There is a Pitching Injury Crisis and It starts in little league.

A Quick Note: I wrote this paper in December, but it is more relevant today than ever. With recent news that aces Spencer Strider, Gerrit Cole, and Shane Bieber are having elbow troubles, fans are desperately searching for answers, and it seems like each fan has their own theory as to why these injuries are happening. As I will explain, after researching my own theory is that it all starts in Little League with the toxic culture that can develop and, as a result, the pursuit of high velocity. I also question the effectiveness of pitch and inning limits, the long-proposed solution to this issue.

The Youth Baseball Injury Crisis

Isaac Groffman

Many American children grow up with fond memories of playing youth sports, getting out of the house, being around friends, and learning lifelong lessons in front of their coaches. Youth sports in the United States today are no longer about kids having fun; they have become a circus of clubs and travel teams. Parents are putting pressure on their kids to perform at unrealistic levels in their sports, often investing large amounts of money that would otherwise go to paying for college. All of this with the hope that maybe their kid will be one of those athletes you see on TV buying a house for their parents with their million-dollar contracts. Not only is this unrealistic and dangerous for the mental health of kids, but it is also harmful to their bodies, 25% of youth baseball pitchers ages 9 to 12 have reported elbow pain while pitching (Sakata et al. 2). In baseball, pitchers are being pushed to throw harder at younger ages, causing irreparable damage to their arms. This affects a large number of adults who are left with lifelong physical injuries.

Arm injuries at every level of baseball have skyrocketed and it has led parents to question the rules and regulations that are already implemented in youth baseball.  Several questions need to be asked before solutions to this problem can be presented. Is there enough proof that pitch velocity causes injury? Are youth baseball organizations doing enough to enforce their rules to protect pitchers, and do these rules actually work? There is a clear correlation between high pitch counts, velocity, and arm injury. As velocity rises in the MLB there is a growing culture glorifying velocity, this is also seen in youth baseball as injuries are rising. The long-accepted solution promoted by youth baseball organizations, for this, has been limiting pitch counts and innings on pitchers. However, seeing as injury rates are higher than ever they do not seem to be working. Youth baseball organizations need to recognize some of the underlying causes of arm injuries including ignorance among coaches on subjects of arm health, throwing different pitch types, and single sport specialization. The environment around baseball at all levels needs to change to be more multifaceted, focusing less on velocity. Youth Baseball Organizations must recognize that the key to preventing injuries is teaching the coaches about arm health, as well as making sure coaches are qualified by implementing evaluations of prospective coaches. 

There is a clear correlation between high pitch counts and arm injuries in youth baseball. This was proven by a flagship study done by Fleisig, Glenn S. et al. In the study, 481 male youth pitchers aged 9 to 14 years old were enrolled in a 10-year follow-up study. The study specifically focused on the risks of pitching more than 100 innings in a year, throwing curveballs before the age of 13, and playing catcher for at least 3 years. The study found that a number of the boys who threw more than 100 innings were 3.5 times more likely to get injured compared to those surveyed who did not (Fleisig et al. 256). This study shows a direct and scientific correlation between workload and injury.  

Over the past 10 years or so in the MLB, there has been more of an emphasis put on high-pitch velocity. Whereas twenty years ago scouts would look for pitchers who could control their pitches well, scouts now look for the pitchers who throw the hardest. College baseball recruiter Andrew Pistone talks about this in his article  “While there is still a place for mixing, matching, and outthinking hitters, popular belief suggests dialing up a fastball that hitters can’t catch up to is the most impressive and simple way to get outs.  It’s a new age of baseball,” Justin Verlander, pitcher from the Houston Astros said. “Fundamentally, it’s velocity that’s driving it.” (Pistone) MLB teams now want pitchers who can strike people out. MLB teams used to want pitchers who could easily induce weak contact resulting in ground outs or popouts, the problem with that is weak contact does not always guarantee an out, a strikeout on the other hand 100% guarantees an out. It is much harder to hit a pitch the faster it's going therefore batters are more likely to swing and miss at a high speed pitch, leading to strikeouts.

