Prevention of Arm Injury in Youth Baseball Pitchers!

By John R. Mishock, PT, DPT, DC
Owner of Mishock Physical Therapy & Associates

Many of us grew up playing summer baseball on one team with one season per year. But now the youth baseball player is playing year-round, on multiple teams at a highly competitive level. With this has come an increase in youth pitching related injuries, notably involving the shoulder and elbow. Correspondingly, surgery for the shoulder has increased significantly in youth pitchers over the past ten years. The injuries that often become evident in high school and college pitchers begin at the youth level from cumulative recurrent micro-trauma from over use and poor mechanics.

In a 2008 study by the Journal of the Louisiana State Medical Society, it was found that pitchers were more likely to have surgery of the elbow or shoulder if they pitched more than 8 months a year (500% increase of surgery), pitched more than 80 pitches per game (400% increase of surgery), or pitched regularly despite arm fatigue (3,600% increase of surgery). To note, arm fatigue had the greatest correlation with subsequent arm surgery.

The USA Baseball Medical & Safety Advisory Committee has now developed guidelines for the baseball pitcher based on age. Following these guidelines may keep your athletes safe from developing the debilitating shoulder and elbow injuries that we see in our clinics.

  • 8-10 years old: 50 pitches per game, 75 pitches  per week, 1000 pitches per season, 2000 pitches per year
  • 11-12 years old: 75 pitches per game, 100 pitches per week, 1000 pitches per season, 3000 pitches per year
  • 13-14 years old: 75 pitches per game, 125 pitches per week, 1000 pitches per season, 3000 pitches  per year
  • 15-16 years old: 90 pitches per game
  • 12-18 years old: 105 pitches per game

Following this recommended pitch count the pitcher should have 4 days of rest prior to pitching again. Also advised is to not throw breaking pitches (curve balls, sliders) until puberty. Instead, a youth pitcher should focus on fastballs, change-ups, and pitch control. Proper pitching mechanics are important as early as possible in the development of the pitcher. Year round physical conditioning should also be employed as the body develops. Pitchers are discouraged from pitching for more than one team in a season. For at least three months a year, a pitcher should not play any baseball or perform throwing drills. A pitcher should not return to the mound in a game after being removed. And finally, pitching practice after a pitched game should be avoided.

Common symptoms of shoulder & elbow injuries…
  • Pain and tenderness along the tendons/ligaments at the elbow or shoulder
  • Pain that worsens with movement or activity
  • Pain that is sometimes worse at night, interfering with sleep
  • Swelling and sometimes redness
  • Stiffness of the involved joint
  • Possible rubbing or snapping with movement
We can help!

If pain is limiting you from doing the activities you enjoy, give Mishock Physical Therapy a call for a Free Phone Consultation at (610)327-2600 or email your questions to Also, visit our website to learn more about our treatment philosophy, our physical therapy staff, and our five convenient locations in Gilbertsville, Skippack, Phoenixville, Barto, and Limerick at (Dr. Mishock is one of only a few clinicians with doctorate level degrees in both physical therapy and chiropractic in the state of Pennsylvania.)

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