Too Much Throwing Too Early Causes Youth Pitcher Injuries

Better education and restraint by coaches, parents, and players can reduce unnecessary shoulder and elbow injuries in baseball

WALNUT CREEK, Calif. (April 17, 2013) — Young pitchers age 8 to 18 are out on the mound imitating Giants’ hurlers Tim Lincecum and Matt Cain. Unfortunately, about 1 out of 5 will wind up on the bench, or worse, with a pitching injury. That could have happened to 18-year-old Acalanes High School pitcher Andrew Merken, but he didn’t give in to pressure to throw too hard, too often when he was too young. He has his mom to thank for that.

When Andrew was young, I got him to do warm-up exercises and limit the number of pitches he threw, said Leslie Merken, Andrew's mother, and a physical therapist. As he got older and more serious about pitching, we worked on how stretching and core strengthening prevent injuries, and to not ignore discomfort and pain.

That’s not the advice parents and coaches all too often give a promising pitcher. Though most youth leagues have adopted pitch-count guidelines, many adults and young athletes ignore such advice. That can have the exact opposite effect a player hopes for in throwing more: an avoidable overuse injury can prevent a talented young pitcher from ever reaching his potential. The start of the season is the critical time to take steps to avoid those injuries.

Most of these injuries involve players who are overexposed to the stress of throwing said Dr. Michael Michlitsch, an orthopedic surgeon at Muir Orthopaedic Specialists in Walnut Creek, CA, who specializes in sports medicine and shoulder and elbow injuries. There’s a temptation to get up to a high number of pitches, but players, coaches, and parents need to resist that temptation.

Specialization in one sport often leads to overuse, with baseball players on multiple teams, playing more than nine months a year, and doing even more throwing with special coaches. Players who mature quicker than others in their age group tend to suffer more injuries because they are over-played. And it’s generally a bad sign when someone shows up with a radar gun to clock a developing pitcher, said Michlitsch, who is head team physician for Monte Vista High School in Danville, CA.

For pitchers younger than 15 who are skeletally immature, one of the most common injuries is little league shoulder, which is a disruption in the growth plate at the top of the shoulder usually caused by too much throwing. That requires rest. A common elbow injury is valgus extension overload due to force being delivered at the elbow and repeated stretching.

Proper conditioning beginning in the preseason can help young pitchers avoid shoulder and elbow injuries and should include strengthening the legs and body core. That’s because throwing is a ground reaction event, in which power is generated by pushing off the ground, transferred up the trunk, through the arms and into the release of the ball, said Michlitsch. It’s very important to develop proper pitching mechanics attuned to that kinetic motion because improperly transferring that energy leads to bone and ligament injuries.

Pain and soreness are signs of trouble and should not be overlooked. Loss of pitching control can be another sign of a developing injury. Michlitsch says that ignoring these early signs can lead to more serious injuries, including Tommy John ligament surgery on teenage pitchers.

Catchers are also susceptible to injuries and should practice good throwing mechanics and limit the number of throws. The throwing mechanics of girls’ fast-pitch softball are not as strenuous on the shoulder and elbow, sparing young women the injuries that baseball pitching often entails.


About Muir Orthopaedic Specialists

A regionally recognized orthopedic practice located in the San Francisco Bay Area, Muir Orthopaedic Specialists is comprised of an expert team of physicians and providers with a variety of specialty focuses. Using state-of-the-art techniques in orthopedic medicine, Muir Orthopaedic Specialists restores mobility in musculoskeletal injuries, treating the foot, ankle, knee, hip, spine, shoulder, elbow and hand. Muir Orthopaedic Specialists facilities are located east of San Francisco in Walnut Creek (two locations), Brentwood, San Ramon and Concord. For more information, please visit