Arm Injuries in Youth Baseball and Softball: What You Need to Know

Spring is officially here on the calendar, and we can all feel the weather changing around us.  One of my favorite parts about spring is that it means my favorite sport is just around the corner: Baseball.  With baseball and softball starting up soon and many athletes already starting throwing programs, I would like to discuss ways to prevent overuse injuries in those athletes.  The two main areas of the body that may be injured with throwing are the shoulder and the elbow.  Shoulder injuries usually occur in the rotator cuff and surrounding musculature, while elbow injuries typically happen on the inside of the elbow at the ulnar collateral ligament.

Shoulder injuries often occur due to the rapid acceleration and deceleration of the arm during the throwing motion.  Throwing a ball includes four phases: wind-up, early acceleration, acceleration, and follow-through. The acceleration and follow-through phases are where most of the damage to the shoulder muscles tends to occur.  Our rotator cuff helps us stabilize our shoulder during the movement while allowing for smaller movements such as internal and external rotation.  There are many muscle groups that attach from the spinal column and thoracic cage to the shoulder blade as well, so it is important to make sure that the shoulder blade has proper stabilization and movement during all phases of the throwing motion.

The elbow is also commonly injured with throwing overuse, and many times it is in the ulnar collateral ligament that the elbow is injured.  This ligament takes a lot of force during throwing due to its position on the inside of the elbow.  As the shoulder muscles begin to accelerate the arm forward, your hand lags behind with the ball to generate more force so you can throw the ball forward.  That puts a lot of tension on the ulnar collateral ligament.  Another cause of concern in younger athletes is the numerous growth plates located around the elbow joint. The stress of throwing a ball can put undue pressure on those growth plates and cause issues going forward.

Most injuries in the body occur in one of three ways: overuse, a traumatic event, or a smaller traumatic event happening to an area that has been overused.  Injuries to the shoulder and elbow with throwing are typically due to overuse.  This happens because during each throw microtears occur in the muscle and ligament tissue.  With adequate rest in between throws or days of throwing, these tears will heal with no lingering effects. However, if you continue to over use the same areas, the microtears will damage the tissue and may eventually result in a sprain of the involved ligament or strain of the involved muscle.

Some guidelines to follow in order to reduce overuse as much possible include limiting the overall number of innings thrown, pitches thrown per game, and number of months playing per year.  Increases in injuries tend to occur when an athlete consistently throws more than 80 pitches per game, 100 innings per year, or plays more than 8 months out of the year.  The leading research also shows that you should limit other overhead activities during the 4 months of the year (the baseball/softball “offseason”), including volleyball and swimming.  Players should also avoid playing catcher on days that they pitch and avoid strenuous throwing if their arm feels fatigued at all.  The following chart is handy in helping to space out pitching outings properly with the recommended days in between:

Age, (years) 1 Day (rec. rest) 2 Days 3 Days 4 Days
8-10 20+ (pitches) 30+ 40+ 50+
11-12 25+ 35+ 55+ 55+
13-14 25+ 35+ 55+ 70+
15-16 25+ 35+ 60+ 75+
17-18 30+ 45+ 60+ 85+


Feel free to contact us with any questions you may have about these upcoming sports, and I look forward to getting involved in coaching within Eldora’s youth baseball program this summer.

In good health,

Dr. Zak