Return to Throwing

While many young players seem to recover quickly from elbow and shoulder injuries, in reality, these injuries can be long-lasting—and in some cases, even career-ending. Dr. Romeo has worked with and operated on countless injured pitchers during his career. Studies show a concerning trend: over the past decade, there has been a significant increase in the number of pitchers between 15-19 requiring ulnar collateral ligament surgery, also known as Tommy John surgery. 

The need for guidelines

Younger players need help to pace themselves and take adequate rest time, which can be enforced through strict pitch counts to ensure pitchers play within their limits. As a member of the MLB’s Advisory Committee, we created Pitch Smart guidelines, a practical, age-appropriate set of guidelines to help parents, players, and coaches avoid overuse injuries. They include specific recommendations for pitch counts per game, innings per year, cross-training options, and recommended rest quotas for various age groups.

Although appropriate pitch counts depend partly on age and level of expertise, no pitcher should play to the point of exhaustion. Coaches and trainers need to keep an eye out for signs of fatigue so players can be pulled pre-injury. Fatigue leads to sloppy pitches, and sloppy pitches lead to injuries.

To prove this, my colleagues and I set up a simulation game a few years ago to study the effects of fatigue on young players. Elite pitchers between the ages of 13-16 were recruited to throw a 90-pitch simulated game. Velocity and accuracy were measured for every pitch and every 15th pitch was videotaped to assess mechanics.

We found that as the pitchers progressed through the simulated game and became increasingly fatigued, their velocity dipped and they began to move differently. Their hips moved earlier in the pitch cycle than before, suggesting their core muscles were becoming fatigued and they were having trouble delivering force from their lower body to their upper body and throwing arm. Simply put, the more pitches they threw, the more their technique suffered.

The long-term effects of either respecting or exceeding recommended pitch counts are noteworthy. I recently took part in a study where we looked at more than 600 Little League World Series (LLWS) pitchers ten years after they competed in the LLWS. Of those who went on to play professionally, 50% of the pitchers who exceeded pitch counts in the LLWS required Tommy John surgery. Only 1.7% of those who did not exceed pitch count recommendations required the same surgery. It’s also important to note that out of these highly talented players, only three (0.5%) went on to pitch in the MLB.

Lowering pitch count to prevent injury

Certain studies have shown that increased pitching workload is a major risk factor for injuries that lead to this kind of surgery. To lower these risks, strict pitch counts should be implemented. Limiting pitch count is key to optimal performance. Not only does it reduce injury rates, but it also prevents fatigue. Fatigue reduces velocity, accuracy, and overall technique, which can lead to injuries. On the other hand, by enforcing strict pitch counts to ensure that pitchers play within their limits, performance is optimized and injuries are avoided.

In fact, the MLB has seen rates of these injuries decreasing as a result of the growing awareness about overuse injuries for pitchers. This awareness needs to be applied to youth, high school, and college pitching to lower the risk of injury and surgery.

Perhaps, in the future, we will see the major leagues make further changes to ensure the long-term health of its pitchers. In the meantime, youth coaches can lead the way by reducing pitch counts to minimize injuries caused by overuse and fatigue.

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