In addition to training athletes in the weight room and on the field, I consult with parents, coaches, and athletes about strategies to prevent injuries. I get questions from parents and coaches often with concerns about young pitchers experiencing arm injuries and/or pain. It’s common for parents and coaches to ask for exercises to improve arm strength and flexibility. While focusing on strengthening and balancing the musculature that supports the shoulder joint is important, pitching injuries at the shoulder and elbow also have a lot to do with overuse, along with deficits in trunk and lower body strength and mobility.
The overhead and windmill motions are full-body movements that draw power from the core and hips. When strength and mobility through the core and lower body are not adequate, forces at the shoulder and elbow will increase. Although a good pitching coach can tweak mechanics, without core and lower body training to improve strength, stability, and mobility, performance is compromised and injury risk increases.
Because young athletes are still growing, the risk for repetitive stress injuries—those that happen over time when a motion or activity is repeated—is different from that of adult athletes. Pitchers are among a group of athletes at special risk. In general, young pitchers are susceptible to injure the attachments between bones and ligaments or tendons because growing bones have soft “growth plates.”
As a result of early sports specialization plus the trend toward longer baseball and softball seasons—with school teams, local leagues, travel ball, and showcases—adolescent pitching injuries are on the rise.
Dr. Glenn Fleisig, Research Director at the American Sports Medicine Institute and Chair of USA Baseball Medical and Safety Committee, studies the science behind injuries as well as the prevention of injuries. Partnering with Dr. James Andrews, a world-renowned orthopedic surgeon who performs Tommy John surgeries—ulnar collateral ligament reconstruction (elbow UCL)—the colleagues see a concerning trend. In the early 1990s, Dr. Andrews saw NO high school or younger patients who required Tommy John surgeries. By the end of that decade, 33% of his patients of that age range were prescribed the surgery. Today, high school athletes represent the largest population for pitching surgeries in the nation.
Fleisig says, “Once we saw this happening, we started studying risk factors. Our research from the last 10 plus years proves that kids who pitch more and kids who pitch when fatigued are the ones who suffer serious elbow and shoulder injuries almost regardless of if they had good mechanics or bad mechanics.”
Dr. Andrews notes that these injuries are not isolated to the overhead throwing motion. In his book, Any Given Monday, about sports injuries and how to prevent them, Andrews discusses the softball windmill pitching motion. “It is a myth that fast-pitch softball, with its windmill delivery, can’t produce injuries to the thrower’s shoulder or elbow. Softball- related overuse injuries of the shoulder and elbow that require surgical intervention are quite common today, and are on the rise, whereas I almost never saw such cases when I first started in sports medicine.”
Dr. Sherry Werner—PhD in biomechanics and a sports mechanics researcher—has extensively researched effects of throwing motions at the shoulder, elbow, and wrist. One past projects was data collection and analysis of elite softball pitchers during the 1996 Olympic Games in Atlanta, Georgia. Dr. Werner is also a softball pitching instructor, so she has a unique perspective when it comes to the windmill motion. Werner says, “Probably the most common question I’m asked is: Is windmill pitching—as compared to baseball pitching—a safe and natural motion? The answer is absolutely not. It’s a very complex motion that puts a lot of stress on the elbow joint and the shoulder joint.” Dr. Werner also points out that hitting, overhead throwing, and windmill pitching use similar muscles and all need to be accounted for when considering the volume of reps placing stress on those muscles and joints.
Other experts agree with Fleisig, Andrews, and Werner. Throwing too many pitches too often and without adequate rest is attributed to the the rise in throwing arm injuries for youth baseball and softball:
- According to the American Sports Medicine Institute (ASMI) Position Statement for Tommy John Injuries in Baseball Pitchers, the rise in Tommy John surgeries is due to too much competitive pitching in adolescence. “In previous generations, Major League pitchers grew up competitively pitching only a few months each year, but nowadays leagues and teams are available for adolescents to play competitive baseball almost all year. Research has shown a strong link between too much competitive pitching and arm injuries.”