As this trend is happening in Major League Baseball there is a culture that has developed around velocity, it is cool to throw the hard and pitchers post on social media showing how they train to throw harder. Youth baseball players look up to these people and like to imitate them.  Injury rates in youth baseball have been skyrocketing, in their study Jun Sakata et al. report that 25% of youth baseball pitchers ages 9 to 12 report elbow pain while pitching (Sakata et al. 2). Youth baseball pitchers look to emulate their favorite players by throwing as hard as they can at ages where they are not supposed to. 

In their article John P. Kriz et al. talk about the rise of high school baseball showcases, displays where hopeful student athletes display their skills in front of college recruiters and scouts. According to Kriz et al. high school pitchers who can throw 90 mph and above are highly coveted at these events often getting drafted in early rounds and receiving scholarships to some of the premier baseball schools in the country. However, the pitchers who were throwing 90 mph at high school showcases had lower odds of making it to the MLB than players who didn’t start throwing at these speeds until they were older (Kriz et al. 8). 

To counteract this emphasis on pitch velocity, youth baseball organizations need to promote diverse skill development. Young athletes should be encouraged to focus on all aspects of the game, rather than just on pitch velocity. Rather from a young age ideally around 8 years old when youth baseball starts to get seriously competitive, young athletes should be focused on “how” to pitch. Meaning kids should be taught how to field their positions, locate the ball in the strike zone, and get a thorough understanding of the rules of the game. This would take the focus of pitching off of pitching and therefore prevent overtraining from a young age. Kids are not supposed to train the same way pro athletes do, and forcing them to use vigorous training methods can cause injury. 

At this age, coaches should not designate players on their team to be only pitchers. It is valuable for young athletes to play multiple positions. This is the most effective and fulfilling way for kids to quickly learn the game. When they do pitch, rather than focusing on pitching mechanics and maximizing body movement to generate the most velocity possible, coaches should teach their players very basic and standard pitching delivery that puts little stress on the arm. As they get older, when deemed appropriate athletes can start to tweak this simple delivery to make it more comfortable for them and eventually to create velocity.

By shifting the focus to a more comprehensive skill set, organizations can reduce the pressure young pitchers often face to throw faster and harder at an age when their bodies are still developing. This approach not only promotes a healthier approach to the game but also contributes to overall player development. The solution to this problem can only come with a multifaceted approach. Encouraging diverse skill development can alleviate the pressure on young pitchers, and closely monitoring and eventually developing pitching mechanics can offer early intervention to prevent injuries. 

Youth baseball organizations have recognized the seriousness of the issue of arm injuries and have tried to combat it mostly by implementing pitch count and inning limits. For these organizations, namely Little League Baseball, the stated goal of these limits was to protect young pitchers from injury, they recognized that since the athletes in their organizations were growing it would be dangerous for the development of their bones to throw too many pitches.  Bakshi et al.'s study of these regulations in The American Journal of Sports Medicine argues that these limitations have not done what they were supposed to do since injury rates are still sky-high. Their review of current workload recommendations for baseball pitchers revealed that the existing rules fall short of effectively preventing injuries (Bakshi et al. 229). 

One of the critical questions that emerge from Bakshi et al.'s findings is whether these limits are consistently enforced by coaches at the youth level. While regulations may exist on paper, the real challenge lies in their implementation. To what extent are coaches, parents, and players adhering to these guidelines? Are these rules monitored and enforced, or are they often overlooked because of the desire to win? Inconsistent enforcement of these regulations can contribute to their ineffectiveness. To look into the question of whether these regulations are truly effective, youth baseball organizations should consult with sports scientists and pediatricians to gain a full understanding of the science behind the issue. While pitch count and inning limits are effective to some extent, they may not address the underlying issues that lead to arm injuries. Bakshi et al.’s research makes it clear that the current regulations in youth baseball are insufficient to curb the epidemic of arm injuries. They argue that focusing on better education and awareness among players, parents, and coaches.

