Arm pain and year-round baseball/softball

There are more opportunities today than ever before to participate year-round and “specialize” in a particular sport. This is no more evident in any sport(s) than baseball and softball, especially here in the South due to our great weather conditions. I will briefly discuss some information on what I think are the two most important factors, throwing volume and poor strength/conditioning, concerning arm pain in throwers.

Arm injuries, as are all youth sports injuries, are skyrocketing along with the progression of little-league All-Star teams, AAU teams, fall ball teams, showcases, camps, etc. This equals a ton of throwing and playing, and leaves very little time for recovery and preparation. Throwing a baseball is arguably the most unnatural movement in sports causing trauma to the shoulder and elbow with every throw. Kids often pitch for multiple teams.  They play catcher, or go straight to another position from the mound, and they throw pitches when they lack the neuromuscular control and technique to execute properly.  Other factors adding to this include inadequate rest from throwing, inadequate strength and poor nutrition.

A few of the most prominent names in sports medicine published a study in 2011 that followed 481 kids aged 9-14 for 10 years. They found that kids that threw more than 100 innings/year were at 3.5 times greater risk of shoulder or elbow surgery or even retirement during that 10 year period! (1) Do not get hung up on innings, because number of pitches thrown is likely more important. At a time when development and identifying warning signs for injury are of most importance, the supporting system is failing.

Now forget the fact that kids are throwing way too much and consider this. If your kid is playing baseball or softball year-round, then they are performing the exact same movement over and over and over and…well you get the point. Their athletic development becomes skewed and they develop asymmetries which are prominent in overhead athletes.

Asymmetries are weaknesses/mobility deficits on one side of the body compared to the other that undoubtedly lead to injury. Group this with too much throwing and your child’s arm is a ticking time bomb. Unfortunately kids spend more time participating than preparing their bodies to endure the demands of participation. Poor strength and conditioning leads to fatigue which leads to injury. Throwers, perhaps more than any other athletes, need PROPER rest and a PROPER strength and conditioning program to withstand one season in a year, let alone two or three.

This post is not intended to jab at any coaches or parents, but to educate for the safety and proper development of your children. I just wanted to bring attention to what I believe to be the two most important factors in keeping arms healthy. Please review the guidelines below produced by USA Baseball Medical and Safety Advisory Committee (Table 1-2) and contact us for information concerning our thrower specific strength and conditioning program.

Vann Jordan PT, DPT, OCS

Table 1. (2)

Arm Pain Remove from game immediately; if >4 days of arm pain,seek medical attention
Pitch Counts Game Week Season Year
9-10 years old 50 75 1000 2000
11-12 years old 75 100 1000 3000
13-14 years old 75 125 1000 3000
Pitch Types No breaking pitches until bones have matured around puberty (~13 yrs)
Multiple appearances Once removed from mound do not return to pitching
Showcases De-emphasize and or avoid, if necessary; then give adequate time to prepare with no overthrowing
Multiple leagues Pitch for only 1 team at a time, with no overlapping seasons
Year-round baseball Baseball pitchers should compete in <9 months of baseball/year


Age 1-Day Rest 2-Day Rest 3-Day Rest 4-Day Rest
8-10 21±18 34±16 43±16 51±19
11-12 27±20 35±20 55±23 58±18
13-14 30±22 36±21 56±20 70±20
15-16 25±20 38±23 62±23 77±20
17-18 27±22 45±25 62±21 89±22


1. Fleisig GS, Andrews JR, Cutler GR, Weber A, Loftice J, McMichael J, Hassell N, and Lyman S. Risk of serious injury for young baseball pitchers: a 10-year prospective study. Am J Sports Med. 2011 Feb;39(2):253-7.
2. USA Baseball Medical and Safety Advisory Committee Guidelines: May 2006. USA Baseball Medical & Safety Advisory Committee. Youth baseball pitching injuries.
3. Andrews JR, Fleisig G. Medical and Safety Advisory Committee Special Report: How many pitches should I allow my child to throw? USA Baseball News, 1996.