Inju​ry Prevention for Pitchers

Overuse injuries are by far the most common type of injury that affects young pitchers; up to 40% develop them. In a pitcher who is not finished growing, the growth plates of the elbow and shoulder are the anatomic structures most vulnerable to the stress of overuse. Growth plates are made of soft cartilage and are not as resistant to stress as ligaments, tendons or mature bone. Repetitive stress due to overuse causes irritation and inflammation in these growth plates, resulting in injuries such as Little League elbow and Little League shoulder. Learn more about overuse injuries in this Chicago Tribune article​ featuring our own Rebecca Carl, MD.

Traumatic injuries are less frequent than overuse injuries. The most common traumatic injury is an avulsion fracture of the medial elbow.

Pitchers’ Injuries

Research has shown that the most important risk factor for injury is the number of pitches thrown. The more pitches thrown per game, per week and per season, the greater the risk for injury. Additional risk factors include lack of adequate rest between pitching appearances, throwing breaking pitches at a young age and pitching through fatigue. Young pitchers can reduce their risk for injury by following the pitch count guidelines published by Little League Baseball.

Pitch Count

Pitch count refers to the number of maximum effort pitches thrown. All maximum effort pitches count toward the total number for the week, regardless if they were thrown in a game, in a practice or in your backyard. For more information on which pitches count, see the USA Baseball Medical and Safety Advisory Committee Guidelines​.

Little League Baseball enforces the following pitch count regulation guide in an attempt to reduce the risk of overuse injuries to elbows and shoulders.

Maximum number of pitches 

10 years and younger ​ 75 pitches per day​
11-12 years​ ​85 pitches per day
​13-16 years ​95 pitches per day
​17-18 years ​105 pitches per day
 *Little League Baseball 2010 Pitching Guidelines


A certain amount of repetition is required to develop the strength and skills needed to be a successful pitcher. However, adequate rest is as important as repetition. If rest is insufficient, skill development suffers and the risk for injury increases. A pitcher's body muscles, tendons and bone growth centers need sufficient time to cool down and re-charge for the next event. Pitchers should obtain at least 24 hours of rest after each pitching outing. Once removed from the pitching position, pitchers should not return to pitch in a later inning during the same game.

Advised rest for pitchers 14 years and younger:
66 or more pitches in a day​ 4 days rest​
51-64 pitches in a day 3 days rest
36-50 pitches in a day 2 days rest
21-35 pitches in a day​ 1 days rest
1-20 pitches in a day​ 0 days rest
Advised rest for pitchers 15-18 years old:
76 or more pitches in a day​ 4 days rest​
51-75 pitches in a day​ 3 days rest
26-50 pitches in a day 2 days rest
1-25 pitches in a day 1 days rest
*Little League Baseball, 2010 Pitching Guidelines

Pitching Types

There is evidence to show that throwing breaking pitches before skeletal maturity may increase the risk for elbow and shoulder pain due to the excessive stress these pitch types place on bone growth centers. The USA Baseball Medical and Safety Advisory Committee makes the following recommendations for the earliest age at which pitchers should begin throwing each pitch type:

Pitch Type ​ Minimum Age​
Fastball​ 8
Change-up 10
Curveball​ 14
Knuckleball​ 15
Slider​ 16
Screwball​ 17

 *Contemporary Pediatrics, 2004

Pitching Mechanics & Injuries

There are many theories that implicate specific aspects of a pitcher’s motion that could lead to injury, but there is not yet any scientific evidence to prove or disprove these theories. The Institute for Sports Medicine​ is conducting a research study to investigate the influence of pitching biomechanics on injuries in youth pitchers. Using state-of-the-art, three-dimensional (3D) motion analysis, three shoulder and elbow positions of the pitching motion have been identified to be significantly different between youth pitchers who develop shoulder or elbow pain and those who do not. 

The Institute for Sports Medicine continues to work towards developing recommendations for stronger, safer pitching through direct application of these findings. 3D motion analysis is not currently available for our patients, but our sports medicine team is available to assist you with your injury prevention goals to ensure injury-free throwing throughout each season.

Preventing Injuries

Follow these tips for pitchers to help prevent injury:

  • Do not pitch through pain - Joint pain in the elbow or shoulder is one of the first signs of injury
  • Do not pitch through fatigue - Pitchers who pitch through fatigue may be a greater risk for injury
  • Warm-up properly before all practices and games
  • Maintain appropriate body weight and general fitness throughout the year
  • Learn and practice proper pitching mechanic
  • Avoid playing on more than one baseball team during a single season
  • Take at least three consecutive months off from pitching per year
  • Avoid playing other overhead sports such as football (quarterback), volleyball, swimming during the baseball season to reduce stress on arm

Teaming up with the National Pitching Association Chicago

The National Pitching Association (NPA) was created by coaches, athletes and management teams to help pitchers safely develop their skills and form. Their goal is to provide pitchers of all levels the opportunity to learn, develop, achieve and enjoy the game of baseball.

Coaches' Clinics
Our physicians and athletic trainers are teaming up with NPA to provide injury prevention education for NPA coaches’ clinics. The next one is scheduled for Saturday, September 20, at the Naperville Baseball Academy at 1811 High Grove Lane, Naperville, IL.

Pitching Coaching
Pitching coach Mark Sheehan teaches baseball players proper throwing mechanics and trains throwing athletes to improve the velocity of their throws. Patients may be referred to Mark Sheehan after they have completed formal physical therapy in order to bridge the gap between rehabilitation and full participation on the baseball field.

Learn more on the NPA's website.