Home Baseball Content Your Arm Hurts? Thank Your Little League, AAU, and Fall Ball Coaches.

Your Arm Hurts? Thank Your Little League, AAU, and Fall Ball Coaches.

Written on April 26, 2011 at 8:06 am, by Eric Cressey

I have a policy when it comes to my writing:

If something is going to be controversial and potentially elicit a negative response from my readers, I "sit" on the topic for 24 hours.  During that time, I weigh the decision of whether me publicly writing about something is for the better good – meaning that it'll help people in the long-term even if it makes them recognize that they've been goofing up in the short-term.

I did some thinking on that front last night (actually, for the past several nights), and decided to go through with this blog, as I feel like it's something that every single baseball player, parent, and especially coach ought to read.  So, if you're in one of those categories – or are just a baseball fan who loves the game – please spread the word on what you're about to read, whether it's with a Facebook "recommend," "Tweet," or just a friendly email with the link to this article.

If you've perused my Baseball Content page much in the past, you'll know that I don't try to hide the fact that throwing a baseball is an incredibly unnatural and flat-out dangerous motion.  It's the single-fastest motion in all of sports, and every day, physically unprepared athletes go out and essentially play with fire every single time they try to light up a radar gun – or even just play catch.

Not surprisingly, when you mix physically unprepared bodies with arguably the most dangerous sporting challenge on the planet (the folks in Pamplona, Spain might argue with me, but that's a blog for another day), athletes get hurt.  Arm injuries (like all youth sports injuries) are rising exponentially thanks to not "less athletic athletes" taking part in high-risk sports, but also this participation taking place at all-time high rates thanks to the proliferation of little league all-star teams, AAU teams, fall ball, private pitching instruction, and the baseball showcase industry.  A fantastic study by Olsen et al. in 2006 (must-read for anyone involved in baseball development) clearly demonstrated strong associations between injuries requiring surgery and pitching "more months per year, games per year, innings per game, pitches per game, pitches per year, and warm-up pitches before a game" as well as showcase appearances during adolescence.  The message was very clear: throw too much – especially at a young age – and you're going to wind up hurt.

Unfortunately, though, many people glaze over numbers in studies (if they ever read them), and while they may walk away with the "overuse is bad" message, they don't appreciate what true overuse really is – especially since it's age-dependent.  Fortunately, a February 2011 study from Fleisig et al. showed in no uncertain terms that, in ages 9-14, throwing more than 100 innings per year was associated with a 3.5 times higher risk of elbow or shoulder surgery – or retirement altogether.

To put this into context, I'll first ask you: do you realize how challenging it is to throw 100 innings in a little league season?  Let’s say you start baseball the first week of April (little league) and even manage to play on a summer team that runs through the end of July.  That’s a four month season: exactly what I was accustomed to growing up – at the absolute most.

If you look at the Major League Baseball leaders in innings pitched, those at the top of the list generally throw about 35 innings per month (4-5 starts each). In other words, high-performance, skeletally mature pitchers in the most elite baseball league in the world are on pace for roughly 140 innings pitched over the first four months of the year.  However, there are parents and coaches out there that actually think it's okay to send an 11-year old out there for a comparable number of innings?  It's especially troublesome when you realize that younger kids always throw more pitches per inning than their older counterparts, as they don't have good command and insist on trying to strike everyone out instead of pitching to contact here and there.

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Just think about how hard that is to do.  Major League pitchers throw on a five-day rotation, and Little league games are, at most, twice a week.  If a kid pitches once a week for four months, even if he throws complete games every time out (not something I'd advise, for the record), he'd still struggle to hit 100 innings (16 starts x 7 inning games =112 innings).  Rats!  It's actually tough to overuse kids when the season is kept in check.

So, instead, they add seasons.  Join an AAU team (or seven of them). Play fall ball so that you can rack up another seven innings every weekend.  Be sure to hit up a few college camps on Saturdays and throw as hard as you can so that your Sunday outing in 25-degree weather is extra miserable.  Make sure you see your pitching coach for bullpens as soon as fall ball ends.  Get your registration in early for that showcase that's taking place the first week in January.  Just do some band work and a couple of half-ass stretches and you'll be fine.  Riiiight….good thinking.

