticism, physical fitness, and fun

• Focus on learning baseball rules, general techniques, and teamwork

• Do not exceed 80 combined innings pitched in any 12-month period

• Take at least 4 months off from throwing every year, with at least 2-3 of those months being continuous

• Make sure to properly warm up before pitching

• Set and follow pitch-count limits and required rest periods

• Avoid throwing pitches other than fastballs and change-ups

• Avoid playing for multiple teams at the same time

• Avoid playing catcher while not pitching

• Players should not pitch in multiple games on the same day

• Play other sports during the course of the year

• Monitor for other signs of fatigue

• Pitchers once removed from the mound may not return as pitchers

• No pitcher shall appear in a game as a pitcher for three consecutive days, regardless of pitch counts.

AGES 13 TO 14

(Typically, 60′ Pitching Distance)

• Players can begin using breaking pitches after developing a consistent fastball and changeup

• Do not exceed 100 combined innings pitched in any 12-month period

• Take at least 4 months off from throwing every year, with at least 2-3 of those months being continuous

• Make sure to properly warm up before pitching

• Set and follow pitch-count limits and required rest periods

• Avoid playing for multiple teams at the same time

• Avoid playing catcher while not pitching

• Players should not pitch in multiple games on the same day

• Play other sports during the course of the year

• Monitor for other signs of fatigue

• A pitcher remaining in the game, but moving to a different position, can return as a pitcher anytime in the remainder of the game, but only once per game

• No pitcher shall appear in a game as a pitcher for three consecutive days, regardless of pitch counts

AGES 15 TO 18

(Typically, 60′ Pitching Distance)

• Players can begin using breaking pitches after developing a consistent fastball and changeup

• Do not exceed 100 combined innings pitched in any 12-month period

• Take at least 4 months off from competitive pitching every year, including at least 2-3 continuous months off from all overhead throwing

• Make sure to properly warm up before pitching

• Set and follow pitch-count limits and required rest periods

• Avoid playing for multiple teams at the same time

• Avoid playing catcher while not pitching

• Players should not pitch in multiple games on the same day

• Make sure to follow guidelines across leagues, tournaments and showcases

• Monitor for other signs of fatigue

• A pitcher remaining in the game, but moving to a different position, can return as a pitcher anytime in the remainder of the game, but only once per game

• No pitcher shall appear in a game as a pitcher for three consecutive days, regardless of pitch counts

References

1. Yang G, et. al. Risk-Prone Pitching Activities and Injuries in Youth Baseball; American Journal of Sports Medicine; 42(6): 1456-1462, 2014.

2. Lyman, S., et. al. Effect of Pitch Type, Pitch Count, and Pitching Mechanics on Risk of Elbow and Shoulder Pain in Youth Baseball Pitchers. American Journal of Sport Med. 30(4): 463-468, 2002.

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For additional information on the Pitch Smart program, go to http://www.usabaseball.com or http://m.mlb.com/pitchsmart.