Popular Questions About Kids Pitching

I have been asked many questions from concerned parents and coaches about some medical issues. I don't think that it will come as a surprise to any of you that I am not properly qualified to answer these questions. But, fortunately for all of us, I have some friends at the Mayo Clinic that are more than qualified.

A big "Thank You," to Dr. Amy McIntosh, a Pediatric Sports Orthopedic Surgeon, who has agreed to answer some of the questions that keep popping up. Here are some answers to some popular questions about kids pitching.

Mike: What are the main baseball related injuries you see with kids?

Dr. McIntosh: Thrower’s shoulder/ posterior shoulder impingement, Proximal humeral physeal widening, Medial Epicondylitis/ Apophysitis (AKA Little Leaguer’s elbow) and Capitellar Osteochondritis Dessicans

Mike: Do you have guidelines for pitch count?

Dr. McIntosh: The recommended allowable pitch counts vary by age and are presented in the following table, adapted from the American Orthopaedic Society for Sports Medicine (AOSSM) and the sports injury prevention website.

Age Pitches Per Game
7-8 50
9-10 75
11-12 85
13-16 95
17-18 105

Mike: What about a pitcher throwing a curve ball?

Dr. McIntosh: Pitch styles should be limited based on the age of the pitcher with general recommendations adapted from stopsportsinjuries.org presented below:

Pitch Style Age
Fastball 8±2
Change-up 10±3
Curveball 14±2
Knuckleball 15±3
Slider 16±2
Forkball 16±2
Screwball 17±2

Mike: What are your thoughts around players playing year round?

Dr. McIntosh: Year round throwing is not recommended for youth athletes due to the potential for overuse injuries of the shoulder and elbow to occur.

Mike: Can you explain Little League arm?

Dr. McIntosh: Little league elbow is an overuse injury to the medial epicondylar apophysis. An apophysis is a growth area that does not contribute to the overall length of the bone. The medial epicondylar apophysis is the growth area where the ulnar collateral ligamnet attaches (the ligament that is reconstructed when an adult undergoes “Tommy John Surgery”) When a child’s elbow experiences overuse, this apophysis may be injured, and this may result in continued pain and may eventually fracture and displace this growth area. The symptoms of this condition include pain and possibly swelling at the side of the elbow closest to the body, and xrays may confirm an irritation of the apophysis. When symptoms develop, the arm should be rested immediately and no further throwing or use of the elbow should be allowed. The child should see a physician to confirm the diagnosis and to develop a treatment plan. If the pain is ignored, the apophysis can fracture. This often requires surgical fixation and inability to return to throwing activites for 3-4 months.

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  • Youth Pitching

    This is one of the greatest things I've read on your blog, and thats saying something! I have agreed with 99.99% of what you say, and this is no different. I have a 9U team, and we are developing every kid to pitch. Not only because we want every kid to have the ability to pitch, but so they dont get over used!!!! I watch team after team throw the same kid 4 or 5 innings in a game, and then come back the next day and pitch a couple innings. We keep our kids on a pitch count PERIOD. I dont care if they throw 50 pitches in one inning. Thats all they will throw for that day! This is a great tool for all youth coaches. Thanks for the time you take to do this!