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Are Baseball-Related Injuries Increasing?

Over the past few weeks, I have seen the responses of many pitching experts, baseball managers, Sports Medicine Doctors, Physical therapists, and Athletic Trainers on the issue of MLB and the dramatic increase in injuries this year. If we look at the stats, is it an increase in arm injuries, or is it just more known players? However, as we look at the trends, we see increased arm injuries over the last 15 years. What has changed in that time? Is it the concentration of velocity? Is it the concentration on pitching metrics (i.e., spin rate, etc.)?  

"MLB pitchers have demonstrated gradually increasing mean fastball velocities from 90.9 in 2008 to 93.3 in 2017 . Several recent articles have studied the potential causes of the rising elbow UCL tears in professional baseball" (1)

However, I would expand the concentration to a more concerning issue: the increased injuries in youth baseball, from Little League to High School and even College. These metrics continue to be on the rise. Dr. Andrews reports a 10-fold increase in Tommy John surgery, and Dr. Ahmad reports a 200% increase between 2002 and 2011.

Why are we seeing an increase in injuries? We seem to have proper safety measures, such as pitch counts and arm care programs. Let's look at a few things:

  1. Velocity 

  2. Pitch Counts

  3. Weekly volume

  4. Effort

  5. Overuse

Some steps we can take as preventive measures:

Velocity, the concentration of throwing hard, has been an injury issue. As velocity increases in MLB, there is a comparable spike in Tommy John Reconstruction surgeries. The saying, "Speed kills," is true; the angular velocity of the arm contributes to injury. This velocity creates tremendous torque on the elbow and often exceeds the strength of the ulnar collateral ligament. The game has changed, and we need to take time to develop young players. The focus should be on mechanics and development. If we build a solid foundation based on mechanics, we can reduce injuries as kids grow.  

Pitch Counts are in place for a reason. However, it's not just in-game; every throw counts, including warm-up throws. Some interesting stats below:

  • Three times more likely for injury pitching 100 + innings a year

  • Four times more likely for injury pitching 80 + pitches per game

  • Five times more likely for injury playing eight or more months a year


Log all throws during the week. Track effort, length of throw, and arm feel, i.e., pain, fatigue, etc. Logs should be as detailed as possible.

"Five percent of youth pitchers will suffer a serious elbow or shoulder injury within 10 years, and pitching volume is the strongest known predictor of injury" (4)

Effort should not be the pitcher's perceived percentage of throwing. It turns out pitchers are not good at estimating the rate of throwing intensity. Track items like getting into my legs, hip-shoulder separation, stride length, and arm feel. I am not a fan of radar guns for young guys. This turns on the ego, and mechanics fly out the window.   

"Unfortunately, we know that these young athletes often play with pain. Up to 74% of youth baseball players (ages 8–18) report some degree of arm pain while throwing, and almost a quarter (23%) report injury histories consistent with overuse " (5)

"What is more concerning are the results of a survey by Makhni et al., in which 46% of youth respondents said they were encouraged on at least one occasion to keep playing despite having arm pain" (5)

In summary, all of these factors point to overuse injuries. Little League elbow, avulsion fractures, UCL sprain/strains, and of course UCL reconstruction Tommy John or UCL repair. Moving into the shoulder, we have Little League Shoulder, Biceps tendonitis, rotator cuff tendonitis, and labral tears. Our responsibility as coaches, parents, and clinicians is to prevent these overuse injuries. Parents, please step up and be diligent about pitch counts. Coaches need to be aware; sometimes, there are so many moving parts they lose track of pitch counts.  

  1. Melugin HP, Leafblad ND, Camp CL, Conte S. Injury Prevention in Baseball: from Youth to the Pros. Curr Rev Musculoskelet Med. 2018 Mar;11(1):26-34. doi: 10.1007/s12178-018-9456-5. PMID: 29353376; PMCID: PMC5825337.

  2. Olsen SJ, 2nd, Fleisig GS, Dun S, Loftice J, Andrews JR. Risk factors for shoulder and elbow injuries in adolescent baseball pitchers.  Am J Sports Med. 2006;34(6):905–912. doi: 10.1177/0363546505284188.

  3. Fleisig GS, Andrews JR, Cutter GR, Weber A, Loftice J, McMichael C, Hassell N, Lyman S. Risk of serious injury for young baseball pitchers: a 10-year prospective study.  Am J Sports Med. 2011;39(2):253–257. doi: 10.1177/0363546510384224.

  4. Position statement for adolescent baseball pitchers 2013; American Academy of Sports Medicine

  5. Makhni EC, Morrow ZS, Luchetti TJ, Mishra-Kalyani PS, Gualtieri AP, Lee RW, et al. Arm pain in youth baseball players: a survey of healthy players. Am J Sports Med. 2015;43(1):41–6.


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