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April 20, 2021  
SHOULDER NEWS: Feature Story

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  • Keeping Pitchers’ Elbows Safe in Little League

    Keeping Young Pitchers’ Elbows Safe in Little League


    June 09, 2006

    By: Jean Johnson for Shoulder1

    Little League days and nights have arrived once again. The sounds are all there: “Batter up!” and the soft, satisfying thunk of the ball homing into the catcher’s mitt. Then there’s the smell of hot dogs in steamed buns drifting over the bleachers and the sight of arrow straight lines marking off the baseball diamond; chalk white under a blaze of yellow lights on a warm summer evening.

    Take Action
    Tips for helping youngsters avoid sports injuries include:
  • Doing conditioning exercises at least a month prior to a season and stretch immediately before participating in a sport.

  • Eating right by choosing a balanced diet that includes a variety of unprocessed, fresh foods.

  • Staying hydrated. Don’t wait until thirst beckons. Instead stop at the drinking fountain whenever possible and aim for eight glasses of water a day with more in hot weather.

  • Finally, when in doubt, take a break. As Victor Guadalupe’s father says, “Read the signs. Be able to recognize that maybe a little soreness may not be OK.”


  • The problem, of course, is that like most sports, baseball is competitive. Everyone wants victory.

    “We had such fun as kids,” said Nicholas Perry thinking back on his Little League days in Phoenix. “The only thing was that some of the parents took it too seriously. Yelling at the umpires and storming around like puffed-up drill sergeants – even the women. I remember this one mother. She was the worst. So this friend of mine in seventh grade – a girl – wrote an essay about it. How these over-amped parents ruined the fun and put too much pressure on their kids to win and all. Not that my friend’s efforts changed anything. But at least some of the parents realized that they were being noticed and coming up on the shy end of the bat.”

    Even if parents aren’t as outrageous as the ones Perry recalls, they still tend to cheer when their kid’s team kicks into a winning stretch. It’s the same with the coaches and the players.

    Pitchers can especially be competitive, and especially the good pitchers who are few and far between, and who have a tendency to push themselves for the good of the team or any other number of reasons.

    Little League elbow

    According to Mitchel Storey, M.D., the team physician for the Seattle Mariners who visited with ESPN on the subject in 2000, “The problem with young pitchers is that in many cases they’re either throwing too hard too often or trying to build up their endurance too quickly. In my practice I see many adolescent players with arm problems, and 90 percent of the time it can be linked to some sort of a sudden change in the intensity or duration of the activity.”

    Storey goes on to explain that increased pitching time can result when a player decides suddenly that baseball is going to be his main sport and he starts playing for two summer teams. Excess strain on young elbows can also come from changes in the distance or elevation from the pitcher’s mound to home plate – or having a new, more aggressive coach come into the picture.

    Whatever the cause, soreness, some swelling, and pain when the player throws the ball usually come on gradually – and diminish when the arm is rested. Indeed, rest is a key in treating these injuries, as is icing the area.

    “Typically the recovery time is going to be six weeks or so for minor problems to as much as three months for the more significant problems,” said Storey. During that down time, the physician notes that players can catch and take grounders, just not throw the baseball. He adds that pre-high school players age 10 to 15 tend to be the most prone to problems, with those 12 to 14 especially vulnerable.

    Limit the number of pitches youngsters throw

    “Little League pitchers can throw more than 100 pitches per game – almost twice that of a professional player – placing substantial stress on a young, still developing arm,” said physical therapist David A. Boyce, P.T., Ed.D., O.C.S., E.C.S and assistant professor at Bellarmine University’s Physical Therapy program. “Kids sometimes mistake strength for proper pitching mechanics and may be trading six innings of excitement for years of debilitating arm and shoulder problems,” Boyce said.

