Risk-Prone Pitching Activities and Injuries in a National Sample of Youth Baseball Pitchers

Objectives: High pitching volume, coupled with limited recovery, often leads to arm fatigue, thus placing young pitchers at a greater risk for elbow and shoulder problems. This study aimed to correlate pitching-related risk factors with both increased pitching-related arm problems and injuries. Methods: A national survey recruited 754 youth pitchers, ages 9 to 18, pitching in organized baseball leagues during the past 12 months. Self-reported risk-prone pitching activities were compared with recommendations by the American Sports Medicine Institute. Relationships between self-reported pitching activities, shoulder and elbow problems, and injuries were assessed using multivariable logistic regression. Results: Of the 754 participating pitchers, 43.4% pitched on consecutive days, 30.7% pitched on multiple teams with overlapping seasons, and 19.0% pitched multiple games per day during the 12 months prior to the study. Pitchers who engaged in these activities had increased risk of pitching-related arm pain (OR=2.53, 1.85, and 1.89, respectively). Nearly 70% of the sample reported throwing curveballs, which was associated with 1.66 greater odds of experiencing arm pain while throwing. Pitching-related arm tiredness and arm pain were associated with increased risk of pitching-related injuries. Specifically, those who often pitched with arm tiredness and arm pain had 7.88 and 7.50 greater odds of pitching-related injury, respectively. However, pitching on a travel baseball team, playing baseball exclusively, and playing catcher were not associated with arm problems. Conclusions: The results of this study reinforce the importance of avoiding risk-prone pitching activities in order to prevent pitching-related injuries among youth pitchers.