Cleat Geeks

Since when are teenagers getting Tommy John surgery?

In this day and age where IPhones, video games, and television play such a large part in an adolescent’s average day; participation in our national pastime—baseball—may be one of the healthiest and most rewarding distractions a kid can find. But perfection is hard to come by, and recently baseball has been getting some less than glamorous media attention due to a recent increase in injuries to our little league ptichers’ elbows and shoulders. I am here to set the record straight and dig up some of the evidence for and against these proclamations toward our pastime.

Once upon a time shoulder and elbow injuries in baseball appeared to be reserved for professional pitchers, and while feeling remorse for their pain, I think a lot of us remembered in the back of our heads these pitchers were on multi-million dollar guaranteed contracts—a thought that seemed to slightly ease some of the concern. This is no longer the case. In 1994 only 6 pitchers received Tommy John surgery on the ulnar collateral ligament (UCL) in their elbow, and none of these players were under the age of 18; however in 2010, 41 of the 131 surgeries were in youth and high school athletes (Fleisig, 2012). Part of this trend in data change is no doubt attributed to advancing medical diagnostics and increased reporting of injuries, but it is hard to argue that could account for such a dramatic increase in youth injuries over the last 16 years.

I am sure there are many possible explanations as to why there has been a steady increase in substantial injuries in young pitchers, but here are some of the most likely ones. Since I was in high school–almost ten years ago–there has been a large increase in young athletes joining traveling teams, out-of-season leagues, and adding many other forms of practice and playing time in their sport. Like any sport, as you continue to play more and more, the chances of receiving some kind of related injury will increase. Furthermore we could be seeing more injuries in this age range simply from the sheer fact of their young age, and that many little leaguers have yet to reach puberty. And what does puberty bring? Other than a bit of social awkwardness around the fairer sex and the required bout of acne, puberty is a large stepping stone in the physical development of males. Bones become denser, muscles become stronger, and all-in-all a kid can better handle the stressors that competitive pitching can place on the body. So now that we have a bit of an understanding as why our adolescents may become a possible target for pitching related injuries, let’s look at some of the specifics from a baseball standpoint.

The curveball is one of the deadliest pitches in a player’s arsenal when put to perfection, but unfortunately, it is frequently dubbed public enemy number one and the prime suspect for what could be causing increased injuries in young pitchers. The idea stems from the rotation a pitcher is forced to put on the ball in order to obtain that dramatic last second breaking motion we have grown accustomed to seeing in today’s best professionals, and this motion could potentially be increasing the strain on the elbow. But yesterday’s villain has been found innocent in recent research. In fact some studies have discovered that the stress put on the UCL is actually slightly less than that used when throwing the much more utilized fastball (Nissen, 2009; Dun, 2008). I must throw in a small addendum here and let you know that many clinicians, despite this new research will still add caution for youngsters trying to bend it like Buehrle—so-to-speak. So where is the increased injury rate coming from if it is not the broadened selection of pitches we are asking our young athletes to master? Perhaps it isn’t a matter of the type of pitching that is occurring more and more frequently, but instead it could be a problem of the sheer number of pitches being thrown.

The study conducted by Fleisig et al. also compiled data from multiple other research groups looking at young pitchers over the years to discover what factors might qualify as risky and lead to potential injuries later on in their lives. Here is some of the data that they collected.

Risk factors Increased risk of injury
Pitching with fatigued arm 36.18x increased risk
>8 months competitive pitching per year 5.05x
>80 pitches per game 3.83x
Fastball velocity >85mph 2.58x
Pitching >100 innings per year 3.5x
Played catcher as well as pitcher 2.7x

Table 1: Injury was qualified as future surgery or necessitating the player to end his baseball career.

There has always been a warning to coaches and players about the adverse effects of throwing too many pitches or pitching on a tired arm, and this helps collaborate those warnings. The most important part of most of these risk factors (as seen in the table) is that they could be easily avoided. Because of this, coaches and parents alike should keep statistics like these in mind. Plus to be frank, I don’t think the game would change too much in youth leagues if pitchers had a mandatory amount of days’ rest in between games and heavy practices or if a pitch count of no more than 80 pitches was instigated for players under the age of 16. And personally, as a fan of monster home runs and a lot of offense, I’d love to put a cap of 85mph on every pitch anyway—but something tells me I would probably strike out pretty quickly trying to push that idea around. Now before too many heads start to turn and panic begins to spread regarding the safety of young athletes, let us remember the grand scale in which these numbers play a part. Every year millions of children participate in structured baseball leagues, and of those millions, yearly incidence of adolescent pitchers reporting substantial injury was around 5% (Fleisig, 2012). That being said I would wager that if some of these risk factors were given more consideration that number would begin to decrease.

In wrapping up, the last thing that I want is for anybody to think that I am trying to persuade anyone from participating in or shying away from sports—especially our kids. This is not the case at all, and it is quite the opposite. This article serves more as a reminder to keep the long-term interests of young pitchers in balance with the short-term ones (such as letting your pitcher play one more inning, throw those ten extra pitches, or—worst of all—play with one fewer day of rest). Baseball is a great sport, but like all the other ones, it is important to stay safe . . . at least until you sign that first professional contract with all that guaranteed money.





Dun, S., Loftice, J., Fleisig, G. S., Kingsley, D., & Andrews, J. R. (2008). A biomechanical comparison of        youth baseball pitches. The American Journal of Sports Medicine, 36(4), 686-692.

Fleisig, G. S., Andrews, J. R. (2012). Prevention of elbow injuries in youth baseball pitchers. Sports Health, 4(5), 419-424.

Nissen, C. W., Westwell, M., Ounpuu, S., Patel, M., Solomito, M., BSBE, & Tate, J. (2009). A biomechanical comparison of the fastball and curveball in adolescent baseball pitchers. The American Journal of Sports Medicine, 37(8), 1492-1498.


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