At risk of sounding arrogant, I'm good at what I do.  I've devoted my life to keeping baseball players healthy. They comprise 85% of our clientele at Cressey Performance, and I work with millions of dollars of arms every off-season and see players from ages 9 to 50+. I do my best to surround myself with the smartest people in strength and conditioning, rehabilitation, and skill-specific training in and outside of the game.  I managed the first subpectoral biceps tenodesis in major league history. I can talk mechanics with the best pitching coaches around, write strength and conditioning and throwing programs, manually stretch guys, you name it.  I've got two fantastic therapists in my office to do massage, ART, Graston, chiropractic adjustments, and a host of other manual therapy approaches – not to mention great physical therapists nearby who can handle all our complex cases.  You know the only things I, we, or anybody on this planet can't control?

Poor judgment by athletes and their parents and coaches.

And that – no doubt about it – is the primary reason that kids get hurt.  We can do all the strength training, mobility work, and soft tissue treatments in the world and it won't matter if they're overused – because I'm just not smart enough to have figured out how to go back in time and change history. Worried about whether they're throwing curveballs, or if their mechanics are perfect?  It won't matter if they've already accumulated too many innings.

While athletes might be playing with fire each time they throw, the pain presentation pattern is different.  You burn your hand, and you know instantly.  Pitching injuries take time to come about. Maybe you do microscopic damage to your ulnar collateral ligament each time you throw – and then come back and pitch again before it's had time to fully regenerate.  Or, maybe you ignore the shoulder internal rotation deficit and scapular dyskinesis you've got and it gets worse and worse for years – until you're finally on the surgeon's table for a labral and/or rotator cuff repair.  These issues might be managed conservatively if painful during the teenage years (or go undetected if no pain is present) – but once a kid hits age 18 or 19, it seems to automatically become "socially acceptable" to do an elbow or shoulder surgery.

Of course, this isn't just applicable to coaches in the 9-14 age group.  You see "criminal" pitch counts in the high school and collegiate ranks as well, and while they may be more physically mature than the 9-14 year-olds, that doesn't mean that they're exempt from the short- and long-term consequences.

This is why we need the best coaches at the youngest levels.  It's also why we need pitching coaches that understand "managing pitchers" as much as – if not more than – teaching pitching mechanics.  And, it's why coaches need to understand the big picture in terms of what different kids can do at different ages, at different times in the year.

It's also while parents need to be proactive with their young pitchers.  If a coach isn't going to track his innings – and a 9-year-old kid certainly can't be expected to do so – the parent needs to step up and do so.  I've met a lot of parents of kids who have been injured at ages 17-21, and most of them look back with a lot of anger toward coaches at younger levels for overusing their sons.  Hindsight is always 20/20, but foresight is what saves an arm.  Don't be afraid to step up and say something, as you aren't telling a coach how to do his job; you're protecting your kid, just as you would be locking the door at night or making sure he brushes his teeth.

In terms of planning the competitive year, I have no problem with a 9-14 year-old kid playing baseball 4-5 months of the year, as the other 7-8 months per year should be devoted to at least two other sports.  It's basically the "rule of thirds" for long-term athletic development: three sports, four months apiece.  Kids can strength-train year round.

At ages 15-16, I'm fine with kids changing things up and going to only two sports.  Baseball might occupy 7-8 months, but a big chunk of that should be focused on preparation.  So, a kid might start playing catch in November, start his high school season in March, and then play summer ball through the end of July.  August through November would be devoted to a fall sport and fall ball would be altogether omitted, as it was the only idea worse than making Rocky V.  Kids would, of course, strength-train year-round.

At ages 17 and up, it's fine with me if you want to specialize in baseball, but that doesn't mean you should play year-round.  I actually advocate kids only throw for 8-9 months of the year (at most) – which is right on par with what most professional players do.  The only thing that'd be different is that the season would be shifted up a bit in the year, as the high school season usually starts a few weeks before the professional season.  Pro guys get half of October, then all November and December off from throwing.  "Specialized" high school players get August, September, and October off (again, because fall ball is as useful as a trap door in a lifeboat).  Strength training is year-round.

