By James T. Monica, MD

The end of winter signals the start of baseball season for tens of thousands of youth players in the state of New Jersey. For some, it will be the first time playing on a team. For others, it is an opportunity to show off the hard-earned hitting and pitching skills that have developed since last season.

Baseball is a great game, but involvement can bring some risk of injury. Staying healthy and on the field should be the goal of all players, parents and coaches. That said, here are some suggestions to keep youth baseball players on the field:

1. Warm up! Light exercise involving running as well as multi-joint movements like jumping jacks, skipping and bounding should be done as a way to increase circulation. Athletes should exercise to the point of sweating before picking up a ball to start throwing or stretching. Warm muscles are more flexible and may perform better than cold muscles.
2. Do not pitch with arm fatigue. Studies show that players who experience arm fatigue are at a significantly greater risk for sustaining a serious arm injury. According to the American Sports Medicine Institute (ASMI), adolescents pitching with arm fatigue were 36 times more likely to undergo shoulder/elbow surgery in their lifetime. Coaches should watch for signs of fatigue, such as decreased ball velocity, decreased accuracy, upright trunk during pitching, dropped elbow during pitching or increased time between pitches. If an adolescent pitcher complains of fatigue or looks fatigued, let him/her rest from pitching and throwing. Some experts even recommend removing young pitchers if they throw more than 25 to 30 pitches in a single inning as rising pitch counts may be indicative of fatigue.
3. Follow recommended pitch counts for specific ages. Pitch Smart, an initiative by USA Baseball and Major League Baseball (MLB), published an excellent set of guidelines for youth pitchers. Many leagues have adopted these guidelines, but it’s important for parents to take an active role in keeping track of the number of pitches that their child is actually throwing. There are numerous apps that parents can use to track the number of throws. It’s crucial for parents to communicate with coaches about the amount of pitching their child is throwing. This is particularly imperative if a child is playing on more than one team.
4. Refrain from pitching on consecutive days. Following pitch count restrictions will often restrict pitching on back-to-back days; however even if a few pitches were thrown, it is best to have at least one day off to recover. Recovery days shouldn’t involve throwing, batting practice or playing catcher as each contribute to arm fatigue.
5. Only pitch for one team at a time.If a player is going to play for multiple teams, he/she should only pitch for one team to allow for full recovery. Make sure there’s enough recovery time between pitching. A high school coach may do a diligent job of giving a player the opportunity to rest between outings, but decision making and risk for injury will be compromised if the player is pitching on more than one team.
6. A pitcher should not play catcher.Playing catcher involves a good bit of throwing, and many catchers do it from a crouched position putting more stress on their shoulders and arms. Spending extended time in a crouched position can create leg fatigue which can also impact pitching mechanics. According to ASMI data, pitchers and catchers had a 2.7x greater incidence of major shoulder or arm injury when compared with all other positions. Players should choose between the two positions and be careful of how many throws they make while playing any other position.
7. Avoid throwing curveballs and sliders, and using a radar gun.Though the research on the impact of curveballs is a bit conflicting, best practice recommendations suggest that young pitchers should work on their fastball, master a changeup and refine their ability to locate the ball in specific spots. Throwing a curveball or slider often changes mechanics in younger pitchers, and this may lead to injury. Use of radar guns with youth pitchers should be discouraged as this practice risks overthrowing and altering normal mechanics in an attempt to bolster their speed on the gun.
8. An injured player should not be pitching. This should be obvious with an upper body injury. However, an injury to the abdomen, back or lower body, will likely change body mechanics that may lead to additional injury. The slogan no pain, no gain doesn’t apply to youth pitchers. Pitching with pain is NEVER okay. Instead, adhere to the slogan when in doubt, get it checked out.
9. Teach all players on the team to pitch. Coaches should take time to teach everyone on the team how to pitch. Basic instruction on good pitching mechanics coupled with encouragement may provide coaches with multiple pitching options and reduce pitching burden which would fall on one or two pitchers on the team.
10. Condition the legs with running to prevent fatigue. Leg fatigue is a major contributing factor in pitching performance decline. Find creative ways to make running fun at practice in order to help reduce pitching injuries.

Though it is impossible to prevent every injury, following these suggestions will certainly help players stay healthy and in the game.

Dr. James T. Monica is a board certified, fellowship trained orthopaedic surgeon with University Orthopaedic Associates (UOA).