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Pitch Count Restrictions- An Athletic Trainer’s Perspective

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By Betsy B., Athletic Trainer

Posted on June 13, 2022 


Nolan Ryan once said “you have to be open-minded. Closed minds don’t make progress.” The game of baseball has changed immensely over the last few decades. No longer are we producing upcoming generations of multi-sport athletes, but rather single-sport prodigies. With an uptick in parents choosing an early route in sports specificity for their child – including year-round play – there has been an increase in overhead throwing injuries.

In skeletally immature athletes, shoulder injuries account for 25-35% of all baseball-related injuries, while elbow injuries trail close behind at 17-35%. Ulnar collateral ligament (UCL) injuries have spiked over the last 20 years. “One report suggested the number of UCL reconstructions between 2003-2014 increased 343%, with 56.6% in those aged 15-19 years. Furthermore, the rate among adolescents increased more quickly than that among individuals older than 18.” [1]

…It makes sense why youth baseball players have reported their arm(s) hurt 74% of the time.

To minimize injuries, throwing protocols and restrictions have been implemented from Little League Baseball up to the Major Leagues.

In March 2021, The Orthopedic Journal of Sports Medicine, published an article reviewing the data of effectiveness in reduced number of pitches versus the effectiveness of limiting the number of innings pitched in youth baseball pitchers. The overall conclusion stated, “a pitch count limit of ≤70 pitches per day for baseball pitchers ≤12 years could be more protective against elbow pain and reduced flexion than a limit of ≤7 innings per day”. [2]

Interested in learning more about protocols and restrictions?

Interested in learning more about protocols and restrictions?

The MLB provides information related to pitch count limits and rest recommendations for every age group.

In summary, it’s unlikely that sport-specificity will go away anytime soon (if ever). But reducing the number of sport-related injuries can be possible if we follow data-driven protocols.

Of course, there are also extrinsic factors to consider- position on the field, nutrition, strength and conditioning, arm-care programs, recovery tactics, multiple pitches at a young age, and sports-specialization. We will take a look at some of these factors in coming articles. Stay tuned!

  • [1] Zaremski JL, Zeppieri G Jr, Tripp BL. Sport Specialization and Overuse Injuries in Adolescent Throwing Athletes: A Narrative Review. J Athl Train. 2019 Oct;54(10):1030-1039. doi: 10.4085/1062-6050-333-18. PMID: 31633409; PMCID: PMC6805054.
  • [2] Matsuura T, Takata Y, Iwame T, Iwase J, Yokoyama K, Takao S, Nishio S, Arisawa K, Sairyo K. Limiting the Pitch Count in Youth Baseball Pitchers Decreases Elbow Pain. Orthop J Sports Med. 2021 Mar 18;9(3):2325967121989108. doi: 10.1177/2325967121989108. PMID: 33796588; PMCID: PMC7983445.
  • Holt JB, Stearns PH, Bastrom TP, Dennis MM, Dwek JR, Pennock AT. The Curse of the All-Star Team: A Single-Season Prospective Shoulder MRI Study of Little League Baseball Players. J Pediatr Orthop. 2020 Jan;40(1):e19-e24. doi: 10.1097/BPO.0000000000001391. PMID: 30994580.