Preventing Baseball Throwing Injuries in Young Athletes

Baseball season is in full swing. Whether you’re a Tigers fan or Indians fan, you know how injuries can affect a team. They can result in time lost on the field (e.g., Miguel Cabrera and Yan Gomes) and can be a lingering issue where a player doesn’t recover as expected (Justin Verlander).

Baseball pitchers, especially, are more susceptible to shoulder and elbow injuries possibly because of individual physical characteristics, the frequency of throws and – to a more arguable extent – pitching technique.

During the motion of pitching, a thrower’s arm is raised away from the body and fully rotated. Muscles are also forced to work to slow the arm after the release of the ball. Doing this repetitively or not having enough strength in the throwing arm can lead to an injury. Symptoms could include weakness, loss of mobility, pain during activity, pain at night, or a clicking/snapping sensation when raising the arm.

Preventing Injuries from Overuse

It seems that nowadays, more than ever, young athletes are specializing in sports. Rather than play a different sport each season, athletes are playing the same sport year round and/or playing with multiple teams/clubs in a particular sport. This repetitive activity can lead to under training and overuse and eventually injury.

When an athlete plays on multiple teams, they should be carefully monitored by their parents. I know there is more pressure than ever for young players to perform well and often (due to college scholarships, continuing careers, high level of competition, etc.). However, appropriate rest and participation now may help prevent significant injury in the future.

With the help of Dr. James Andrews, co- founder of the American Sports Medicine Institute (a non-profit institute dedicated to injury prevention, education and research in orthopaedic and sports medicine), pitch count has become a strong emphasis in little league baseball. The following recommendations have been established by Dr. James Andrews et al in regards to pitch count, rest between pitching, and when to learn a particular pitch. (For more information, click here.)

Maximum pitch count
Age Pitches per game
7-8 50
9-10 75
11-12 85
13-16 95
17-18 105


Rest period between games with amount of pitches thrown
Ages 14 and under Ages 15-18 Days between pitching
66+ 76+ 4
51-65 61-75 3
36-50 46-60 2
21-35 31-45 1
1-20 1-30 0


Age to begin throwing specific pitches
Fastball 8 + 2
Change-Up 10 + 3
Curveball 14 + 2
Knuckleball 15 + 3
Slider 16 + 2
Forkball 16 + 2
Screwball 17 + 2


Strengthening and Stretching to Prevent Injury

Strengthening and stretching exercises can help players of all ages avoid injury. A set of exercises called Thrower’s Ten has been developed for ball players. This set of exercises has been well established and researched to strengthen the muscles of the arm, possibly preventing injury. Click this link for a printable handout of these exercises.

Because pitchers develop excessive external rotation and tend to lack internal rotation of their arm, I generally recommend a couple of stretches to allow for a more normal range of motion. Stretching should be performed for 20-30 seconds, repeated three times.

Posterior Capsule Stretch
Pull your throwing arm across your body with your non-throwing arm (generally pulling at the elbow) until a mild stretch is felt in the back of the shoulder.

Post capsule stretch

Sleeper Stretch
Lay on the side of your throwing arm, with your upper arm at a 90 degree angle to your body. Push down at the wrist using your other hand. Again, only a mild stretch is felt in the back of the shoulder.

With all athletes, I typically provide a good core strengthening exercise program. With all athletic activities, especially baseball, the core and leg muscles should be well conditioned, which can also lead to improved performance.

If a young player has suffered an injury or has taken some time away from the game, they should not jump back into the sport too quickly. There is a well-established protocol with return to throw after an injury, and a sports medicine healthcare provider should help your child through this. Your child will begin with warm up throws and throwing at 50% maximum, progressing to simulated game pitching.

I think it’s important to remember to keep your participation in perspective. While every parent wants their child to be a professional athlete, very few reach that level. Sports should be fun! They should serve as a way to exercise, socialize and build self-esteem. Let your child explore multiple sports and find what they are passionate about; there are many cross training benefits to participating in a variety of sports as well. Having to take a few days/weeks off of a sport is healthy and sometimes necessary to prevent future injury or complications.

As always, speak with a health care provider before beginning an exercise program. Make sure your child feels comfortable with each exercise and that the exercises do not cause increased pain.

I encourage you to ask questions, share your experience and leave suggestions for future topics in the comments below. I will do my best to respond to each as timely as possible!

imageBryon Renwand, PT, DPT, CSCS, works with ProMedica Total Rehab and received his Bachelors of Science in Exercise Science from the University of Toledo, where he also received his Doctorate of Physical Therapy. For his full bio and other articles, please click here.