You'll notice that there isn't a single penny spent on off-season baseball showcases.  That wasn't an accidental omission (read here why I don't like them).  If you insist on going to one, pick one between June and early August.

I'm convinced that the next big thing in Major League Baseball's "scouting revolution" is meticulously analyzing what players did when they were younger.  If they are going to draft kids, they want to know that they haven't been overworked for years prior to entering professional baseball.  You're already seeing this taking place in collegiate baseball based more on an assumption: pitchers from the North are getting more and more opportunities to play down South because coaches recruit them (beyond just talent) under the assumption that they've accumulated less wear and tear on their arms.

This piece might have ruffled some feathers.  Kids want to play year-round.  Parents want to make kids happy – and they enjoy watching them play.  You know what else?  Kids love chocolate, and parents want to see kids happy – but that doesn't mean that kids should get a limitless amount of chocolate to consume, right?  You put away the Easter candy this week to stress moderation and look out for their long-term well-being.

Coaches enjoy coaching and want to win – and they may take a commentary like this personally because they're the ones who sent a 9-year-old out for 120 innings one year – and now he's the one having the elbow surgery.  Or, maybe it's the college coach who let a kid throw 160 pitches in a game and killed his draft status because teams know he'll have a shoulder surgery in three years.  Admitting you're wrong is hard enough, but admitting you're wrong and learning from that mistake to help future kids is even harder – but all the more rewarding.

This post wasn't intended to make anyone feel bad, but bring to light an issue (throwing volume) that I think is the absolute most important consideration when taking care of arms.  We can do everything right in terms of physical preparation, but if you throw too much – especially at vulnerable ages – none of it matters.

Again, if you could help spread the word on this, I'd really appreciate it.  And, feel free to comment below; I'm here to help.

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  • JC – If he’s already getting two starts per week, I think he’s doing plenty. No need to add a third session off the mound. I’d put him at another position.

  • Greg

    Very well-written article. It’s nice to learn from someone with experience with the aftermath of such overuse. Just wanted to mention that not all coaches/leagues are so cavalier with young players. I coach a little league team and then run a travel ball team in the offseason. Our Little League keeps close track of pitch count during the season. The main travel teams are run by coaches from our league, and are typically only 4 to 5 tournaments spaced 2-3 weeks apart at the end of the Little League season for those players who want to play a little more in summer and fall. The Travel Ball season consists of about 20 games, bringing their combined total baseball games played to between 40-45 games per year, and we don’t overlap Little League and Travel Ball games. Then, we shut baseball down for November-February and pick it up again in the Spring. I know there are Travel Ball leagues that play between 80-100 games per year, and overlap their Little League season so that a child could potentially be pitching in 3-4 games per week since there is no required communication/accountability between the two leagues. We are a rabid baseball community, but I like to think we try to keep a good balance. By having some of our Little League coaches also coach Travel Ball, we ensure that we know how much each kid is pitching. You usually go into Travel Ball with 7 or 8 kids on your team who can pitch, so that you don’t overuse one or two “studs” to try to win games, and by not having both seasons overlap, you don’t have kids pitch 6 innings on a Thursday in Little League, and then pitch 7-8 more innings over the following Saturday/Sunday in a Travel Ball tournament.

    I confess that there is always that competitive nature that has to be squelched, but hopefully we can keep each other in check.

  • Thanks, Greg, for your contribution! Glad there are good coaches out there like you.

  • Rogers Hornsby

    We call them here in Eastern Carolina where baseball is king. If a kid does not make a Travel Ball or All Star Team, one magically appears via the Dad. A protective then surrounds the boys, no matter how poor they play they never sit the bench. Ever. The Game is so watered down it’s a shame. Sore arms are the norm. Several budding ‘superstars’ have had surgery on bad elbows and shoulders- 12..13…14 yrs old. High School is even worse. The Bubble Boys get a strangle hold on playing time. How ? Long before the Bubble Boys show up their Dads are mowing the field, donating time and cash to the Program, on and on it goes. Some great talent falls by the wayside. Bubble Boys do not lose their positions no matter how many errors they commit. No matter how many times they get picked off a base. If they bat their weight- no big deal, winning is not a concern. Playing time and advancement is the only concern of the Daddy Ball Coaches and parents. And are the Coaches clueless !!! The arm injuries are damn near epidemic.

