Epidemiology
The popularity of baseball among children and adolescents is evident as there are nearly 3 million Little League, adolescent, and high school-aged baseball players in the United States. Studies have shown that there were more than 22,000 high school baseball-related shoulder injuries in the high school population alone between 2005 and 2007. Pitching was the most common mechanism causing shoulder and elbow injury. In addition, there has been a significant rise in adolescent and high school elbow injuries resulting in the now well known "Tommy John" surgery.
These statistics validate the importance of these injuries and indicate that all coaches, parents, and athletes should be aware of the most up-to-date recommendations for injury prevention in this population.
Overuse Throwing Injuries
Some tips to keep you in the game throughout your life include:
- Warm up properly by stretching, running, and easy, gradual throwing
- Rotate playing other positions besides pitcher and catcher
- Concentrate on age-appropriate pitching
- Adhere to pitch count guidelines
- Avoid pitching on multiple teams with overlapping seasons
- Don’t pitch with elbow or shoulder pain. If the pain persists, see a doctor
- Don’t pitch on consecutive days
- Don’t play year-round
- Never use a radar gun
- Communicate regularly about how your arm is feeling and if there is pain
- Develop skills that are age appropriate
- Emphasize control, accuracy, and good mechanics
- Master the fastball first and the change-up second, before considering breaking pitches
- Speak with a sports medicine professional or athletic trainer if you have any concerns about injuries or prevention strategies
Little League Pitching Guidelines
Garnering enough rest between starts and between seasons is one way to prevent overuse injuries in the throwing shoulder. Below are the most up-to-date pitch restrictions according to Little League Baseball.
Maximum Pitches/Game
| Age | Pitches/Game |
|---|---|
| 7-8 | 50 |
| 9-10 | 75 |
| 11-12 | 85 |
| 13-16 | 95 |
| 17-18 | 105 |
Rest Period Required
| Ages 14 and Under | Ages 15-18 | Required # of Days of Rest |
|---|---|---|
| 66+ | 76+ | 4 calendar days |
| 51-65 | 61-75 | 3 calendar days |
| 36-50 | 46-60 | 2 calendar days |
| 21-35 | 31-45 | 1 calendar days |
| 1-20 | 1-30 | None |
Source for charts: Little League Baseball
Rehabilitation and Physical Therapy
Rehabilitation and preparation for the next pitching session begins immediately after the current pitching session ends. The USA Baseball Medical and Safety Advisory Committee wrote on the essentials of an effective post-pitching recovery regimen. These recommendations included post-pitching routines such as stretching, ice, and a whole body conditioning program. In addition to rehabilitation from pitching during games and in-season, it also is imperative to maintain and improve strength in the off-season.
Rehabilitation and Physical Therapy
In the case of an overuse throwing injury, your son/daughter/player will be referred to one of our Sports Medicine Specialists. Once a full evaluation has been completed, rehabilitation will begin. Rehabilitation of the overhead throwing shoulder has 4 phases: acute, intermediate, advanced with strengthening, and return-to-activity. Every athlete is different, so there is not a set start and stop date for each phase. Remember that the ultimate goal is to allow an effective and efficient return to throwing without pain or discomfort.
Maximum Pitches/Game
| Phases | Acute | Intermediate | Advanced | Return to Activity |
|---|---|---|---|---|
| Modalities | Ice Iontophoresis Electrical stimulation | |||
| Exercises | Flexibility Strengthening Rotator Cuff | Continued stretching and strengthening the shoulder Core/abdominal strengthening and leg strengthening | Plyometric program endurance drills | |
| Throwing | None | None | Short distance throwing program initiated | Interval throwing program |
Source for chart: Wilk KE, Obma P, Simpson CD II, et al. Shoulder injuries in the overhead athlete. J Orthop Sports Phys Ther 2009;39:38-54.
Recipe for Success
Many organizations, including the National Athletic Trainers Association and the American Academy of Pediatrics have recommended that children and adolescents participate in a variety of sports to allow enhancement of general fitness and aid in motor development and also develop athleticism (versus sports-specific skills) and love of sports.
Schedule an Appointment
352-273-7001
Contact us to schedule an appointment to be evaluated for a sports-related injury with one of our sports medicine providers.
UF Health Sports Medicine Providers
| Provider | Specialty |
|---|---|
| Kevin Farmer, MD | UF Team Physician — Sports Medicine Surgeon |
| Joshua Reside, MD | UF Team Physician — Sports Medicine Surgeon |
| Ryan Roach, MD | UF Team Physician — Sports Medicine Surgeon |
| Ridhi Sachdev, MD | UF Team Physician — Sports Medicine Surgeon |
| Joshua Altman, MD | Primary Care Sports Medicine |
| Manuel Britto, MD | Primary Care Sports Medicine |
| Sarah Chrabaszcz, MD | Primary Care Sports Medicine |
| Sara Gould, MD | Primary Care Sports Medicine |
| Ryan Mark, MD | Primary Care Sports Medicine |
| Alejandro Sanoja, MD | Primary Care Sports Medicine |
| Nicholas Smith, MD | Primary Care Sports Medicine |
| David Tran, MD | Primary Care Sports Medicine |