A common argument in this topic is the idea that one of the main causes of arm injuries is young pitchers starting to throw curveballs prematurely. However, in their study, Dun et al. try to disprove this. Their research shows that the highest levels of elbow and shoulder strain occur when pitchers throw fastballs, while the least amount of strain occurs during the execution of a change-up. This is solid evidence that throwing curveballs is unlikely to be the primary cause of these injuries. Education of players, parents, and coaches is a common theme in the literature regarding solutions to this problem. Popchak et al. argue that improved education is an essential component in reducing the incidence of arm injuries (Popchak et al. 406). To underline the urgency of improved education, researchers need to recognize the gaps in knowledge that currently exist among youth baseball coaches. Fazarale et al.'s research reveals that a significant portion of youth baseball coaches in the United States lack knowledge of standard pitching regulations (Fazarale et al. 202). It could be that this ignorance is well-intentioned, little league coaches are often parents that volunteer and they may have no knowledge of some of the dangers pitchers face. However, there are travel baseball coaches who value winning over everything and disregard regulations. 

It would be wise for youth baseball organizations to implement some type of qualification evaluation for people who want to coach youth baseball, if it is found that the individual does not have sufficient knowledge of injury risks there should be an online course/seminar developed by sports scientists and other experts in the fields of anatomy. After researching I found no comprehensive and free program that aims to educate prospective youth baseball coaches. A program like this would also have to find a way to educate in a quick but effective manner, as most of these people are busy with their families and jobs. 

Arnold et al. introduce another critical aspect to the issue, identifying single-sport specialization as a leading factor in arm injuries. Their study emphasizes the importance of kids playing many sports growing up. Single-sport specialization at a young age is dangerous both physically and mentally as forcing a child to focus on just one sport from a young age can lead to overtraining and isolation. This is important in the context of arm injuries, as their research shows that those who specialize in baseball before the age of 13 exhibit a higher frequency of arm injuries (Arnold et al. 1121). The study also finds that 57.9% of specialized athletes and their parents did not know that they were at higher risk for injury (Arnold et al. 1121). This is another area that needs to be covered when educating coaches. 

As for a counterargument, there are many experts in pitching that stand by the claim that no matter what the negative side effects, high pitch velocity is without a doubt the most important tool a pitcher can have in modern baseball. One of the main advocates of high velocity in baseball is Driveline Baseball, a baseball training facility in Kent, Washington that uses cutting-edge technology like high-speed cameras and motion capture devices to analyze pitchers' deliveries. 

Driveline has a team of experts that break down this data and work with pitchers on how to maximize their mechanics and conditioning to produce more velocity. In a 2013 article from the Driveline Baseball website one of their Athletic Trainers, Kyle Boddy states that “velocity is king”.Boddy recounts a conversation he had with a friend of his who is a Minor League Baseball pitching coach. The coach was complaining about how many young pitchers he was working with just threw 95 MPH but could not locate it. 

The coach goes on to say that he would rather have a pitcher who throws in the low 80s but can locate his pitches (Boddy). Boddy counters this buy by saying that while it is important to be able to control the ball in the strike zone, the only reason these coaches are complaining about pitchers that can’t locate the ball is because everyone they have throws hard, none of them are complaining and then saying that they would rather have a guy that throws in the low 80s. They get frustrated by a pitcher who throws 97+ but can’t locate but they would always take that pitcher over someone who throws 82-84 and has perfect command (Boddy).

 This is because the ceiling is so much higher with the hard-throwing pitcher, you can work with him, and if the training methods are effective you could be left with a pitcher that throws 97+ with perfect command, creating a pretty much unhittable pitcher. Whereas it's a lot harder to teach someone to go from throwing in the 80s to the upper 90s. This goes back to the need for a cultural shift in the world of pitching. I believe scouts should focus on scouting players who show potential to have all the different tools needed to be a great pitcher, as opposed to looking for pitchers with just one tool, velocity. 

Youth baseball in the United States is dealing with a growing epidemic of arm injuries, particularly among young pitchers. The relentless pursuit of high pitch velocity, along with the pressures of early single sport specialization, has taken a toll on the physical and mental health of these young baseball players. The existing regulations, while well-intentioned, have proved to be inadequate in preventing the rise of these injuries, showing the urgent need for a change in strategy. Youth baseball organizations must take proactive measures to prioritize the health and well-being of their players. Their goal should be to ensure that the desire to win on the field is never at the expense of a player's long-term health. 