    All agree that the first line of defense is to limit the pitches or number of innings young pitchers throw, so Victor Guadalupe’s grandmother sits in the stands in Long Beach, Calif., and counts his pitches. Sixty is the recommended maximum for a 12-year-old like Victor, who loves the game so much that in 2005 before he realized what happened, he over-stressed his elbow and ended up having to have a screw surgically placed to repair the damage.

    Timothy Gibson, M.D., who is Guadalupe’s surgeon, told CBS that he sees an increasing number of Little League elbows. “I will say without question in the last five years the number of overuse injuries in kids has risen dramatically.”

    For Guadalupe’s part, he now realizes that he needs to let someone know if his arm is hurting – even a little. “You have a long way ahead of you if you have dreams,” he said. “If you mess it up here, this is just Little League. This is just the first stage.”

    Take time to find good coaches for kids

    Another way of translating the 60 pitch rule of thumb is to allow seven innings on the mound and no more. That said, in a tight race when you’re the team’s best hope, it’s tough for a pitcher to sit out. That’s where having a good coach and parents who can focus on long-term as well as short-term outcomes can be critical.

    “Parents should look at the philosophy of any program their child is going into,” Douglas McKeag, M.D., chairman of the Indiana University School of Medicine’s department of family medicine and director of the university’s Center for Sports Medicine told HealthDay News. The idea, he said, is to find a coach who appreciates the body dynamics of his or her players and understands how the game affects young joints and muscles.

    “Proper biomechanics is the way to staying injury-free, really, for any sport,” said McKeag. “A parent needs to be mindful of ‘Gee, are they doing too much?’ All of the overload experiences adults have, kids are subject to as well.”

    Save the fancy pitching for later

    The second main way to protect young pitchers’ limbs is to reserve the fancy pitches for maturity. That means curveballs and sliders and such, all of which put exceptional strain on the elbow.

    Baseball’s Safety Advisory Committee recommends the following, according to the American Physical Therapy Association:

    “The first pitch introduced to Little Leaguers should be the fastball at eight years old, followed by the change-up at 10, the curveball at 14, the knuckleball at 15, and the slider and forkball at 16.”

    Again, the University of Pittsburgh’s Boyce has commented about using just the standard grip that a fastball requires and saving all the twisting and flexing that fancy pitches demand for later on.

    “It’s when young pitchers start throwing curveballs that Little League elbow starts to surface. Young pitchers don’t possess the neuromuscular control and stability in their bodies to withstand the forces that are placed across the elbow when throwing more technical pitches.”

    How baseball stacks up against other sports

    The following statistics are from the National SAFE KIDS Campaign and the American Academy of Pediatrics. Approximately three million children and adolescents ages 14 and under get hurt each year playing sports. For 1998, the latest year in which statistics are available, the chart looks something like this for children and adolescents age five to 14 who were treated in emergency rooms after a sports-related injury.

    Football                             320,000
    Basketball 200,000
    Baseball and softball 91,000
    Soccer 77,500
    Trampolines 5,000
    Inline skating 67,000
    Skateboarding 27,500
    Gymnastics 25,500
    Snow skiing/snow boarding 22,500
    Ice skating 15,500
    Sledding 8,500


    No matter what the sport and its stats, though, as seven-year-old Little Leaguer Cal Loggins in Upland, Calif. says, it’s best to err on the safe side.

    “I got hurt a lot of times playing Little League,” he said. “Like one time when I was playing I tried to catch the ball before it bounced and it hit my wrist. I had to stop playing because it was stinging me.”

    That pitching rule of thumb, says Loggins, should be in place across the board, especially with pitchers. “If his arm hurts, he should probably stop pitching and let someone else take his place.”

    Even if it means your team will lose?

    “Yeah,” Loggins said. Leaving a boy with a gimpy arm that will haunt him throughout life would never do. “Maybe after he’s rested we might win the game the next time.”

    Ahh. From the mouths of babes. Although the heat of the moment can consume with such passion – there always is another day.

    Last updated: 09-Jun-06

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