The Rise Of Youth Baseball Injuries — And How We Can Prevent Them

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By Stephanie Springer

The 2024 baseball season is about to start, both at the professional and youth levels. In fact, many young baseball players started their winter workouts when pitchers and catchers reported to MLB Spring Training over six weeks ago.

Sadly, the return of baseball also means the return of a toxic culture in youth sports, driven by a “winning is everything” mentality. In the 2022 book Take Back the Game: How Money and Mania Are Ruining Kids’ Sports - and Why It Matters, author Linda Flanagan devoted an entire chapter to injury. Flanagan notes that the “relentless emphasis on more, more, more” from overzealous parents and coaches is driving an increase in injuries which can have long-term health effects.

Unfortunately, youth baseball provides clear examples of the rise in injuries related to the “more, more, more” push. Last year, my husband and I wrote about youth baseball player injuries for STAT News, a publication widely read by people working in medicine and biomedical research. We may have been preaching to the choir, though – professionals in sports medicine are well aware of baseball-specific injuries in youth baseball players. Although an orthopedist stated, “We all know that we are in the middle of an epidemic with our youth throwers,” this is far from common knowledge amongst parents and coaches in youth baseball leagues. By the time a child sees an orthopedic surgeon or sports medicine professional, it is too late for preventative measures.

It is a relief to see that family practitioners are taking part in sports injury prevention. As an example of this, American Family Physician recently published guidance for family practitioners to advise young athletes and their families on common overuse injuries in sports. The authors recommend that family practitioners familiarize themselves with Pitch Smart.

The Pitch Smart program was launched in 2014 to address concerns from orthopedic surgeons noticing an increase in young baseball players with elbow injuries. Pitch Smart is a free resource outlining guidance from MLB, USA Baseball, and American Sports Medicine Institute experts, including age-based guidelines for players as young as 7 years old. That said, in the 10 years since the Pitch Smart guidelines were released, there have been few updates. A recent article presents a convincing argument that Pitch Smart updates are sorely needed. MLB organizations consider pitch count and days of rest, but they also weigh other factors in injury risk, including workload, intensity, and fatigue. Pitch Smart fails to incorporate these additional considerations, leaving the guidelines open for interpretation.

Although it is not perfect, Pitch Smart is at least a starting point for discussion. Parents may hear about Pitch Smart from their child’s pediatrician; however, there is evidence that the parents remain largely unfamiliar with pitching safety best practices. A survey revealed that only 58.9% of parents are familiar with pitch count guidelines, and only 83% of caregivers of 7- to 18-year-old baseball players are aware of safe pitching guidelines.

One might assume that a parents’ lack of familiarity with Pitch Smart guidelines is due to insufficient messaging from coaches. However, coaches themselves are also unaware of the potential risk factors for injury. In a recent survey, only 13% of youth baseball coaches correctly identified risk factors for overuse injuries, while another survey revealed that only 43% of youth baseball coaches correctly answered questions regarding pitch count and rest periods.

It is clear that providing a link to PitchSmart.org is not a replacement for actively promoting the guidelines and educating coaches, parents, and players. A 2021 survey observed, “Noncompliance with Pitch Smart guidelines in tournament settings occurred in more than 90% of teams and almost half of all pitchers.”

It is troubling when clear, albeit imperfect and oversimplified, guidelines lack adherence. It is even more worrisome when one takes a step back and recognizes that Pitch Smart is specific to pitching. There is little to no guidance regarding other baseball-specific injury risks for kids. It is clear to fans that the physical demands for a pitcher are not the same as the physical demands for a catcher or outfielder; injury prevention measures should reflect this. This gap in safety guidance coupled with the increased use of wearable devices to monitor pitching velocity or bat speed is alarming. Even something as simple as the use of a weighted ball puts a skeletally immature player at increased risk of injury. Advertising the use of devices that goad kids to pitch faster and hit harder, without also promoting sport injury preventative measures, is irresponsible.

It is increasingly clear that MLB is not interested in communicating the injury risk for kids playing baseball. But this is where the baseball community needs to step in to fill the void. We, the fans of baseball, promote our love of the game in many different ways. We should also promote messages about the harms of overuse injuries. We know better than anyone else the heartbreak of seeing a beloved player prematurely end their career due to injury. Whether you are a fan, a coach, a parent, or all of the above, we all need to ensure that young players are equipped to play and enjoy baseball for as long as possible. Let’s make sure kids can enjoy the game, and not get hurt in the process.

Stephanie Springer is a scientist and a baseball fan who writes about the intersection of science and baseball. She can be reached on Bluesky at @stephy.bsky.social and X/Twitter at @stephaniekays.