There are a few different places where these scholarly conversations can be continued. There needs to be more research done by youth baseball organizations in conjunction with scientists and doctors about ways to promote multifaceted skill development at a young age. I saw little if nothing while reading scholarly articles about this as a proposed solution to this problem. Also, there needs to be clear steps, easily accessible to players and coaches, that show how a young athlete should develop their pitching mechanics. This plan would show players and coaches what they should be doing at certain ages and how to ideally develop their pitching delivery in a way that can generate velocity but also prevent injury. Most importantly, scholars should promote the idea that youth baseball organizations should implement some type of qualification evaluation for people who want to coach youth baseball. In my research, I found no comprehensive and free program that aims to educate prospective youth baseball coaches. 

There is a lot of value in being interested in baseball, it is our national pastime, therefore a big part of American culture, so many Americans grow up with warm memories of going to baseball games. The game itself teaches patience, strategy, and sportsmanship if taught in the right way. However, if hypercompetitiveness and the perception of baseball as a job or chore continues to spread it will deprive people of what could be a fundamental part of their childhood. Even if just one kid, parent, or coach sees my research it might be able to save a young baseball player from getting injured. So many people who played baseball in their childhood now have serious arm issues. Youth sports are such an important part of many people's childhoods and they learn many life lessons from playing. Hopefully, with my research and plan, I can save young athletes from getting these pivotal experiences robbed from them.

 Works Cited 

Arnold, Amanda J., et al. “Sport Specialization and Increased Injury Frequency in Youth Baseball Players: A Prospective Study.” Journal of Athletic Training, vol. 54, no. 10, Oct. 2019, pp. 1115–22. DOI.org (Crossref), https://doi.org/10.4085/1062-6050-349-18.

Bakshi, Neil K., et al. “Current Workload Recommendations in Baseball Pitchers: A Systematic Review.” The American Journal of Sports Medicine, vol. 48, no. 1, Jan. 2020, pp. 229–41. DOI.org (Crossref), https://doi.org/10.1177/0363546519831010

.Boddy, Kyle. “On Velocity Being the Most Important Thing in Pitching.” Driveline Baseball, 22 July 2021, www.drivelinebaseball.com/2013/10/velocity-important-thing/. 

Dun, Shouchen, et al. “A Biomechanical Comparison of Youth Baseball Pitches: Is the Curveball Potentially Harmful?” The American Journal of Sports Medicine, vol. 36, no. 4, Apr. 2008, pp. 686–92. DOI.org  (Crossref), https://doi.org/10.1177/0363546507310074.

Fazarale, Joseph J., et al. “Knowledge of and Compliance With Pitch Count Recommendations: A Survey of Youth Baseball Coaches.” Sports Health: A Multidisciplinary Approach, vol. 4, no. 3, May 2012, pp. 202–04. DOI.org (Crossref), https://doi.org/10.1177/1941738111435632.

Fleisig, Glenn S., et al. “Risk of Serious Injury for Young Baseball Pitchers: A 10-Year Prospective Study.” The American Journal of Sports Medicine, vol. 39, no. 2, Feb. 2011, pp. 253–57. DOI.org (Crossref), https://doi.org/10.1177/0363546510384224.

Kriz, John P., et al. “Effect of High School Showcase Exposures and Timing of Ulnar Collateral Ligament Tear on Professional Baseball Careers in Elite Pitchers.” The American Journal of Sports Medicine, vol. 51, no. 4, Mar. 2023, pp. 926–34. DOI.org (Crossref), https://doi.org/10.1177/03635465221150509.

Popchak, Adam, et al. “Factors Related to Injury in Youth and Adolescent Baseball Pitching, with an Eye Toward Prevention.” American Journal of Physical Medicine & Rehabilitation, vol. 94, no. 5, May 2015, pp. 395–409. DOI.org (Crossref), https://doi.org/10.1097/PHM.0000000000000184.

Pistone, Andrew . “College Baseball: Young Pitchers Focus on Throwing Harder than Ever.” Gmtm.com, GMTM, 2023, gmtm.com/articles/baseball-young-pitchers-focus-on-throwing-harder-than-ever.

Sakata, Jun, et al. “Efficacy of a Prevention Program for Medial Elbow Injuries in Youth Baseball Players.” The American Journal of Sports Medicine, vol. 46, no. 2, Feb. 2018, pp. 460–69. DOI.org (Crossref), https://doi.org/10.1177/0363546517738003.