  • Scott Deming

    I liked this article alot. For kids that are just starting kid-pitch however, shouldn’t we be looking at total pitches in an outing as opposed to innings? I see kids that can’t throw strikes get left in games for 10-12 batters and leave with no outs after 8 walks and a couple hits.

  • Tom Sherwood

    My 10 yr. old belongs to a club that has very stringent rules regarding pitch count. It is the same formula that I have seen elswhere. 5 X age +10 max. So for a 10 yr. old the max. would be 60 pitches. Our team actually keeps them closer to 50, having 11 guys who can all win games for you helps this, also sticking to these guidelines makes you use everyone and not rely on just a few. Therefore everyone is being developed. Using the gamechanger application also puts pitch counts out there for everyone to see. Gamechanger is a great way to monitor your pitch counts. We regularly see our opponents throwing guys in access of 80 pitches in a start. I saw a 10 yr. old throw 150 pitches in a two day tournament. I just can’t understand how any coach or parent would allow this to happen. I would love to mention to them that professional baseball teams would not come close to doing that to a 25 yr. old ,6’5 250 pound man, let alone a 10 yr. old boy.

    I also think that pitching rules that are based on innings pitched is ridiculous! The only way to do it is based on pitch counts. We have kids who are efficient and will throw 13 to 14 pitches per inning on avg. and we have guys who throw 20 and actually one guy that is around 30. The guy that throws 30 is the hardest thrower on the team, and the least consistent. He will walk a couple, go full count with everybody and eventually collect 2 or 3 strikeouts every inning because when they are strikes nobody is hitting it. Has to go by pitch count. We will lose games because of it, but we will have 11 strong pitchers, and no one is getting abused.

  • Well said and executed, Tom! Need more coaches like you out there!

  • Scott,

    Yes, that’s also super important to watch.

  • In principal I agree. But the studies have some problems. Please consider the following:

    – I pitcher who throws 100 pitches is TWICE as likely to get hurt as a pitcher who throws 50 pitches. Why? Because there are twice as many chances of getting hurt. Yet, that’s not entirely true, because a pitcher who throws twice as many pitches will build up some additional arm strength.

    – Throwing year round is much better for the arm. Consider a tree up north. The tree adds one ring each year for the seasons. Trees in the south have no rings because they grow all year long, and they dont weaken. Pitchers who stop throwing each winter will be weaker, just like a tree with rings.

    Now, I am not saying to overthrow a pitcher. Of course not! But pitch counts are merely one metric, and it is a HUGE problem in Little League beyond just health.

    In my town, we record pitch counts by inning, for every pitcher, but we dont even record stats. By not recording stats, players become less interested in the game, because only the game is important — not all the days in between, as you follow the competition.

    And you wonder why attendance is shrinking?

    As for extra teams… You wonder why people play Little League, AAU, New England Elite, and All-Star at the same time? Because schedules have been reduced so much to protect players, that players need to find additional leagues just to get enough play! It is actually part of the problem, not the solution.

    Anyhow, very good article, and protecting kids IS important. But the way we measure it, and what we do about it, is mostly wrong — because the data is interpreted and managed incorrectly.

  • TOO true Eric! As a health & PE teacher, I see daily how kids are not the well rounded athletes they should be at their ages.

  • Daniel Malloy

    What if the kid is not a pitcher? Do you still recommend the three sport, two sport paradigm?

  • Steve Mather, MA, PT, LAT, OCS

    Nice article, good food for thought. The overtraining evident in youth sports really concerns me, meaning all sports, not just baseball. My colleagues who work university sports tell me that they are having 19-20 year old kids who have had multiple joint surgeries, multiple concussions, and that their bodies are just breaking down. I have young children and I want them to play sports, but will not stand for their health being at risk senselessly.

  • Daniel,

    It certainly won’t hurt! 

  • Larry

    Great infoG

  • Scott

    On going battle. Thanks for the article.

  • red

    Thx

  • Bruce

    Eric,

    How does this effect a catcher who catches 7 innings? Is there something to look for? My 12 YO son catches and starts every game and it always seemed to me he was throwing way more than anyone else, let alone 5 or 6 throws to second. Only once has his arm been sore and that was because he pitched one day and then caught the next. Which I stopped and he now only catches. Thanks.

