Youth baseball can lead to overuse injuries: What parents need to know

Baseball season is near, and one orthopedic surgeon is warning young players and their coaches and parents about the very real danger of overuse injuries.

Dr. Mark Cohen is a hand, wrist and elbow surgeon at Midwest Orthopaedics at RUSH, in Chicago. He's also an official team physician for the Chicago White Sox.

"I'm a huge baseball fan and have enjoyed treating professional and youth players for many years," Cohen explained in a RUSH news release. "I love it when we can get a player back on the field. What concerns me is the rate at which Little Leaguers are experiencing big league conditions that may interfere with their body's normal function as they grow."

Some of these "big league conditions" include simple chronic arm pain, but also torn ulnar collateral ligaments (UCLs) in the elbow, Cohen explained.

UCLs often require extensive "Tommy John" surgeries—named after the first major leaguer to get the surgery back in 1974.

According to one study of 261 youth and high school pitchers, published in 2023 in the Journal of Shoulder and Elbow Surgery, one in four suffered some kind of injury to their arm over the course of their career. The longer they pitched, the higher their risk for these injuries and the need for surgery, the study found.

"Ten years ago, Tommy John surgery was a treatment for Major League Baseball players," Cohen said. "While my partners and I have been performing this surgery successfully on adults, I'm worried that the majority of patients are now under the of age 20. We are also seeing an increase in the prevalence of these elbow injuries in adolescents."

Cohen blames the "epidemic" of baseball overuse injuries in the young to the increasing intensity of practice and play. Youth baseball often has players working year-round, and many concentrate on just the one sport.

Pitch counts (days of rest between pitching) are often unregulated, Cohen said, weighted balls are being used in pitching practice and there's strong pressure put on young players to increase their pitch velocity. All of that puts enormous strain on young throwing arms.

Taking the pressure off players

To help counter this, organizations like Major League Baseball (MLB) and U.S. Baseball initiated Pitch Smart. It urges that players ages 15 to 18 "take at least four months off from playing, including at least two to three continuous months off from any throwing," according to the RUSH news release.

But Cohen acknowledges the increasing popularity of off-season training programs can make that advice tough to follow.

Then there's efforts by Little League International, MLB and state high school associations to implement safe pitch counts. Cohen said that those guidelines are "subject to interpretation," however, so many teams might deviate from the rules, upping players' odds for an injury.

What to do?

Cohen offered up the following advice to parents of young pitchers:

• Make sure your young athlete understands the mechanics and techniques behind proper pitching
• Get to know your child's league pitch count rules and make sure they're being tracked and followed
• How many teams is your child playing for, and how much time are they spending on the mound? Ask yourself, is it too much? Talk this over with your child, too
• Allow your child to simply rest, away from pitching, on non-playing days
• Diversify, because kids who play other sports (swimming, basketball, cycling, to name just a few) are less prone to injury
• If you ever see your child in pain during practice or in a game, alert a coach or manager and get your child to stop right away
• If pain lasts more than a day or two, seek treatment