- The American Sports Medicine Institute Position Statement for Adolescent Baseball Pitchers recommends no overhead throwing of any kind for at least 2 to 3 months per year (4 months is preferred), and no competitive baseball pitching for at least 4 months per year.
- An article by Steward Orthopedic & Sports Medicine Center, Salt Lake City, Utah, states: “Teens and adolescents who focus on one particular sport, playing or practicing in the off-season are at the highest risk of injury. When that sport is baseball or softball, year-round overtraining without adequate rest of the throwing arm leads to injury. Bones grow through cartilage structures called growth plates. The growth plates of the elbow do not fuse until the late teens. Youth involved in organized softball and baseball programs are at risk of damaging the growth plates if they ignore symptoms of pain.”
- Nationwide Children’s Hospital Department of Sports Medicine addresses injuries in young throwers. “The key is prevention. This responsibility is widespread, involving the team physician, coach, athletic trainer, parents, and officials. The main culprit of pediatric elbow injuries is simply allowing children to throw too much. Emphasis must also be placed at an early age on preseason conditioning, proper throwing mechanics and proper warm up exercises.”
USA Baseball and Major League Baseball have teamed to provide recommendations for success and safety. Parents and athletes should work closely with coaches to ensure that age appropriate guidelines are followed over the course of a year. Information and guidelines are available at www.pitchsmart.org.
Pitch Count Limits & Required Rest Recommendations from Pitch Smart
NOTE: Reprinted from Pitch Smart USA Baseball, 2018, Guidelines for Youth and Adolescent Pitchers
Age-Specific Pitching Guidelines
from Pitch Smart NOTE: Information for table retrieved from Pitch Smart, 2018, Pitching Guidelines. http://m.mlb.com/pitchsmart/pitching-guidelines/
It may be challenging to meet all guidelines during tournament play. When I consult with tournament baseball coaches and parents, I suggest the following:
- Develop as many pitchers and catchers as possible.
- Prohibit catchers from pitching when the team has only one or two primary catchers.
- Follow pitch counts and monitor for signs of fatigue—such as a drop in velocity, a consistently elevated fastball, or relying more on the arm and less on the lower body for power. Less developed pitchers or pitchers with poor mechanics are likely to fatigue sooner than those with more experience.
- Closely monitor athletes who pitch much over 15 pitches an inning for signs of fatigue. The number of pitches thrown in a single inning is more crucial than total pitches thrown in a day. If Pitcher A throws 90 total pitches in a day while Pitcher B throws 70, you might think that Pitcher A had a more demanding work load. What if Pitcher A threw 35 pitches an inning over just two innings and Pitcher B threw 14 pitches per inning over five innings? Because Pitcher A threw extended innings without rest, he is at higher risk for fatigue, overuse, and possible injury. Data and analysis by experts suggest that about 15 pitches per inning is ideal. Pitchers who have thrown more than 30 pitches in an inning are done for the day.
- Comply with Pitch Smart and the required rest recommendations. Days off from pitching is vitally important for rest and recovery. It’s better for pitchers to go slightly over their daily max—provided they are in the 15-per-inning range and have no visible signs of fatigue.
Pre-Season Training to Develop Pitching Foundation
Creating a throwing foundation prior to competition is essential for both improved performance and injury prevention. Throwing too many pitches too soon and without adequate rest is a recipe for fatigue, poor mechanics, and injury. As stated in the bullet points above, keeping the number of consecutive throwing reps between 15 to 25 when doing multiple sets and adhering to recommended rest days, will go the furthest to prevent injuries. With that in mind, here is my recommended schedule for developing a pitching foundation.
Begin about 8 weeks prior to the first competition
NOTE: If incorporating these guidelines into a team practice, use rest periods for lateral movement drills.