  • Bruce,

    It’s a bit different because catchers don’t throw off the mound, which dramatically increases arm stress.  That said, catchers also aren’t as efficient with using their lower body during throwing because the motion is more rushed.  I would just look to get days off completely throughout the season here and there, and I’d still look for 8-12 weeks of no throwing in the off-season.

  • Eric I just wanted to clarify your comment to Bruce about pitching off the mound. Are you saying pitching off the mound dramatically increases arm stress or flat ground throws increase arm stress? My son does both pitching and catching, although catching has just became more frequent this season, so I am concerned. Another point is tracking innings pitched versus actual pitches thrown. Last weekend my 11 year old threw over 100 pitches on two separate outings in a weekend tournament, which I believe is too many, but he only threw 5 innings (bad defensive team). Innings pitched is far less telling of arm stress than actual pitches In my humble opinion.

  • Hi Steve,

    It’s pitching off the mound that increases arm stress: http://www.eurekalert.org/pub_releases/2008-03/mcow-sfp032108.php

    I’d agree that innings pitched isn’t the most specific measure; long innings can be a big problem, too.  I’d say that 100 pitches over a weekend is lot at age 11.  Here’s a good guideline for time off after specific pitch counts:

    21 – 35 pitches = 1 day rest
    36 – 50 pitches = 2 days rest
    51 – 65 pitches = 3 days rest
    66 + pitches = 4 days rest

    You really shouldn’t exceed 100 over an entire week in that crew.  If he’s catching, too, that makes it even more problematic.

  • Kyle

    Great points

  • Thanks for the response Eric. I have been looking through your baseball content and I tried to click on The Ultimate Pitching coaches bootcamp link but it wasn’t active anymore apparently froman article in 2009. If I lived in the your area I would bring my son in in a heartbeat but since I’m in Lincoln, Ne (my wife spoke at same Postural Restoration Symposium recently that you spoke at. Great info, thanks) I need to know what you would recommend to start building strength and flexibility the right way for an 11 year old baseball/basketball player. Books, dvd’s or anything else you would use with your own son hypothetically speaking. Thanks in advance.

  • maggie

    Amen…

  • Eric. what resource would you recommend for building a strength and conditioning routine for 11 year old baseball/basketball player. any guidance on products or articles would be appreciated. thanks in advance.

  • Larry Martin

    Hammer, meet nail! Very well written, and is dead on in my opinion. I see this all the time unfortunately. What’s sad is is there are a lot of good coaches out there that preach to their players about curve balls, and the dangers of overuse. At the same time you can see a dad in the stands giving their son who’s on the mound signs on what to throw. Totally overruling what the coach is trying to do. It’s a two way street, and parents need to wake up and see the light. Take care of your child’s arm. Don’t get caught up in the glory of it all. I only wish this type of literature and awareness for this problem had been around a lot more 30 years ago. Had it been, I’d be able to go out and throw a heck of a lot more now with out my arm feeling like its going to fall off.

  • David

    I watched a coach do this to a kid this summer. He was the hardest throwing 12 year old in our area, and the coach had no interest in developing other pitchers. He saw him as his ticket to a successful season. As assistant coach, I warned him that he was way overusing him. A number of other coaches from other teams also warned him. I took my son and left this team as it became apparent that the coach’s approach was to win at all cost, without regard to the health of his players. By the end of the season, the pitcher whose natural talent was so obvious to everyone, was advised by doctors that he had separated a growth plate in his elbow, and that if he pitched in the State or WS tournaments, he would most likely be leaving the field in an ambulance. We started the season as a AA team and were bumped to AAA fairly early, but because the coach did not develop enough pitching and because he lost several players due to his intransigence, the team only had one win against an in-class team the rest of the year. Consequently, he lost his “ace”, and last I heard, he is doing the same thing to another pitcher all over again.

  • Laurie

    Great article! A must read for every parent of a baseball player from 5-15!!I raised 2 boys from little league to college ball. My youngest a pitcher. I was very unpopular with coaches because I counted innings and pushed them to pull kids when they didn’t need to pitch more. I coached when they were small and monitored them through high school. These small high schools where the players do double duty don’t always have coaches who know baseball. They make assistant football coaches coach baseball with little or know knowledge of the game. Parents need to be knowledgeable about the sports your children play!

