Dr. Andrews discusses the risk factors involved in youth baseball that can lead to injuries

Risk Factors for Injury

Overuse and fatigue

By far, the biggest risk factor for pitchers is overuse and fatigue. Compared to healthy teammates, adolescent pitchers who undergo elbow or shoulder surgery were 36 times more likely to have routinely pitched with arm fatigue. Pitching mechanics, such as hip-to-shoulder separation and forward trunk tilt, change as players become fatigued. Numerous studies have shown that pitching too many months, pitching too many innings, pitching too deep into games, violating pitch count recommendations and acute spikes in workload significantly increase the risk of injury. Pitchers should avoid pitching on consecutive days. Follow Pitch Smart guidelines to succeed and stay on the field.


A showcase can be a terrific opportunity for young players to demonstrate their skills for college coaches and professional scouts. However, pitching in a showcase during the offseason can be particularly hazardous, especially if a pitcher does not have his arm in proper pitching shape. Pitchers should treat these appearances as they would any other game for purposes of daily, weekly and annual pitch count limits. Furthermore, they should avoid the temptation to overthrow in an attempt to light up the radar gun to make a favorable impression.

Throwing curveballs and sliders at a young age

Young pitchers who throw curveballs and sliders may experience more elbow or shoulder pain. However, field studies have not shown increased risk of elbow or shoulder injury with throwing curveballs. Furthermore, the curveball produces similar or even less force, torque and muscle activity about the elbow and shoulder than the fastball does. Hence, pitchers should learn good fastball mechanics and proper arm slot first before introducing breaking balls.

Pitcher-catcher athletes

At any level, a pitcher should not also be a catcher for his team as the combination of these two positions results in far more throwing than is required at other positions. Pitchers who also played catcher were three times more likely to suffer a major arm injury than pitchers who did not also play catcher.


Injuries are more likely when there is more stress placed on the body. Higher velocity throws place more stress on the shoulder and elbow, and pitchers who throw with greater velocity than other players their age should be particularly careful to follow Pitch Smart guidelines. It is important that all players establish proper mechanics and throwing technique before trying to increase their velocity.

Mound height and pitching distance

Youth baseball pitching mounds vary from flat ground to 10-inch-high adult mounds. One study found less stress on the throwing arm when pitching from flat ground, but two other studies found no such difference. Both variations are thus likely acceptable. Pitching distance is another important consideration. In some communities young players transition directly from 46-feet pitching distance to adult 60.5-feet pitching distance, whereas other communities include leagues with an intermediate distance (such as 50 or 54 feet). Shoulder force increases with pitching distance, so inclusion of intermediate pitching distance leagues while adolescent pitchers work up to the adult distance is preferred.

Single-sport (baseball) specialization

Many youth and adolescent players choose to not play any other sports and focus solely on baseball to improve their skills and to make themselves more competitive. However, focusing just on baseball year-round may increase the risk for injury. Several retrospective studies of professional baseball players have demonstrated that those players who specialized in solely baseball prior to high school have higher rates of injury. It is thus recommended that single-sport specialization be delayed at least until high school and preferably until college, although all athletes should maintain baseball-specific strength and conditioning in the offseason, such as maintaining shoulder range of motion as well as the strength and endurance of the muscles within the core and around the shoulder blade.