Weeks 1 and 2
Day One: 3 sets of 10 with 3 minutes rest between each set
Day Two (3 days later): 3 sets of 10 with 3 minutes rest between each set
Weeks 3 and 4
Day One: 3 sets of 15 with 4 minutes rest between each set
Day Two (3 days later): 3 sets of 15 with 4 minutes rest between each set
Weeks 5 and 6
Day One: 2 sets of 20 with 5 minutes rest between each set
Day Two (3 days later): 3 sets of 15 with 4 minutes rest between each set
Weeks 7 and 8
Day One: 2 sets of 25, with 6 minutes rest between each set
Day Two (3 days later): 4 sets of 15, with 4 minutes rest between each set
In-Season
Day One (Game Day): Follow the previously mentioned guidelines for competitive pitching while considering pitches per inning and rest days to be of primary importance. Pitchers who threw more than 20 pitches (up to age 14) or more than 30 pitches (ages 15 and up) should follow Pitch Smart recommendations for rest days.
Day Two: (3–4 days later): 3 sets of 15 with 4 minutes rest between sets
NOTE: Pitchers who don’t get into a game for at least 20 pitches should throw 2 sets of 15 on the Monday following the tournament.
Day Two—for pitchers who didn’t play in competition (2–3 days later): 3 sets of 15 with 4 minutes rest between sets
Pitching Guidelines for Softball
Although there is growing concern among the medical community about pitching injuries in softball, few pitching guidelines have been established. To date, Little League Softball is the only organization that requires any pitching limits. The only requirements: Minors (ages 5-11) and Little League Majors (ages 9-12) pitch no more than 12 innings in a day; and if a player pitches seven or more innings, one day of rest is mandatory.
Dr. Sherry Werner, biomechanics consultant with Sport Science Unlimited and a pitching instructor at the Sherry Werner Fastpitch Academy, offers guidelines for youth softball pitching she believes will protect arms and decrease chances of injury. Werner acknowledges that these recommendations may not always be possible in tournament situations.
- 10U – pitch no more than 60 pitches per day (to include competitive pitching and practice) with a full day of rest between workouts.
- 12U – pitch no more than 70 pitches per day (to include competitive pitching and practice) with a full day of rest between workouts.
- 14U – pitch no more than 80 pitches per day (to include competitive pitching and practice) with a full day of rest between workouts.
- 16U – pitch no more than 90 pitches per day (to include competitive pitching and practice) with a full day of rest between workouts.
- 18 and Up – pitch no more than 100 pitches per day (to include competitive pitching and practice) with a full day of rest between workouts.
Dava Laxton—former college softball pitcher, now pitching instructor—also believes there should be guidelines for young pitchers. Laxton says, “I’m not sure exactly what those guidelines should look like, but setting some limits on the number of innings a pitcher can pitch in a day would not only protect pitchers from overuse, it would give more girls the opportunity to develop as pitchers.
If coaches ‘label’ a girl as a pitcher at the younger ages, it can push out girls that might excel at that position later. And the girls that are pigeon-holed early as pitchers miss out on developing the agility and hand-eye coordination nurtured by playing other positions. This is an absolute mistake.”
My own experience and research is consistent with the evidence of other experts in the field: Following pitching guidelines can reduce the risk for injuries in both baseball and softball pitchers. However, for athletes who have weaknesses in strength and range of motion through the trunk and lower body, monitoring the volume of pitching is simply not enough.
The overhead and windmill motions are full-body movements that draw power from the core and hips. When strength and mobility through the core and lower body are not adequate, forces at the shoulder and elbow will increase. Although a good pitching coach can tweak mechanics, without core and lower body training to improve strength, stability, and mobility, performance is compromised and injury risk increases.
Injury prevention and athlete development is a long-term process with multiple elements working together for safety and success. For more information about long-term development of youth athletes check out more of my articles below.
Best and Worst Upper Body Strength Exercises for Athletes
The Risks of Early Specialization in One Sport
Athlete Development Model for Ages 4-19
Best and Worst Lower Body Strength Exercises for Athletes
Best and Worst Core Exercises for Athletes
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