  • Awesome post, Laurie.  What is popular is not always right, and what is right is not always popular!  Glad that you educated yourself so that you could be an advocate for your kids.

  • Anna

    Thank you for putting this into perspective. We just had this discussion as the boy (8) wants to also play summer and fall ball and wants to pitch ALL THE TIME. Our path is clear thanx to you. In saying that though, I have to praise our league, Pleasant Hill Baseball Association (pleasant hill, ca). The cut off is 50 pitches per week. The more ya know…!

  • Good stuff, Anna!

  • Jack

    I have been coaching my son’s teams since he was 8 years old in both Spring and Summer travel ball. My son is the most talented pitcher in his league (Now at 12U). One of the main reasons why I have coached is because I fear that another coach will use his arm too much. I adhere to the LL pitch count rules (20 pitches – No rest, 21-40 pitches – 1 day rest, 41-60 pitches – 2 days rest, etc…)

    Next year he will play middle school ball (8th grade) in the spring, and Connie Mack in the summer. I plan on coaching in Connie Mack. However, eventually a time will come when “Daddy” can’t be there to regulate when he does/does not pitch.

    What do I do? Of course I will monitor how much he is being used, but how much is too much? Do I monitor innings pitched vs. days rest, or actual pitches vs. days rest?

    Any suggestions that you have would be very much appreciated!

    Thanks!

  • Jack,

    The name of the game is to educate him and make him an advocate for himself. The answer is a little bit different for everyone, depending on what position he plays when he isn’t pitching. So, he has to listen to his body and be a good communicator to you and his other coaches. You really have to monitor the whole puzzle.

  • Sarah

    I’ve got an eight-year-old who is playing in a travel ball team. He mostly plays shortstop and acts more as a relief pitcher when needed, so I’m not worried about pitch counts at this point. Additionally his coach is very good about not overusing pitchers. But my question is this, he throws with a sidearm. Is this something that will change as he gets older and stronger? Or should we actively be looking for a pitching coach to help him adjust his throws? He is short and small for his age so he definitely will do a lot of growing in years to come. One part of me thinks that he will grow out of this as he gets older and stronger, but another part of me worries that he could be creating a lifelong bad habit.

  • I really like and appreciate your article. Great.

  • mike077

    I’m sorry, but I don’t think you’ve yet hit on the real reason for all the pitching arm problems today.

    From the late 19th century through WWII, baseball was THE sport. Millions of American boys ate, drank, and slept the sport. They played — and threw — all the time, spring, summer, fall, and winter. They played on the local sandlot ballfields for organized teams and then went home and played in the streets and parks. Yet, these were the same guys as adults who regularly threw 300-350 innings per year. 300 innings was the norm for elite pitchers when I was following MLB as a boy.

    There ARE arm problems today. However, I am inclined to think that even with all today’s technology, the real reason for the rash of arm problems hasn’t been correctly identified. Heck, it could be in the water or food. Fluoride was added to most municipal drinking water systems in the 50s and 60s ((I am not an anti-fluoride nut, BTW, just an example). Has anyone investigated the impact of fluoride on tendons and ligaments? It could be a subtle factor. That’s just one thought. There are others too. Coffee ingestion has increased dramatically, for another example. Some think coffee softens bones. Could that be a factor? Even the chlorination of water might have a long term effect.

    However, I don’t think youth overuse is, overall, the real culprit.

  • Maxbps8

    Great blog-article. As a coach, we will immediately implement the 100-inning rule for my 11U team/players.

    As for finding the reason for all the arm problems and TJ surgeries, the man who benefits most from the latter did a study and found unequivocally that OVER-USE ABSOLUTELY IS CAUSING the arm problems. But a KEY FACTOR WAS KIDS THAT PITCH AND CATCH; particularly when they do so in the same and/or back-to-back games.

    So we are implementing a Catch Count as well and keeping my catchers that pitch from doing so back-to-back. My pitchers/catchers are also playing more 1st base thus having to throw less during games, warm-ups, etc..


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